Paul R. McHugh

"I think the issue of sex-change for males is no longer one in which much can be said for the other side. But I have learned from the experience that the toughest challenge is trying to gain agreement to seek empirical evidence for opinions about sex and sexual behavior, even when the opinions seem on their face unreasonable. One might expect that those who claim that sexual identity has no biological or physical basis would bring forth more evidence to persuade others. But as I’ve learned, there is a deep prejudice in favor of the idea that nature is totally malleable. Without any fixed position on what is given in human nature, any manipulation of it can be defended as legitimate. A practice that appears to give people what they want—and what some of them are prepared to clamor for—turns out to be difficult to combat with ordinary professional experience and wisdom."

"Psychiatrists and other mental health professionals should employ modes of assessment that encourage the pursuit of truth. They must view this pursuit as central to their commitment to responsibility and remain skeptical of cultural idioms that come and go, such as the adolescent’s plaintive cry in transgender cases: “I am a boy trapped in a girl’s body!” This cry is never a factual report about the reality of her or his sex, but usually a cry for help, seizing upon a newly coined “idiom of distress”: “I’m so fearful and unsure of myself and my future, I must, as others claim, be living in the wrong body, trapped in the wrong sex.” Psychiatrists help not by “affirming” the bizarre conclusion but by seeking and treating the source of the generating fears."

"This intensely felt sense of being transgendered constitutes a disorder of ‘assumption’—the notion that a person’s maleness or femaleness is determined by feelings or behavior rather than by anatomy."