 Thank you. And thank you to Scott for inviting me to attend and to speak at this conference. I've never been to one of those Steubenville summer conferences, but I always have heard about them. And so it's amazing just to see how much good this university does. And I should also mention that two months ago, in April, the university hosted a conference here on the transgender moment and how Catholics should respond to it. I'm a visiting fellow here in the Veritas Center at Franciscan, and they let me organize this conference, bring together a team of medical doctors, psychiatrists, surgeons, endocrinologists, pediatricians, philosophers, theologians, counselors, lawyers for a two-day conference on how to understand what's going on and how to respond to it. And I can't think of any other university that would host such an event that would allow the speakers that I selected to speak at such an event. They were all orthodox. They were all coming at this from a perspective where charity and truth come together, and too many schools sacrifice one or the other. That said, Scott has asked me to condense that two-day conference into a 45-minute talk. So I'm going to do my best. I'll also mention, more or less, everything I'll say today is contained in the book that Scott had mentioned when Harry became Sally. Most of you are old enough to know what the reference is to. When I speak to student audiences, they have no idea what the reference is to, so take that for what you will. And it may be odd to be starting a conference with this talk. What does this have to do with evangelism? What does it have to do with defending the faith? What does this have to do with advancing the mission of the church? And so I want to kind of frame this simply to say, I imagine most of you are well-equipped to talk to your neighbors about the pro-life issues, whether it's the beginning of life or the end of life. I imagine most of you are well-equipped to talk about some of the marriage issues, especially with the Supreme Court recently redefining marriage. But I imagine many of you feel like I felt five years ago woefully ill-equipped to carry on a conversation about gender identity and gender dysphoria and people who feel trapped in the wrong bodies. And this is something that we need to equip ourselves to be able to speak into the culture, because the reality here is that there is a segment of our neighbors who are suffering profoundly. Imagine feeling so alienated from your own body, such a sense of distress and alienation and discomfort that you would contemplate having radical surgeries to permanently remove certain body parts and to then try to recreate other body parts to make you look like the opposite sex. These people aren't faking it, they're not making it up, they're not choosing to have gender dysphoria, but they're being mis-served by many in the medical professions, they're being mis-served by many in the media, they're being mis-served by many in the academy and many people on university campuses. And to my mind, the only institution in the United States that has a fighting chance at actually ministering in both truth and love to these neighbors of ours is the church. That if we don't do it, it won't get done. That if we leave it to the academy, to the media, to the courts, to the Congress, it's not going to happen. And so hopefully I'll be able to share a few things with you tonight. First to inform you as to what's going on, Scott said the talks would be profound, they would be funny. The first half of this talk is this going to be depressing, but that's the reality of what's going on in our culture, and it's important that we know what's going on. And the second half of the talk will be how do we evaluate it? How to understand and make sense of what's going on, and then lastly how to respond. So let me start by saying I think John Paul II got the 20th century entirely right when he said it was a crisis of faulty anthropology. When he was Pope, he was analyzing this in terms of the two world wars, the Holocaust, the Gulag, the killing fields, and then the horror of abortion. Had he been with us for the past decade, he would have extended that analysis to include the legal redefinition of marriage and now even the very redefinition of what it is to be a man or a woman. All of these things are built upon a faulty anthropology, what Henri de Luboc described as atheistic humanism, right, a faulty humanism. But in our culture, the high priests aren't the philosophers and the theologians, right? In our culture, the high priests, the people with credibility on cable news, they're not the philosopher theologians like a caravotiva or a Joseph Ratzinger. In our culture, the high priests are the doctors and the scientists. So what's fundamentally a philosophical debate about anthropology is being dressed up as a scientific or medical debate. And so the first quote I want to share with you and I should mention everything that I'm good at quote will go up on the projection so you can see the slides read along. Feel free to pull out your smartphone, take a picture of it if you want to have the reference for the future. If you don't want to do that, all the quotes with footnotes and citations are in the book. So feel free to do whatever is going to be best for you for taking notes. But here's the first quote. From a medical perspective, the appropriate determinant of sex is gender identity. It is counter to medical science to use chromosomes, hormones, internal reproductive organs, external genitalia, or secondary sex characteristics to override gender identity for purposes of classifying someone as male or female. Now those are radical claims. Radical claims for at least two reasons. The first is that just a generation ago, radical feminists were telling us that sex was merely a bodily biological thing and that gender was merely a social construct. Gender was a socially constructed imposition on us, stereotypes. Now we're being told that your gender identity determines your sex. Just five years ago, the bread and butter of medical science were things like chromosomes, hormones, internal organs, external genitalia, secondary sex characteristics. Now we're being told that if any of those aspects of objective reality conflict with someone's subjective identity, the subjective identity trumps objective reality. This isn't a scientific or a medical claim. This is a philosophical claim about relativism, about subjectivism. It's a bad