Med Schools Are Now Denying Biological Sex
Professors are apologizing for saying ‘male’ and ‘female.’ Students are policing teachers. This is what it looks like when activism takes over medicine.
Today we bring you another installment of Katie Herzog’s ongoing series about the spread of woke ideology in the field of medicine. Her first story focused on the ideological purge at the top medical schools and teaching hospitals in the country. “Wokeness,” as one doctor put it, “feels like an existential threat.”
Katie’s latest reporting illustrates some of the most urgent elements of that threat. It focuses on how biological sex is being denied by professors fearful of being smeared by their students as transphobic. And it shows how the true victims of that denial are not sensitive medical students but patients, perhaps most importantly, transgender ones.
Some of you may find Katie’s story shocking and disconcerting and perhaps even maddening. You might also ask yourself: How has it come to this? How has this radical ideology gone from the relatively obscure academic fringe to the mainstream in such a short time?
Those are among the questions that motivate this newsletter. We feel obligated to chronicle in detail and in primary accounts the takeover of our institutions by this ideology — and the consequences of it.
So far, it has taken root in some of our leading medical schools. Some. Not all. But I’m left thinking: What state will American medicine — or any other American institution — find itself in after being routed by this ideology?
If you think reporting like Katie Herzog’s is important I hope you’ll support us by subscribing here.
During a recent endocrinology course at a top medical school in the University of California system, a professor stopped mid-lecture to apologize for something he’d said at the beginning of class.
“I don’t want you to think that I am in any way trying to imply anything, and if you can summon some generosity to forgive me, I would really appreciate it,” the physician says in a recording provided by a student in the class (whom I’ll call Lauren). “Again, I’m very sorry for that. It was certainly not my intention to offend anyone. The worst thing that I can do as a human being is be offensive.”
His offense: using the term “pregnant women.”
“I said ‘when a woman is pregnant,’ which implies that only women can get pregnant and I most sincerely apologize to all of you.”
It wasn’t the first time Lauren had heard an instructor apologize for using language that, to most Americans, would seem utterly inoffensive. Words like “male” and “female.”
Why would medical school professors apologize for referring to a patient’s biological sex? Because, Lauren explains, in the context of her medical school “acknowledging biological sex can be considered transphobic.”
When sex is acknowledged by her instructors, it’s sometimes portrayed as a social construct, not a biological reality, she says. In a lecture on transgender health, an instructor declared: “Biological sex, sexual orientation, and gender are all constructs. These are all constructs that we have created.”
In other words, some of the country’s top medical students are being taught that humans are not, like other mammals, a species comprising two sexes. The notion of sex, they are learning, is just a man-made creation.
The idea that sex is a social construct may be interesting debate fodder in an anthropology class. But in medicine, the material reality of sex really matters, in part because the refusal to acknowledge sex can have devastating effects on patient outcomes.
In 2019, the New England Journal of Medicine reported the case of a 32-year-old transgender man who went to an ER complaining of abdominal pain. While the patient disclosed he was transgender, his medical records did not. He was simply a man. The triage nurse determined that the patient, who was obese, was in pain because he’d stopped taking a medication meant to relieve hypertension. This was no emergency, she decided. She was wrong: The patient was, in fact, pregnant and in labor. By the time hospital staff realized that, it was too late. The baby was dead. And the patient, despite his own shock at being pregnant, was shattered.
Professors Running Scared of Students
To Dana Beyer, a trans activist in Maryland who is also a retired surgeon, such stories illustrate how vital it is that sex, not just gender identity — how someone perceives their gender — is taken into consideration in medicine. “The practice of medicine is based in scientific reality, which includes sex, but not gender,” Beyer says. “The more honest a patient is with their physician, the better the odds for a positive outcome.”
The denial of sex doesn’t help anyone, perhaps least of all transgender patients who require special treatment. But, Lauren says, instructors who discuss sex risk complaints from their students — which is why, she thinks, many don’t. “I think there’s a small percentage of instructors who are true believers. But most of them are probably just scared of their students,” she says.
And for good reason. Her medical school hosts an online forum in which students correct their instructors for using terms like “male” and “female” or “breastfeed” instead of “chestfeed.” Students can lodge their complaints in real time during lectures. After one class, Lauren says, she heard that a professor was so upset by students calling her out for using “male” and “female” that she started crying.
Then there are the petitions. At the beginning of the year, students circulated a number of petitions designed to, as Lauren puts it, “name and shame” instructors for “wrongspeak.”
