Short Answer

Why The Emphasis On Transgender?


FEB 22, 2024

Have you thought about why there is so much news about transgender surgery?  It seems we have shifted our social focus from being gay and abortions to the radicalness of transgenderism.  Part of the reason is the legal war that gay groups fought was won, and abortion has been rendered meaningless as a federal issue due to the Dobbs decision.

Except, there is more.  As they say, follow the money.  It’s hard to quantify the costs and arrive at net profit.  It is possible to estimate top-line revenues and discount them back to the present value of those revenues to see why decisions are being made.   One of the metrics businesses use to make strategic decisions about the business is the customer acquisition cost (CAC) of getting one customer versus the long-term value (LTV) of that customer.

There are ways to look at this without making value judgments about abortion and transgenderism. Personally, I am pro-life. The clump of cells is human and I think we can change a lot of the things that cause people to make the choice to become pregnant. School choice, supporting nuclear families, and other policies would decrease the rate of abortion in the US. When people have hope, they make different decisions.

I am against transitioning anyone’s sex until after the age of 18 and I don’t think insurance should pay for it. I am also against males playing female sports, or using female locker rooms or bathrooms.

But, those are my values. They might not be someone else’s. However, when you look at the cashflows, you might understand why things are served up the way they are.

I am against government mandates to any kind of care in both these areas. Mandates cause problems and costs to rise for everyone.

Let’s look at each via the cold objective eye of business. Draw your own conclusions and leave them in the comments. I guarantee there will be controversy over this post simply because of the topics.

Customer acquisition costs are high in the abortion business. We are going to assume that only women can get pregnant.  First, you can only market to females who have the ability to get pregnant.  There are 65.54 million women between the ages of 15 and 45 in the US.  Secondly, of that market segment, there is a minority of them that actually want an abortion.  There are 3.6MM births per month in the US compared to 88K abortions, or 2%.  It costs money to get the word out and advertise.  This raises the costs of acquiring customers. When you are only targeting 2% of an entire marketplace, it’s not a good business model.

Once a customer is acquired, there is only one transaction.  One and done. An abortion is performed and the customer walks away.  According to abortion rights advocate Gruttmacher, abortions are increasing in number nationwide, not decreasing.  This data flies in the face of anyone who is breathing heavily over the Dobbs decision that overturned Roe v Wade and turned the decision over to the states. In 2023, the monthly abortion rate in the US was 87,800 per month.  Also according to Guttmacher, the incidence of repeat abortions is low.   That makes the business model even worse.

By the way, I would not spend any government money on abortion. Make it a 501(c)(3) and let donors who believe in it support it.

This is not the case with transgenderism cash flows. It is not a one-and-done business model.  There is an entire stream of payments that come with a one-time customer acquisition.  There is psychological diagnosis, then counseling.  There is a regiment of drug treatments to stop pubescent growth, or to change hormones post puberty.  Finally, there is the radical surgery necessary to turn one sex into another sex followed by more hormone therapy and quite possibly more psychological counseling.

I also wouldn’t do any public insurance or mandated insurance for transgender. If someone wanted to pay for a rider on their policy, fine. It should be private, not public.

Let’s look at the cash flows of each business.

I checked the abortion advocate Planned Parenthood’s website to see the costs. Morning-after pills range from $580 to $800 depending on where you access them.  If you get an in-clinic abortion during the first trimester, the cost is $600 to $800.  Once you are past the first trimester, the costs rise significantly to $1500-$2000 later in the second trimester.  Of course, some states allow abortions in the third trimester, and Virginia, Illinois, and California have “born alive” statutes on the books.  Predictably, third trimester abortions are even more expensive.

Insurance doesn’t usually cover elective abortion procedures so that money comes out of a person’s pocket.  If we use Gruttmacher’s numbers, the business is a $61.4 million monthly business assuming most abortions happen in the first trimester.  That is a $737 million per year business.  This would be considered a small or midsize business by a consultant or private equity firm.  It’s not a Fortune 500 business. It is not a scalable startup venture-backed business model.

