How to Reason with Americans

Gender medicine is based on lies, but my compatriots just want to know if it works

Imagine a country called Deducto-stan. Its citizens value systematic reasoning above all else and teach formal logic to children throughout their schooling. When a new medical technology is developed – usually in another country, because these guys aren’t the most creative – they call a panel of 13 random citizens to judge the pitch.

GENDER SALESMAN: I’m here today to tell you about a child named Alyx, whose gender identity –

PANELIST: What’s a gender identity?

SALESMAN: It’s a person’s sense of their gender.

**Trap door beneath Salesman opens, Salesman falls down chute.**

Alas, I don’t live in Deducto-stan. I live in the USA. Here’s how a similar scene would play out in an American courtroom where, say, a jury is deciding the fate of a law that bans gender medicine for kids.

LAWYER FOR SALESMAN: I’m here today to tell you about a child named Alyx, whose gender identity is male and sex assigned at birth is female. [Image of cute child appears on screen.] Alyx is bullied at school for being transgender. His classmates call him Pussy Boy. His teacher once referred to Alyx using she/her pronouns, which made Alyx cry.

**Four members of the jury are weeping. Two are on the lawyer’s LinkedIn to see if he went to a good school. A woman in a Gays Against Groomers hat is miming male masturbation. A man leaps from his seat and bellows, “I’ll fight for you, little girl, I mean boy! Where’s the misgendering teacher? WHERE IS SHE? OR HE?”**

Deductive reasoning is the right tool for tackling gender. We should dismiss the whole concept based on its failure to define foundational terms, and not waste time debating male sports advantage. But sadly, most Americans aren’t comfortable taking action based on analysis of underlying principles.

It’s not because they’re dumber than Deductoslavs. Rather, their culture favors a different type of logic. Americans understand the world through data, anecdotes, feelings and credibility assessments. Most of all, they care about outcomes. Theory? Pretentious.

In this post I’ll explain why we should analyze the logical underpinnings of gender medicine – and why we don’t. Then I’ll offer ideas for making the case against gender medicine in a way that is culturally sensitive to Americans. In the end, I argue we can’t abandon theory.

Aversion to deductive reasoning has left Americans vulnerable to gender nonsense. Other countries are vulnerable because of their own unique pathologies. For example, Iran transes gay men because it’s homophobic; Germany fines TERFs 10,000 euros for saying cross-dressing men are men because of a cultural inclination toward auth– sausages! Germans love bratwurst too much. That’s all I was getting at.

Why We Should Apply Deductive Logic to Gender Medicine

Invasive new treatments should be put through some sort of review before the proponents are allowed to mess with patients. (Logic-based medicine?) Gender medicine passed a review of sorts in the 1960s when gender doctors persuaded US medical schools to let them open “gender identity clinics.” They were armed not only with logic but with funding from the Erickson Educational Foundation. Debates ever since have focused on the methods and outcomes of gender medicine, not the underlying logic of it.

Why are we deferring to the decisions of dead white guys who ran medical schools in 1966? Their values around sex and sexuality were nothing like ours. They supported unethical treatment of babies with disorders of sex development, gays, women … 

It’s not too late. We could demand a review of the core tenets of gender medicine. If the gender doctors can’t define gender identity or sex in a coherent way, toss their proposal in the garbage. (I’m talking about political tactics – there’s no legal mechanism for this.) But instead we call for time-consuming outcome studies while more and more patients are harmed. 

There’s one possible justification for green-lighting gender medicine despite not knowing how it works. According to this argument, it’s worth experimenting because we might find out that gender medicine alleviates suffering. Who cares about the underlying theory if the thing works? This argument fails because we’ve been allowing US gender doctors to experiment for over fifty years. They’ve never produced a study that shows gender medicine (as an isolated variable) improves patients’ lives in comparison to a control group. Time’s up.

Why Americans Can’t Handle Abstractions

Americans aren’t comfortable making decisions based on general rules (like “doctors must be able to explain their treatments using terms that they can define” or “definitions must tell you what a word means”). Instead we’re all about case-by-case analysis, drawing inferences from messy data, judging the thing by whether it “works,” and looking for flaws and exceptions to general rules. This makes us vulnerable to ideas that make no sense but are pitched with compelling stories.

Here's how our culture sets us up to think this way. 

Philosophy: We’re Pragmatists

Our most important ancestors, the English (please don’t tell my Irish-Catholic mother I said that), gave the world inductive logic. Sixteenth century thinker Francis Bacon created the scientific method. Principles could now be derived from natural facts, and they were more functional than maxims drawn from, say, Catholic teaching.

