Why Transphobia Makes No Sense

What actually changes in your life when someone else lives authentically? We start there and follow the evidence, tracing how medicine shifted from trying to “fix” people to supporting them, and why that change dramatically improves mental health, safety, and quality of life. Along the way, we tackle the loudest myths—bathroom panic, “think of the children,” and chromosome mic drops—with clear explanations, real data, and human stories.

As clinicians and citizens, we’ve watched the language move from “disorder” to “dysphoria,” separating identity from distress and centering care on outcomes. We explain how affirmation lowers depression and suicidality, why conversion efforts failed and harmed, and how global bodies now condemn those practices. We also get honest about medical nuance: hormones carry risks that are known and manageable through informed consent, and broader mortality patterns are shaped by stigma, poverty, and violence rather than hormones alone.

If you’ve ever heard “XY settles it,” we break down intersex conditions like androgen insensitivity and Swyer syndrome, mosaicism, and the simple truth that biology is more complex than a slogan. We touch on sports with a call for case-by-case fairness based on hormone levels and transition timing, not blanket bans. Most of all, we return to a core principle: if affirmation reduces harm and lets people live, why would we choose anything else?

If this conversation clarified something or challenged you, share it with a friend. Subscribe for the follow‑up on youth care, leave a review to help others find the show, and tell us: what question should we tackle next?

Chapters

• 0:00 Opening: Empathy And Confusion About Transphobia
• 2:28 Lived Stigma And Medical Perspective
• 4:55 Shift To Affirming Care And Outcomes
• 8:43 Anti‑Woke Backlash And Projection
• 12:12 Kids, Gender Education, And Clarity
• 15:30 Separating Gender From Sexuality
• 19:05 Safety Myths, Bathrooms, And Crime Data
• 24:10 Pathology vs Human Variation
• 28:34 Conversion Therapy’s Harmful History
• 33:08 Health Risks, Hormones, And Tradeoffs
• 37:01 Chromosomes, Intersex Conditions, And Complexity
• 41:09 Sports, Fairness, And Nuance
• 44:15 Rhetoric, Policy, And Real‑World Harm
• 48:25 Closing Reflections And Next Steps

Transcript

SPEAKER_00: 0:00

The phenomenon of transphobia has always baffled me. Listen, if a man wants to live as a woman, what effect does that actually have on my life? How does it harm me and how does it hurt me? I can't see any avenue for uh for hurt or harm to come. You know, I it doesn't bother me in the slightest. And so therefore, I guess uh I just don't understand transphobia and why there's been recently such uproar with regards to the anti-woke movement. Um and I despair, I despair. You know, trans people are subjected to certain horrific cruelty and crimes. They are often victims um of brutality and horrible things. They s they suffer from depression, there's a high amount of suicidiality in uh this population of people, and it's hard to be a transgender person. And so when the work movement rose and these people started to get more accepted in in as part of our community, uh that made me really happy, you know. Um but then with the rise of the anti-work movement, all I can think is that this is a sign of humanity taking a massive step backwards, and I really despair, you know. I feel deep, deep empathy for this group of people, and I'm not even sure why. I'm not transphobic, I'm cisgendered female, not even an inkling of that having any gender dysphor uh dysphoria, you know. But I guess having been a marginalized part of society as an ex-drug addict, uh having felt the weight of stigma before, I guess I can empathise with these people and I feel deeply for them. I I I really do. I feel deep empathy. Um as a medical doctor, when I was a medical student, I have uh seen a change in the way the medical profession deals with the problem of tr gender dysphoria. Now, when I was a six-year medical student, um I was doing a urology term and and there was a transgender woman who came in with some complications from her surgery, and at that point I was told it was very taboo and frowned upon to offer gender reassignment surgery. Um that was in about 2000, around about the year 2000. Fast forward to between 2015 and 2020, you know, I saw patients uh as a renal physician with gender dysphoria and so looked into how the medical profession deals with this problem and was surprised to find that there'd been a complete revolution in thinking and best medical practices. And instead of, you know, trying to deny patients the right to uh you know to transition, instead of trying to counsel them out of their gender dysphoria, tides have changed. Studies had been done and it had been well shown that these people do a lot better when they are supported into a transition of gender. And so that to me further solidified my thinking and my belief that this just shouldn't be an issue. There should be no room for transphobia in our society, no more than there is for homophobia, and no more than there should be for racism as well. These people should be embraced, they are not a danger to us, they suffer greatly, they just want to live the way uh in a in a manner of authenticity, you know. And I guess as someone who has struggled with authenticity in the past, being a closeted drug addict, you know, one of the keys to my survival is learning how to be authentic. And I just can't imagine how one can be mentally well if they are not able to show up with authenticity because they are not living as a gender that they truly feel that they are. Now, this might all seem very wishy-washy. Um and I guess the thing about it is that people can be fearful of human conditions that they don't understand, you know. Um yet we must have empathy for these people and and accept them. Um, you know, I really this this anti-woke bullshit just has to stop, you know. It's just that a movement that gives an excuse to people who are not evolved, who you know are have got their own issues with their own gender. Toxic masculinity would be one issue, uh, and that's why inherently when they come across a transgender person they feel uncomfortable. And these the the anti-work movement, all this does is it gives them an excuse to really say hot, you know, live according to these biases without doing the work to examine where it's all coming from within them. You know, if we have a strong reaction to another group of people, it's usually something to do with us ourselves and not to do with the other person at all. So the anti-woke movement really springs from I think people feeling like they've had the woke movement like shoved down their throats. They're like, you know, I'm not comfortable with this, you know, why should I have to now answer questions about pronouns and everything? I don't want to think about this, whatever, you know. And I guess I can I can sort of understand that perspective, and I think in some respects maybe the woke movement no, I don't want to say it was too loud. Uh it was you know, maybe if a little less um fuss was made about it, then maybe there wasn't there may not have been such a pushback. But having said that, you know, when you then have to consider the oppression and cruelty that that trans people live like are are subjected to, then why the fuck shouldn't they be loud and about coming out as, you know, this is now okay, I can now comfortably come out and be who I am and and you