Here is the math behind that calculation.  I used the 87,800 abortions per month nationally times the average cost of a first-trimester abortion $700.  I assume that they all are first-trimester abortions.  The morning-after pill and the procedure are the same average price. Again, this doesn’t even factor in the second trimester and beyond abortions, and the monthly cash flow would be a bit higher if we did.

Let’s look at the cash flows for the transgender industry.  When you analyze the cash flows, it’s easy to see why advocates for transgenderism are pressuring independent health insurance companies to cover the costs.  If they do, the transgender business becomes a discounted cash flow gold mine.

The total cost to transition is higher to go from a man to a woman than a woman to a man.

Top surgery to transition averages for $8,000.  “Bottom” surgery is significantly more expensive, $25,000.  In the following cash flow analysis, I don’t take those costs into account because they are “one and done” cash flows.  It’s $33,000 per person and at 1.6MM people results in a total one-time revenue stream of $52.8 billion.

The real money is in the drug cocktail Transgenders take for the rest of their lives.  They will spend $40 to $400 per month on hormone drugs.  The average cost is $2,880 per year.  If a person transgenders at age 18, the age of consent, and lives to the full life expectancy of 77, that’s 59 years of consistent payments or 708 months.

Using a discounted cash flow analysis, one can see what that customer is worth today.

I used a discounted cash flow analysis calculator that uses the normal DCV formula to analyze cash flows.  I assumed a 1% growth rate in the cost of hormones and discounted the cash flows back using a 5% discount rate.  The 5% is roughly the current US 10-year note rate.  I also used a 0% terminal value because once a person is dead, they don’t need the drugs and there is nothing to sell.

The cash flow has a discounted cash flow of roughly $70,863 over the life of the person.  If we take that $70k and divide it by the total number of months (709) a person is expected to use the drugs, it’s a monthly discounted cash flow of $100.

According to the Williams Institute at UCLA, there are roughly 1.6 million people in the US who identify as transgender.  Out of all transgenders, 25% are 13-17 years old and need to be taken out of cash flow calculations because they are minors.  That yields a monthly discounted cash flow of $120MM per month, or $1.4 billion per year.  That’s just for the drugs.

Of course, there are plenty of other costs involved with changing your sex from one to another.

Looking at the payment stream for puberty blockers that minors will use creates a totally different and significantly higher stream of cash flows.  It also seeds the ground for the next stream of cash payments that we analyzed above, lowering those customer acquisition costs to almost 0. Using the Williams Institute numbers, we assume 600,000 people between the ages of 13-17 identify as transgender.  In the analysis, we also assume 100% of them use puberty blockers.  Those drugs cost roughly $1200 per month, or $14,400 per year, to inject puberty blockers into minors.  Using the same assumptions as above, this results in a net discounted cash flow of $64,000 per person. The net discounted yearly cash flow for minors using puberty blockers is $7.7 billion per year.

It’s also possible to implant a device that will release puberty blockers.  Those cash flows are even more.  Depending on the implant, the cost is $4500 to $18,000.  They need a new implant each year.  The discounted net present value of implants on all minors who identify as transgender is $300 billion, or $60 billion per year.

Of course, there is a choice between monthly drugs or an implant, but you can see the incentive for drug companies to try and get the implants. The actual cash flow will be a combination of these numbers because some people will choose one or the other. They do not need both.

Now we are talking about some rambunctious positive long-term values of a customer, and you can see why there is such a push for transgenderism.  You can also see why the Transgender Industrial Complex led by legal groups such as Lambda Legal is petitioning and filing lawsuits to get insurance companies to cover the costs. They already have won the “Gay Wars” and need a reason to exist.

The above costs ignore the costs of psychological therapy which many people engage in before and after surgery.  According to Good Therapy, the cost of an hour of counseling is between $60 and $250.  It’s impossible to predict with any accuracy how many hours of counseling a person would use pre and post-operation.  But, you can estimate in your head given the other numbers that the net positive discounted cash flows are staggering.

