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Anorexia and Transgenderism: 2 different problems, 2 different solutions.

Updated: Mar 1, 2022

Anorexia is a horrible illness. I have dealt with several anorexia patients over the years. Anorexia nervosa is the full name, but it is usually shortened to just anorexia. About 10% of the cases occur in men, but I have only seen it in females. Successful treatment requires a team approach, generally including a psychiatrist and internist, and sometimes hospitalization.

The advanced cases look horrible, emaciated and near death. After you get them undressed for an exam, you begin to see the full extent of the problem. They are literally skin and bones. They look like the pictures we have all seen of concentration camp survivors, like the Jews that were rescued from the death camps. But they all insist when they look in the mirror that they appear fine. They have this pervasive fear of gaining weight, and just can’t force themselves to eat.

Their appearance is so repugnant, so startling, so upsetting it is hard to continue the exam. Most of them are hard to get into treatment, because they think they are doing great, as their family and co-workers watch them shrink away. Ultimately the condition is often fatal, (death rate about 20% if untreated) as people my age found out when Karen Carpenter, a musician, died of anorexia in 1983. Her death introduced the public to anorexia.

Anorexia is a very difficult mental illness to treat. Many approaches have been tried with varying degrees of success. One thing that we never do is agree with the patient that their weight is OK, even though some therapists have theorized that initially agreeing with the patient might help create the necessary ‘rapport’, to be able to ultimately help them. “Meet the patient where they are” is how they describe it.

But experience has shown that approach does not work and we must never agree with the patient's delusional thinking. We certainly care about these people, and are sympathetic, and want to help them, but our help must be reality based:

  • they are not fat,

  • they aren’t on the verge of becoming fat,

  • they aren’t eating enough and

  • they must eat more or they will die.

Are we obligated to intervene with anorexia? Yes, anorexia is the most deadly mental illness known, fatal to 1 out of 5 without treatment. Breast cancer has a better survival rate than anorexia! Whether you are the parent, spouse, sibling or friend, you must do what you can to get them into treatment.

Rachel Levine, the first openly transgender federal official to be confirmed by the U.S. Senate.
Rachel Levine, 1st openly transgender federal official.

Transgenderism has some similarities to anorexia but requires a different approach. Transgender people become convinced that they are actually the opposite gender. They often state they are trapped in the wrong gender body. Transgenderism starts with Gender Dysphoria, which is a dissatisfaction with ones gender. The decision to act on that dissatisfaction, by adopting the opposite gender as their new "identity" is the essence of transgenderism.

Some of them will only adopt the clothing and grooming style of the opposite gender. Some will seek medical treatment, IE hormone therapy to adopt more of the opposite genders appearance and some actually have their genitalia surgically altered to assume the appearance of their new gender.

They describe themselves as transgender. A “trans woman” means they were born as a male, but now “identify'' as a female. A “trans man” is somebody who was born as a female, but now identifies as a male. These people may or may not still have the genitalia they were born with. In the transgender world, you can assume the new gender, when you make the decision to do so, even if you still have the genitalia you were born with.

You may have seen the term, “the gender they were assigned at birth” which I do not use, because it is misleading. The gender wasn’t “assigned” or “chosen”, it was recognized. The hospital didn't say, "we've already met our quota for girls babies today, so assign this one to the male gender." All they did was look at the baby and mark the appropriate box for male or female.

When a person with gender dysphoria decides to transition to the opposite gender it does not change their DNA. They don't actually change genders, they just change their appearance to one extent or another. A trans woman can't become pregnant. A trans man can't sire a child. Gender is a biological reality, not something that is chosen or assigned by the doctor or the parents at birth, or changed later based on preference. Gender is a fact, not a choice.

Or is it a choice? The whole transgender movement believes that it is a choice, justified by gender dysphoria. Currently the medical establishment agrees with them. Transgenderism used to be classified as a mental disorder by the American Psychiatric Association, but recently has been declassified and is no longer considered a mental disorder. Does everybody agree with this declassification? Of course not. You never get total agreement on anything. There are always a multitude of opinions.

Is transgenderism a problem? Do we need to intervene, as with anorexia? I think not and here's why. Transgenders are either right or wrong. If they are right, we should be loving and supportive. After all they got kind of a raw deal, being born in the wrong gender body. And if they are wrong, they won't change until they want to. Until they believe they need to change. So what should we do if they are wrong? Be loving and supportive. If they need to change, it will only happen when they decide they need to change. Whether transgenders are right or wrong, we should be loving and supportive, which incidentally is how we should treat all people. Enough with the judging, the outrage, the animosity, over any and all issues. Share your opinion with respect and consideration and show the same respect for other's opinions.

Hence if a person wants help overcoming transgender feelings or beliefs, then of course we should help. But offering help to a transgender person who does not want to change is a waste of everybody's time. What transgender folk and non-transgender folk need to learn, is learn how to get along peacefully and respectfully.

So what's the rub? Consideration and respect is a 2 way street. Just as we should show respect for all, transgenders must also show respect for those with different points of view. It's a big world and we all need to get along.

Problems occur when trans people want to use public restrooms assigned to the opposite gender. In many cases they have been offered single use restrooms, but they claim that is discrimination, and they insist on using the group restroom and locker rooms of their “new” gender. It’s not enough that they can believe whatever they want to believe, and live however they want to live. Part of the transgender phenomenon is that they want society, they want you, to believe it as well. And they want you to show your belief, your support, by allowing them to use the restroom of their choice, even if their anatomy still matches their birth gender. If you don’t accept it they label you ‘transphobic’. That's a problem, because many people don't want their teenage daughters sharing a shower and locker room with trans girls, some of whom still have male genitalia. My wife doesn't want to share the locker room at the local gym with people that were born male.