By contrast, around the same time French philosophers like Rene Descartes were using abstract principles to painstakingly prove natural facts such as their own existence.

In the late 19th century, American thinkers developed pragmatism, a system of thought that eschewed abstract theories. They wanted instead to focus on consequences. An idea was good if it could be used to produce good outcomes. In sloppier form, this mindset encourages skipping to the end rather than analyzing underlying principles:

“OK, so gender identity lacks a rational definition. Now let’s study examples of gender identities. ‘Mushroom’ might be made up, but ‘male’ sounds reasonable.”

Language: English is Anarchy

I used to take Spanish classes at a language school that attracted an international student base. My favorite teacher was Rolando, a Mexican-American who’d moved here after college. He told me his American students drove him a little crazy: they seemed bright yet they could not apply grammatical rules to scenarios they hadn’t been specifically taught.

Because English doesn’t have any rules! I mean, maybe you can divine some patterns that hold true part of the time if you study German and Latin first? The few rules we have, we wantonly break. For example, the “with whom” construction is so prohibitively pompous in most contexts that it might as well be thought of as obscure slang.

Spanish, by contrast, is so logical that all its syllables are the same length; there are only five vowel sounds. English has twenty vowel sounds. How long to make a given syllable, or which “a” sound to use, are negotiable. That’s why we have so many different regional accents. Because we don’t impose order.

We also code switch and use different lingo depending on who we’re talking to. Other languages accommodate social hierarchies too – but according to a set of rules. In America, none of it’s codified. You just have to know when a word choice would be too casual for the setting or – so much worse – too formal.

How do you learn these non-rules? By hanging around; by induction.

Manners: Generalities Are for Bigots

Making assumptions about people based on their characteristics is called stereotyping. It’s taboo – good! Mostly. When you refuse to assume someone is a man even though he has a penis, I’d say you need to put down the etiquette book.

Another ground on which we don’t stereotype: religion. This leads to an ironic situation. Most Americans are not ideologues – we really are pragmatists – yet we’re very open-minded toward ideologues. Peace-and-love Christians in South Carolina get along great with their fire-and-brimstone neighbors. Fuzzy Unitarians in Connecticut defend rigidly sexist … religions I won’t name. All belief systems are super unique and interesting to us, yet somehow all the same, and we think it’s wrong to evaluate them based on their foundational principles.

Show Americans How Abstract the Trans Argument Is

On the surface, the case for gender medicine is all feelings, anecdotes, (junk) studies and authority – elements that strongly appeal to Americans. But at its core, the case for gender medicine is based on abstract theory.

Here’s how to expose that weakness in the trans case.

“Trans Activists Reject Practical Solutions”

The average trans-friendly American knows that affirming trans identity is the rule, but they don’t realize deviating from the rule is tantamount to genocide.

Start with an edge case, preferably drawn from real life. The gigantic high school boy who wakes up one day and says he’s a girl who wants to play girls’ lacrosse; the 11-year old girl who announces she’s a boy after her first period. 

The trans-friendly American is likely to say, “Well, generally affirmation is good but not for those individuals. Instead, let’s encourage the boy to play a non-contact girls’ sport; tell the girl to grow into herself for a few years before medicalizing.” It’s the American way to work out a practical, unprincipled solution to cases like these.

So your friend will craft a compromise they believe is wise and humane. Then you tell them:

“Unfortunately, the ACLU argues that’s unconstitutional.”

For real life trans sports data, check out the lists at Women’s Sports Policy and SheWon and follow ICONS for ongoing stories.

“Trans Activists Hide Facts”

Memorize the risks and side effects of each gender intervention. Trans activists wave them away by saying gender identities must be affirmed no matter what, but Americans are skeptical of absolutism. They crave understanding of the nitty-gritty so they can make a pros and cons list. Their con list will be much longer and more vivid.

“Gender Doctors Refuse to Run Studies”

Set aside all the trashy Jack Turban studies. Look at what gender doctors don’t study. Those omissions suggest they don’t care about outcomes but rather cling to their abstract theories.

Gender doctors have never tested whether talk therapy, picking up a hobby, or nothing is more effective at alleviating “dysphoria” than gender medicine. They boast about short-term lack of regret but can’t or won’t keep track of patients long-term. They eschew objective measures of well-being, like physical health and ability to hold down a job. When it comes to etiology, they insist trans identity has to be biological even though their studies have never born fruit in over fifty years — and they don’t research alternative explanations.