When one looks at the abortion business and transgenderism business, it’s clear which one pays more.  Seeing the cold hard cash flows inform everyone why there is such a push for transgenderism in the mainstream today.  That ignores the political goals that align with the left wing of American politics.

There is an entire billion-dollar opportunity available for the taking when you analyze the life cycle of cash flow for transgenderism.  It is also okay to note that the ideas put forth by transgenderism go against eons of experience and ideas about humanity that have been with mankind since its inception.   It is also worth noting that abortion is not health care, and in sum, it hurts our society.

If you can get people to reject the obvious, you can get them to do anything.



Scientists Shocked to Discover That Male and Female Athletes are Different!

By Brian C. Joondeph, M.D.

It was once a commonsense belief and universal truth that men and women, boys and girls, are different, especially in the realm of athletics. With rare exceptions, men and women compete in their own categories, from high school level through college to the Olympic games and professional sports.

Mixed competitions place women and men on the same team, such as mixed doubles in tennis, or dancing, either in the ballroom, or on ice. Equestrian sports are an exception, but the fact that a horse is a major part of the sport reduces the sex difference between competitors.

Based on strength and power, two major determinants of success for many sports, males have a clear advantage over females. For decades, this was not in dispute with rare exceptions, the most notable that of tennis player Renee Richards.

Richards is a kindred spirit of the author, not because “he” had sex change surgery to become a “she,” but because Richards was an ophthalmologist.

As a tennis player, Richards wanted to compete in the U.S. Open as a woman but was told 'no.' At least, until a New York State judge with a unique view of the law decided Richard could compete.

Forty years later, former President Donald Trump is contending with the next generation of New York judges reinventing the law. Richards did compete in the U.S. Open but lost in the first round.

Interestingly Sports Illustrated, at the time, called Richards “an extraordinary spectacle.” Today Sports Illustrated has a man, identifying as a woman, as a cover model for their swimsuit edition. My, how things have changed.

Now we have tampon dispensers in men’s rooms and a surprisingly widespread belief (delusion) that men can become pregnant.

What was this shocking scientific discovery that men and women are different in sport? As published recently in BMJ Open Sports and Exercise Medicine, “Study shows sex could be a better predictor of sports performance than gender identity.”

Ya think? From the paper’s results, in scientific lingo, “Natal-male non-binary athletes outperform natal-female non-binary athletes at a confidence level of p=0.1%.”

In plain language, this means that as athletes, men outperform women. No kidding. It’s basic biology.

The science, according to the International Olympic Committee is simple: “A number of scientific papers have recently shown people who have undergone male puberty retain significant advantages in power and strength even after taking medication to suppress their testosterone levels.”

Puberty is when boys differentiate from girls through muscle and bone mass, strength, and power. Once the athletic engine is built, adult testosterone levels matter little. This means that a trans female athlete keeping his testosterone level below a certain number isn’t relevant since he went through male puberty years earlier.

How about some examples:

!n the 2021 Olympic Trials, these differences were quite evident. In the 100-meter run, the winning time for men was 9.80 seconds compared to 10.86 seconds for women, a full second, or about 10 percent slower.

In swimming, the results were similar. Take the 200-meter breaststroke as one example. The winning men’s time was 2:07.55 compared to 2:21.07 for women, a 14-second difference, again about 10 percent slower.

If men and women competed equally in these sports, the Olympic team would be virtually all male, as even some of the slowest men’s qualifying times, posted by those nowhere near reaching the finals, would easily be Olympic medal times for women.

What about a sport requiring raw strength and power, like weightlifting? Compare men and women, similar in weight class, at the 2016 Rio Olympics.

The winning lift for +75 kg women was 307 kg, combining snatch and clean and jerk. For men in the 77 kg weight class, the winning total was 379 kg, 23 percent more.

Athletes have weighed in on these issues.

Former Olympic decathlon champion Bruce, now Caitlyn, Jenner has strong opinions, being on both sides of this controversy. Jenner recently told a reporter,

It’s a question of fairness. That’s why I oppose biological boys who are trans competing in girls’ sports in school. It just isn’t fair. And we have to protect girls’ sports in our schools.

