THEY RESTARTED GENDER SURGERY FOR PROFIT??? Paul McHugh on John Money and Johns Hopkins (#22)
17 July 2025
With Paul McHugh
North America
Dr Paul McHugh closed Johns Hopkins' gender identity clinic in 1979 after the outcome data failed to justify surgery. Now 94, he explains that decision and places it within a wider critique of psychiatry — a profession he believes has repeatedly traded evidence for ideology. His account maps closely onto the findings of the Cass Review, which concluded that NHS gender services for children were built on an inadequate evidence base and a culture hostile to clinical scrutiny.
In 1979, Dr Paul McHugh made a decision that would define his career: he shut down the gender identity clinic at Johns Hopkins University after reviewing the available outcome data and concluding it did not justify surgical intervention. Now 94 and still University Distinguished Service Professor of Psychiatry at Hopkins, he remains one of the most persistent critics of what he describes as medicine that treats ideas rather than illness. This episode gives him the space to explain, in his own words, why he acted as he did — and why he believes the profession has repeated the same error across decades. McHugh draws a direct line between three episodes of what he regards as ideological capture in psychiatry. The multiple personality disorder epidemic, in which clinicians validated and sometimes encouraged the proliferation of alter personalities in vulnerable patients; the recovered memory movement, in which adults came to believe, through suggestive therapy, that they had suffered abuse which had not occurred; and the current clinical insistence that a patient's self-declared gender identity must be affirmed medically, regardless of underlying psychological complexity. Each followed a similar pattern: a compelling narrative, institutional momentum, and the marginalisation of dissent. A significant portion of the conversation turns on John Money, the psychologist at Johns Hopkins who constructed the theoretical framework for gender identity and whose work shaped clinical practice for generations. McHugh describes watching Money's lectures and finding them deeply troubling. The account matters because Money's claims — that gender could be assigned and shaped independently of biological sex — became foundational to the affirmative model that spread from the United States into European medicine, including the model adopted by NHS gender services. This is precisely the terrain covered by the Cass Review, which reported in April 2024 following a four-year independent examination of gender services for children and young people in England. Dr Hilary Cass found the evidence base for medical transition in minors to be remarkably thin, the culture within the NHS Gender Identity Development Service to have become one in which clinical questioning was discouraged, and the welfare of vulnerable young people to have been inadequately protected. NHS England subsequently halted the prescription of puberty blockers for gender dysphoria in under-18s. McHugh's experience at Hopkins — the institutional resistance, the ideological pressure, the eventual decision to stop — reads as a precursor to what the Cass Review documented four decades later. The episode's title refers to the decision by Johns Hopkins to reopen its gender surgery programme years after McHugh closed it. He addresses this directly, and the question of what drove that reversal — whether commercial incentive, political climate or shifting professional norms — is not an abstract one in Britain, where NHS England is now rebuilding gender services from the ground up following the closure of the Tavistock's Gender Identity Development Service. For clinicians, commissioners and policymakers navigating the aftermath of Cass, McHugh's career amounts to a detailed case study in the cost of institutional capture — and in what it takes to say no when a profession has stopped asking the right questions.