know, um, you guys need to make room for me, you know, and and and and that sort of thing. But I guess um, you know, I I don't mind for instance, I don't mind answering questions about whether I'm an Aboriginal Torres State Islander, I don't mind uh asking questions about what my answering my questions about what my pronouns are. Hey, it's like a second of my time. If that makes a marginalized group of people feel more comfortable in ordinary everyday settings, then what the fuck is the issue with ticking a box? And really, people who get agitated by this are just people who've got issues with their own gender, and it's just reminding them of their own uh internal pain and discomfort with their own selves, and that's why they get irritated at it, you know. Um a lot of the crew, and then of course, the the the children sort of argument is is always thrown up, you know. Like I don't want my child being having this, you know, rammed down their throats, you know, it's gonna confuse them, oh my god, it might even make them trans. Listen to me, right? Children knowing about transgender isn't firstly, I don't see what the big fucking problem is. We're not talking about sexuality here, we're talking about gender. And gender and sexuality are two completely different things. It can be related, you know, like in terms of if you're you know, you're attracted to men, you're cisgender female, you know, you want to feel sexy and feminine, you know, and that does link in. But being feminine, you know, we can talk about gender without sexualising it, you know. Um, and so like yeah, I I I guess I don't see why I think when we make it this big fucking taboo with kids, make it a big taboo issue and that sort of thing, then that makes it an even bigger issue, which probably does mean that they will labour over it longer and maybe get more confused, you know. If you're just very matter-of-fact with kids, it's fine. I mean, sure. You know, I don't think again, we you don't need to spend schools shouldn't be spending hours on educating people about trans people, but it would be more like you know, hey, like if my son sees a uh transgender woman in the street and ask questions, I would just factually answer them, you know. And I have before, you know, a smiley uh this man he wants to be a female, he is a female inside, you know. Um, and it's like like when you wanted to have purple hair and you dyed it purple, well, it's kind of the same thing, all right? You don't need to complicate it, but the more you build it up, that's when you do confuse people. I think fundamentally, I think what irks me about all this is that like you know, people are so perverse in their approach to transgender people, you know, like it's all about oh, has she still got a dick and everything, you know? Like, what the fuck? Like, if I see a trans woman, she's a trans woman, she's a woman. When I meet up with my friends, right, my female friends, I don't wonder what their vaginas look like, by the way. And I'm sure uh and and dudes too, you know, I'm not wondering what their dicks look like. So why all of a sudden, when a transgender person presents themselves, do some people suddenly start to wonder what the hell is in their pants? Like it's perverse, you know, it is literally perverse. And just because someone is transgender and jet and dressing as the opposite sex, well, that doesn't mean they're thinking about you sexually either. In fact, probably not, I would suggest, you know, definitely not. So why it's like we the the unevolved cannot separate the concept of gender from sexuality. Like if you have to c dress in the opposite gender or whatever, you must be somehow sexually b depraved. No, the two are separate, you know. Just like honest to God, it's so disrespectful like to start to wonder what is in someone's pants just because they're transgender. You don't do it for your cisgender people. So where's the fascination, you know, and that comes from within yourselves. That comes from within these anti-woke people, and it's to do with their own fucked up sexual perversions, you know, they're all they're doing is projecting. Um, and yeah, I guess I just get so very angry because I've had to do a lot of work to face the demons within myself inside myself in order to live. And these people continue on in the world being cruel and horrible and hurting others, and when really all they need to do is really do the work and look inside themselves and and and and address the issues there, not with other people. So, yeah, sorry about that, Rant. I do want to keep this also factual. I don't want to just go on a rant either, but I do get impassioned. The other the other point I would make is listen, educating children about transgender people, why the fuck would you think that that would make them gender phobic, uh gender um gender dysphoric? Like I I don't understand the link. Just because they're aware of something, it doesn't mean that they're going to become that thing. You know, and this is where it comes down to people pathologizing transgenderism. You know, it's not a pathology. We have to wrap our brains around this. Transgender people have been around as long as humans have been around, you know, as long as humans have been around, of every different type, even non-binary people. Um, so you know, this is a real condition. Okay, we've cut society has generally accepted the fact that gay is real, you know, like in the Bible there are gay people and whatever, you know. So that's so like next big piece of news is that transgenderism has been around with every ancient culture, as long as humans have been around. I mean in other cultures, like you've got the faffa in the in the islanders, you know, the the men who dr they just uh born and their families go, you're now a woman and you'll be a faffa, you'll dress as a woman and you'll do woman jobs. And uh like this this gender thing, this gender swapping, or you know, i is not new, it's natural to the human condition, you know. Um I mean, like I was so that I can understand gender dysphoria, uh, I can understand how that works, um, you know, but I non-binary is one that I do struggle with to actually understand. I'm not dismissing that it's not real. Yeah, I I after doing research, I I 100% do believe it's real. Now, why am I questioning that? I mean, you know, in this whole work movement, what you did, what I observed anyway, is that there were some people, you know, coming out saying, Oh, I'm gonna identify as a cat now and things like that. And I like, okay, well, you know, that's maybe is it attention seeking, or you know, that's a very judgmental way to frame that. Is it I think also too if you you the young people of today are very disenfranchised, probably because there's in the Western world less structured religion. You know, um if you look at the Eastern cultures where Eastern religions are very strong and and and cultures are very strong right uh across the board, there seems to be less disenfranchisation, I guess. I don't know if that's the word. But when people when we don't have humans need to belong, we need to have an identity, we need to be part of a part of a um a um not a gang, I want to say, and like but you know, part of a tribe. We're tribal, you know. And so when you take religion away, organised religion, um, then people are looking for somewhere to belong. And and you know, I guess some people find find comfort in the work movement and yeah, identifying as a cow. I mean, that's you know, a little bit on the outer rim of being