anthropology. And this was an expert testimony that was delivered in a federal court when the previous administration was suing the state of North Carolina for passing a law that said biological males couldn't enter female-only restrooms and locker rooms. And this was the expert witness to say that gender identity is the appropriate determination. What's happening in courtrooms is also increasingly happening in classrooms. So this next graphic is called The Gender Bread Person. And you'll see that this is a graphic used to cataclyse children on how they should think about their own bodies, how they should think about their own identities with respect to their bodies. And you'll see it has five rainbow-colored spectrum. So you see each and every one of these ideas has an arrow that exists along a spectrum. I'm actually going to move the podium so I can see my monitor so I can read them off to you accurately. There's gender identity, which is how you identify in your head. And those arrows go from woman-ness to man-ness. And you could exist anywhere in between. Then there's gender expression, which is how you give expression to your gender identity. There's biological sex, which also exists along a spectrum. You'll see the two arrows. And then they have sexual attraction and romantic attraction. And none of these five aspects of your identity need to necessarily line up. Your gender identity could be one way, your sexual attraction is another, your romantic attraction is a third direction. And you as a child, because this graphic is being used in grade schools, you need to decipher for yourself where do you fall along these spectrums. These aren't realities that God has created you with. These are malleable determinations that you determine, not the creator. Now the gender bred person has gotten in trouble. And so the new graphic that they're using is called the gender unicorn. And you'll see the two major differences are the criticism of the gender bred person was that it looked like a man. And so it was supporting the patriarchy. So it looked like a gingerbread man. So the gender unicorn doesn't have a identifiable body type as male or female. I mean, it's oddly appropriate that they're using a mythical creature to embody their worldview. I'm not entirely sure they thought this all the way through. But you'll also notice that it no longer says biological sex because that's now considered a hate speech. That's now considered politically incorrect. So the new phrase is sex assigned at birth. The idea here is that if the doctor merely assigned your sex at birth, the doctor can reassign your sex later in life. Through puberty blocking drugs or cross sex hormones or surgery, your sex can be reassigned. Now when you saw this graphic, the reaction in the room was one of disbelief. And somewhat one of ridicule. You kind of laughed at it. You weren't being persuaded by this. This isn't meant to persuade you. This is meant to persuade your children and your grandchildren. This graphic is colorful. It's playful. It looks like Barney. So in that respect, they did their market research. They wanted a graphic that would shape the moral imagination of your children and your grandchildren. And so now imagine two kids with the same feelings. Each child feels a sense of distress and alienation and discomfort in his own body. One has been cataclyzed to believe that he's created by an all-powerful, all-loving God as male, and that he can overcome this feeling of discomfort, that God has created him as a boy, he is going to grow up to be a man, and that there are ways in which he will one day again feel comfortable in his body. The other child has been cataclyzed with the gender unicorn to believe that his sex was merely assigned at birth, that his gender identity is what determines reality, and that doctors can reassign his sex later in life through puberty-blocking drugs, cross-sex hormones, etc. How are those two children going to interpret the very same feelings, the very same thoughts? How are their parents and their doctors and their counselors and their pastors, all of the adults in their lives, going to respond to the same exact situation, depending on whether they believe a true anthropology, or if they believe the gender unicorn's anthropology? To give you an idea as to why they're using this new expression, the next slide, they explain biological sex is an ambiguous word that has no scale and no meaning, besides that it's related to some sex characteristics. It's also harmful to trans people. Instead, we prefer sex assigned at birth, which provides a more accurate description of what biological sex may be trying to communicate. Okay, so from this worldview, this anthropology, this ontology, this gives rise to a certain medical treatment protocol. And so the official guidelines that have been published by the Endocrine Society call for four-part standard of care for children with gender dysphoria. First is what's known as social transition. A child as young as two or three years old who is persistent, insistent and consistent that they're the opposite sex should be allowed to socially transition, meaning they should be given a new name and a new wardrobe, new pronouns, access to new bathrooms. They should be treated as if they are the opposite sex. The second step as that child approaches puberty, they should be prevented from going through puberty in the quote, wrong body. So doctors are using off-label a drug that's not FDA approved for this purpose, but they're using a drug to indefinitely block a child's pubertal development. This then sets up the third step in this treatment protocol because now you have a young teenager who is trapped in an adolescent's body. This 13, 14, 15-year-old hasn't gone through puberty, hasn't hit the growth spurt, hasn't matured in the way that all of his or her classmates have, and so they try to mimic puberty of the true gender identity. So they all administer testosterone to high school girls to masculinize her body, and they'll deliver estrogen to high school boys to feminize his body, to try to develop their bodies in accordance with their true gender identity. The official guidelines recommend this at age 16, but increasingly it's being done at younger ages, increasingly starting at age 14. And then the last step, the fourth step, is surgical transition. So you have social transition, puberty blockade, hormonal transition, and the fourth step is surgical transition. The guidelines