Dr. Paul R. McHugh, the Distinguished Service Professor of Psychiatry at Johns Hopkins University, and former psychiatrist-in-chief at Johns Hopkins Hospital who has studied transgenderism and sex-reassignment surgery for 40 years, said the condition is a “mental illness” and to enable it is equal to “collaborating with madness.”

A transgender person is someone whose biological sex at birth is different than who they think they are sexually on the inside; for example, an anatomical male who believes he is a woman.

Sex-reassignment surgery is an operation where a person’s genitalia is changed from what it was biologically at birth; for example, a man’s penis and testes are removed and a faux-vagina is created by surgeons. The man may also receive breast implants and hormone treatments.

The gay-rights activist group Human Rights Campaign includes sexually reassigned people in its definition of transgender, as well as those who have not undergone the operation.  The HRC defines “gender identity” as “one’s internal concept of self as male, female, a blend of both, or neither,” regardless of one’s anatomy and chromosomal makeup – XX female, XY male.

But as Dr. McHugh explains in the chapter “Surgical Sex” in his book The Mind Has Mountains: Reflections on Society and Psychiatry (Johns Hopkins University Press), transgender is a “mental illness,” and to surgically alter someone’s genitalia is to enable a disorder.

“I have witnessed a great deal of damage from sex reassignment,” states Dr. McHugh in his book. “The children transformed from their male constitution into female roles suffered prolonged distress and misery as they sensed their natural attitudes” as males develop.

“As for the adults who came to us [at Johns Hopkins Hospital] claiming to have discovered their ‘true’ sexual identity and to have heard about sex-change operations, we psychiatrists have been distracted from studying the causes and natures of their mental misdirections by preparing them for surgery and for a life in the other sex,” he said.

“We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it,” said Dr. McHugh.

Johns Hopkins used to provide sex-reassignment surgery in the early 1970s, but after Dr. McHugh – psychiatrist-in-chief at Johns Hopkins Hospital 1975-2001 — and his colleagues studied the issue further, they concluded “that Hopkins was fundamentally cooperating with a mental illness.”

“We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia,” he said.

Regarding the patients, nearly all men, who underwent the surgery and hormone treatments to change into women, it seemed illusory, said Dr. McHugh.

“The post-surgical subjects struck me as caricatures of women,” he said. “They wore high heels, copious makeup, and flamboyant clothing … but their large hands, prominent Adam’s apples, and thick facial features were incongruous (and would become more so as they aged).”

Prior to surgery, these transgender men “spent an unusual amount of time thinking and talking about sex and their sexual experiences; their sexual hungers and adventures seemed to preoccupy them,” said Dr. McHugh.

Also, discussion of children or babies was of little interest to them, he said, and, thirdly, many of the transgender men “reported that they found women sexually attractive and that they saw themselves as ‘lesbians.’”

This form of “sexual misdirection” is termed “autogynephilia,” explained Dr. McHugh.

For the post-surgery transgender men, data collected by one of McHugh’s colleagues showed that most of the patients did not regret the genitalia change “[b]ut in every other respect, they were little changed in their psychological condition,” said Dr. McHugh. “They had the same problems with relationships, work, and emotions as before.”

“We saw the results as demonstrating that just as these men enjoyed cross-dressing as women before the operation so they enjoyed cross-living after it,” he said. “But they were no better in their psychological integration or any easier to live with.”

Dr. McHugh and his Johns Hopkins colleagues found that there were essentially two types of men who were pushing for the “radical treatment” of sex-reassignment.

“One group consisted of conflicted and guilt-ridden homosexual men who saw a sex change as a way to resolve their conflicts over homosexuality by allowing them to behave sexually as females with men,” wrote Dr. McHugh.

“The other group, mostly older men,” said McHugh, “consisted of heterosexual (and some bisexual) males who found intense sexual arousal in cross-dressing as females.”

As those cross-dressing men got older, they became “eager to add more verisimilitude to their costumes and either sought or had suggested to them a surgical transformation that would include breast implants, penile amputation, and pelvic reconstruction to resemble a women,” reported McHugh.

“I concluded that to provide a surgical alteration to the body of these unfortunate people was to collaborate with a mental disorder rather than to treat it,” said Dr. McHugh in his book.

After the early major research was concluded, “we in the Johns Hopkins Psychiatry Department eventually concluded that human sexual identity is mostly built into our constitution by the genes we inherit and the embryogenesis we undergo,”said Dr. McHugh.

“Quite clearly, then,” he said, “we psychiatrists should work to discourage those adults who seek surgical sex reassignment.” (Johns Hopkins eventually ceased its sex-reassignment service.)

“The ‘transgender’ activists (now often allied with gay liberation movements) still argue that their members are entitled to whatever surgery thy want, and they still claim that their sexual dysphoria represents a true conception of their sexual identity,” reported Dr. McHugh.

However, those activists have presented “little evidence” to refute the diagnosis that transgender is a mental illness, said the doctor.

“One might expect that those who claim that sexual identity has no biological or physical basis would bring forth more evidence to persuade others,” said Dr. McHugh. “But as I’ve learned, there is a deep prejudice in favor of the idea that nature is totally malleable.”

Dr. Victor Frankenstein thought that way.  We know how that story ended.

Dr. McHugh’s chapter, “Surgical Sex,” from his 2006 book, The Mind Has Mountains: Reflections on Society and Psychiatry, was first published in First Things magazine in 2004.