Tennis legend Martina Navratilova agrees,

It’s insane and it’s cheating. I am happy to address a transgender woman in whatever form she prefers, but I would not be happy to compete against her. It would not be fair.

These are not fringe opinions from right-wing fanatics. Jenner is transgendered and Navratilova is a lesbian, both strong supporters of LGBT rights but also of athletic fairness, the latter lost on the woke left.

The tide may be turning. In uber-woke New Zealand, “Transgender athletes could be banned from publicly funded women’s sport under new Government policy.”

Not here though. “USA Boxing to allow biological men to compete against female boxers after introducing transgender policy.” Wait until a far stronger transwoman kills or maims a real woman in the boxing ring.

Do I exaggerate? Remember, “When transgender fighter Fallon Fox broke her opponent's skull in MMA fight”? This is abuse and should not be tolerated. Why aren’t the so-called “women’s rights groups” speaking out?

Is anyone following the science here? What did the BMJ say? “Natal-male non-binary athletes outperform natal-female non-binary athletes at a confidence level of p=0.1%.” The science is clear.

William Shakespeare, in Romeo and Juliet, summed it up 400 years ago, “A rose by any other name would smell as sweet.” In other words, a thing is what it is regardless of what one calls it.

A man is a man, and a woman is a woman. Claiming otherwise is magical thinking, fine for one to indulge personally, but not at an athletic, societal, or cultural level.

Otherwise, it’s a mockery of women’s sports, grossly unfair to woman and girl athletes who have sacrificed endless hours of practice to reach the pinnacle of their sport, only to have a man, claiming to be a woman,  snatching victories, championships, and medals away under false pretenses.


Transgender ideology has created the biggest medical scandal of our generation

Vulnerable young people who transitioned before they were ready are paying a high price for this disastrous project


4 August 2023

I’m not sure what’s more offensive about Costa Coffee’s cartoon, featuring a young trans person who has had a double mastectomy. How many oak-milk matcha lattes must the snowflakes at Costa have drunk to come up with this orgy of wokery?

You’d have to be freebasing frappuccinos to think the best way to prop up post-pandemic Americano sales is with a big old van featuring large lips, blue hair and breast removal scars. “I’ll have one mastectomy-infused mocha, please!”

Naturally, the bizarre image went viral on social media, leading to calls for a boycott of the coffee franchise. Following hot off the heels of Nike being criticised for getting transgender influencer Dylan Mulvaney to model one of its sports bras, it seems customers have had it up to here with transgender promotion being used to flog products.

Like all companies which unthinkingly ram this nonsense down our throats in some misguided bid to be down with the Gids (that’s the recently closed Gender Identity Development Service at London’s Tavistock Clinic), Costa claims it is “celebrating diversity” and creating an “inclusive environment” to “encourage people to feel welcomed, free and unashamedly proud to be themselves”. But that only seems to apply to people who think it’s a good idea to be showing off the scars of what, to women suffering from breast cancer, is often an extremely traumatic experience.

There is more at stake here, however, than mere gender identity wars. Maya Forstater, the fearless campaigner who is on the board of Sex Matters, a human rights organisation calling for clarity on sex in law and policy, hit the nail on the head when she said in response to the Costa image: “Young women are being sold a lie that if they have their breasts removed and take hormones they can become men, or at least avoid being women.” 

For what Costa is doing here is glorifying major surgery that women may later come to regret deeply. In doing so, it is trivialising the underlying mental distress and body dissociation suffered by teenage girls who think they’ve been born into the wrong body. Sex Matters calls it “a social contagion and medical scandal masquerading as a social-justice movement”.
Ultimately, this attempted normalising of transitioning turned a largely psychological issue into an ideological one, to the detriment of the troubled young people going through it. And the scars – social, psychological and physical – remain long after people have taken puberty blockers or undergone gender reassignment surgery.