recommend this to take place at age 18. Increasingly doctors are suggesting age 16. As part of a NIH-funded study, so your tax dollars-funded study, it was revealed that there were two girls who were 12 years old who had had double mastectomies performed on them as their participation in this study. So this is radical surgery that permanently removes various body parts, secondary sex characteristics like breast tissue, external genitalia, internal reproductive organs, and then they use the techniques of cosmetic surgery to try to create something that would resemble the body parts of the opposite sex. So that's the four parts standard of care. Why do they start so young? Peer-reviewed research demonstrates that pre-puberty children asserting a different gender identity from the one they were assigned at birth are cognitively capable enough to be aware of the gender they are asserting. The meaning of a child's gender identity assertion at a younger age is no less valid than the meaning of a gender identity assertion of an older child. This is from Dr. Scott Liebowitz, another expert witness in that federal lawsuit against the state of North Carolina. So there's peer-reviewed research that says your pre-puberty child knows that he's actually a girl trapped in a boy's body, or a boy trapped in a girl's body. I'm going to skip the next couple of slides just for the sake of time and actually I want to read one of them so I'm going to skip ahead to this one right here. Speaking of children with gender dysphoria, the director of mental health at the University of California San Francisco says these children, quote, refuse to pin themselves down as either male or female. Maybe they're a boy girl or gender hybrid or gender ambidextrous moving freely between genders, living somewhere in between or creating their own mosaic of gender identity and expression. As they grow older they might identify themselves as agender or gender neutral or gender queer. Each of these children is exercising their gender creativity and we can think of them as our gender creative children. Just two things to say about this. First, had you ever heard of the term boy girl or gender hybrid or gender ambidextrous before? If you were the parent of a child suffering from gender dysphoria living in the San Francisco area and being a conscientious parent you said I'm just going to go to the best hospital I can find to the director of mental health at that hospital and she's going to help me with my child, this is the advice you could be given about your child. Many of these children, many of these parents they're victims of the activists and if anything we shouldn't feel any form of like contempt or hostility towards people who are transitioning. Many of them are simply making the best of a bad situation based upon bad advice from people like Dr. Aronsoft. The second thing to say about this is in the very same breath that this physician would say we should prescribe puberty blocking drugs or we should prescribe cross sex hormones she also admits that as the child grows older the gender identity might change. So why are we making radical transformations of a child's body today in accordance with the gender identity that the child happens to have today while even the most progressive activists acknowledge that that gender identity may very well change over time. Why not give the child the time and the space to grow out of a stage of gender dysphoria to give them the child the help to reconcile their identity with bodily reality? Why are we trying to transform bodies into conformity with misguided thoughts and feelings rather than trying to help people align their thoughts and their feelings with the reality including the reality of their bodies. They're two different ways of thinking about what's going on here. All right so I've mentioned some of the anthropology. I've mentioned some of the medicine. Let me say a few words about the public policy and then I'm going to start evaluating this. Four aspects of public policy that I want to mention. First what will be taught to your child and your neighbor's child at school? What will be taught at your local Catholic school? You can't just assume that parochial schools are going to get this correct. We need to be vigilant to make sure that our Catholic schools are actually teaching the truth on these issues. But also what will be taught at the government-run schools? Maybe you're fortunate that you can opt out of the government-run schools but part of being a good citizen, being a good neighbor, is making sure that the neighbor's children aren't being indoctrinated by the state. Will the gender unicorn, the gender-bred person be used as the truth of the matter, right, as gospel fact in public schools? Second, how will access to sex-specific facilities and programs be governed? You've probably seen the headlines of several track championships in the New England states where female athletes have lost championship races to males who are identifying as females and competing as females. What will happen to the equality of female athletes when they're forced to compete against boys who identify as girls? What will happen to their privacy, their safety in bathrooms, locker rooms, shower facilities, dorm rooms, hotel rooms for overnight field trips? Will they be governed on objective facts about bodily reality or subjective identities where boys who identify as girls have access to the girls' bathrooms and locker rooms, et cetera? A third, how will speech be governed? Scott mentioned that New York is highly represented here. Well, for the New Yorkers here, if you go to New York City, you can be fined up to a quarter million dollars if you intentionally misgender someone. If you intentionally fail to use the proper pronouns, you could be fined up to a quarter million dollars. And then lastly, how will the provision of medical services be governed? And here are two concerns. One is, will bad medicine be mandated? And then two is, will good medicine be prohibited? And so let me take those in reverse order. First, I believe the number is now 12. So in 12 states, Dr. Paul McHugh, the former psychiatrist and chief at Johns Hopkins Hospital, who back in 1979 shut down the Johns Hopkins sex reassignment clinic, in a dozen states he could lose his medical license for practicing medicine with a minor according to how he believes medicine ought to be practiced. In 12 states, a physician could lose his or her medical license