Ryan T. Anderson discussed his new book When Harry Became Sally with our own Ben Weingarten. What follows is a full transcript of their discussion, slightly modified for clarity.

You can also listen to their interview in its entirety below. And to instantly receive Encounter Books Podcast interviews like this one upon publication, be sure to subscribe.

Ben Weingarten: Why and how did we arrive at as your subtitle describes it, a “Transgender Moment” given the relatively small size of the population actually impacted by this issue.

Ryan T. Anderson: Sure, so part of it has to deal with the politics of these issues. The acronym LGBT need not have been conjoined with the “LGB” part and the “T” part, but largely for political reasons, it became one single acronym. And as soon as LGBT activists had successfully won on what they call “marriage equality,” all these organizations which were lavishly funded and had deep connections with media, and with Hollywood, and with politics, they moved on to their next policy item which was transgender identity. They had accomplished their major policy goal on the “LGB” part, and they pivoted to the “T” part. But as I mentioned, there’s no reason why you should necessarily think that sexual orientation and gender identity have anything in common, and therefore what I’ve discovered is that many people who are in favor of same-sex marriage have deep reservations about some of the claims that are being made about gender identity and transgender identities right now.

Ben Weingarten: So would you say that the organized groups behind this movement and co-joining the T and the LGB part — is it that essentially at the ground level you have gay folks and lesbians who do not like the fact that their movement has kind of been hijacked for a group that they consider substantively different — but at a higher level, the political actors that cynically use these issues are all about using identity as a cudgel, and it just made sense for them to create this sort of broader movement?

Ryan T. Anderson: Also, I think at first…where you could say there was some logic to uniting here was that if you think about the ’60s, the ’70s, and the ’80s, here you had sexual minority groups that were being mistreated by the general population and so they found alliances and they formed alliances where they could. And part of the initial wave of activism here was merely for tolerance and for basic human respect. I think living today we can forget how poorly treated many LGBT Americans were, just a generation or two ago, and the way that many still are today. And so some of the initial kind of unity there was merely defined alliances where very few people were willing to be allies. But now that we’re in the 21st century and tolerance is no longer what’s being asked for, respect is no longer what’s being asked for, but affirmation is what’s being demanded and I think that’s where…I’ve seen some lesbian and gay activists say that they find some of the transgender claims to be a bridge too far.

Actually, I hosted an event here at the Heritage Foundation (and I mentioned this in the book) where the first lesbian to be reinstated to the military after “Don’t Ask Don’t Tell” was lifted, was one of the panelists for a panel of four women speaking. The title was “Biology Isn’t Bigotry.” And it was four women—two from the left side of the political aisle, two from the right side—speaking out against some of these transgender policies, and their underlying argument was that when gender identity wins, women lose. And so I just thought it was very fascinating that you have a pioneering lesbian activist, speaking at the Heritage Foundation to say that men who identify as women, being allowed to use women-only facilities, or little girls being told that they’re actually boys trapped in the bodies of girls, and teenage girls being given testosterone…these are all ways in which women are losing because of some of the transgender ideology that’s being promoted.

Ben Weingarten: Yeah, strange bedfellows indeed as always in politics. In order to grapple with the political and social issues around transgenderism in an intellectually honest way, we have to start by defining terms. And to that point I wanted to ask if you would let our listeners know some of the salient scientific and medical points around transgenderism since they’re so intrinsic to all these other issues that we deal with in the political and social spheres.

Ryan T. Anderson: Sure. Part of it is that it’s not even clear exactly to me what the phrase “transgenderism” refers to. And I imagine it has something to do with kind of a transgender worldview or transgender ideology, but the medical term is “gender dysphoria.” But not everyone who identifies as transgender has gender dysphoria, and not everyone who has gender dysphoria identifies as transgender. So it might be helpful for listeners to start by just distinguishing those two.

