A Pediatrician’s Manifesto for the Modernization of Gender Medicine

Postmodern medicine may superficially resemble Modern medicine, yet it seeks to dismantle its underlying philosophy.

Image Credit: Modified from Nadzeya Haroshka

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Introduction

The ethical abuses and lack of respect for science that occur in contemporary gender clinics have long been a topic of intense discussion. In this essay, Dr. Li outlines eight ways where the practice of medicine in current American gender clinics is grossly abnormal. She then explains the behavior of practitioners in these clinics with Critical Social Justice doctrine, and makes her case that ideology and doctrine from Postmodernism influence and determine the behaviors of gender medicine practitioners.

Dr. Erica Li is a pediatrician in Washington State. She went to medical school at UC Davis and trained in general pediatrics in Los Angeles. She currently teaches medical students from three medical schools and interns from four residency programs. Certified in Pediatric Hospital Medicine by the American Board of Pediatrics, Dr. Li is a subspecialist who identifies as a generalist. She is passionate about helping trainees approach clinical problems by mapping out a chain of cause-and-effect, such that each node in the chain can be examined as a potential opportunity to interrupt pathology. 

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Stop Calling My Profession “Western” Medicine

“He got his pain meds and psych meds,” the nurse said. During a shift change at a children's hospital, the departing nurse provides a report to the incoming nurse about the patients under their care. “He is medically cleared,” the nurse continued, “The psych team is going to see him and determine if he needs to go to the inpatient psych unit for trying to kill himself. And…” the nurse paused. “I just gave him a tampon for … gosh it’s so weird to say that. She got her period today.” 

This is the paraphrase of a real conversation that I overheard. I am a pediatrician specializing in the care of hospitalized children. One of the most common reasons a trans-identifying teenage female becomes hospitalized is due to attempted suicide through medication overdose. My seven years of rigorous training in medical school and pediatric residency were steeped in the principles of Modern medicine. However, I’m increasingly confronted with the sense that my profession is drifting away from its modernity. I believe medicine is being “queered,” or Postmodernized. Let me clarify.

There exist diverse metanarratives about health and healing globally. The mainstream form of allopathic medicine, typically referred to as “Western Medicine,” presumably stands in contrast to “Eastern Medicine” or other alternatives. This categorization suggests parity between “Western” and “Eastern” or “alternative” medicine, implying all these different metanarratives are equally valid. However, I would contend it is more accurate to place medicine as practiced around the world into three categories: “Premodern,” “Modern,” and “Postmodern.” The distinction should be based on underlying philosophy rather than incidental geography or ethnicity.

Examples of Premodern medicine would encompass practices such as attributing illnesses to witchcraft, consuming tiger penises to increase virility, or cannibalizing albino people’s body parts to gain health and good fortune. These practices, rooted in superstition rather than empirical evidence, were once common worldwide, including in the Western world, and they still exist in various forms today. On the other hand, Modern medicine, typically practiced at your local hospital or clinic, is a product of the Enlightenment, prioritizing reason, science, and individual sovereignty. It transcends geographical boundaries and ethnic divides, benefiting humanity globally.

Postmodern medicine seems to have a particular foothold in the West, especially in the United States, where it has become institutionalized. It is relatively new but is embedded in multiple American medical societies and medical schools. While it leverages the same technologies as Modern medicine, thereby superficially resembling it, it fundamentally seeks to dismantle Modern medicine’s underlying philosophy. While Postmodern medicine is being propagated across American medical schools through Diversity, Equity, and Inclusion bureaucracies, nothing exemplifies Postmodernity more than the gender ideology that drives the American “gender-affirming” model of care.

I wish to strongly advocate for Modern medicine and urge readers to resist the ideological shift towards the Postmodernizing or “queering” of my profession. It is crucial to clarify that I am a steadfast supporter of LGBT civil rights, as I support civil rights for all Americans, and I strongly advocate for high-quality Modern medical care for sexual minorities. However, I reject the overmedicalization of children propagated by many gender activists. At its core, Postmodern medicine is as far removed from Modern medicine as witch-burning. It poses serious risks to patient welfare and should be vehemently resisted.