if they try to help a child feel comfortable in his or her own body. The government calls that conversion therapy because you are trying to convert the child's true gender identity into something that it's not. So if you try to help the boy feel comfortable being a boy, that's conversion therapy and you can lose your medical license. By contrast, in all 50 states, if you prescribe that boy puberty blocking drugs and then prescribe that boy estrogen, that's entirely acceptable. And it might one day be mandated. In the very last months of the previous presidential administration, the Department of Health and Human Services issued a new rule under Obamacare that said every health care plan that covered testosterone therapy for men with low testosterone also had to cover testosterone therapy for women who identify as men. That every health care plan that covered hysterectomies and mastectomies in the case of cancer also had to cover hysterectomies and mastectomies in the case of sex reassignment. It was an order of Catholic nuns that sued the federal government and on New Year's Eve, just hours before that new regulation was to go into effect, a judge ruled in their favor, placing a 50 state injunction on the enforcement of that rule. And then three weeks later, there was a change in presidential administration and then a new Department of Health and Human Services has agreed with that judge and has subsequently moved to formally remove that regulation. My former boss at the Heritage Foundation is now the director of civil rights at the Department of Health and Human Services. But as soon as there is a different, as soon as there is a different administration in DC that is hostile to people like me, we can expect to see this regulation come back. And this will be a crisis for Catholic physicians, pediatricians, endocrinologists, surgeons, psychiatrists, psychologists for Catholic hospitals, for Catholic healthcare. It would be as if the government was saying that Catholic physicians had to perform abortions. Catholic hospitals had to offer abortions. Businesses, hobby lobby, had to pay for abortions. We would see all of those same struggles come back but with respect to sex reassignment procedures. For the physicians, for the hospitals, for the healthcare plans, this unfortunately it'll be back either in a year and a half or in five and a half years or whenever that transition takes place. I don't think we can avoid this. And so we have to prepare for it. I want to skip a slide and go to this one and just let you know what the bottom line is for schools. The school environment must be set up so that transgender girls are treated like all other girls and transgender boys like all other boys. Remember what a transgender girl is. It's a boy who identifies as a girl. And the bottom line here is that that student, the boy who identifies as a girl, needs to be treated like all other girls. This is in the official handbook that was produced by the ACLU, the Human Rights Campaign, Gender Spectrum, the National Center for Lesbian Rights, and the National Education Association. So the largest teachers union in the nation partnered with a left-wing law firm and three LGBT activist groups to produce a handbook on how schools should allow students to transition. And then the most shocking part to me as a new dad, privacy and confidentiality are critically important for transgender students who do not have supportive families. In those situations, even inadvertent disclosures could put the student in a dangerous situation at home. So it's important to have a plan in place to avoid any mistakes or slip-ups. What this quote is getting at, and then the handbook has an entire worksheet, is how principals can create a school environment where a student can transition without the parents knowing about it. That's the plan in place. And it includes advice on how you could have a separate wardrobe waiting for a student in the nurse's office so the student could go to school, dress as a boy, go to the nurse's office, change clothes, go throughout the day, dress as a girl, being referred to by a girl's name, a girl's pronoun, etc., etc., without you ever knowing. Because the privacy and confidentiality of the student trumps the parental authority. Okay, so that's the depressing part of the talk. Let me now turn to some of the evaluation, which might also be depressing to be quite honest. All right, so I want to go through this in three steps. First some of the philosophy, then some of the science, and then finally some of the medicine. So it's largely going to track the opening part. And the first thing to say is that the transgender worldview, it combines a new form of the ancient heresy of Gnosticism, in which the real self is something other than a material body, while simultaneously embracing materialism, in which only material bodies exist. And so there are all sorts of contradictions at the heart of this worldview. Here's one of them. On the one hand, they say the real me is something other than my body. But at the same time, they're largely almost entirely materialists, in which nothing but material bodies exist. Both of those things can't be true at the same time in the same place. It violates the principle of non-contradiction. But they don't matter, they don't seem to care if it contradicts. They'll advance whichever argument is most appealing at the time. It actually relies, so another contradiction, it relies here on rigid sex stereotypes, where gender identity is defined as boys play with trucks and girls play with dolls. Boys like the color blue, girls like the color pink. So it relies on rigid sex stereotypes. Yet it also insists that gender is purely a social construct. And so that there are no meaningful differences between men and women, and yet gender identity is real and meaningful. You can't believe both of those things at the same time. So let me ask you a couple of questions. If gender is a social construct, how could your gender identity be innate and immutable and determined in the womb? Right, so how could your identity with respect to a social construct be determined while you were still a fetus? If gender identity is ever, if gender is a social construct which is ever changing because society is constantly restructuring and constructing it, how could your identity with respect to gender be biologically determined so that you could be quote trapped in the wrong body? But what does it even mean to talk about