So transgender is a term that refers to someone who identifies as the opposite sex. So a man who identifies as a woman or a woman who identifies as a man, that would go by the label “transgender.” Gender dysphoria is the condition of feeling or thinking that you’re the opposite sex, and having deep discomfort about that reality, the reality that you are a biological male but you feel as a woman. But not everyone with gender dysphoria will identify as the opposite sex. Many will feel that they’re the opposite sex, but they know that they’re not actually the opposite sex. And not everyone who does identify as the opposite sex experiences gender dysphoria because they may or may not feel any distress with their identity of the opposite sex. So, that’s kind of the short synopsis of how those two words are used.

And then, there’s the further question of, what’s the general worldview? And I think that’s where the transgenderism comes into play.

Ben Weingarten: Yeah, and as for that worldview, unfortunately as we’ve seen in almost every discipline within the academy, politics often trumps all else. And one of the stories that you speak about is that of Dr. Paul McHugh in Johns Hopkins. Speak a little bit to that story because I think it’s a real microcosm of what is happening ironically here where, when the science doesn’t comport with that worldview, the science is essentially junked and attacked.

Ryan T. Anderson: Yeah. So, the book kind of opens with the discussion of Paul McHugh and what happened at Hopkins 40 years ago. McHugh was an undergraduate at Harvard, he then did his medical degree at Harvard Medical School. And then in the 1970s, he became the psychiatrist-in-chief at Johns Hopkins Hospital and the chair of the psychiatry program at Johns Hopkins Medical School. The reason this is relevant is because back in the ’60s, Hopkins was the first major medical institution in the United States to open a sex reassignment clinic.

So, in the ’70s, a decade later, when McHugh is now the head of all psychiatric health at Hopkins, he – it’s now up to him to kind of say, “Do I go along with this or not?” So, he asked one of his colleagues to conduct a study of what were the long-term outcomes for the patients who had had their sex “reassigned” at Hopkins. And what he saw was that the patients were happy with the surgery as a cosmetic matter. It had done what they wanted to be done to their bodies. But they didn’t show any objective signs of improvement on their underlying psycho-social conditions. So, in terms of their anxiety, or their depression, or their substance abuse, alcohol abuse, their suicide ideation, the surgery hadn’t brought them the change that they were hoping for because they weren’t just having the surgery for the sake of the cosmetic part—they were having the surgery because they thought that their underlying symptoms would improve as they “reassigned” their sex.

So, as a result of that study, McHugh had Hopkins shut down the sex reassignment clinic. And for the next 40 years, the way that Hopkins responded to gender dysphoria was by targeting therapy at the thoughts and the feelings of the patient rather than at the body. Now unfortunately, a year-and-a-half ago, Hopkins announced that it was reopening a sex reassignment clinic, not in the light of new evidence, but largely because of pressure from activist groups who had gone after Hopkins, that had gone after Dr. McHugh for not going along with the claims that were being made about gender identity and its fluidity, and the ability to reassign it, etcetera, etcetera.

Ben Weingarten: What were your findings regarding those who fully transitioned, and speak a little bit to some of the harrowing stories that you describe of those who detransitioned or regretted their transitions?

Ryan T. Anderson: Sure. So, in terms of what the outcomes are in general, in the book I quote several different literature reviews of the studies, including a 2016 report that the Obama Administration’s [Center] for Medicare and Medicaid Services conducted. And so that most recent study, that 2016 report from the Obama Administration, what they point out is that there’s no robust scientific evidence that suggests that sex reassignment surgeries improve the underlying quality of life of the patients, and that there’s some research—including the most rigorous research—that suggests that at the very least those underlying symptoms continue, and that possibly the reassignment makes things worse. And there they referenced a study that was conducted and it was a long-term study. And so, it would look at patients 10, 15, 20, up to 30 years after reassignment, and that showed that patients who had undergone sex reassignment procedures were 19 times more likely to die by suicide.