As Dr Hilary Cass’s interim report into Gids concluded in April, “there appears to be predominantly an affirmative, non-exploratory approach” that has been applied to young people who identify as trans, which means there has not been adequate exploration of the other issues that may affect them.

As a consequence, some young people who were encouraged to change gender are now experiencing awful consequences. Far from solving their problems, transitioning has only made them unhappier.

Brave Chloe Cole in the US described recently how awful transitioning turned out to be for her. The 19-year-old called on Congress to review gender-reassignment therapies and surgeries for minors, arguing that her “childhood was ruined” by the medical interventions.

“I used to believe that I was born in the wrong body,” she told members of the House Judiciary Subcommittee on the Constitution and Limited Government. “And the adults in my life, whom I trusted, affirmed my belief, and this caused me life-long, irreversible harm.”

Describing herself as “a victim of one of the biggest medical scandals in the history of the United States of America”, Cole implored: “We need to stop telling 12-year-olds that they were born wrong, that they are right to reject their own bodies and feel uncomfortable with their own skin.

“We need to stop telling children that puberty is an option. That they can choose what kind of puberty they will go through just [like] they can choose what clothes to wear or music to listen to.”

The Biden administration is unlikely to listen, however, because its assistant secretary of health, Rachel Levine, is a transgender woman who believes young people can “go through the wrong puberty”.

In Britain, the closure of the Tavistock clinic vindicated the concerns raised by campaigners like Keira Bell, who transitioned to male but came to regret it.

By her own admission, she presented at the clinic “adamant” she wanted to transition. But as she now points out: “It was the kind of brash assertion that’s typical of teenagers. What was really going on was that I was a girl insecure in my body who had experienced parental abandonment, felt alienated from my peers, suffered from anxiety and depression and struggled with my sexual orientation.”

Like other teenagers claiming to have been “born into the wrong body”, what Keira really needed was therapy, not a double mastectomy. The examples don’t stop there. This week, Sinead Watson revealed how transgender propaganda convinced her to have a double mastectomy that she wishes had never happened.

Pointing out that there is nothing normal about young women like her having “our healthy breasts surgically removed”, she described her transitioning to male six years ago as “a catastrophic mistake” that she regrets “every single day of my life”.
She also highlighted the pain and discomfort she suffered after the surgery – not to mention the fact that she will never be able to breastfeed. “I visualised myself shirtless on the beach – just like the Costa cartoon,” she said. “Instead I woke up in excruciating pain and, when the bandages came off, I saw a chest riddled with scars that looked nothing like a man’s ever would. I looked like what I was – a woman who’d taken testosterone and had a double mastectomy.”

The harsh reality is that for Keira, Sinead, and other young people like them, it is impossible to detransition completely. They are stuck with the mental anguish as a result of the rash decisions they were encouraged to make as teenagers, fuelled by transitioning evangelists who turned a blind eye to the real issues at the heart of their gender dysphoria to push an extreme ideological agenda.

The errors made upon the minds of unready people cannot ever be entirely healed, and yet still we have companies such as Costa pandering to flawed practices which risk doing more harm than good. When will we finally wake up to the insanity of this pernicious ideology?

Facts, not ideology, determine reality. As Dr Michelle Cretella explains in Gender Ideology Harms Children :

“1. A person’s belief that he or she is something they are not is, at best, a sign of confused thinking.

2. Puberty is not a disease and puberty-blocking hormones can be dangerous.

3. …as many as 98% of gender confused boys and 88% of gender confused girls eventually accept their biological sex after naturally passing through puberty.

4. Pre-pubertal children diagnosed with gender dysphoria may be given puberty blockers as young as eleven, and will require cross-sex hormones in later adolescence to continue impersonating the opposite sex. These children will never be able to conceive any genetically related children even via artificial reproductive technology. In addition, cross-sex hormones (testosterone and oestrogen) are associated with dangerous health risks including but not limited to cardiac disease, high blood pressure, blood clots, stroke, diabetes, and cancer.

5. Rates of suicide are nearly twenty times greater among adults who use cross-sex hormones and undergo sex reassignment surgery, even in Sweden which is among the most LGBTQ-affirming countries.