normal or not pathology, I guess. But um, so one thing that I have to wonder is non-binary like that, you know, is it just is it is it really real? You know, or is it just sort of people looking to identify with something, you know, and and it's more like created within the individual. Um, but in fact, I actually found that that's not true. There's been non-binary people around since ancient times. In fact, in ancient Roman times, there was non-binary people around and they were revered as gods, you know, they they held the balance in courts and stuff like that. So I I don't I don't understand it. I don't understand how that would be to be non-binary, and I yeah, my brain, I I would be quite open and honest. I I don't understand it. I wish I could, um, but it's one that that bends my brain a bit. In terms of non-binary on examples, certainly I have convincingly seen someone who is uh non-binary, so like the character in billions, you know, that that was a um like a drama series on I think it was on Stan, I think, one of those, and there was a non-binary character in that, convincingly so. Like there was nothing put on about the way this person was. That was who they were, they were non-binary, and I I could see it and I could understand it, but I couldn't understand how it would be to be like that, I guess. So I I yeah, I want to I want to just make it clear that I'm not paying disrespect to non-binary people. I believe it's a thing, and I I do I'm curious, I wish to know more about it actually. Um I I would love to sit down and have a chat with a non-binary person who is obviously comfortable to talk about what their experiences are and how they experience the world, you know. So sexuality, right? Let's go there. Now, I'm not an authority on this, okay? I'm not, and I must admit, you know, even in my own mind, I understand that gender and sexuality are quite separate, yet they are related, I guess, you know. I mean, yeah, they are. And look, I am willing to be fully corrected if I am wrong, okay? Um, and but my and I, you know, I I don't I don't sort of I don't um tout myself as an expert on the area. So I'm gonna give you the way I understand it, and as I say, I hope this doesn't offend, and if I'm wrong, I'd rather be corrected. Um I or would like to be corrected actually because I uh yeah, I want to know what the true experience is. Okay, but like so I was uh trying to actually uh get a sense of like what the actual like spread of sexual preferences is across transgender people, and there's no clear data or no no clear like I guess um information with regards to that. And what I could gather is maybe it is a little bit more fluid in transgender people. Um uh like if the statistics that I could drag up seem to suggest that uh there that that there was a high amount of bisexuality in um transgender people, but in terms of the actual sexual partners that they have had had, it um less like if they were trans women, they predominantly had had experiences with men and not so much women. And I I I don't know why that is or even if that's a true thing or not. Um but my lived experiences, I've known some transgender people and I've known men too, who like to have sex with transgender women, you know, it's a thing, and that that doesn't make them gay at all. It doesn't make them gay because that is a transgender woman, it's not a man that they're attracted to, you understand? So, you know, like attraction and sexuality is not all about the penis and the vagina, you know, it's about so much more than that. Um that that you can't and I I know some people can't wrap their heads around the fact that they're like, well, if that's a man who's attracted to transgender females and he is gay. No, he's not, because that is a woman presenting herself as a woman, and you know, and and I'm sometimes the fact that they've got a penis is an added turn-on for some dudes. It's a thing. You don't not many men will will uh openly admit that, but as a former sex worker, certainly I was surprised at how many men actually that was their kink, they liked it, and um and so you know um yeah it's kind of heartwarming that that there's a there's there's there's a category of dudes there that just want to fuck uh transgender women and that's that's wonderful, you know. Um and they are often there's a lot of shame, like a lot of them are not gonna come out and openly admit that's the case, but as I say, as I was as a former sex worker, yeah, uh because gentlemen were telling me what they preferred or what they desired in a booking, you know, that's when it came to my knowledge that that this is a common thing, you know. Okay, so like now a lot of the anti-work people are like, well, we think that transgender people are dangerous, you know, and like you know, really they're just perverse men just dressing up as females so they can cop a perv in the woman's toilet or whatever, and you know, sexually abuse women in the women's toilet. Uh and I that is absolutely preposterous to me, okay? Like, so firstly, one thing that dudes just have to understand is that there's cubicles, no urinals in a woman's toilet. So, you know, a lot of the derobing happens behind a cubicle door, alright? Uh and so I don't feel in the slightest threatened by sharing a bathroom with a transgender woman who might just have a penis. Okay? Alright. Chances are this the transgender woman is not gonna want to use her penis on me. She's probably more attracted to dudes anyway, you know, and like I it's just ludicrous anyway. And and dudes who are fearful of, you know, maybe accidentally hopping into bed with a chan trans, you know, woman and finding out too when it's too late, listen to me and listen good, alright? These women, transgender women, are the victims of brutal, brutal crimes. Brutal crimes, you know? How on earth do you think that they are going to want to actually trick you and get you into bed, you know, and not tell you they've got a penis? Like, do you think that these people are stupid? They know if they were to do that they would end up dead, like you know, bashed to death or whatever. No, this is not a danger. Stop saying it is, because it's just simply not, you know, it is not a danger at all. And as I said before, because there is a genre of men who actually prefer to meet up with transgender women, then there is someone to love them as well. So, you know, it's not like they uh have to trick men into getting to bed with them because no one wants to fuck them. No, that's simply not the case, you know. Uh, and indeed, yeah, as I say, it would be unsafe to not inform a gentleman of what the lay of the land is beforehand, anyway. Everyone knows that. Transgender people are not dangerous, okay? They're not dangerous. You are the like, you know, they are far more often the victims of crime. So when we're looking at actual rates of violent crime against transgender people, um it's sometimes it's difficult, you know, let's uh because sometimes studies actually um uh underreport the amount of transgender people in the study um that's been looked at. But so what I'm about to say is uh that that the rates that I'm about to quote here are probably right largely um under under um calling it. Okay, so it's probably worse than this. So in the US, 8.6% of transgender versus only 2.2% of cisgender uh people reported uh violent crimes over that was people over 16, 16 to um sorry, just have a look, 16 plus um from in one year period. In a one year period. So over one year, that's an astounding figure. So over one year, 8.6% of transgender people experienced violent were were victims of violent crime, and only 2.2% of cisgender. Okay, um now looking at broader data, 5.15% per year for transgender adults in 2017 to 2020. So that's per year, that's not a total, so that's five 51.5 per thousand, which is uh like too high. And in Canada, 59% reported experiencing violent victimization through um for transgender or gender diverse people. 