“Gender Medicine Has Barely Changed in 50 Years”

Our side uses the term “experimental” as a smear, but I’m afraid it makes gender medicine sound scientific and cutting-edge. Americans like experiments! Throughout history we have called ourselves an experiment over and over and over.

If gender doctors were really “experimenting” on patients then they’d try to learn from the outcomes and adjust their theories and practices in response.

Look at the ancient wisdom of gender medicine and tell me how much has changed:

1. “Gender identity” refers to “one’s sense of belonging to a particular sex.” Robert Stoller and Ralph Greenson, 1964.

2. The desire to change sex cannot be treated with talk therapy (bedrock principle of the Gender Identity Clinic at Johns Hopkins, 1966).

3. A person who wants to change their “gender of assignment” has “gender dysphoria” and it’s unhelpful to analyze whether they’re motivated by a fetish or internalized homophobia. Norman Fisk, 1974.

4. It’s OK to transition minors. (Evidence suggests Harry Benjamin may have done it in the 1960s, Norman Spack in the 70s, and Ira Pauly in the 1980s; Susan Bradley and Kenneth Zucker “supported” minors in seeking gender medicine in the 1990s, possibly as far back as the 1970s.)

We should be condemning gender medicine as a hidebound practice that refuses to update its mid-century assumptions — not calling it “experimental.”

“Gender Authorities Condone Eunuch Surgery”

Talk about the WPATH SOC8 Eunuch Chapter. That freaks people out.

Friend: How can surgeons believe that’s OK?

You: They’re super rigid about following their theory of affirming gender identity no matter what. 

It actually annoys me how much easy mileage I get out of that eunuch chapter. By my lights, eunuch identity is less outrageous than MTF identity because it entails less surgery. To each their own logic.

“Gender Patients Are Suffering”

“Gender identity” contradicts the idea that people’s personalities aren’t defined or limited by their sex. Many American women have figured this out by now. But they aren’t comfortable taking a policy position based purely on feminist theory (even if they identify as feminists). Supply them with data to make them feel safe:

“Yeah, I agree it’s suspect to define womanhood by makeup and hairstyles. You know, a lot of the people who do this end up really unhappy. The suicide rate for post-surgery trans people is 19 times that of the general population.”

Sometimes you don’t actually need data. I’ve found that many normies know a trans-identified person who is (in the secret opinion of the normie) mentally unwell or narcissistic. They’ll first mention this person in a broad way, perhaps even as a defense against my attempt to peak them. But then later in the conversation they’ll confess they’ve worried trans identity isn’t working out so great in that instance. 

Get them to open up. Turns out they’ve been carrying the truth inside them all along. You just need to affirm.

Show, Don’t Tell

Because ideology is such anathema to Americans, the term “gender ideology” sounds biased or hyperbolic. To make the conversation flow smoother, try “the theory of gender identity.”

Don’t Abandon Theory

Once you’ve warmed up your target with the type of reasoning they like best, I think you should get into the underlying illogic of trans. It’s too important to let go.

First, we don’t want to reinforce Americans’ instincts that “the studies” are paramount. Studies can show women don’t like their periods, girls gain confidence on testosterone, and men who’ve damaged their bodies with excess estrogen aren’t athletically superior to women in every imaginable way.

Second, Americans have short attention spans. You need big sweeping points in order to cover ground fast — those live in the realm of logic and theory.

Third, if we don’t eventually bring the discourse back around to logic, we’ll end up with mild reforms that merely wind the clock back.

For example, a common gender-critical tactic is to point out how gender medicine changed in the last 20 years or so. The gatekeeping used to be tighter; the sex ratio of patients used to favor males rather than females. It’s interesting but misleading. If we compare the present unfavorably to the past, we’re implying that the whole enterprise was valid or scientific before. It wasn’t. So instead of scoring the cheap point by showing what changed, tell vivid stories about how messed up gender medicine was in the past. (To get you started, here are posts about the 1960s, 70s, 80s, and 90s.)

The reason it never worked: because it’s based on the illogical theory of gender identity.

If we don’t expose gender medicine’s rotten foundation then Americans will follow their natural biases toward keeping it alive on a case-by-case basis, as a “last resort,” when the patient seems like the opposite sex already, on doctors’ orders if the vibes are right. They’ll clamp down on testosterone for ROGD straight girls, but keep the door open for “masculine” 18-year old women and boys who seemed girly from age 3. In other words, we have to drive a stake through the theory of gender identity so that it can no longer hurt gays.

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