One was delivered after a lecture on chromosomal disorders in which the professor used the pronouns “she” and “her” as well as the terms “father” and “son,” all of which, according to the students, are “cisnormative.” After the petition was delivered, the instructor emailed the class, noting that while she had consulted with a member of the school’s LGBTQ Committee prior to the lecture, she was sorry for using such “binary” language. Another petition was delivered after an instructor referred to “a man changing into a woman,” which, according to the students, incorrectly assumed that the trans woman wasn’t always a woman. But, as Lauren points out, “if trans women were born women, why would they need to transition?”
This phenomenon — of students policing teachers; of students being treated as the authorities over and above their teachers — has had consequences.
“Since the petitions were sent out, instructors have been far more proactive about ‘correcting’ their slides in advance or sending out emails to the school listserv if any upcoming material has ‘outdated’ terminology,” Lauren tells me. “At first, compliance is demanded from outside, and eventually the instructors become trained to police their own language proactively.”
In one point in the semester, a faculty member sent out a preemptive email warning students about forthcoming lectures containing language that doesn’t align with the school’s “approach to gender inclusivity and gender/sex antioppression.” That language included the term “premenopausal women.” In the future, the professor promised, this would be updated to “premenopausal people.”
Lauren also says young doctors are being taught to declare their pronouns upon meeting patients and ask for patients’ pronouns in return. This was echoed by a recent graduate of Mount Sinai Medical School in New York. “Everything was about pronouns,” the student said. The student objected to this, thinking most patients would be confused or offended by a doctor asking them what their pronouns were, but she never said so — at least not publicly. “It was impossible to push back without worrying about getting expelled,” she told me.
This hypersensitivity is undermining medical training. And many of these students are likely not even aware that their education is being informed by ideology.
“Take abdominal aortic aneurysms,” Lauren says. “These are four times as likely to occur in males than females, but this very significant difference wasn’t emphasized. I had to look it up, and I don’t have the time to look up the sex predominance for the hundreds of diseases I’m expected to know. I’m not even sure what I’m not being taught, and unless my classmates are as skeptical as I am, they probably aren’t aware either.”
Other conditions that present differently and at different rates in males and females include hernias, rheumatoid arthritis, lupus, multiple sclerosis, and asthma, among many others. Males and females also have different normal ranges for kidney function, which impacts drug dosage. They have different symptoms during heart attacks: males complain of chest pain, while women experience fatigue, dizziness, and indigestion. In other words: biological sex is a hugely important factor in knowing what ails patients and how to properly treat them.
Carole Hooven is the author of T: The Story of Testosterone, the Hormone that Dominates and Divides Us and a professor at Harvard who focuses on behavioral endocrinology. I discussed Lauren’s story with her and Hooven found it deeply troubling. “Today’s students will go on to hold professional positions that give them a great deal of power over others’ bodies and minds. These young people are our future doctors, educators, researchers, statisticians, psychologists. To ignore or downplay the reality of sex and sex-based differences is to perversely handicap our understanding and our ability to increase human health and thriving.”
A former dean of a leading medical school agrees: “I don’t know the extent to which the stories you relate are now widespread in medical education, but to the extent that they are — and I hear some of this is popping up at my own institution — they are a serious departure from the expectation that medical education and practice should be based on science and be free from imposition of ideology and ideology-based intimidation.”
He added: “How male and female members of our species develop, how they differ genetically, anatomically, physiologically, and with respect to diseases and their treatment are foundational to clinical medicine and research. Efforts to erase or diminish these foundations should be unacceptable to responsible professional leaders.”
There is no doubt the rules are changing. According to the American Psychological Association, the terms “natal sex” and “birth sex,” for example, are now considered “disparaging”; the preferred term is “assigned sex at birth.” The National Institutes of Health, the CDC, and Harvard Medical School have all made efforts to divorce sex from medicine and emphasize gender identity.
When Asking Questions Can Destroy Your Career
While it’s unclear if this trend will remain limited to some medical schools, what is perfectly clear is that activism, specifically around issues of sex, gender, and race, is impacting scientific research and progress.
One of the most notorious examples is that of a physician and former associate professor at Brown University, Lisa Littman.
Around 2014, Littman began to notice a sudden uptick in female adolescents in her social network who were coming out as transgender boys. Until recently, the incidence of gender dysphoria was thought to be rare, affecting an estimated one in 10,000 people in the U.S. While the exact number of trans-identifying adolescents (or adults, for that matter) is unknown, in the last decade or so, the number of youth seeking treatment for gender dysphoria has spiked by over 1,000 percent in the U.S.; in the U.K., it’s jumped by 4,000 percent. The largest youth gender clinic in Los Angeles reportedly saw 1,000 patients in 2019. That same clinic, in 2009, saw about 80.