59%, right, in a in actually uh in a group of people studied had reported uh being victims of violent crime. That's just uh despicable, like it's it's just too high, you know. Now in terms of um in terms of them being perpetrators of crime, um a lot of the anti-work people like say that these are dangerous people, you know, they're overrepresented in in um prison, you know, in prison populations. Like, you know, there were one source states that 21% of transgender women in the US have spent time in prison or jail versus 5% of all adults. But what we have to understand here is that this is the there is that transgender individuals face high rates of victimization, discrimination, poverty, homelessness, and survival economies, like so you know, they might have to do prostitution or become involved in drugs as a result of where their fall in society. And all of these risk factors for both uh uh victimization and involvement in the criminal justice system, uh you know, all of which are risk factors for victimization and involvement in the criminal justice system. So what it probably affects more is that they're persecuted and you know, find themselves in situations where they fall easily into crime, or you know, like drug-related crimes and things like that, or or you know, they're in the wrong place at the wrong time, or indeed sometimes can be accused of doing things that they haven't done. And when really are they more violent? No. I I would I would gather, I would uh as I understand, or my belief is that no, they're not. You know, these are persecuted people, they're not violent offenders, you know. Um, you know, so many surveys and criminal records don't do not library record or disaggregate gender identity, leading to underrepresentation or misclassification. And offending is not the same as violent crime, is what I'm saying. So even when there is an overrepresentation in the justice system, it it's probably for non-violent offences like you know, survival, sex work, as I said, trespass, substance use, minor theft, rather than being assault, robbery, or or murder. So, you know, there's no good data to back that up. Um uh all we can say is in Australia, for instance, 0.3% of prison entrants are transgender. Um, but because they don't really um record what actual crimes were committed versus the actual whether they're trans or cisgendered, then there's actually no data available for any of that. But that's still fairly low proportion um yeah, of the prison inmates. I mean, cisgender male men make up a far more higher um percentage of um people committing violent crimes, you know. So look, I I don't think there's any any evidence whatsoever that that transgender people are violent or dangerous to us in any way. Um the anti-work people like caused more pose more danger to them. Um, and I feel that that myth is is pretty solidly dismissed, really. So a lot of the transphobic people um you know state that being uh gender diversity is a pathology and and not a human condition. And so we can look to evidence and arguments supporting this as being a a um a human condition rather than an illness, I guess. Um so first you look at terminology and diagnostic framework changes in the medical psychiatric literature, the shift from gender identity disorder or transsexualism to gender dysphoria in the DSM V reflects an attempt to separate having a gender identity per se from a distress or impairment. The DSM V defines gender dysphoria as distress or impairment stemming from incongruence between experienced gender and assigned sex. Some critical reviews observe that many trans and gender diverse individuals do not actually experience uh clinically significant distress, or at least not solely due to their identity per se, but due to external factors like stigma and discrimination. For example, not all trans and intersex people suffer from gender dysphoria. It was found in one review. That's interesting. That's true too. I was listening to like a TED talk last night. Um it was really good, actually. It was a trans woman who started out, he lived, she lived the first part of her life as a white, privileged male in the executive arena, and even had a family and kids and that, and then just felt I'm not living authentically. I want to come out in authenticity, and then she transitioned. She didn't really describe gender dysphoria, I guess. So that's interesting. Human rights uh reports reports argue that pathologization or labelling gender diversities and illness can itself be harmful, violate rights, and that gender diversity is better framed as part of human variation. For example, the paper, there's a paper called Gender Is Not an Illness by the Global Action for Trans Equality argues for depotologization, which I would agree. Uh some brain, so when we look at uh you know, like biological evidence or new scientific evidence that what we're dealing with is not an illness, it's just a diver a different human condition. Some brain structure research finds that transgender individuals show brain structural features that differ from cisgender individuals of their assigned sex, suggesting neurobiological, neurological correlates of gender identity rather than purely being psychosocial pathology. For example, one study found that uh sex classifier algorithm applied to a sample of transgender women, so pre- and post-treatment, had lower true positive rate for biological sex classification and univariate analysis showed structural differences in regions such as the Partaman and the Insula. So while this does not conclusively prove a cause or fixed innate gender, it supports the idea that experiences of gender incongruence have biological or neurobiology correlates and they're not just simply a choice or purely just a psychosocial disorder. When we look to cultural, historical and global uh global diversity of gender expression, The recognition of gender diverse roles in many cultures, so two spirit in indigenous North American cultures, the hijra in South Asia and third gender categories in various societies, suggests that gender diversity is not only a Western or modern phenomenon, or it this broader anthropological anthropology supports the idea that gender diversity as human variation as a variation of humanity rather than an illness, which is true. Like I said, there's examples of, if you will, transgender people in other societies and ancient societies. The historical review of how gender incongruence has been classified over time notes that the medical psychiatric framing of pathology versus variation has varied across epochs and it is influenced by culture. We look at the human rights or ethical arguments, the United Nations and regional human rights bodies have recognised that transgender and gender diverse individuals are subject to violence, discrimination, deprivation of rights in part because of their gender identity and the stigma attached. For example, the UN special procedures note the struggle of transgender uh transdiverse persons globally. The argument here is if it gender identity or diversity is framed as a pathology, it