gender in this way that's disconnected from the body? What does gender feel like? When they say that your gender identity is your internal sense of gender, what does your internal sense of gender feel like? What does it feel like to feel like a woman? Do all of the women in this gymnasium feel the same way? Have you talked to each other to see if you're having the same feelings? Is that what makes you women? Right, is it some internal feeling of womanhood that you all share and that's what makes you all members of the class woman? How would I know if I was feeling like a woman? Right, so they're both ontological metaphysical questions of what is gender identity, what is it to feel like a woman? And then there are epistemological questions, knowledge questions of how would I know if I was feeling like a woman? It assumes that there's this thing out there that I could be experiencing that I would have knowledge that I'm feeling the way that my wife is feeling and that my wife is feeling the way that all other women are feeling and that's what makes her a woman. This is why so many feminists get upset at transgender activists because they say, look, you're just perpetuating stereotypes. What does it like to feel like a woman when Bruce Jenner became Caitlyn Jenner and posed for that cover picture? It was like red lipstick, high heels and cleavage, all of the stereotypes about what it is to be a real woman that feminists had been fighting for 30 years and that's why you see these interesting disagreements between radical feminists and transgender activists. But here's another question. Why should feeling like a woman, whatever that means, make someone a woman? Our feelings don't determine reality on anything else. Just because you feel like you're old doesn't make you old, just because you feel like you're young doesn't make you young. No one went along with Rachel Dolezal, the white woman who felt like she was black who was running the local NAACP chapter. Do you remember this from a few years ago? So no one said, oh, she's transracial. That wasn't, so why say that a man who feels like a woman, whatever that even means apart from stereotypes, why say that means that person is a woman? The last thing I'll say here is that gender identity to a certain extent can sound a lot like religious identity. And by that I mean identities that are determined by beliefs. But just like religious identity our beliefs don't determine the truth, right? So a Christian is someone who believes that Jesus is the Christ. A Muslim is someone who believes that Muhammad is the prophet. Now here's the reality. Jesus either is or is not the Christ regardless of what any of us believe. And the entire point of the religious life is to conform our beliefs to reality, to conform our beliefs about God to the reality about God, and then to conform our actions in accordance with the truth about God, about nature, about reality, about our own reality. And so the same thing is true about gender. Someone either is or is not a man regardless of what anyone believes, including that individual him or herself. I either am or am not a man regardless of what any of you believe, regardless of what I believe. And so the task of formation is to try to align my beliefs and my actions in accordance with the truth, in accordance with the truth about God and in accordance with the truth about me. And this is what trained professionals, whether it's spiritual realities, spiritual professionals, priests or medical professionals. This is what their professions are all about, helping people live in contact with reality. And so why should it be any different with gender identity? Okay, so that's some of the philosophy. Let me now turn to some of the science. The first thing to say here is that precisely because sex isn't assigned at birth, it can't be reassigned later in life. Our sex is determined at conception by the chromosomes that we inherit from our mother and our father, from that sperm and that egg that fused to create that one cell zygote. At that very moment, we are determined to be either a man or a woman. In utero, that unborn baby starts developing to have different chromosomal compositions, xx or xy, which leads to the development of certain internal organs which produce certain hormones that then lead to the development of certain external genitalia. All of this takes place before week 20, so that when you go for your 20-week ultrasound, the ultrasound technician can tell you if you're having a boy or a girl. This isn't sex assigned at ultrasound. The ultrasound technician isn't assigning a sex to your child. The ultrasound technician is doing what all of us do. He or she is recognizing a reality. So when I look out in this auditorium, I can recognize realities of men and women. When you greet each other, you can recognize realities. When that ultrasound technician who is trained to read that blurry black and white screen, he or she can tell if you're having a boy or a girl, a male or a female child. And none of that can be reassigned later in life. You can't go back and change the DNA composition of every cell in the body. You can't go back and rearrange how the body has developed to produce certain hormones, to produce certain internal reproductive organs, certain external genitalia. All you can do is masculinize or feminize bodies. What you can do is remove certain body parts and then use plastic surgery to create appendages that resemble the opposite sex. But that doesn't actually reassign the sex of the individual. So Dr. Larry Mayor at Arizona State and Johns Hopkins, scientifically speaking, transgender men are not biological men and transgender women are not biological women. The claims to the contrary are not supported by a scintilla of scientific evidence. And then my co-author, Robbie George, changing sexes is a metaphysical impossibility because it's a biological impossibility. Okay, so now turning to the medicine. Sadly, just as sex reassignment is physically impossible, it also proves not to be the best idea from a psychological and a social perspective. What the best studies show is that even when the transition goes well as a cosmetic matter and even in communities that are very trans-friendly, individuals who have transitioned still face a host of elevated risks for outcomes. In terms of depression, in terms of substance abuse, in terms of anxiety, in terms of alcoholism, in terms of suicide ideation, in terms of suicide attempts, and deaths by suicide. It doesn't adequately address the underlying problem. What Dr. McHugh has said is that you're using a surgical technique, a bodily technique to solve what isn't a bodily problem. And surgery doesn't address the underlying psychosocial struggles. So Dr. McHugh wrote shortly after Bruce Jenner had his 2020 interview, transgender men do not become women nor do transgender women become men. All become feminized men or masculinized women, counterfeits, and impersonators of the sex with which they identify. In that lies their problematic future. When the tumult in shouting dies, it proves not easy nor wise to live in a counterfeit sexual garb. The most thorough follow-up of sex reassigned people extending over 30 years and conducted in Sweden where the culture is strongly supportive of the transgender documents their lifelong mental unrest. 