What that study can’t tell us is whether or not the surgery was the cause of that 19 times increase, or if it was just the underlying conditions of gender dysphoria that were the cause and that the surgery just didn’t improve those outcomes. So, it can’t say whether or not the surgery made things worse, but it can tell us that the surgery didn’t make things better enough because I think any of us would say that a procedure where the outcome is a 19 times greater likelihood of suicide, death by suicide, isn’t sufficiently treating those underlying conditions. This has been replicated on a number of studies that show a persistence in poor psycho-social outcomes for people who identify as transgender.

Dr. McHugh thinks that what’s happening here is that there’s the underlying condition—the gender dysphoria itself—that causes some of the struggles, but then also that trying to live as if the opposite sex makes life that much more difficult. So, there’s the underlying gender dysphoria that’s creating difficulties in people’s lives, they don’t feel comfortable in their own bodies. But then also it’s the trying to live as if the opposite sex, whether that’s just a social transition where they will wear a new wardrobe and refer to themselves with new pronouns and change their name, or if it’s also a hormonal and possibly even a surgical transition, that that just proves to be difficult.

The other part that you asked was, the people who transition and then detransitioned. And this was the chapter of the book that was most difficult to write. And it’s what initially kind of convinced me that I had to do a book about this because I started seeing different YouTube videos and blog posts from people, frequently in their 20s and 30s, who had transitioned as teenagers or in their early 20s, and then five or 10 years later have regretted it and were now in the process, or had completed the detransitioning and were now re-identifying…or living now as their biological sex.

And what’s heartbreaking about these stories is that, so many of them repeat common themes. So for the people who transitioned as teenagers they say, “I was much too young and immature to be making such a life-altering decision when I was 17 years old. I was going through a stage that many teenagers go through and I shouldn’t have made a decision that would leave me in my 20s, infertile and with a five o’clock shadow and with a scarred chest from having removed my breasts.” And they said that, “We weren’t mature enough in our understanding of what it means to be a man or a woman, and so our thinking wasn’t mature enough to be making these decisions. But also we weren’t at a stage in our life where we should be having that type of authority regardless of whether or not we had mature concepts of gender.”

They also report that the clinician that they had spoken with didn’t really discuss all of the possible underlying causes of their gender dysphoria or all of the possible treatments. They really presented it to them as if, “You are a boy trapped in a girl’s body, and taking testosterone is your only option.” And so they regret that they weren’t given additional information and additional options.

And then many of them also say that it’s people like me who are partly to blame. They say that it’s social conservatives, it’s evangelicals or conservative Catholics who are too rigid in their understanding of gender roles or sex stereotypes and they’re too stigmatizing towards sexual minority. And the reason I include that in the book is I want to caution myself and my readers not to do anything that’s going to make life worse for people who are struggling with their gender identity, for people who may transition. It’s important.

So the seventh chapter of the book is actually an attempt of getting rid of bad sex stereotypes and having a more mature, nuanced understanding of gender as a relevant presentation of our bodily sex, but not buying into either androgyny, where there are no differences between the sexes, nor buying in on the opposite extreme, kind of a rigid gender role or rigid sex stereotype in which boys have to play with GI Joe and girls have to play with Barbie. We want to avoid both of those mistakes, precisely so that people can feel comfortable being who they are, in the body that they are. If you’re a boy who likes Barbie, if you’re a girl who likes GI Joe, that’s fine. You don’t have to transition because of that.

Ben Weingarten: I found it very striking in reading this book—and you just alluded to it a moment ago—the idea that you had clinicians who, in what I would suggest is a dereliction of duty as you noted, did not necessarily weigh out all the options or in a sense, openly and honestly advise and counsel their patients. If doctors were following the Hippocratic Oath, how should they address this issue properly?

Ryan T. Anderson: Sure, so chapter six of the book goes through a bunch of case studies from the clinical literature. So these are published case studies in the academic literature and specifically on young people with gender dysphoria because I think that’s, to my mind…the most crucial area right now…if Bruce wants to be Katelyn, it’s a free country and adults can make their own decisions and we should do everything we can to have informed decisions. At the end of the day, it’s up to Jenner to make that decision. But with children, they’re minors, they don’t have a kind of legal authority in making these decisions, so frequently they’re being made on their behalf by other people, and so it’s vitally important that we get this right.

