Fertilizing Dreams

Readers, if you bother finishing this piece, you owe me one for having slogged through this article for you:  “We need more transgender and gender nonbinary doctors.”

Yep, that’s exactly the thing we were missing in medical school.  This New York City (oh great) MD/PHD candidate told a friend’s story:  “Years of distress from gender dysphoria and constant bullying for being “effeminate” led Krystal — now in their mid-20s and working as a retail clerk — to come to the clinic to explore the gender transition process.”  “Their”?  So Krystal was also suffering from multiple personality disorder?  Nothing psychiatric there…

“So, when Krystal reached out … In my mind, I hurriedly combed through a list of all the attending physicians who had given lectures: No one was TGNB-identifying that I knew of.”  Oh no, what to do?!

“In a 2018 matriculating student survey by the Association of American Medical Colleges, just 0.7% of respondents identified as TGNB…”  It would have seemed pretty disconcerting to me if I had been asked about my cis/mono-binary/LGBTQWTF-status during my med school interviews. 

The author asserts that there are approximately 1.4 million transgender/non-binary in the U.S. and “The need for that care is growing exponentially.”  What care, specifically different than what one would receive from a physician NOT suffering from severe mind-body disconnect, or subsequent hormonal, psychologic, and even surgical mutilation?

The author gives skepticism the day off when he/his states that being TGNB “translated into high rates of depression, self-harm, homelessness, disordered substance use, and HIV and other sexually transmitted infections,” not wondering whether mental illness leads to these secondary problems.  And then this line:  “…and nearly half have had to teach their clinicians about the care they need.”  To keep it topical and fashionable, we also learn that “transgender women with HIV” have been more likely to contract COVID-19.  There was no follow-up as to whether the virus was targeting transgenders, or whether it was going after the immunosuppressed the way it does in the non-trans population.

This silliness concludes that medical schools need to print brochures and actively recruit TGNB students to fulfill the same old diversity and inclusivity goals the worth of which no one can ever really define.  Also recommended are outreach efforts to colleges, high schools…and middle schools “to vocalize acceptance of any gender identity.” 

Aaaand there we have the real goal.  The entire TGNB-recruitment movement is based on mental illness elevated to the level of a civil rights plea, and coopting medicine to validate it.  Are physicians trained to say to the 90 lb. anorexic who actually sees a 300-pounder in the mirror, “that’s good, that’s healthy, go with your feelings”?  Do we tell the addict that our recognition of their unique health problems means their behavior choices don’t contribute to their discomforts?  The author is a “diversity representative” at his medical school, clearly more interested in sexual politics than the subject he purports to pursue.  Like the patients who have to “teach their clinicians”, this student somehow needs to teach his school about what he should be taught.  That is an impressive degree of hubris even in a know-it-all med student (and we’ve all known ‘em).  That a medical student is pushing to recruit more students who will ignore objective reality and encourage patients to do likewise, is the real rub.  This is not a push for better care, but for acceptance, and then embrace and celebration of a psychiatric condition.  This is the opposite of compassion, and the opposite of authentic medicine.