What if the most destructive concept in modern psychiatry emerged from men lying to get hormones? Mia Hughes traces the shocking origins of childhood gender dysphoria back to the 1960s, when researchers studying effeminate boys were actually chasing ghosts—transgender children who didn't exist. Meanwhile, Stella O'Malley shares her harrowing personal journey as a child who desperately wanted to be a boy, offering a rare window into what gender dysphoria actually feels like from the inside. Their conversation challenges everything: Is this a real diagnosis? Should it exist? And in our current culture, is it too dangerous to leave in the DSM?
The Origin Story: When Autogynophiles Created a Category
Hughes unveils the disturbing genesis of childhood gender dysphoria, beginning with Christine Jorgensen's 1952 transition. "This guy, he went to Denmark... comes back and he's on the cover of newspapers and he's a blonde beauty. And it triggers the first social contagion," she explains. The flood of men seeking similar procedures told consistent stories of lifelong femininity—stories researchers later realized were scripted lies.
The deception had devastating consequences. Researchers like John Money, Richard Green, and Robert Stoller turned their attention to actual effeminate boys, conducting 20-year prospective studies searching for "transsexual children." Their findings? "They hadn't found transsexual children. They had found pre-gay boys that were destined to grow up to be gay."
DSM-3 Revolution: When Everything Became a Disorder
The 1980 publication of DSM-3 marked psychiatry's watershed moment. Robert Spitzer's diagnostic manual exploded from a slim volume to a comprehensive catalog of human suffering, introducing transsexualism, gender identity disorder of childhood, multiple personality disorder, and borderline personality disorder in one fell swoop.
Hughes reveals the arbitrary nature of these classifications: "Being on those committees is rather like a group of friends deciding on what to have for dinner and one person wants Indian and another person wants Chinese and they all settle on going for Italian." The two-week threshold for depression? "We just thought 5 was too many and three wasn't enough."
Living It: Stella's Childhood in Gender Chaos
O'Malley's personal narrative cuts through clinical abstractions. From age 3, she was "infamous" in her town as the child who insisted she was a boy. "I was misogynist. I hated girls... their prissy little clothes and their fancy paper and their frills... they made me want to scratch my skin off."
Her description of pre-pubertal realization is haunting: "I've been telling everybody I'm a boy. I've been acting in this magical thinking, childish way... And now you've realized they were pandering to you. They were laughing at you, they were indulging and colluding with you." The shame and secrecy around her eventual acceptance of being female carried an intensity she compares to sexual development—so private that any comment would send her "back into more boyishness for months."
The Dutch Disaster: When "Help Them Earlier" Became the Answer
The 1980s brought a catastrophic pivot. Dutch clinicians, observing that transitioned adults weren't thriving, concluded the problem was timing: "Maybe these men need to transition earlier because they would pass if they didn't go through puberty."
This logic—that failed adult outcomes justified earlier intervention—would lay the groundwork for pediatric transition. As Hughes notes bitterly: "OK, our experiment failed on these men, so let's do it to kids."
Paul McHugh's Bombshell: Following Up Actually Matters
In 1979, Dr. Paul McHugh at Johns Hopkins did something revolutionary in gender medicine: he checked outcomes. While transitioned men self-reported happiness, objective measures—depression, anxiety, homelessness, psychiatric admissions—painted a darker picture. His conclusion was damning: "We were colluding with a mental illness rather than trying to help the patients."
The clinic closure triggered what Hughes identifies as the birth of modern trans activism: "They are hardcore. They want the medical treatment... The focus becomes access to medical treatment." The movement needed legitimacy, and the concept of the transgender child provided it perfectly.
Social Transition: The Trap That Wasn't There
O'Malley's experience illuminates the power of social transition through its absence. Despite everyone knowing she claimed to be a boy, no adults affirmed it officially. "Imagine the child that's had... their whole childhood has been a lie and all of the parents and the teachers and all of the adults in their life have colluded with that lie. How on earth are they ever supposed to reverse course?"
A chilling moment came when her sister's friend cornered her: "I was you. You need to watch yourself. You're going to get yourself into the corner and you won't be able to get yourself out." O'Malley remembers thinking: "I am in it. I can't get out."
The Diagnosis Wars: To DSM or Not to DSM?
The hosts diverge on solutions. Hughes advocates complete removal from DSM-6: "The very idea that this is a real psychiatric disorder is too dangerous to be loose in society." She cites Jazz Jennings' mother finding the diagnosis in DSM-4 and using it to set her child on an irreversible path.
O'Malley proposes "identity disorder" as an alternative, encompassing not just gender dysphoria but the broader phenomenon of identity fixation in our age. "They're fixated on something... just like I would with somebody with anorexia." This would provide clinicians a framework without the specific dangers of "transgender child" terminology.
Gender: The Word Everyone Hates but Can't Escape
In a striking coda, the hosts address their critics who insist "there's no such thing as gender." O'Malley pushes back: "I'm finding it incredibly weird when people say there's no such thing as gender... what are all these kids experiencing?"
She distinguishes sex (male/female) from gender (masculine/feminine traits), citing Carole Hooven's work on testosterone and observable differences in children's play patterns. The discussion reveals the bind activists create: denying gender differences while simultaneously insisting some children are "born in the wrong gender."
The Black Box Solution
Hughes offers a compromise from Allen Frances: If gender dysphoria must remain in DSM-6, slap it with a "black box warning" like dangerous medications. Alert clinicians that "there is a cultural fad going on and there is rampant overdiagnosis... this is a dangerous diagnosis and if you really must apply it, you need to apply it with great caution."
The implication haunts: In our current moment, even naming childhood gender distress might be too dangerous. As Hughes concludes: "I think the most harmful concept psychiatry has ever come up with... is the concept of the transgender child."
If you've ever felt like something bigger is happening but struggled to make sense of it, Beyond Gender is for you. This podcast cuts through the noise with honest, thoughtful discussions about one of the most pressing topics of our time.
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