And what the clinical literature shows here is that 80 percent to 95 percent of young people with a gender identity struggle — gender dysphoria, or other…what used to be called gender identity disorder prior to the new version of the DSM [Diagnostic and Statistical Manual of Mental Disorders] — that they would naturally grow out of it. They would resolve their gender identity in accordance with their biological sex if their development wasn’t interfered with. And so what therapists had been doing, and what many still do, is they’ll talk to a child about what it is that they find distressing about their biological sex, and what is it that they find attractive about the opposite sex. So they would talk to that eight-year-old boy about what it is that he finds distressing about being a boy, and what it is that he finds attractive or appealing or reassuring about being a girl. And then they will try to, once they identify some of the underlying causes, they try to remedy those causes.

So I’ll give you two examples of these. One involves a young boy identifying as a girl. His parents take him to see a clinician. And in the course of talk therapy of the clinician asking him “why” questions, “Why do you think you’re a girl? What is it about being a boy that you find distressing?” the clinician discovers that the child was being bullied by the other boys in his class; that the other boys in his class are calling him a sissy, and they’re calling him a wuss, and they’re picking on him because he’s not a particularly macho guy, a particularly masculine guy. As a coping mechanism for this, he formed closer friendships with the girls at his class, and his interests were now more stereotypically feminine. And so he was convincing himself at a subconscious level that he was actually a girl trapped in a boy’s body, and that’s why the boys are picking on him, and that’s why the girls are his friends.

So the therapist suggested three things to the parents: One, “Take your son out of this environment. This is a toxic environment. And it’s the bullying that’s causing your son to feel uncomfortable with being a boy.” The second is, “Keep bringing your son to sessions with me, so that we can keep talking to your son about what a more robust understanding of boyhood and masculinity looks like. So that he can know that real boys can be gentle, and they can be sensitive; that his understanding of boyhood and masculinity is too rigid, it’s too narrow. He thinks that the only real boys are the bullies. Since he’s not a bully, he’s not a real boy.” And then third, they said, “It’s not enough to talk to him about this. He needs to experience it. You need to help your son find a new friend group, a new peer group, a new play group of boys who are like him. If he develops friendships with boys who share his interests, he’ll come more readily to know that he’s a real boy.”

So after the parents did this, about a year later, their son was re-identifying as a boy. So he was spared a life of visits to an endocrinologist to take estrogen. He was spared a life of transitioning.

The other example that I’ll mention now, the therapy wasn’t directed at the child, it was directed at the parents. So in the course of talk therapy, there was a boy identifying as a girl. He said to his therapist, “Mommies are nicer to their daughters than they are to their sons.” And that kind of set off the antennae of the therapist. So he says to the mother, “You know, your son said that mommies are nicer to daughters than to sons. What might be causing this?” And she reveals to the therapist in the course of their conversations that a few years earlier, she had been raped. And as a result of her sexual assault, she had developed an antipathy towards men, an aversion towards men. And she was subconsciously even applying this to her own son. She was physically incapable of being as affectionate with him as she was with her daughter. And her son was picking up on this.

So as his coping mechanism, he was trying to curry his mother’s favor and affection by identifying as a girl. So the response here was to get the mother the help that she needed to heal from her sexual assault, and to bring her that wholeness that she needed after experiencing that assault. After she was given the help she needed to heal, she was then able to be more affectionate with her son. Her son was then able to more readily identify as a boy. So another example of how in terms of what the Hippocratic Oath kind of prescribed here is, identify what’s causing the gender dysphoria, and then try to remedy those underlying causes.