reinforces stigma and makes discrimination more likely. Whereas framing it as a human variation and ensuring rights or affirmations reduces harm. Um so it's less harmful lens to view it all through. And then again, arguments that that it is a it's a it's a variation rather than a pathology. Well, there's clinical outcomes tied to affirmation. So evidence shows that when transgender and gender diverse people are supported in their gender identity, so social affirmation, medical affirmation when needed, mental health outcomes improve relative to environments of rejection. For example, the DSM 5 patient info pages page notes that family and societal rejections are strong predictors of mental health difficulties amongst transgender people, that makes sense. This suggests that the distress often associated with gender dysphoria arises in large part from mismatch plus social stigma rather than being inherently ill by no n by virtue of being trans. Okay, so we wrap our heads around that. Uh yeah, if if it was a pathology, then you wouldn't see improved mental health outcomes with transitioning, you know, because you'd be making the problem worse, you'd be reinforcing it. So that that supports this being a a um yeah, a variation in humanity, not a not a pathology. Having a transgender identity or being gender diverse is not automatically non-pathological. The diagnosis of gender dysphoria still exists and is intended for those who do experience clinically significant distress or impairment from incongruence. So I guess Yeah. Maybe what they're s suggesting here is that I'm not sure what to make. I have to circle back to that. The neuroscience of biological evidence is emerging, not definitive, it shows correlates but some com com not complete causal pathways. Cultural and historical evidence supports diversity but doesn't by itself prove non-pathology in all cases. Each individual's experience can vary widely. The framing of human condition versus pathology is partly a normative ethical argument, involves how we treat people as much as how we classify the condition. Diagnostic criteria made in place to enable access to care for those suffering. So fully removing pathology frame is complex in practice. So the weight of energy the weight of gender diversity, uh the weight of evidence suggests that gender diversity is best understood as part of a spectrum of human variation than an inherently pathological condition. The distress or impairment, like gender dysphoria that some individuals experience is real and may require clinical intervention, but that doesn't mean the identity itself is an order, is a disorder. Ah, right, okay. So I mean the thing is that gender dysphoria occurs because they're not in the right body, and so then the transition and that should go away. So how could you argue that the f the presence of gender dysphoria means that being transgender isn't a po is is a pathology, it's a symptom, it's a symptom of of of your condition and being made to live in the wrong gender by society, I guess. Framing matters. So by treating trans and gender diver diverse people as having pathology, we risk reinforcing the stigma. Absolutely. Worsening mental health and undermining rights. By contrast, recognizing the identity is legitimate, human variation helps support affirmation rights and better outcomes. Yeah, so I mean, yeah, this is where it becomes a you could argue in circles with someone who's trying to say, you know, it's not a real condition, it's a pathology. Um what what we would say is that it's harmful to consider it a pathology, you know. Um, and so that that argument should always trump anything that that person believes because the the intent should be not to do any harm to anyone um at all. And I I guess whether we consider a condition to be like human variation or pathology, actually when you think about it, it has less to do with any biological evidence and more to do with the way we choose to frame it. Like for instance, you know, you could there could be observable differences between a transgender person's brain and a cisgender person's brain or group of and you know, you can interpret that as pathology or something going wrong, or human variation, you know, just because there are differences in brain structure, it doesn't necessarily, I guess, prove that there's a dysfunction there, you know, that that needs to be corrected. The the framing of something as a pathology as opposed to a human variation is, yeah, um, more to do with how we interpret it, um and less to do with what's actually going on, I guess, in the person's body. I don't know, I feel like I'm still going in circles. I hope I'm making sense. When we look at I mean this is a pretty macabre piece of history, really, like the sort of perverse things that used to be done to trans people, you know, what sort of therapies used to be used to try to make people not trans? Uh, and it's disgusting. I mean, historically, a range of therapies were used to try and make transgender or gender diverse people not trans. And these practices, often called conversion or reparative therapies, uh, sought to rely on someone's gender identity or expression with their assigned sex at birth, and none of them were shown to be effective, and are now widely condemned by major medical and psychological bodies as being unethical and harmful. So the breakdown by era, so psychoanalytical and psychodynamic therapy was early to mid-20th century, and it was rooted in Freudian pathology. So merely early psychiatrists viewed gender variance as neurosis, or trauma response, or failure to identify pro properly with the same-sex parents. And so treatment involved just talk therapy aimed at uncovering unconscious causes and encouraging proper masculine or feminine identification. And studies and case reports from the 50s through the 70s show that these attempts were just blatantly ineffective and often increased depression, shame, and suicidality. There were behavioural aversion therapies in the 1950s and 70s, so this is influenced by early behaviouralism therapies, used like conditioning techniques, so electrical shocks and nausea-inducing drugs, or noxious stimuli paired with cross-gender thoughts or behaviour, and reinforcement of gender normative behaviour and punishment for gender-diverse behaviour. So dark and macabre. These methods mirrored those used in attempts to suppress same-sex attraction, which is also horrible. Long-term follow-ups showed no success in changing gender identity. Subjects frequently developed PTSD anxiety or suicidal ideation. So, you know, the whole yeah, okay, so you anti-woke people, if you think transgenderism or you know, is is is a perversion or condition that needs to be treated, well, how are you going to treat it then? Because there is nothing that has worked. Um, hormone suppression and forced conformity, oh gosh, it's just horrendous. 