Forty years ago, Paul McHugh, former psychiatrist-in-chief at Johns Hopkins Hospital, was well aware of the negative outcomes for those who sexually transition when he closed the hospital’s sexual reassignment clinic in 1979. He found that those who had surgically transitioned were 20 times more likely to commit suicide than the non-transgender population. He concluded that gender dysphoria was a psychological problem: “Transgendered men do not become women, nor do transgendered women become men. All ... become feminized men or masculinized women, counterfeits or impersonators of the sex with which they ‘identify.’ In that lies their problematic future.”