Medical journals are ranked by prestige, like universities and restaurants, based on criteria that might be more in the eye of the beholder than based on objective criteria. In the medical world, The Lancet and the New England Journal of Medicine are ranked number one and two, respectively, despite both having had to retract shoddy published COVID papers over “data integrity questions.”

JAMA, or the Journal of the American Medical Association, is number five on the “best medicine journals” list. It would be reasonable to expect such journals to be publishing cutting-edge medical research papers rather than nonsense better suited for supermarket tabloids.

JAMA, a few weeks ago, published a research letter stating the obvious about males and females. The title of the letter sounded innocuous: “Prostate cancer in transgender women in the Veterans Affairs Health System, 2000-2022.”

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It’s a surprise that transgender veterans were much of a thing 23 years ago. Then again, there was Corporal Max Klinger, the cross-dressing medic in the movie and TV series M*A*S*H.

The first sentence of the letter—“Transgender women retain their prostate even after gender-affirmation surgery and thus remain at risk of prostate cancer”—shows the study authors to be masters of the obvious. What did they expect? That men who declare themselves to be women, take estrogen, possibly receive breast implants, and undergo surgical castration are suddenly no longer biological males? As another military veteran character, Gomer Pyle, would say, “Shazam!”

The rationale for the study is that there are only 10 case reports of prostate cancer in transgender women. So what? These are biological males with prostates and are lumped into males with prostate cancer, the most common non-skin cancer in America, affecting 1 in 8 men.

Are there papers on the incidence of sex-specific cancers in each of the 70-plus genders? No, there are not. They focus, instead, on male and female only, not the medically irrelevant social construct genders.

What are the basics here? These are concepts taught in middle school biology and, one hopes, within the grasp of one of the top medical journals.

We are all born either male, with an X and Y chromosome, or female, with two X chromosomes. Everything beyond that is window dressing, ignoring the reality of what is, not what one wants it to be.

Note the word “reality,” which the Cambridge Dictionary defines as, “The state of things as they are, rather than as they are imagined to be.” This sums up the transgender movement. Human beings imagine themselves to be all sorts of things—smart, witty, attractive, successful, and often the opposite attributes—when reality may be far different.

Carried to the extreme, this type of delusional thinking becomes pathologic. Do we indulge anorexic individuals by agreeing with them that they are too overweight and letting them continue to starve to death? Or do we get them the necessary help to regain a sense of reality? If it’s just a “lifestyle choice,” why are there numerous eating disorder centers and programs?

Disconnection from reality is the basis of psychosis. The definition of “psychosis,” according to the National Institute of Mental Health, says the term “refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality.”

Reality is what is, not what we imagine it to be, although that basic premise seems to be changing. Examples of imaginary reality on a national stage include transitory inflation, a secure border, and election integrity.

In medicine, reality is straightforward, such as dead or alive. But when it comes to male versus female, the medical establishment, just like a recent US Supreme Court nominee, is suddenly unable to define “woman.”

Just to clear up any misconceptions over terminology, this is no longer the era of men and women, guys and dolls, fellas and gals, or boys and girls. According to Wikipedia, “A trans woman or a transgender woman is a woman who was assigned male at birth.” In other words, a trans woman is, in reality, a male human being.

Imagine the confusion when a transgender woman presents to the emergency room with abdominal pain and cramping. If the patient is a woman, a pregnancy test is mandatory. Does a transgender woman require a pregnancy test? Can men now become pregnant? Confused yet?

A Planned Parenthood doctor clears up the confusion. “This is medicine. Men can get pregnant; Planned Parenthood doctor tells Congress.” Can I sue my medical school for teaching me misinformation? During my OB rotation as an intern, I do not recall any men on the Cook County Hospital labor line. The only people I ever saw pregnant were women, and sometimes teenage girls.

So, what the JAMA letter is stating is that men, who, unlike women, have a prostate gland that can become cancerous, are still at risk for prostate cancer even if they grow their hair, have breast implants, or take estrogen.

This would be like a scientific paper reporting on a study demonstrating that boys dressed up as Superman cannot fly, or girls dressed as witches or fairy princesses cannot cast spells on people.

A Cedars-Sinai physician states the obvious, demolishing the need for such a study, “Transgender women, no matter what gender-affirming surgeries they may or may not have had, have prostates and are at risk of prostate cancer.” We needed a research letter in a major medical journal to tell us that? America’s collective disconnection with reality is a form of mass psychosis.

Reality is that transgender men like swimmer Lia Thomas, Caitlyn Jenner, or Budweiser mascot Dylan Mulvaney are at risk for prostate cancer, regardless of their names or gender identities. Similarly, Chastity, now Chaz. Bono, originally the daughter of Sonny and Cher, cannot get prostate cancer but remains at risk for ovarian, uterine, and cervical cancer unless these organs were already surgically removed. This is medical reality.

It is also common sense, now in short supply in the medical world and in the media. Thirty years ago, in 1992, Time magazine famously asked, “Why are men and women different?” Their extensive and hard-hitting research led them to conclude, “They are born that way.” Wow! Stop the presses! Men and women are born differently!

Thirty years later, a prestigious medical journal is reaching the same conclusion that men (or women) are men (or women) regardless of how they feel or how pop culture labels them.

Rather than stating the obvious, JAMA and other research journals should be focusing on the harms of the transgender movement, as this non-emphasized tidbit in the research letter notes, “Another finding was that transgender women who were taking estrogen, a common feminization therapy, had the most aggressive prostate cancer.”

How about looking at prostate cancer mortality in men taking or not taking estrogen and other hormones? Lia, Caitlyn, and Dylan might feel edgy and liberated as trans-gals, but do they know that their “gender affirming choices” might prove fatal due to a turbo-charged cancer? Isn’t that worth emphasizing?

The medical profession is losing another dollop of credibility after pushing nonevidence-based COVID prevention and treatment measures, now doing the same with the transgender movement. What happened to first do no harm?

Brian C Joondeph, MD, is a physician and writer.

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