Don’t Know

Don’t Know


Leonard Zwelling

Frank Bruni’s column in The New York Times on April 11 discusses the issue of the new laws being initiated all over the country in mostly Republican state legislatures to outlaw trans-females participating in women’s sports and forcing transgender people to use the bathroom consistent with their sex at birth. More importantly, these state legislatures are outlawing the use of puberty-delaying medical treatments for transgender teenagers. What these puberty blockers do is allow young people confused as to their actual gender preference to delay the onset of secondary sexual characteristics until they have had the time to sort out this difficult decision with their parents and their physicians. Such therapy was lobbied for by the parents of these young people and by their physicians.

I’m lucky. I have always found it easy to determine my gender, sex, and preferred sexuality. Good for me. It’s not so easy for everyone and they didn’t teach me about this in medical school, although I bet they would now. I have had to learn, often slowly, often abruptly, that the scope of gender preference is wide and diverse and so is the preference for sexual partners. These are not matters for politicians to litigate. These are personal matters and when they occur in those under 18, they are family matters that well-meaning and tested parents need to make with the active assent of their kids and the help of their caregivers.

I understand the clinical presentation of breast cancer and the manifestations of sickle cell disease and congestive heart failure. The pathophysiology of these conditions was drummed into my head for years in medical school, residency and fellowship.

By contrast, the spectrum of human sexuality was not discussed in medical school in the 1970’s. The HIV crisis elevated this discussion to great clinical significance. Despite these many years of homosexuality being an important issue for all humans to understand, its origins at the level of the genome and the brain are still topics for study. Why is someone attracted to someone of the same sex? No one knows. When I asked a lesbian this question while sewing up her leg in an ER after a lover’s quarrel she only said that she knew she was attracted to women about the same time in her life when I knew I was. It was a good answer, but not etiologically or intellectually satisfying.

Then, I became an employee of Legacy Community Health, a federally-qualified health clinic meeting the needs of people of all sexual and gender proclivities. I learned about transgender individuals and the challenges that they face. I did not understand why transgender people are transgender. I just came to accept that fact. I still don’t know, but am comfortable with my don’t know.

People come in all different types. People’s sexual orientation, gender identity, and partner preference belong to the individuals. Being a teenager is confusing enough. When one’s gender is among the big questions in a young life, being able to put off final and irrevocable decisions might be a really good idea. No, it is a good idea and state legislatures have no role in those types of decisions.

For my Republican friends, this war on gay and transgender people is owned by legislatures uniquely of the GOP variety. They are using these complex issues to further split the country over the issue of putative morality, when these are really issues of biology—biology that is not completely understood.

If you want to know why I so often criticize the Republican brand, you need go no farther than these issues plus Matt Gaetz. The Democrats have their own issues. They see the solution to every problem as a new government program. That’s not good either.

Somewhere, there has to be a middle ground where Americans can meet and make good laws that make good sense. Spending money we don’t have is a bad idea. So is interfering with decisions that ought to be between individuals, parents and doctors. Not state legislatures.

Republicans, this is bad policy. Stop it! We simply don’t know enough to make good policy about gender issues. Politicians need to stay out.

Leave a Comment

Your email address will not be published. Required fields are marked *