Ben Weingarten: One of the disturbing things that you talked about in the book is the idea, as you just mentioned Bruce Jenner is an adult and can make decisions for himself or herself as the case may be. On the other hand, we’ve seen society in many ways elevate children and treat children as if they are in a position to make decisions that were previously in the domain of parents up until a certain age. In addition to that, there’s been an elevation of the power of school, and school as in school administrators over the parents themselves when it comes to the treatment of children who are dealing with gender dysphoria or psychological issues, and the like. Speak a little bit to that.

Ryan T. Anderson: Sure. One of the most disturbing things that I came across when I was researching for the book was a handbook that’s about four or five different LGBT activist groups, and the ACLU, and the National Education Association, the largest teachers’ union in the country had jointly produced. So that alone should be shocking to most parents that the teachers’ union is partnering with the ACLU and half a dozen LGBT activist groups to produce a handbook for local teachers, and principals, and superintendents on how to make their school “safe for transition.”

And what I came across in this was a section on how to deal with “uncooperative parents.” [Editor’s note: The handbook references “unsupportive parents]. And it’s an entire checklist on how to ensure that a student can transition at school without their parents knowing about it, so that a school might keep a separate wardrobe on campus for that student. The parents drop their young boy or their young girl off at school in the morning. The student might go to the principal’s office, change into the opposite sex’s uniform or the opposite sex’s dress-code, outfit, whatever. Live that day as if the opposite sex, go back to the principal’s office at four o’clock, change back into their original clothes and go home to mom and dad without the parents ever knowing. They had an entire system on how you would ensure that internally, you referred to the student by the new name and the new pronouns but then externally, when communicating to the parents, you would use the original name and the original pronouns.

And this has struck me as one of the grossest violations of parental authority that I’ve seen. The only thing that has gone beyond that was after the book was released, a court in Cincinnati, Ohio, removed the child from the custody of her parents because the child wanted to transition…There’s a 17-year-old girl who wanted to take testosterone therapy and the parents wanted their daughter to receive a psychological therapy, a therapy directed at her thoughts and feelings not at her body. And the court sided with the government, the Child Protective Services, not with the parents.

Ben Weingarten: And the state has sought to impose its ideology with respect to gender in other ways as well. You speak to the created distinction between sex on the one hand and gender on the other. What are the policy implications that have transpired as a result of this shift in these two concepts?

Ryan T. Anderson: Yes. So what we saw was, in the last year of the Obama Administration, the Department of Justice, the Department of Education and the Department of Health and Human Services, redefined the word sex to mean gender identity. And so anywhere in federal law, where it said no discrimination on the basis of sex, they now said that that meant no discrimination on basis of gender identity, and that it was discrimination on the basis of gender identity to make a bathroom or locker room policy on the basis of biology rather than gender identity.

So it’s a double play on words. First, they’re redefining sex as gender identity, and then second, they’re saying it’s discrimination on the basis of gender identity to not make gender identity the basis of your policies but to base your policies on biology instead.

And what I mean by this is that they told the Department of Education, Department of Justice sent a letter to all of the nation’s schools saying that Title XI now requires that you make bathroom, locker room, dorm room, and sports policies based on the gender identity of your students not their biology. So if you have separate facilities for boys and girls, separate teams for boys and girls, separate hotel rooms for overnight field trips for athletic competitions, separate dorm rooms, you have to do all of that now based on the gender identity of the student, not based on the biology of the student.

Thankfully, the Trump Administration did away with this. There were several courts that ruled against the Obama Administration on this, and then when the Trump people came into the office they let those court rulings stay in place, and then they rescinded the Obama guidance. But some states are continuing to do this and we can expect that the next left-leaning administration will pick right back up where the Obama Administration left off because the activists haven’t changed any of their demands. So the activists are continuing to press their case in court and to press their case with left-leaning politicians.

Ben Weingarten: The most famous case relating to this topic is North Carolina’s HB2 law, which was of course attacked by activists and then the business community as well. You challenge those who would claim that it was an unjust or unconstitutional law. Explain your thinking on HB2.