6. Conditioning children into believing a lifetime of chemical and surgical impersonation of the opposite sex is normal and healthful is child abuse.”

Long Answer


Gender Ideology Harms Children
Updated September 2017

The American College of Pediatricians urges healthcare professionals, educators and legislators to reject all policies that condition children to accept as normal a life of chemical and surgical impersonation of the opposite sex. Facts – not ideology – determine reality.

1. Human sexuality is an objective biological binary trait: “XY” and “XX” are genetic markers of male and female, respectively – not genetic markers of a disorder. The norm for human design is to be conceived either male or female. Human sexuality is binary by design with the obvious purpose being the reproduction and flourishing of our species. This principle is self-evident. The exceedingly rare disorders of sex development (DSDs), including but not limited to testicular feminization and congenital adrenal hyperplasia, are all medically identifiable deviations from the sexual binary norm, and are rightly recognized as disorders of human design. Individuals with DSDs (also referred to as “intersex”) do not constitute a third sex.1

2. No one is born with a gender. Everyone is born with a biological sex. Gender (an awareness and sense of oneself as male or female) is a sociological and psychological concept; not an objective biological one. No one is born with an awareness of themselves as male or female; this awareness develops over time and, like all developmental processes, may be derailed by a child’s subjective perceptions, relationships, and adverse experiences from infancy forward. People who identify as “feeling like the opposite sex” or “somewhere in between” do not comprise a third sex. They remain biological men or biological women.2,3,4

3. A person’s belief that he or she is something they are not is, at best, a sign of confused thinking. When an otherwise healthy biological boy believes he is a girl, or an otherwise healthy biological girl believes she is a boy, an objective psychological problem exists that lies in the mind not the body, and it should be treated as such. These children suffer from gender dysphoria. Gender dysphoria (GD), formerly listed as Gender Identity Disorder (GID), is a recognized mental disorder in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5).5 The psychodynamic and social learning theories of GD/GID have never been disproved.2,4,5

4. Puberty is not a disease and puberty-blocking hormones can be dangerous. Reversible or not, puberty- blocking hormones induce a state of disease – the absence of puberty – and inhibit growth and fertility in a previously biologically healthy child.6

5. According to the DSM-5, as many as 98% of gender confused boys and 88% of gender confused girls eventually accept their biological sex after naturally passing through puberty.5

6. Pre-pubertal children diagnosed with gender dysphoria may be given puberty blockers as young as eleven, and will require cross-sex hormones in later adolescence to continue impersonating the opposite sex. These children will never be able to conceive any genetically related children even via artificial reproductive technology. In addition, cross-sex hormones (testosterone and oestrogen) are associated with dangerous health risks including but not limited to cardiac disease, high blood pressure, blood clots, stroke, diabetes, and cancer.7,8,9,10,11

7. Rates of suicide are nearly twenty times greater among adults who use cross-sex hormones and undergo sex reassignment surgery, even in Sweden which is among the most LGBTQ – affirming countries.12 What compassionate and reasonable person would condemn young children to this fate knowing that after puberty as many as 88% of girls and 98% of boys will eventually accept reality and achieve a state of mental and physical health?

8. Conditioning children into believing a lifetime of chemical and surgical impersonation of the opposite sex is normal and healthful is child abuse. Endorsing gender discordance as normal via public education and legal policies will confuse children and parents, leading more children to present to “gender clinics” where they will be given puberty-blocking drugs. This, in turn, virtually ensures they will “choose” a lifetime of carcinogenic and otherwise toxic cross-sex hormones, and likely consider unnecessary surgical mutilation of their healthy body parts as young adults.

Michelle A. Cretella, M.D.
President of the American College of Pediatricians

Quentin Van Meter, M.D.
Vice President of the American College of Pediatricians
Pediatric Endocrinologist

Paul McHugh, M.D.
University Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School and the former psychiatrist in chief at Johns Hopkins Hospital

Originally published March 2016
Updated September 2017

The inconvenient truth about transwomen

George Orwell Quote

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