Queering the Norms of Modern Medicine

What does it mean to “queer” an academic field or a profession? It means to disrupt, deconstruct, criticize, and ultimately dismantle its norms. David Halperin, a renowned queer theorist, asserts “Queer is by definition whatever is at odds with the normal, the legitimate, the dominant. There is nothing in particular to which it necessarily refers. It is an identity without an essence.” Like young people with gender dysphoria, Modern medicine is grappling with its own identity and trying to maintain its Enlightenment essence. Transgender medicine, as currently practiced in the United States, has dismantled and corrupted many norms of Modern medicine.

Queering Medical Science

One fundamental norm of medicine is the standardization of treatment for common conditions, reliant on established guidelines. Quality care is contingent on consistent care. I have corresponded with people who were happy with the gender care they received, describing it as judicious and unhurried. But it is inadequate that only some patients receive good care. Adherence to guidelines helps reduce variance, fostering a consistent quality of care. These guidelines do not merely encompass empirical evidence but necessitate a systematic review of the scientific literature to evade confirmation bias. In other words, the authors of guidelines are not allowed to cherry-pick studies that merely confirm their preconceptions. Topic-specific practice guidelines are issued by major medical societies such as the American Academy of Pediatrics (AAP), which historically have provided valuable advice on conditions like bronchiolitis and urinary tract infections. Guidelines always grade the strength of the evidence, then make action-oriented recommendations. Every recommendation within these guidelines is meticulously evaluated, and all considerations and value judgements are explicitly stated.

Despite what mainstream media suggest, the AAP and other key American medical societies have not released practice guidelines on transgender care. In fact, the AAP leadership has refused to commission a systematic review on the topic, despite petitions from their own members to do so. At the 2022 national meeting in Chicago, the AAP leadership didn’t allow Resolution 27 to be put up for a vote by its own rank-and-file members. As a result, the AAP has no basis for creating practice guidelines. The AAP has instead issued “statements” on transgender care that parrot activist rhetoric, which are then propagated by organizations like GLAAD, asserting that “the science is settled.”

This is not normal.

A significant focus of Modern medicine lies in determining the cause of a patient's symptoms. When I teach medical students and interns, I almost always begin by asking, “What is a diagnosis?” I define a diagnosis as “an adequate explanation of the patient’s signs and symptoms.” Most of the time, this process requires obtaining multiple objective data through testing to confirm that a particular explanation is correct, and disconfirming test results are respected. I explain that there is often a chain of causality leading to the patient’s presentation, and our responsibility is to identify every causal node that we can intervene upon.

After thoroughly documenting the patient’s signs and symptoms, we then proceed to categorize the diagnosis. Is it mild, moderate, or severe? Chronic or acute? Type 1, 2, or 3? This nuanced classification helps tailor therapy and provides relevant information about prognosis. If the disease does not progress as anticipated, based on follow-up, it is incumbent upon us to reassess our initial diagnosis or classification. Perhaps we had the wrong explanation or overlooked a complication. In other words, reality keeps us accountable.

Strangely, when dealing with gender dysphoria, the pursuit of causality routinely appears to be overlooked, or is regarded as unimportant. Currently, there is no standard distinction between inherent gender identity disorder and secondary gender dysphoria. There is also no objective data obtainable through testing that can disconfirm the transgender diagnosis. Regardless of a teenager’s biological sex, history of family dysfunction or sexual trauma, age of onset of transgender identity, potential social contagion, or autism, the prescribed treatment remains the same—puberty blockers and cross-sex hormones.

When I attended the 2023 gender symposium co-sponsored by Seattle Children’s Hospital and Swedish, I listened to 7 hours of content dedicated to treatment options, with no time allocated for discussing diagnostic criteria, classifications, or confirmatory testing. In Postmodern medicine, doctors accept a child’s self-diagnosis that provides no insight into cause and prognosis and cannot be disconfirmed, and yet, they still somehow prescribe a high-risk treatment.

This is not normal.