Curious about what was happening, Littman surveyed about 250 parents whose adolescent children had announced they were transgender — after never before exhibiting the symptoms of gender dysphoria. Over 80 percent of cases involved girls; many were part of friend groups in which half or more of the members had come out as trans. Littman coined the term “rapid-onset gender dysphoria” to describe this phenomenon. She posited that it might be a sort of social contagion, not unlike cutting or anorexia, both of which were endemic among teenage girls when I was in high school in the ’90s.
In August 2018, Littman published her results in a paper called "Rapid-Onset Gender Dysphoria in Adolescents and Young Adults: A Study of Parental Reports” in the journal PLOS One. Littman, the journal, and Brown University were pummeled with accusations of transphobia in the press and on social media. In response, the journal announced an investigation into Littman’s work. Several hours later, Brown University issued a press release denouncing the professor’s paper.
Littman’s paper was republished in March 2019 with an amended title and other minor, mostly cosmetic changes. The journal has since confirmed that, while the paper was “corrected,” the original version contained no false information.
But Littman’s career was forever altered. She no longer teaches at Brown. And her contract at the Rhode Island State Health Department wasn’t renewed.
Littman is hardly alone. Trans activists have also targeted Ray Blanchard and Ken Zucker in Toronto, Michael Bailey at Northwestern, and Stephen Gliske at the University of Michigan for publishing findings they deemed transphobic. In a recent case, trans activists shut down research that was to be conducted by UCLA psychiatrist Jamie Feusner, who had hoped to explore the physiological underpinnings of gender dysphoria.
Nor is this limited to academia. Journalists who question the new ideological orthodoxy, like Abigail Shrier and Jesse Singal (with whom I co-host a podcast), have also been smeared for their work. After the American Booksellers Association included Shrier’s book, Irreversible Damage, in a promotional mailing to bookstores, activists went ballistic, prompting the ABA’s CEO to apologize for having done “horrific harm” that “traumatized and endangered members of the trans community” and “caused violence and pain.”
I had a similar experience in 2017 after writing about de-transitioners — people who transition to a different gender and then transition back — for the Seattle alt-weekly The Stranger. After the piece came out, people put up flyers and stickers around Seattle calling me transphobic; someone burned stacks of the newspaper and sent me a video of it. I lost many friends, and later ended up moving out of the city in part because of the turmoil.
But far more concerning than the treatment of journalists chronicling this story is the treatment of patients themselves.
Patients Are Suffering
Julia Mason is a pediatrician in the Portland suburbs who, unlike most doctors I spoke to, allowed me to use her name. Mason explained that she works at a small private practice and her boss is a libertarian. In other words: she won’t get fired for being honest.
Mason has been practicing for over 25 years, but it wasn’t until 2015 that she saw her first transgender patient: a 15-year-old trans boy who Mason referred to a gender clinic, where the patient was prescribed testosterone.
Since that first patient, she says there have been about 10 more requests for referrals to gender clinics. As this number increased, Mason started wondering about the advice her patients are getting at these clinics.
“A 12-year-old female came to see me, and the dad told me that they went to a therapist, and in the first five minutes, the therapist was like, ‘Yep. He’s trans,’” she told me. “And then they went to a pediatric endocrinologist who recommended puberty blockers on the first visit.”
Mason generally avoids prescribing puberty blockers, which inhibit the development of secondary sex characteristics like breasts or facial hair. The reason, she says, is that because there have been no controlled studies on the use of puberty blockers for gender dysphoric youth, the long term effects are still unknown. (In the U.K., a recent review of existing studies found that the quality of the evidence that puberty blockers are effective in relieving gender dysphoria and improving mental health is “very low.”)
In girls, Mason says, blockers inhibit breast development, but “you end up shorter, and the last thing a female who wants to look male needs is to be shorter.” Other side effects may include a loss of bone density, headache, fatigue, joint pain, hot flashes, mood swings and something called “brain fog.” In boys, blockers inhibit penis growth, which can make it harder for them to achieve orgasm and for surgeons to later construct those penises into “neo-vaginas,” a procedure known as vaginoplasty.
