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The idea that one’s sex is a feeling, not a fact, has permeated our culture and is leaving casualties in its wake. Gender dysphoria should be treated with psychotherapy, not surgery. For forty years as the University Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School—twenty-six of which were also spent as Psychiatrist in Chief of Johns Hopkins Hospital—I’ve been studying people who claim to be transgender.

Over that time, I’ve watched the phenomenon change and expand in remarkable ways. A rare issue of a few men—both homosexual and heterosexual men, including some who sought sex-change surgery because they were erotically aroused by the thought or image of themselves as women—has spread to include women as well as men. Even young boys and girls have begun to present themselves as of the opposite sex.