Modern medicine goes to great lengths to discuss relative and absolute contraindications of all treatments. For instance, before prescribing estrogen in the form of birth control pills, doctors screen for risk factors like migraines, smoking, and clotting disorders. Those that screen positive may be offered alternative options for contraception. Even advocates for the medical transition of children should agree that it’s vital to screen out potential victims of Munchhausen’s by Proxy and patients with conversion disorder. Unfortunately, this is not always the case. Both Jamie Reed and clinicians at Tavistock have witnessed cases of Munchausen’s by Proxy, but the victims were still deemed eligible for transition. Ms. Reed also documented a case where a patient with conversion disorder, who identified as blind despite being able to see, was deemed appropriate for medical sex transition.

Not normal.

Lastly, Modern medicine differentiates between false positives and false negatives (Type I and Type II errors), considering false positives far more detrimental because they can lead to harmful interventions. In normal medicine, we consider certain mistakes “never events,” like amputating the wrong limb. Such an error is totally unacceptable, regardless of how infrequently it occurs. When such an event does occur, every step of the care delivery system is meticulously reviewed to ensure patient safety. This is not an infringement on the rights of amputees. We are not committing a “genocide” against disabled people. It’s simply a necessary precaution to ensure only the correct procedures are carried out on the right patients.

If we could definitively identify those who would undoubtedly benefit from medical transition and exclude those who wouldn’t, medical transition could be a reasonable course of action. However, considering the severe risks of treatment, even the existence of a single detransitioner should sound alarm bells about the current diagnostic criteria producing too many false positives. These false positives arise due to the artificially inflated prevalence through social contagion and the non-specific nature of the diagnostic criteria. We must reevaluate these criteria to eliminate false positives, even if it risks producing some false negatives. This is the essence of the “do no harm” principle. It’s a deontological imperative that applies to individuals, not groups. For treatments with high risks of morbidity, we must avoid treating a minority of false positives even if it means we treat fewer true positives.

Queering Medical Ethics

Modern pediatric care strongly emphasizes collaboration with parents and guardians. Like any pediatrician, I sometimes encounter disagreements with the parents of my patients. When working with teenagers, we strive to maintain family cohesion, even if the parents don’t seem so reasonable to us. It is unthinkable to deliberately drive a wedge between a teenage patient and her parents, let alone emotionally blackmail parents with statements like “would you prefer a living son or a dead daughter?” It is unthinkable to pit a divorced mother and father against each other, using the parent more willing to transition their child as leverage against the hesitant one. It is unthinkable for pediatric doctors to treat parents who don’t consent to puberty blockers “as if the parents were abusive, uneducated, and willing to harm their own children.”

Not normal.

Modern medicine involves conducting soul-searching, self-flagellating morbidity and mortality conferences (M&Ms) whenever a case turns out poorly. Patient abandonment is strongly condemned. When young adult patients, such as Chloe Cole, detransition and face severe complications from double mastectomy and cross-sex hormones, any responsible doctor would apologize sincerely and take accountability. “You are still my patient,” they would reassure. This would typically be followed by a conference aimed at refining their practice.

Instead, when a tragic outcome such as Cole’s occurs, Postmodern medicine plays games with words. During the 2023 gender symposium co-sponsored by Seattle Children’s Hospital and Swedish, I was informed that I must not use the word “detransitioner” because it is “harmful to the community.” Instead, I was instructed to say “people who changed their gender goals.” Postmodern medicine is oddly comfortable abandoning detransitioners like Cole. “My surgeon doesn’t know what to do with me,” she confessed during an interview with Jordan Peterson. As Hannah Barnes revealed in her book Time to Think, gender clinics frequently lose track of detransitioners, leaving their numbers largely unknown.

You know what I’m going to say.

Modern medicine, in contrast, is averse to giving patients false hope. I have managed many pediatric patients with grave prognoses, both in the ICU and on the cancer ward. The conversations surrounding poor outcome and death are gut-wrenching, but it is our duty to tell families the truth. I can't recall a situation where it seemed fitting to use an image of a rainbow-colored unicorn while having such grave conversations. Queer Medicine uses such images to proselytize to “educate” children dealing with family dysfunction, autism, sexual trauma, and complex psychiatric comorbidities that manifest as severe body dysmorphia. These cases are complex and challenging, and promising that everything will improve once their body aligns with their “gender identity” is reprehensible.