10 to 15 years after surgical reassignment, the suicide rate of those who undergone reassignment surgery rose to 20 times that of comparable peers. This was the knowledge that Dr. McHugh had back in the 70s when he shut down the Hopkins sex reassignment clinic. Hopkins reopened that clinic two and a half years ago. Not in light of new evidence, human nature hasn't changed in the past 40 years, but largely because of ideology and because of pressure from activist groups. Dr. McHugh is now in his 80s, he still sees patients one day a week there, but he's no longer the psychiatrist in chief and he's no longer the chair of the psychiatry department. And so as new people have assumed leadership roles, they reopened the clinic. And let me point out one thing here where Dr. McHugh says it proves not easy nor wise to live in counterfeit sexual garb. He says that, you know, in that lies their problematic future. What he's getting at is there's an underlying problem that leads someone to feel distress at their own body. And then that problem doesn't go away when you now try to live as if the opposite sex. That problem persists and there are now new problems that are created. It's not easy nor wise to try to live as if the opposite sex. And what the best research shows is that first patients are happy about it, right? Their desires are fulfilled. They've been longing to be the opposite sex for a while. They have the hormonal transition, they have the surgical transition and they're like, fine, like it to be my real self. And then over time, they realize all of those same struggles persist. That's why as Dr. McHugh points out here, it's 10 to 15 years after the surgery. You see the spike in death by suicide. Let me read you a couple other quotes to reinforce the same perspective. So in 2004, the Guardian newspaper in the United Kingdom, they asked Birmingham University to do a study of 100 post-op studies. This is the Guardian reporting on its own commission study. Guardian Weekend asked Birmingham University's aggressive research intelligent facility, ARIF, to assess the findings of more than 100 follow-up studies of post-op transsexuals. ARIF, which conducts reviews of health care treatments for the NHS, concludes that none of these studies provides conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, which skewed results in favor of physically changing sex. There was no evaluation of whether other treatments such as long-term counseling might help or whether their gender confusion might lessen over time. So 15 years ago, there was no conclusive evidence that this was beneficial. Many of the studies were poorly designed. And lo and behold, all of those poorly designed studies were skewing the results in one direction in favor of changing sex because the people conducting the research had a vested interest in what the outcome of the research was going to be. So five years ago, a Hayes incorporation, this is a consulting firm that hospitals and health insurance plans use to figure out what medical treatments are safe to be offering to the general public, they did a literature review just five years ago. Statistically significant improvements have not been consistently demonstrated by multiple studies for most outcomes. Evidence regarding quality of life and function in male to female adults was very sparse. Evidence for less comprehensive measures of well-being was directly applicable to gender dysphoria patients, but was sparse and or conflicting. The study designs do not permit conclusion of causality and studies generally had weaknesses associated with study execution. There were potentially long-term safety risks, but none have been proven or conclusively ruled out. So what Hayes was saying five years ago, this is a giant experiment, right? The research shows that nothing has been conclusively proven or ruled out. We don't have statistically significant improvements being demonstrated by multiple studies. What we are doing is experimenting on a patient population. So if you don't believe Dr. McHugh, if you don't believe Birmingham University or the Guardian newspaper, if you don't believe the Hayes incorporated, would you believe the Obama administration? And in this case you should because three years ago, the Obama Center for Medicare and Medicaid Services issued a report and this is what they wrote. Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria. There were conflicting, inconsistent study results. Of the best design studies, some reported benefits while others reported harm. The quality and strength was low due to the mostly observational study design, with no comparison groups, potential confounding of causality and small sample sizes. Many studies that reported positive outcomes were exploratory studies with no confirmatory follow-up. So what they were saying just three years ago was that it's a giant experiment. Some report benefits, some report harms, and the ones that are reporting benefits are frequently the ones that don't actually have controls or follow-ups. So this was their proposed decision memo which came out in June of 2016. Two months later in August they issued their final memo and you can see here they just repeat all of the study design problems. So when you hear the media say there's a consensus of all the studies, just three years ago the Obama administration was willing to point out all of the problems in the research design. No comparison groups, subjective endpoints, potential confounding of causality, small sample sizes, lack of validated assessment tools, and considerable loss to follow-up. And unfortunately that's a euphemism