Trans activists often claim the effects of puberty blockers are fully reversible, but this remains unproven, and studies show that the overwhelming majority of teens who start on puberty blockers later take cross-sex hormones (testosterone for females and estrogen for males) to complete their transition. The combination of puberty blockers followed by hormones can cause sterility and other health problems, including sexual dysfunction, and the hormones must be taken for life — or until detransition. Little is known about their long-term effects. While the line that blockers are “fully reversible” is oft-repeated by activists and the media, last year, England’s National Health Service back-tracked this unsubstantiated claim on its website.
Mason is one of several doctors who voiced concerns about the fast-tracking of adolescents seeking to transition — and the new normal in the medical establishment, which seems to encourage that fast-tracking.
In 2018, the American Academy of Pediatrics recommended that pediatricians “affirm” their patients’ chosen gender without taking into account mental health, family history, trauma, or fears of puberty. The AAP recommendations say nothing about the many consequences, physical and psychological, of transitioning. So perhaps it is not surprising that surgeons are performing double mastectomies, or “top surgery,” on patients as young as 13.
One leading clinician, Diane Ehrensaft, has said that children as young as three have the cognitive ability to come out as transgender. And the University of California San Francisco Child and Adolescent Gender Center Clinic, where Ehrensaft is the mental health director, has helped kids of that age transition socially.
But not all clinicians have cheered these developments. In a paper responding to the AAP guidelines, James Cantor, a clinical psychologist in Toronto, noted that “every follow-up study of [gender dysphoric] children, without exception, found the same thing: By puberty, the majority of GD children ceased to want to transition.” Other studies of gender-clinic patients, stretching back to the 1970s, have found that 60 to 90 percent of patients eventually grow out of their gender dysphoria; most come out as gay or lesbian.
In an email to me, Cantor said: “The deafening silence from AAP when asked about the evidence allegedly supporting their trans policy is hard to interpret as anything other than their ‘pleading the 5th,’ as you in the U.S. put it.”
Erica Anderson, a clinical psychologist at the UCSF Child and Adolescent Gender Center Clinic and a trans woman herself, also voiced skepticism about the AAP’s approach to would-be transitioners. Unlike Mason, Anderson says withholding puberty blockers from dysphoric children is “cruel.” But she is suspicious of the sharp spike in young people, and especially young women. While she doesn’t like phrases like “rapid-onset gender dysphoria” or “social contagion,” she said something is definitely going on.
“What makes us think that gender is the one exception to peer influence?” she told me. “For 100 years, psychology has acknowledged that adolescence is a time of experimentation and exploration. It's normal. I'm not alarmed by that. What I'm alarmed by is some medical and psychological professionals rushing kids into taking blockers or hormones.”
Because Anderson has been so vocal, including a recent 60 Minutes appearance in which she discussed detransitioners, she regularly gets calls from frantic parents. She told me she’d gotten off the phone with the parents of a 17-year-old who had announced that they were trans and wanted hormones. “It’s alarming to these parents,” Anderson said.
Anderson isn’t opposed to pediatric transition when patients are properly diagnosed, but she wants to see more individualized care rather than the activist-driven, one-size-fits-all approach. That, however, goes against current AAP guidelines.
Will Science Prevail?
Medicine is not impervious to trends.
“In the 90s, when I was training, everything was about controlling pain,” said a pediatrician in the Midwest who declined to be named for fear of repercussions. “We were taught that it was really hard to become addicted to narcotics. Look where that got us.”
Around the same time, she says, there was a rash of kids being diagnosed with bipolar disorder, something we now know is exceedingly rare in children. Before that, there was the recovered memory craze, multiple personality disorder, and rebirthing therapy, a bizarre treatment for attachment disorders that lead to the deaths of several children in the U.S. So how does this happen?
“Some idea will get picked up by major medical associations that put out reports and their members turn to those instead of the actual literature,” this pediatrician said. “And when you get too far ahead of the research, that's when you get into trouble. That's what’s happening now.”
For her part, Lauren, the medical student in California, is both hopeful for the future — and not. “On the one hand, I have this idea that the truth will eventually come out and science will ultimately prevail,” she said.
But the difference between things like rebirthing therapy or multiple personality disorder and the new gender ideology is that the latter is portrayed as a civil rights movement. “It seems virtuous. It seems like the right thing to do,” she said. “So how can you fight against something that’s being marketed as a fight for human rights?”
We want to keep telling the stories others aren’t. If you have a tip, please reach out: email@example.com
For those of you who missed it: I sent out a reader survey last week and the responses I’ve received so far have been immensely helpful.
If you haven’t taken it yet, the good news is that it doesn’t take more than five minutes to complete. I would be so grateful if you’d take it here.