Regardless of the question of whether he has had his genitals amputated, Cox is not a woman, but an effigy of a woman. Sex is a biological reality, and it is not subordinate to subjective impressions, no matter how intense those impressions are, how sincerely they are held, or how painful they make facing the biological facts of life. No hormone injection or surgical mutilation is sufficient to change that.
Genital amputation and mutilation is the extreme expression of the phenomenon, but it is hardly outside the mainstream of contemporary medical practice. The trans self-conception, if the autobiographical literature is any guide, is partly a feeling that one should be living one’s life as a member of the opposite sex and partly a delusion that one is in fact a member of the opposite sex at some level of reality that transcends the biological facts in question. There are many possible therapeutic responses to that condition, but the offer to amputate healthy organs in the service of a delusional tendency is the moral equivalent of meeting a man who believes he is Jesus and inquiring as to whether his insurance plan covers crucifixion.
This seems to me a very different sort of phenomenon from simple homosexuality (though, for the record, I believe that our neat little categories of sexual orientation are yet another substitution of the conceptual for the actual, human sexual behavior being more complex and varied than the rhetoric of sexual orientation can accommodate). The question of the status of gay people interacts with politics to the extent that it in some cases challenges existing family law, but homosexual acts as such seem to me a matter that is obviously, and almost by definition, private. The mass delusion that we are inculcating on the question of transgendered people is a different sort of matter, to the extent that it would impose on society at large an obligation — possibly a legal obligation under civil-rights law, one that already is emerging — to treat delusion as fact, or at the very least to agree to make subjective impressions superordinate to biological fact in matters both public and private.
As a matter of government, I have little or no desire to police how Cox or any other man or woman conducts his or her personal life. But having a culture organized around the elevation of unreality over reality in the service of Eros, who is a sometimes savage god, is not only irrational but antirational. Cox’s situation gave him an intensely unhappy childhood and led to an eventual suicide attempt, and his story demands our sympathy; times being what they are, we might even offer our indulgence. But neither of those should be allowed to overwhelm the facts, which are not subject to our feelings, however sincere or well intended.
You can read the whole thing here.
Update: John Piper weighs in on the article as well, using Romans 1.