1960s is a 1980s. So some doctors prescribed androgens to trans women or estrogens to trans men to suppress gender expression and sexual drive. So, like, basically, so what it is like, so a man a cis cisgender man who was a trans woman, they're now going to give them more testosterone to force them away from being a woman, basically, quite cruel. Adolescents were sometimes placed in institutional or re-education programs enforcing gender normative clothing, behavior, and speech. These interventions failed to alter gender identity and often cause physical and psychological harm. So these things are harmful, you know. How can something be a disease that needs treating? When you try to correct it, it causes more harm. It just flies in the face of that being logical. So reparative counselling and pastoral therapy in the 1980s to 2010s, continuation of conversion frameworks, often promoted by religious or ideological groups, claim to heal gender identity through spiritual realignment, prayer, talk therapy, or cognitively retraining. Scientific reviews found no evidence of benefit, clear evidence of harm, including depression, anxiety, and again self-harm. Global condemnation and bans, two thousands to present. So major professional bodies, so APA, Endocrine Society, Royal Australia, New Zealand College of Psychiatrists, WHO have stated these practices unethical. Many countries, including Australia, Canada, UK, and parts of the US, now ban or restrict conversion therapies targeting either transsexuality or sexuality or gender identity. The WHO in 2019 removed gender identity disorders from the mental disorder category in the ICD 11, reflecting a shift towards affirming care. Today, legitimate gender affirming therapies focus on export exploring and supporting gender identity safely, managing dysphoria and improving quality of life, reducing stigma, discrimination and distress, rather than trying to cure the identity. Sounds just so much more um yeah, compassionate, doesn't it? You know. Um and as we look through the like history of how things have evolved in the medical world, so you know, there's these terrible case studies where, you know, like there was a dude called um David Remer case, a boy reassigned as female. Uh this was in the 1950s, after a botched circumcision, right? So basically they fucked up the circumcision so badly his dick needed to be cut off. And so instead of dealing with that, they just figured, well, we'll just call you Brenda now, and you can go on to live on as a girl. But the child later rejected the female identity and reverted to male and and later died by suicide. The case became a landmark example of the failure of e and uh of the failure and ethical danger of attempting to impose gender identity on someone. Um so yeah, uh behavioral. So then there was a thing called, oh god, it sounds so so perverse, isn't it? Like feminine feminine boy project. Sounds like Man Love Boy Association. Experiments aiming to prevent future homosexuality or transsexualism, use reward punishment systems, praise or candy for masculine behaviour, punishment or withdrawal, of affection for feminine play. Like this is where this is a home of masc of toxic masculinity, isn't it? The most famous subject, Kirk, later known as Craig Kirk Murphy, later died by suicide. Rack is later involvement with conversion therapy, advocacy advocacy underscored the deep ethical problems with his approach. You know, um, and then so in the 1980s, there was an endocrinologist called Harry Benjamin, um, and he's called the father of transgender medicine, and he broke with psychoanalytical orthodoxy and argued that transsexualism was a human variation, not a delusion, which is what we're trying to say here, uh, and advocated a supportive therapy with access to medical transition when uh when was appropriate. And his work inspired the formation of the World Professional Association of Transgender Health and the Standards of Care. So there's a really good body of evidence that supports best medical practice and encompasses, you know, multidisciplinary approach. So, you know, there's very careful vetting and counselling and psychological support that goes on with this. It's not a cookie-cutter, one size fits all sort of approach, you know, and and it's more like clinicians help people to understand and express their gender identity without judgment, and it's more focused on exploration rather than correction because some people don't wish to transition all the way, you know, they're comfortable somewhere in between as well. Um, and uh they these people should be supported and not suppressed. And and more importantly, studies now show that affirm affirmation, social and medical, significantly reduces depression and suicide allergy amongst transgender youth and adults. So instead of doing harm, now we're actually helping these people. Um, and I just don't see how you can argue for anything against that approach. So, like, let's look at um the actual like, is there potential to do harm with, you know, like um yeah, changing your sex by or your gender by using hormones, okay? Now, because I I used to have one of my f good friends was actually an endocrinologist and and she used to struggle with provo with providing um you know hormone treatments because the body of it like what she told me back then is that basically um women transitioning to become men, um, when you give them testosterone, it actually increases their cardiovascular mortality risk. Um, and that's that's the point that she struggled with, and that makes sense because men are more likely to have heart attacks than women anyway. Uh, but you know, I would argue that, well, if you asked a transgender person, they would probably accept a shorter, happier life rather than having to endure a longer, uh, more painful life because they're not living the way they want to live. So we have to keep that in mind too, that you know, whilst, you know, it there could be some risks, informed consent is always important and it's up to the individual, you know, if they're happy to accept that risk, and like I don't see it as a reason not to proceed with that sort of treatment. So, like when we look at uh men transitioning to women, so trans feminine um hormonotherapy, so introgens plus antiandrogens, uh, pretty much consistently um there is a higher rate of blood clots, so venous thromboembolism in trans uh gender uh females um as opposed to cisgender men. So in a large case report, excessive VT risk, so for venous thromboembolism risk was found in about uh 16 to 17 per thousand people over eight years versus cis men um which was uh 13 to 14. So it's not that much higher, but risk grows after uh estrogen initiation, which is a hormonal effect, which is you know true, like if you're on the pill and you're a female, it's a risk for blood clotting. Um but in terms of uh stroke and heart attack risk, there was no increase in stroke or heart attack risk with estrogens, um, and that was found in a couple of big studies. Uh but when the opposite happens, so transmasculine or testosterone therapy, uh several cohorts show a much higher risk of MI, so myocardia infarct, which is a heart attack in transgender men, so versus just cis women. So the new Dutch study reports 4.2 times higher a heart attack risk and 1.6 times higher stroke risk if you're using um testosterone to change your gender. Uh, and also there's a common lab effect that can raise thrombetic risk if severe. So you when you use testosterone to change your gender, uh, 11% of people have an increase in red blood cell concentration, but basically that can be modified by altering doses and things like that. So that's a side note. So, but interestingly enough, um looking at overall cardiovascular mortality in long-running Amsterdam co uh cohort, so that's a study that's run from 1972 to 2018. Overall mortality, so death was higher in both trans feminine and trans masculine people versus the general population. But that doesn't mean that it's due to the hormone therapy. I mean the deaths in trans feminine patients, so that's um trans women who started off life as men, uh, deaths from a cardiovascular disease, which