Finally, there’s the issue of children's ability to provide informed consent, a topic that has been widely discussed. During my training and practice, I have encountered dozens of pediatric patients with cancer. For them, chemotherapy can truly be life-saving. However, even in these cases, we don’t deem the children capable of providing their own consent for chemotherapy. We don’t place the burden of evaluating uncertainty and risks on children; only adults are given the responsibility of handling such outcomes.

Modern medicine has evolved norms for valid reasons. While there have been horrors enacted in the name of Modern medicine, norms serve as vital self-corrective mechanisms. They provide checks and balances, ensuring that our attempts to improve health and lives don’t become catastrophes rooted in utopian visions. The encroachment of Postmodern ideologies into Modern medicine risks eroding these norms. It advances its objectives by intimidating physicians who would voice dissent, while using deceptive language to mislead the public. It will not stop unless we stop it. To stop it, we must understand why these abuses occur, and how such a harmful ideology infiltrated our medical institutions. 

Ideology and Behavior: Why the Abuses Occur

Ideas have consequences. All the abuses above can be explained by attending to the doctrines within Postmodern Critical Social Justice ideology.

Science Must Fall

Postmodernism posits a moral universe where both science and objective reality must ultimately crumble. Bret Weinstein attests that during the Evergreen State College meltdown of 2017, a black female student was accosted by radical leftist students and prevented from going to her lab.  This kind of activist behavior and the blatant attempt to dismantle science in gender clinics come from the same Postmodern doctrine.

Defining Postmodernism is challenging, yet some key principles it encompasses are “skepticism about objective reality, the perception of language as the constructor of knowledge, the ‘making’ of the individual, and the role played by power in all of these.” The Encyclopedia Britannica broadens this definition by adding “a general suspicion of reason” in its definition. According to James Lindsay and Helen Pluckrose, under Postmodernism, “the scientific method… is not seen as a better way of producing and legitimizing knowledge than any other, but as one cultural approach among many, as corrupted by biased reasoning as any others.” Science, a product of Western thought, is viewed as an oppressive structure that upholds and disseminates White Supremacy, and its domination over “other ways of knowing” is therefore deemed illegitimate. 

The Absence of Individual Harm

The Postmodern perspective on ethics sheds light on the behavior of some American gender medicine practitioners. As staunch advocates for cultural constructionism and cultural relativism, Postmodernists express profound skepticism towards the existence of universal ethical standards. They have also declared that the idea of the sovereign individual is a construct of oppressive Western culture. Robin DiAngelo, author of White Fragility, and her co-author Ozlem Sensoy argue that “The ideal of individual autonomy that underlies liberal humanism (the idea that people are free to make independent rational decisions that determine their own fate) was viewed as a mechanism for keeping the marginalized in their place by obscuring larger structural systems of inequality.”

With the concept of the universal and individual out of the way, Modern medicine’s concerns about morbidity, mortality, providing false hope, and patient abandonment vanish. What becomes paramount is the trajectory of Trans People as a class, a group, and a concept. Will this group gain power? Under Gender Ideology there is no such thing as individual dignity and therefore there is no harm that can be done to individuals. There is only collective Social Justice. 

In Postmodernism, language wields immense power. This is evident in gender clinics where clinicians are instructed to replace the term “detransitioner” with “people who changed their gender goals.” The existence of detransitioners represents medical malpractice catastrophes, but in a Postmodern world, language constructs reality itself. By manipulating language, such as avoiding the use of the word “detransitioner” and claiming its use harms “the community,” a Postmodern practitioner conveniently sidesteps acknowledging individual harm, placing blame instead on the child seeking medical transition and the consenting parent(s).