They may also demand their medical record be scrubbed of all references to their birth gender, which is a dangerous situation. There are emergency, life threatening conditions that only happen to a particular gender. For example, if a “man” presents to the emergency room with a tubal pregnancy, (that can only happen to a female), they can bleed and die before anybody diagnoses the tubal pregnancy, because it is not a diagnosis you consider with a “man”. Hiding your birth gender is not fair to medical professionals.

Transgenders often want to compete in athletic events in their “new” gender. Men are generally bigger and faster than women. There are some leagues where the lowest performing male athlete out performs the highest performing female athlete. Here in the U.S. nearly 300 high school boys could beat the world's fastest female sprinter. That is why genders compete separately in these sports. When one of these, male at birth, athletes chooses to compete with the female at birth athletes, his victory is assured and female athletes are justifiably disappointed and discouraged. Some pushback is growing from the female competitors who have little realistic chance of success when forced to compete against these men who choose to compete as women. We need to be fair to female athletes.

In some cases, male prisoners, who now consider themselves female, want to be housed in female prisons. And some states and counties are going along with this and have already begun letting prisoners choose which gender they are housed with, based on their stated “gender identity”. Some prisoners, who were men at birth, demanded to be housed with female prisoners and then used their penis to rape female prisoners. According to a recent report, official figures show transgender inmates, when housed with their new gender, are 5 times more likely to sexually attack other inmates. This is not fair to female prisoners or the guards that have to police the situation.

There have been similar problems at shelters designed for women escaping domestic abuse, when men, who now believe they are women, demand to be housed in these same emergency shelters. This results in women who are escaping violence, and in some cases sexual assault, having to share dorm-like sleeping arrangements with strange men, some with penises, who consider themselves to be female, despite anatomical evidence to the contrary. Allowing trans females into these shelters is making it into a real "from the frying pan into the fire" experience for the shelters intended guests.

Recently we saw an event for youth to “come out” to their peers in a group setting. This was shown on a national news show. A 4 year old boy was sent in front of the group, and we were told he was going to announce to his peers, (a large group of youth that appeared to be his age up through about 12,) that he was actually a girl, and was going to announce his new “girl” name.

He was not able to say anything in front of the group, and his mother rapidly joined him onstage, stating he was shy, and she made the announcement for him. The adults and youth present appeared very impressed and clapped to show their support. Obviously this little boy's transgenderism was a product of the mothers imagination. Imagine the potential harm when this boy is started on hormone blocking drugs to prevent male characteristics from developing. If he regrets his mothers choice when he becomes a legal adult, he can stop the chemical castration drugs but many effects will be permanent. And of course surgical alterations are also permanent.

Some states are now adopting laws banning transgender treatments for minors, whether pharmaceutical or surgical. When the minors become adults they will be able to make the choice for themselves. Some states are also banning athletes that were born male from competing against females. Even Caitlyn Jenner agrees with this. All of these are promising signs that we can achieve the right balance, that allows people to live as they wish to live, but still allows others to not be imposed on by beliefs they don't accept. This seems reasonable to me.

CW Jasper

May 5, 2021


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Mary Minor, ND
Mary Minor, ND
May 06, 2021

I'm so glad you make the point of being loving and supportive towards trans people. That is so important. It is well known that gay, lesbian, trans people, especially adolescents have very high suicide rates. That's why Dan Savage (of Savage Love, an internationally syndicated column on relationships and sex) started the "It gets better" movement for this population. Kids can be so cruel.

As to the sports issue, this is a solution in search of a problem. Statistics I have seen indicate only 12% of trans girls and 14% of trans boys participate in sports compared to 63% of school-age children generally. So far none of the politicians that have promoted these laws banning trans athletes from participating in…

Doctor Jasper
Doctor Jasper
May 07, 2021
Replying to

I just read this morning that the highest rated athlete for a gold medal in the Tokyo Olympics is transgender weightlifter Laurel Hubbard. If the word is already out, how many female athletes are throwing in the towel right now, rather than go through the expense, just to compete against a biological male.

In the military data, females transitioning to male with hormone therapy caught up with the biological males in a year or so. They test running, sit-ups, pushups, etc. Males going to female lost some of their advantage right away, but still at 2.5 years in some things were still closer to male in performance than female. I don't think they have data going past 2.5 years, so…


Gerald Hacker
Gerald Hacker
May 05, 2021

Dr. Jasper, thank you for the precise explanation with compassion you explained here in your article. I believe it is important to not alienate people, whether they are suffering from anorexia or gender dysphoria, from the support systems ( that the will rely on when struggling with these life altering decisions.


Allison Smith
Allison Smith
May 05, 2021

I appreciate the discussion about female athletes and women's shelters. I'll never forget seeing three transgender high school girls claiming that they had no advantage over other female athletes and that if the girls wanted to win they just needed to practice more. The reality is that no amount of physical training will produce women who can outperform men who are also training for athletic competition. There are some things that need to be accepted as true. We need to learn to separate what is true from our preferences, opinions, and desires.

Gerald Hacker
Gerald Hacker
May 05, 2021
Replying to

You are right and I would also like to add that women's scholarships are on the line as well! If transgender men dominate the high school sports world, women athletes may never again get athletic scholarships to college again. Sometime this is the only way a high school girl can even make it to college!

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