is what uh cardiovascular disease, HIV, lung cancer, and suicide contribute mostly. But importantly, that cause gives no indication to a specific effect of hormone treatment. So it's likely these are things coming from lifestyle and comorbid morbid burdens and social things like you know, having more poverty and that sort of thing, um uh than it being the result of hormones. So you can't really argue it's due to the hormones. A large UK analysis also found elevated overall mortality in transgender and gender-diverse groups driven largely by external causes like suicide and homicide or accidental poisonings and not just cardiovascular disease. So I guess what I'm trying to say is yes, you if you're transitioning towards being a male, yep, there's a high risk of heart attack. Probably most people who really have bad gender dysphoria who want to be male would accept that risk because they want a shorter, happier life. But interestingly enough, there's no increase in cardiovascular mortality when you go the other way. So oestrogens are protective, and there's a slightly higher risk of blood clots. But again, all this is known about, you can monitor for it. You know, there can be expectant care, managing other cardiovascular risk factors, like you know, you don't munch the diaries, don't smoke, keep yourself fit, you know, you can mitigate these risks as well, sort of thing. What I'm saying is that they're not absolute reasons to not advocate for this therapy when the balance of it is that we're looking at reducing suicide, increased quality of life. I mean, I know myself I'd much rather live a shorter, happier life than a long and miserable one, you know. So yeah, the next axe I had to grind is that one, like if you particularly I think Charlie Kirk used to bring this argument out. People get hung up on the X and Y chromosome, you know. So, like, yes, you can transition, you can take hormones, but you're still not female because you've got an X and Y chromosome, you know. So, like uh yeah, like how can you be female if you've still got those chromosomes, you know, that that sort of um genotype, um, which is a weak argument anyway, but I feel I have to rise to meet it because it's bullshit. What these people don't understand is that you can naturally in in n like human beings, can actually be born with an XY karyotype, so that's your your chromosomes, and still become female. And how is this? Because it's not just the X and the Y chromosome, right? There's other machinery around that determines sex. So there's there's a few examples. There's a thing called an androgen in sensitivity syndrome. So um the body cells don't respond to androgen, so that's the male sex hormones because of mutations in the androgen receptor gene, which we have on another chromosome in a completely different part of your genome. So you have other genes present in other chromosomes that determine your sex, guys. It's not just X and Y. So just please drop that obsession. Um internally, so these people they lack a uterus and ovaries, but they have undecided testicles, so they're usually identified at puberty when menstruation doesn't start. So they like go through life, they're like they've got yeah, you know, they're they yeah, think they're women, but they're not they're well god, now I'm arguing against myself. Genetically the XY, and they in every other sense of the word, you wouldn't be able to tell that they are anything but female, but they just don't have a uterus or ovaries. They have tatestes and their bodies just don't respond to androgen, basically. This prevalence of this is about one in 20,000 to 50,000 live births, and people with complete AIS are chromosomally male, but phenotypically female. Okay, so for everyone else in the world, they are a female who cannot bear children, and there are plenty of females who can't bear children due to other uh abnormalities with their uterus as well. Okay, the second example is a thing called Swire syndrome. So this is XY gonadal dysgenesis, karyotype XY, you will have an X and Y chromosome, but mutation in genes like SRY or SOX9 or others that regulate testes development. So gonads fail to form testes, there's no testosterone or anti-moolarium hormone. Body develops female internal and external anatomy, including in a uret uterus and fallopian tubes. Okay, because what the thing is is when you're a fetus, everyone starts off as a male as a female, and then uh and then if you're if you're gonna be male and you've got the right genes, then you get all these other hormones that come out and and the the um you don't the you like the ovaries start to develop into testicles instead. So everyone starts off as a girl. That's another thing too. So individuals are raised as girls and usually identify as women, uh, and really they can still have babies and all of that, but they've got an X and a Y chromosome. Chromosomally, they are male, but in every other sense of the word they are females. Usually they need a little bit more hormone replacement at puberty for secondary sex characteristics and bone health, but otherwise they're otherwise just women with XY chromosomes, and you can have mosaic or chimeric karyotypes. So karyotype examples is 45x, 46xy, or xy. So basically a mixture of cells within you, some of which have two X chromosomes, and some of which have an X and a Y chromosome. So mosaicism is like in some parts of the body, like yeah, you get different cell no, I'm not gonna um try and explain it. Sorry, that's detailed kind of uh genetics. But anyway, for the purposes of this, you have uh different populations of cells in your body. Some that are XY and some that are or sorry, XX or X nothing, no Y known no X. Some cells have an X only, alright, and others have an XY, a mix due to early embryonic cell division errors. Wide range of outcomes can uh can can arise from this. So some individuals are phenotypically male, some are female, and some are intersex. It just depends. Um development depends on how the Y-containing cells are distributed within your body in and in the gonads and tissue. So like basically at some point in early embryological development, you get like two populations of cells, like you get one population of cells that is like um got a Y chromosome in it, and one population that has got two X's or just a single X, right? And then and then randomly they will these cells will then you'll have like yeah, a patch, a mix, uh yeah, patchwork of of different sort of uh cells with different uh array of chromosomes in them. Yeah, and so like if the cells that have like the male chromosomes end up in the area of your good ads, you'll be male, pretty much. I hope I'm explaining this right. It's like so mosaicism can be seen in nature with like dogs, right? So dogs that have got a spotty coat, um, that comes from mosaicism. So in the bits where there's white, the melanin is switched off, and when it's black, it's the it's uh that that that um group of cells is behaving genetically different because the uh the melanin gene will be switched on in the black bits and the melanin gene will be switched off in the white bits. I hope that makes sense. Um then there's disorders of sexual development with SRY translocation. So occasionally the SRY gene, which triggers testis formation, is missing from the Y or translocated onto the X of an autosome or an autosome. If SRY is absent or inactive, an XY embryo can develop female anatomy. Conversely, if SRY is added to an X chromosome, an XX person may develop Y trait uh male