Endlessly Analyzing Power Dynamics

Postmodernists obsessively scrutinize power dynamics, assigning privilege to groups they perceive as powerful. This privilege is viewed as sinful, and belonging to an oppressed class is seen as virtuous. Consequently, Trans People, seen as more oppressed, are endowed with moral and epistemic authority. Their oppressed group status equips them with unique, unassailable knowledge, which cannot be derived from any objective method or falsified by reality. Critical Social Justice literature is littered with autoethnographies (i.e. subjective opinions derived from the author’s personal experience) that claim to represent legitimate knowledge about society. In contrast, in Modern medicine, even “my clinical experience” does not override evidence from systematic reviews of the scientific literature. The prioritizing of subjectivity over objectivity is why many American gender clinics lack tests or objective diagnostic criteria to confirm or disprove the diagnosis of gender dysphoria. In this setting, the patient’s knowledge, derived from her internal feelings, is absolute and infallible.

Blurring of Boundaries

Postmodernism is allergic to categorization. The blurring of boundaries is one of its key themes. It detests all hierarchies and priorities. Consequently, practitioners behave as though there is no meaningful distinction between trans identities that began in toddlerhood or adolescence, those resulting from social contagion or autism, or between real and factitious cases. More radically, they believe there is no boundary between biological males and females at all—they consider biological sex a social construct, just like “gender.” Judith Butler writes: “If the immutable character of sex is contested, perhaps this construct called ‘sex’ is as culturally constructed as gender; indeed, perhaps it was always already gender, with the consequence that the distinction between sex and gender turns out to be no distinction at all.”

Currently, Queer theorists are working on dismantling the cis-trans binary. Perhaps, a radically Queer idea is that there is no difference between helping or harming patients at all. 

Children Can Consent

Queer Theory’s main target—cisheteronormativity—is the predominant mode through which humans reproduce and establish families. Natal families are therefore seen as a source of oppression and the idea of nuclear family must be deconstructed. In a remarkable academic paper published in the journal Curriculum Inquiry about Drag Queen Story Hour, Queer Theorists Harper Keenan and Lil Miss Hot Mess remark: “It may be that DQSH is “family friendly,” in the sense that it is accessible and inviting to families with children, but it is less a sanitizing force than it is a preparatory introduction to alternate modes of kinship” (Italics mine).

Mainstream pediatric medicine typically regards the intentional fracturing of families as taboo. However, whistleblower Jamie Reed’s assertions that some gender clinics systematically undermine the role of natal parents align with Queer Theory’s aspiration to create alternative familial structures and parental figures.

Queer Theory also promotes the notion of children guiding their parents and surrounding adults. This is consistent with what Lindsay and Pluckrose call “the postmodern political principle,” which they describe as “a belief that society is formed of systems of power and hierarchies, which decide what can be known and how.” Such systems of power and hierarchies are perceived as arbitrary and illegitimate. Under the current system, children generally possess less power than adults and are positioned lower on the social hierarchy. American Psychiatrist Chester Pierce, known for inventing the concept of “microaggressions,” theorizes this to be a manifestation of “childism,” a discriminatory practice akin to racism but directed against children by adults. For true Social Justice to occur, the hierarchical relationships between adults and children must be redefined or inverted. The Postmodern medical practitioner, according to this perspective, has a moral obligation to facilitate this process by elevating children’s ability to consent to medical procedures and eliminating parental objection.

Conclusion

I have outlined the abuses occurring in some American gender clinics that defy basic principles and norms of Modern medical science and ethics. I have also briefly explained the Postmodern theoretical framework which fuels these abuses. Today’s physicians must contend with Postmodern Queer Theory as a supremacist ideology that manipulates people’s inherent inclination towards compassion. It has gained a definitive parasitic foothold in our medical institutions. Unlike Modern medicine, Postmodern medicine lacks both a self-correcting mechanism and a limiting principle.

It is crucial that we do not permit this predatory ideology to undermine Modern medicine’s integrity and the public’s trust in it. While Postmodern medicine may superficially resemble its Modern counterpart due to access to contemporary technology, it stands in fundamental opposition to it.

If you are a physician, you must speak up, educate those around you, and dedicate yourself to serving our patients and preserving the norms of our profession.

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