Trans – Get Over It Already!

Ever since Dave Chapelle’s transphobic 2021 Netflix special, “The Closer,” I have continued to observe an ongoing, dismaying parade of equally ignorant claims made by public officials and by members of the general public. On Trans Visibility Day this year, March 29, 2024, I produced my reply.

Like many in the United States, I was brought up as a “WASP,” a White Anglo-Saxon Protestant. My parents both started in the medical field at a time when psychiatry still taught that homosexuality was a mental disorder. That was how variations in sexual orientation were classified in the first DSM (Diagnostic and Statistical Manual of Mental Disorders), published in 1952 by the American Psychiatric Association.

Until my early adulthood, I followed along with the general culture around me and thought homosexuality was sinful. Over time, however, I disconnected from both the religious and scientific views of the 1950s. Like my father, I became an MD and went into family medicine.

I recall a party I attended in Southern California, shortly after I finished medical school. A group of women was criticizing the homosexual “lifestyle,” arguing that it should be banned because we live in a Christian country. I remember asking them where they went to junior high and if they took civics there. Didn’t they remember that the Founding Fathers specifically created the United States as a secular nation?

Today, all around the country, local government officials are openly promoting and passing legislative measures hostile to transgender people, based on their own religious views. Local prosecutors around the country are targeting physicians, other medical providers, and educators.

Officials and prosecutors claim they are acting to support and protect children and the concept of “family.” But in fact, their actions are triggering real discrimination, threats, and acts of violence against persons who simply want to live their own lives the way they are. Countless studies since the 1950s have shown that human sexual diversity is an expression of normal human biology and genetics. I’m used to seeing lawmakers and lawyers arrogantly behaving as if they are society’s experts in science and religion, but I don’t understand why more members of the medical profession aren’t speaking up to put lawmakers in their place.

I’m so tired of irritating comments implying that humans with variant expressions of gender identity and sexual orientation are abnormal and morally deviant. As a Christian and a student of the Bible, I am deeply offended by the suggestion that our almighty God will only approve of one type of human – cis-gender. In the Hebrew Bible, the only scriptures that are said to have been written directly by God are the Ten Commandments, and these say nothing about sexual orientation. In the Christian Gospel, although Jesus says good things about marriage between a man and a woman, he says nothing negative about other types of relationships. Being the “Word of God” incarnate, wouldn’t Jesus have been aware of the inner workings of creation? Hatred and violence towards the outsider – these go against everything Jesus taught.

I’m also tired of widespread misinformation about what is biologically natural. When doctors determine the gender of a newborn, they are not extending that determination to the gender identity of the person later in life. To my knowledge, gender identity and sexual orientation are not yet present in a newborn. So even if a newborn could talk, they would have nothing to say on this subject. These functions develop later in life.

When physicians talk or write about the gender or sex of a newborn, they are actually referring only to the appearance of the newborn’s external genitalia. For the most part, during a newborn exam, the genitalia are designated in one of only two categories, penis or vagina. That determination is overwhelmingly binary. Rarely, the descriptive term will be “ambiguous genitalia” or “intersex.” Anatomy that is atypical is just that, an outlier.

Only one chromosome pair determines which external reproductive organs develop in a fetus. The pair that determines an infant’s sex is called the XY pair. Virtually all infants have one X chromosome. The other chromosome in the pair is either X or a Y. There is no Z. The possible genetic combinations here are binary. A child with XX chromosomes will be born with labia and a vaginal opening. A child with XY chromosomes will be born with a penis.

Unlike the specific anatomical facts that medical professionals convey when they talk about “gender” and “sex,” misinformation is often spread when these terms are misused in other contexts. Largely, the confusion here comes from ignoring the fact that the reproductive system and the nervous system are two different systems. The terms “gender” and “sex” have different meanings in those different contexts.

So far, I have only described how medical professionals use the terms “gender” and “sex” in the context of the reproductive system, where God put the gonads. When doctors talk about “gender identity” and “sexual orientation,” they are no longer talking about the reproductive system, they are talking about the nervous system. They are talking about processes in the brain. Gonads are binary. Processes in the brain are not binary.

Many more genes than just X and Y influence gender identity. Thousands of genes influence brain development, resulting in millions of unique combinations. Unlike the XY chromosomes that cause the reproductive system to be binary, the brain is not binary. Gender identity and sexual orientation are determined by millions of genetic variables, which give us a spectrum of gender identities and sexual orientations.

When children are forced by society into only two categories of gender identity, the constraint ignores the reality that each human brain is unique and complex, which can further lead to a destructive dysphoria in a child as they grow up. This is cruel. This is dangerous!

The increasing number of individuals who openly reject stereotypical identities, who freely accept and live as their true selves, reflects a paradigm shift in the U.S. As we have seen over the last few decades, when a society allows natural brain development to occur, without punishing those who don’t fit into stereotypes, individuals will develop as cis, trans, up, down, sideways, backwards, LGBTQRST . . . just all kinds of combinations.

The data in front of our faces actually matches our current understanding of genetics. As of 1987, sexual orientations have not been listed as pathologic states in the DSM. I do put some blame on adult psychiatry and earlier editions of the DSM for failing to see reality sooner. I will never forget my parents’ copy of the DSM, which did list homosexuality as a mental disorder. I’d like to see more apologies from the fields of psychiatry and psychology, and maybe more of an emphasis on neuroscience going forward, instead of guesswork.

More people need to remember the basic civics of our nation. More people need to understand the difference between the reproductive system and the nervous system, including the genetics involved. Too much ignorance about these subjects means that far too many trans youth and trans adults are not getting the protection they need and deserve. Protecting their basic civic rights will also protect our own. ~~

Julie Ralls, M.D., continues to use her medical skills to show the love of God to her neighbors. She lives in the Chinatown neighborhood of Seattle, where many residents are unsheltered and face addiction issues. She has attended several Quaker meetings in the West.