In our cultural rush to achieve potty parity we have failed to ask the far more important medical question of whether gender dysphoria represents a normal variant or psychologically disordered thinking. We cannot let political correctness derail the discussion and force us to carelessly spend our time making new bathroom signs when a medically fragile group is left unattended. Empowerment has a poor track record of treating illness and sex-reassignment surgery and hormone therapy are drastic medical measures that potentially cross the “First, do no harm” therapeutic line.

I find it interesting that the most objective participant in this discussion turns out to be disease. Pathology does not bow at the altar of political correctness. It doesn’t care what gender you choose because it knows your choice is irrelevant to your biology. Unfortunately, believing you are a man trapped in a woman’s body doesn’t decrease your risk of breast cancer.

Medical diagnosis is based on risk factors and biology matters when you are dealing with illness. Pediatricians aren’t labeled misogynists because they have separate growth charts for boys and girls. Oncologists aren’t considered sexist for treating uterine cancer in women and prostate cancer in men. Neonatologists aren’t practicing intolerance when their data reveals that black female premature babies have better outcomes than their white male premature counterparts. Biology matters in the real world of medicine.

Disease is not gender neutral; in fact, gender neutrality turns out to be a disease. Disorders of Sexual Development are a class of diseases that present with ambiguous genitalia, a condition where the external reproductive structures are indistinct preventing the physician from definitively identifying the baby’s sex. In this condition, chromosomal testing is performed in order to determine the genetic make up of the baby. Imaging studies are performed to determine which internal reproductive organs are present or absent and blood testing is conducted to see if there are any hormonal abnormalities. A baby that is a blurred combination of male and female structures suggests abnormalities in genetic regulation, hormonal balance, and anatomic development. This gender-neutral disease is not the best of both worlds but actually the worst of each. A physician cannot in good medical conscience call it a normal variant when they know that it signals a disorder that must be treated. If this physical transgender situation indicates disease, then shouldn’t a doctor be wary when they encounter a biological man who thinks he is a woman? It doesn’t matter what gender box you check on the clinic paperwork, your medical problem still requires a gender-specific exam. How can a physician treat your man or woman problems and then ignore your brain when it thinks contrary to your uterus or prostate?

We, as physicians, cannot let this vulnerable group of beloved image-bearers be used as poster children for a cultural movement committed to redefining biological reality. We cannot allow ourselves to become medical tools for a transgender agenda that hasn’t been properly medically studied. We need to come along side those who are conflicted about their gender and compassionately help them explore the reasons for their mental – physical disconnect, but we cannot allow our culture to silence potential mental health issues with an award and a magazine cover.  I fear for the gender confused who are told to proudly hoist a rainbow banner when deep down inside their flag flies at half mast under an emotionally gray sky.