Biological origins of trans identity?

Dr Kate O'Hanlan weighs in

As a social worker I get lots of emails announcing upcoming trainings. One such email I recently received was for a training from the prestigious Couple’s Institute promoting a webinar on the biological origins of gender identity and sexual orientation by gynecologic oncologist and former surgeon Dr Kate O’Hanlan.

A self-professed lesbian, Dr O’Hanlan did not hide her disdain for recent pronouncements by President Donald Trump on gender (that there are only two), framing Trump’s statements as an attack on the entire LGBT+ community. She clearly believed that if only Trump had the information that she was sharing, he would stop ‘attacking’ sexual and gender minorities.

I couldn’t help feeling sympathy for Dr O’Hanlan. Her motives struck me as noble if naive. She seemed to truly believe that her research debunked the concerns of those who challenge gender affirming care. She was advocating for empathy and understanding, a goal I share. But sometimes empathy and understanding, when decoupled from a pursuit of truth, can lead us astray. I believe it’s led many a Gender Affirming Care (GAC) practitioner astray.

As so often happens in conversations about gender identity development and trans people, Dr O’Hanlan brought up the existence of disorders of sexual development (DSDs) as evidence that sex is a spectrum, even though this is not a scientifically sound argument (see the work of Colin Wright, Carole Hooven and Zach Elliot to understand why).

Essentially, O’Hanlan’s presentation argued that sexual orientation and gender identity both are hardwired from a very young age. She seemed to argue that because they are hardwired, they are unchangeable and unchanging. That is an assumption not supported by the available evidence and a conflation of at least two different issues. While sexual orientation in males seems to be relatively stable, it is less so in females. Gender identity on the other hand has only moderate stability over time, an inconvenient empirical finding that undermines the argument that ‘kids [always] know who they are’. This podcast interview with a mother of a child who desisted from a trans identity directly challenges such an idea.

While her presentation is well-cited, Dr O’Hanlan’s gender identity-related citations are mostly pre-2010. This is an important point because those of us who are immersed in the gender world, know that much has changed since then. While she does mention the recently released Cass Review, she does so only to categorically state that it is debunked, without providing any evidence to support that claim. While the Cass Review has faced a fair bit of backlash, it continues to cause reverberations across the globe, most recently in Australia. And given that the Cass Review’s findings are largely in line with every systematic review that precedes it, I’m not sure what Dr O’Hanlan means by debunked. In fact, the critiques of the Cass Review have recently faced their own scrutiny.

Near the end of her presentation, she makes a surprising claim to the roomful of attendees, most of whom are therapists. She states that all the patients she operated on, were assessed by two psychologists. Then she says: “I don’t think you [psychologists] can be tricked.”

It’s a revealing statement.

So many of the responses to those who oppose GAC, frame the issue as a battle between a big bad anti-trans hate machine seeking to eradicate a poor innocent vulnerable underdog minority from existence. It’s a very compelling David-and-Goliath story, where trans people play the role of David facing down a bigoted, conservative-leaning giant. Trump is a good stand-in for the part of the giant, with his grotesquely larger-than-life personality and menacing presence on the political stage.

In a world where trans people are an oppressed minority, the healthcare providers get to play the role of rescuer ferrying along a poor persecuted victim to the magical land called ‘Authentic Self’. In this land, everything goes: you want your breasts removed? Happy to oblige. Want breast buds? We can help you with that. Want no genitals at all? Sure, why not?

Hormones and surgery are the magical elixir that will alchemically turn stone into gold, or in human terms — boys into girls and vice versa. The elixir will even free the poor persecuted victim from the bonds of gender altogether, entering them into the magical land of ‘Nonbinary’ if they so desire; a place where identity itself is fluid and changing.

Dr O’Hanlan confidently argued in her presentation that psychologists are able to discern who is worthy and who is not from entering this magical land of creative transfiguration.

Even if it were true that gender identity development had biological origins — which of course it must because most phenomena involves some combination of bio-psycho-social interplay — this does not automatically mean that medical interventions are the best way forward.

Equally important to biology, are the socio-cultural forces that encase it. Those social forces can create dysfunctional environments. I believe that is what we are seeing with GAC. It is a social movement that does not care what is lost in its wake.

If being trans is not a medical condition, what makes any of this healthcare? Why would you want to permanently alter someone’s body when that person might very well feel differently about their identity 5 or 10 or 20 years later, if or when the cultural winds shift direction again? Why would you want to weaken a human’s physical health for the fleeting promise of gender euphoria?

These are the questions that have become more pressing to me as I come to terms with what was done to me and what I did to myself. Every decision has its tradeoffs and the tradeoffs I made seemed worth it as a 23 year old. But as someone in my mid 40s now, my priorities have changed. For one thing, I no longer take my physical health for granted. Where once I didn’t dream of living past 30, I now hope that I can live as long as possible.

Dr O’Hanlan pleaded with her audience to spread the word about her research: She wants a world that accepts sexual and gender minorities for who they are. I want that too. But I also want these minorities to grow up as healthy adults. GAC promises happiness but does not deliver for many.

Healthcare providers have been hoodwinked just as much as the public has. Their vulnerability is their desire to be helpful. What greater seduction than to believe that you can deliver authenticity through a syringe or a scalpel.

So, here’s my appeal to Dr O’Hanlan — your goal for a kinder, more inclusive world is a laudable one. But your facts are outdated, your narrative flawed. This is not a straight vs LGBTQ+ David-and-Goliath battle. It’s a battle over evidence suppression and the concealment of facts. The more you peel back the layers of the GAC onion, I believe you too will discover something rotten at its center.