for some patients for suicide. The reason they have been lost to follow-up with is that they are no longer with us. I want to read one more line here from that Obama study starting halfway through the quote, after careful assessment we identified six studies that could provide useful information. Of these the four best design and conducted studies that assessed quality of life before and after surgery using validated psychometric studies did not demonstrate clinically significant changes or differences in psychometric test results after GRS gender reassignment surgery. Let me translate that into English. Out of all of those studies out there the media talks about we could identify six that were actually useful and of these the four best studies show that after sex reassignment surgery there's no clinically significant change in the psychometric test results. So let's say you go to a doctor's office because you're struggling with body self-alienation, you're struggling with discomfort in your own flesh, you're struggling with depression, with suicide ideation, with drug abuse, alcohol abuse, no clinically significant change after the surgery because the surgery wasn't addressing the underlying problems. And this is what the prior administration was willing to admit just three years ago and then they point to that same study in Sweden that Dr. McHugh points to. So starting with the second sentence the mortality was primarily due to completed suicides, 19.1 fold greater than in control suites. In the next sentence we note mortality from this patient population did not become apparent until after 10 years. So when you see the news reports that say how happy Caitlyn Jenner is or when you see the news reports saying there's a new study that shows a year after transition the patients are really happy, that's not looking longitudinally. It's not doing a long-term follow-up of what happens five, 10, 15 years later. When I've spoken to Dr. McHugh about this he thinks that 10, 15 years from now we're going to see a lot of 20 and 30-somethings who are going to be deeply regretting the transitions that were conducted on their bodies when they were children. Children currently transitioning 15, 20 years from now McHugh thinks we're going to see a large increase in the number of people de-transitioning. So let me say a few words about children and then I'm going to wrap this up. First, that four-part standard of care is entirely experimental. There's not a single study on the long-term outcomes of permanently blocking puberty in a child. We have no idea what it does to a child psychologically or physically to not go through their body's puberty because it's never been done before to a human being. It's entirely experimental. There's not a single long-term study on it. Second, parents are being told by clinicians that it's fully reversible. The idea here is that well if we take the child off the puberty blocking drug normal puberty will just recommence. One, they don't know if that's true or not. And then two, it's or norwellian abuse of language to say that going through puberty at age 18 is reversing eight years of blocking puberty. Everything in the developmental biology is sequenced. And so to go through a developmental stage eight years later isn't reversing eight years of blocking it. And so we also have no idea what it means to go through puberty at the end of your teen years. What this means for your height, your weight, your bone density, your bone length, your musculature. It's not just the sexual aspects of our bodies that develop during puberty. Every aspect of our body matures and develops during puberty. And so parents are being told that this is fully reversible, it's safe, and they have no idea. It's entirely experimental. And then the last thing I'll mention is that it may very well be self-fulfilling. Many of the doctors I've spoken with, the doctors who spoke here on campus back in April, they point out that the clinic in Sweden that conducted this technique 100% of the children who went on puberty blocking drugs then went on to cross-sex hormones. 100% of them persisted in their transgender identity. Whereas normally somewhere between 80 and 95% of children will naturally grow out of a gender conflicted stage. That statistic comes from the DSM-5. So the handbook of the APA for mental health issues shows that 80 to 95% of children with a gender identity conflict will naturally reconcile their identity with their body if development isn't interfered with. But the children who were placed on puberty blocking drugs, 100% of them in the study that was performed at the first clinic to do this persisted. So some physicians fear that what we're doing is we're actually locking in the gender dysphoria. That if you take a young child and tell the child you're actually a girl trapped in a boy's body and then you block puberty, you may actually be reinforcing that false identity. And it may very well be that going through puberty, let's say you're a boy who's uncomfortable being a boy, going through puberty, getting that rush of testosterone, hitting your growth spurt, having your voice deep in, developing in your musculature, those may very well be the developmental pathways that help you reconcile your identity with your body. You'll feel comfortable being a man precisely as you go through puberty and develop into a man. And so some physicians fear that the puberty blocking procedure is actually blocking off nature's pathway for helping people feel comfortable in their own body. So it's a self-fulfilling protocol. What's the alternative? Dr. McHugh draws an analogy to anorexia. And he says that if you had an anorexic high school student, no physician would prescribe liposuction because the problem is not with that high school student's body. If you had an anorexic high school student, you would try to figure out what's the underlying cause. And no two cases of anorexia are the same. Sometimes it's a body image struggle. The student has a faulty image of herself. Normally this occurs with high school women, more so than men, but it can happen to both boys or girls. But sometimes it's a body image problem. Sometimes it's an eating disorder where it's primarily focused at control with respect to food. Sometimes the eating disorder and the body image problem overlap. Sometimes they have separate causes. What the therapist would do is try to figure out in this particular case, why does this particular patient have this