traits. So like the SRY is is kind of like the messenger, you know, like you've that that tells like the genes, um, the proteins how to behave sort of thing. So the key concept is sex versus chromosomes, chromosomes, XXY or XY genetic sex, gonads, so whether you've got balls or uh ovaries is gonadal sex. Hormones is causes your phenotypic sex. Okay. Um that these systems often can well not often that can diverge. So the whole argument that you know you can't be a female if you've got an XY chromosome falls on its face because there are natural examples when that just simply isn't the case. So if anyone tries to use that argument, it's absolute rubbish. Don't buy into it. Alright, so like where am I going with all of this too? Um, you know, I guess look, someone who really sticks out in my mind is Charlie Kirk and the arguments that he had against transgenderism. Like, so he asserted very strongly that there are only two genders and described transgenderism and gender fluidity as lies that hurt and abuse kids. Let's just focus on that. We have evidence to suggest that in fact when we apply this w way of thinking to people suffering with gender dysphoria, it causes harm, you know, uh, and and doesn't help these people. So if you're gonna say that, then what's your way of dealing with these people then, you know? He linked gender-affirming medical care, especially for minors, with being harmful or experimental and called for bans or moratoria on such care. Now I want to go into the whole um the whole adolescence thing, children thing in a separate podcast, I think, because it's a huge topic. And look, listen, I guess the thinking about it is that some of the claims by the anti-woke movements are concerning, you know. Like they're they they quote examples of where transitioning has caused harm. So I want to get to the bottom of that because I suspect that a lot of it is bullshit and misrepresentation, but I just probably want to consider that in a different podcast. He argued that allowing transgender women into women's sports is unfair and demands that men physically in to and it demands that men physically intervene so that their daughters are not forced to compete against someone with oh it's so misogynistic with X and Y chromosomes. Ah, so here we go. Listen, but we've already discussed the X and Y chromosomes. You can be endocrinologically female naturally with X and Y chromosomes. So that whole argument fucking falls flat on the ground. Um he described trans gender transition clinics, doctors, as akin to social contagion or destruction. Destructive movement stating that the regime of gender-affirming care for youth in particular was one of the most destructive social contagions in human history. But that flies in the face of any uh any evidence at all. You know, we have evidence of universal harm being done with conversion therapies, which is the only other way to deal with it, and actually, all of the evidence is in favour of supporting transition with improved outcomes. So, you know, uh there's not a lot of fact behind what he was arguing. He used strong rhetoric calling for punitive or legal action, for example, saying doctors who provide gender-affirmed care should face Nuremberg-style trials, yeah, whatever. So again, we've already pointed out that that you know Kirk's framing framing frequently conflates gender identity, um, which is a person's internal sense of gender, with medical transition or medical care for minors, treating both as inherently wrong and harmful. Um many medical and psychological bodies view gender-affirming care as evidence-based and appropriate when delivered under established protocols. So his blanket opposition is contested. And again, his emphasis on biological sex, so X, X, or XY, and sports fairness is part of a broader argument he uses, but critics say it often overlooks the complexities, which I've already discussed, including hormone levels, puberty, suppression, and transition timing and individual variation and paints all trans women as male advantage, which many studies actually dispute or at least nuance. So I mean, like if you've transitioned to a female, then you've suppressed all the testosterone in your body. You're essentially endocrinologically a female. There is no advantage. There could be a small advantage if you're a taller, bigger male and you transition after puberty, but that is negligible. That advantage is negligible. Uh, and to actually propose that someone would go to the trouble of actually fully like transitioning just to win a gold medal is just ridiculous. I cannot no one would do that. It's just silly. Reports and commentary note that his language is highly polarised, described by many as transphobic rhetoric, raising concerns for stigmaticisation, increased risk of trans people being victims of violence, harassment, and poorer mental health matters. Uh why it's important to address this, well, Kirk's arguments feed into policy debates, so bans on gender, affirming care for minors, um, and so understanding him his positions helps to track how cultural and political narratives form. But, you know, this handy work movement, if it manages to push things backwards from being, you know, like the medical profession being able to support people through transition, it's actually a really harmful movement, and that's why I very strongly um object to it. Firstly, most of these people, their lives will never ever be affected um by you know by their being uh um their lives are not affected by people transitioning to a different sex, not in any way. Yet they kick up such a stink and put up all these arguments and what they're doing is actually causing harm to these people. They're causing more harm than than any harm that they're avoiding from themselves, which is no harm. The strong moral and religious framing, so natural law, two genders, abomination references, means his style appeals to a specific conservative Christian base and influences how trans issues are viewed in those communities. Terrible. Um because he is a prominent voice, his rhetoric gets amplified among younger conservatives and can influence activism policy and campaigns and media framing. Yeah. So it's a harmful movement, you know, I think. I mean Yeah. Sorry, I get very impassioned. So pretty much all I really had to say today. I haven't covered the whole topic, so there's a lot more I want to discuss uh in particular about the children thing because you know it's kind of disgusting actually how the anti-work people, you know, use children as a yeah, as an as a as a reason, you know, uh as an argument for not not providing good care to these people, you know. Um and there's a lot of untruths being published out there and inaccurate information as well, you know, and and it just makes me really angry. Look, I deeply, deeply worry about the anti-woke movement. I feel deep empathy for people having to live with such um such difficult lives with such persecution and cruelty. Um and I really hope that the tide changes. I hope none of this reaches Australia. I as a cisgender woman have absolutely no problem with sharing a toilet with a transgender woman. Um and I just think that yeah, people have to really look to themselves and and examine why they feel uncomfortable with transgender people. Um yeah, uh because they pose no danger to us, but we pose more danger to them. Anyway, that's all I have to say. I need a glass of wine now. Thanks, uh, thanks for listening, and um stay tuned for the next episode. Um um on this topic Namaste.