Ryan T. Anderson: Sure. So what HB2 said, it said that when it comes to private organizations, they can make their own policies. So if it’s your toilet, you can decide who uses it. When it comes to public facilities, the government’s policy — so in government schools, public schools, in government offices like court rooms, government office buildings, things like this, those would all be determined primarily based upon biology. But anyone who had had a sex reassignment surgery could apply for a new birth certificate and then update their sex on their birth certificate and their driver’s license.

So the entire point here is that they wanted to have some standard of who’s supposed to go where when it comes to bathrooms and locker rooms and any single-sex facility. But they had a way for people who had actually undergone sex reassignment procedures to change the sex that’s listed on their government identification.

What they wanted to avoid is what’s going on now: Several documented cases in the Target stores since Target changed its policies, [of] men who are disguising themselves as women to engage in sex crimes; either indecent exposure or in the case of Target, peeping toms; men who went in the Target fitting rooms disguised as women and then were using their iPhones to film women who are changing clothes. That’s one of the reasons why we have separate fitting rooms for men and women in the first place, to provide them with the appropriate amount of privacy and safety when they’re in a state of undress from the opposite sex.

So HB2 is trying to codify this in law while also creating a way for people who had had reassignment surgery to access their new facilities, and with allowing schools to accommodate people who are identifying as transgender with the creation of a single-occupancy restroom. For example, many restaurants now do this simply as a matter of course. Rather than having multiple occupancy restrooms, they’ll just have a series of single occupancy restrooms and either sex can use it because only one person is in at the time. These are the types of workarounds that people are trying to promote, that I’m trying to promote. And then activists attack this saying that these themselves are transphobic, that unless you treat the transgender boy exactly like every other boy, you’re not respecting who he is, despite the fact that a transgender boy is a girl who identifies as a boy.

Ben Weingarten: One of the problems in dealing with any of these sorts of issues, in particular in the realm of identity, and in a time in which “identity politics” dominates, is the idea that if you challenge the conventional wisdom or the prevailing ethos on a given topic, whether it’s transgenderism or any other one, you will be called a bigot. And the point of that is in a sense to shut down debate and stifle it before it even starts. Do you see the kind of transgender ideology that you argue against in this book ultimately dominating as so many other ideologies have dominated in the past. Or what do you anticipate occurring in the years ahead on this issue?

Ryan T. Anderson: It’s hard to make the short-term prediction. I think the longer term prediction is that this is unsustainable. So the reason that the subtitle of the book is “Responding to the Transgender Moment,” is that I think ultimately this will just be a moment in history — that transgender ideology because it’s contrary to so many basic truths of human nature…can’t stand the test of time; that you can’t build an ideology based on falsehoods of human nature. In the short run, I don’t know how long this moment will last for, or what the human cost of getting human nature wrong will be, or how aggressive the activists during this moment will be. I could foresee the next presidential administration being very aggressive in trying to enforce transgender ideology. And the reason they have to be so aggressive in enforcing it is that ordinary Americans, regardless of their political affiliation and regardless of their religious affiliation, they know that there’s something not quite right when you’re putting a five-year-old boy in a dress; when you’re putting a 10-year-old girl on puberty blocking drugs; when you’re putting a 16-year-old girl on testosterone; when you’re castrating an 18-year-old boy.

Ordinary Americans think that these are radical experimental procedures, and they’re not going to be willing to be called a transphobic bigot simply because they urge some cautions before making these life-altering decisions. I think this is unlike the same-sex marriage debate in that respect. I think this is unlike some of the other debates where the left has successfully silenced people. I think your average American, “Joe the Plumber,” he doesn’t want his fifth grade son coming home from school and announcing that he’s actually a girl trapped in a boy’s body; and he doesn’t want his 10th grade girl coming home from school and telling him that there’s a boy sharing her locker room. And I don’t think that is a particularly partisan reality. I don’t think that’s a particularly religious reality. I think if “Joe the Plumber” is a left-leaning, Obama-voting secularist, he still has these gut intuitions about his children.