struggle? And then how can I prescribe a therapy that would respond to that underlying cause? Not trying to transform a body into conformity with misguided thoughts and feelings, but trying to realign the thoughts and the feelings with reality. McHugh says that's the same thing you should be doing for children with gender dysphoria. Figure out what the underlying cause is, and then try to address your intervention not at their body, but at either their social environment or at their own self-understanding. Let me give you two examples. Both of them come from a Canadian clinic. In one case, there's a young boy identifying as a girl. The mom takes him to see a therapist. And during talk therapy, the therapist just says, you know, what is it about being a boy that makes you uncomfortable? What is it about being a girl that you find attractive, that you find a solution to your struggles? The boy revealed that he was being bullied. The other boys in school were picking on him. They were calling him a wuss, a sissy, a mama's boy. And the way that he was coping with this bullying was by identifying as a girl. All of his closest friends were girls. And so he had convinced himself, I must be a girl trapped in a boy's body. I must be one of those people that I learned about with the gender unicorn. That explains why I don't fit in with the boys. I do fit in with the girls. So the therapist said three things. First, get your son out of this environment. This is an environment of toxic masculinity, if you want to use that phrase, get him out of there. The bullying is the underlying cause. Second, keep bringing him back to see me week after week so we can talk about what it is to be a real boy, a real man, what masculinity is really about. Contrary to Dr. Scott Liebowitz, your son is not cognitively capable enough to know what it means to be a boy or a girl. All he has is his limited human experience, very limited experience as a child, and then stereotypes. He knows what the stereotypical notions of boyhood, of manliness are. We need to enlarge his self understanding. And then third, precisely because he's a child, it's not enough just to talk to him about this, we actually need him to experience that he's a real boy. The advice to the parents was find your son a new peer group, a new play group with boys just like him. Boys who are a little bit more sensitive, a little bit quieter, a little bit less rambunctious. So he could directly experience the reality that he's a real boy. And so six months later, this boy was readily identifying as a boy again. He was spared a lifetime of visits to an endocrinologist's office to get estrogen. And the other example I like to give, the therapy was not directed at the child, but at the mother. Again, it was a boy identifying as a girl during a therapy session when the physician asked why he wanted to be a girl. He said, mommy's like little girls more than they're like little boys. And so that set off a red flag. And so after that session, the therapist met with the mother and said, what's going on in your family that your son would say this? She revealed that she had been sexually victimized. She had been a victim of sexual abuse. And inadvertently, she had developed an aversion to men, including her own son. So she was more physically affectionate with her daughter than with her son. Her son was picking up on this subliminally. This wasn't like a conscious decision, but he was picking up on the fact mom's more affectionate with my sister if I were a girl, she would cuddle with me more. So the therapy wasn't directed at this child, it was directed at the mother. The mother got the healing she needed after her sexual assault. And then she was able to be affectionate again with her son. Her son was able to identify as a boy again, spared a lifetime of endocrinology visits to get estrogen. All right, let me close by reading you two quotes, just to let you know what the alternative looks like. I was put on hormones after three months of therapy at the age of 17. In fact, because I was only seeing a therapist once per month, it was after three or four visits that I was prescribed testosterone with no meaningful attempt made to process the issues that I brought up that led in part to my wish to transition. When I was transitioning, no one in the medical or psychological field ever tried to dissuade me to offer other options to do really anything to stop me besides telling me that I should wait until I was 18. I want to ask you how many other medical conditions are there where you can walk into the doctor's office, tell them you have a certain condition which has no objective test which can be caused by trauma or mental health issues or societal factors and receive life altering medications on your say so. And then the next quote, I wanted to make a video previously so that folks can see that I'm a real live person, but I didn't out of fear of showing my face. But I think it's important when we talk about these issues to really understand that women like us aren't just statistics, not just some dry data some gatekeeping doctor might throw at you, we're real people. This is a real outcome of transition. I'm a real live 22 year old woman with a scarred chest and a broken voice and five o'clock shadow because I couldn't face the idea of growing up to be a woman. That's my reality. So this comes from two different YouTube videos that Carrie made on transitioning. As you saw on that first quote at age 17, she started the transition process. She went on testosterone at age 18. She had the double mastectomy and then at age 22 she detransitioned. When she says that, you know, she has a scarred chest, that's from the mastectomy, a broken voice, the testosterone changing her vocal cords, five o'clock shadow, the testosterone changing her facial hair. That's her reality because she was given bad information for medical professionals. And so the challenge for us is what can we do to prevent this from being someone else's reality? Given our vocations, whether we're academics or just good neighbors, whether we're doctors, whether we're teachers, whether we're pastors, every one of us has a role to play in helping to better educate and equip people on the underlying truths. And then to walk with people who are struggling in this way. There are people today who don't feel comfortable in their own bodies. What can we do to help them feel comfortable to prevent this from being someone's reality? Thank you.