The mainstreaming of homosexuality took a long time. Gore Vidal’s The City and the Pillar, a literary mediocrity but a cultural milestone, was published in 1948. Fifty-five years later, homosexual acts remained criminal in much of the United States, until Lawrence v. Texas was decided. The culture wasn’t quite sure where it stood: Americans are generally liberal about these things, and positive depictions of gay characters had been an ordinary part of American culture for decades. But even after Lawrence, both Hillary Rodham Clinton and Barack Obama felt it prudent to run as candidates opposed to gay marriage in the 2008 Democratic primaries. It wasn’t until last year that the Supreme Court put the imprimatur of its civil-rights protection on gay marriage with Obergefell v. Hodges.

Transgenderism took a shorter and much more direct path. There wasn’t a transgender City and the Pillar, or even a transgender Will and Grace. Hollywood has always had a soft spot for transvestite comedy, but mainly in the context of broad situational comedy well insulated from any messy sexual questions: Robin Williams cross-dresses to be close to his children, Shawn and Marlon Wayans because they are dedicated FBI agents. It is a longstanding complaint (and one not without some basis) among advocates that media portrayals of transgender characters are largely of the Silence of the Lambs variety, which used to be the Last Exit to Brooklyn variety and, before that, the Vengeance Is Mine variety (spoiler alert: “Juno was a man!”): serial killers, prostitutes (one-fifth of transgender characters in film and television are prostitutes, by GLAAD’s inventory), and vampiric deviants who scheme to ensnare heterosexual men. The anxiety surrounding the possibility that a straight man might fall into a transgender attraction gave us The Crying Game and M. Butterfly; Boys Don’t Cry was unique not in being based on actual events (David Henry Hwang adapted M. Butterfly liberally from an actual episode) but in that the transgender deception is perpetrated on a woman.

Thirty years passed between the American Psychiatric Association’s 1973 decision to remove homosexuality as a mental disorder from its Diagnostic and Statistical Manual and homosexuals’ arrival as a protected 14th Amendment class in Lawrence. The time lapse between the APA’s removal of “gender-identity disorder” (replaced with the less disorderly “gender dysphoria”) and the emergence of transgender people as a protected class under civil-rights law as interpreted by the Obama administration: three years.

The cultural changes accompanying the mainstreaming of transgenderism have been notably different from those that accompanied the mainstreaming of homosexuality. In the case of homosexuals, the main cultural instrument was the sympathetic example. As hectoring as the gay-rights movement so often is, what changed Americans’ minds about homosexuals was the gradual realization that the leather boys in the Chelsea parades are outliers within the gay experience just as they are outliers within the mainstream culture, that homosexuals can be, and generally are, as ordinary and tedious as the rest of our neighbors. That domestication of homosexuals, particularly of gay men, has been lamented, not least by Gore Vidal and others of his stripe. John Waters, the filmmaker who brought the drag queen Divine to popular audiences, declares himself conflicted, telling The Advocate in 2011: “I’m for gay marriage. I don’t want to do it, but I certainly think people should be allowed to, and I wouldn’t vote for anybody that would be against it. But at the same time, why do we have to be good now? Why can’t we be villains in movies?” Perhaps anticipating the worse that was yet to come, Waters continued: “Dumbbell censors are easy. You use their quotes in the ad [for your movie]. Liberal censors are much harder to fight.”

The liberal censors (perverse term) have been aggressive on the transgender issue, the Millennial culture being notably prohibitionary where the gay culture of the 1960s and 1970s was liberationist. For the Obama administration, that means using the cudgel of federal civil-rights litigation against North Carolina after authorities there offered a reasonable accommodation — private facilities — between those who claim a gender identity at odds with their biological sex and those who object, not without some justification, to the presence of biologically male persons in women’s restrooms and locker rooms. (That the converse possibility does not often come up in discussion, and that it is not accompanied by similar anxiety, is perhaps another example of underlying sexual reality asserting itself in spite of our political and cultural attempts to explain it away — which is to say, it is for roughly the same reason that male teachers who have sexual relations with underage female students are treated much more harshly than are female teachers who have sex with underage male students.) For New York City under the mayoralty of Bill de Blasio, that means threatening nonconforming businesses and other entities subject to civil-rights litigation with quarter-million-dollar fines if they fail to adjust their language to the preferences of a person describing himself as transgender, “regardless of the individual’s sex assigned at birth, anatomy, gender, medical history, appearance, or the sex indicated on the individual’s identification.” (The superstition that sex is “assigned at birth” rather than an aspect of biology is now deeply entrenched.) New York being New York, this extends to the use of the plural (“they/them/theirs”) for individuals, as well as mandating the use, if demanded, of the invented gender-neutral pronouns “ze” and “hir.”

The liberal censors who worry John Waters are not only people with formal political power. In June 2014, the Chicago Sun-Times reprinted an essay I had written for National Review titled “Laverne Cox Is Not a Woman.” Laverne Cox, formerly Roderick Cox (a fact scrupulously scrubbed from Wikipedia and most of the public record), is a transgender actor playing a transgender prison inmate in Orange Is the New Black, and he appeared on the cover of Time over a headline announcing “The Transgender Tipping Point.” Because my essay expressed a nonconforming view on the subject (that surgical mutilation should not be considered therapeutic and that the rhetoric of “gender” should not be used to eradicate the fact of sex), there sprang into existence a campaign to have Google’s advertising network banish the Sun-Times as a forum for “hate speech” (the involved activists’ discussion of that project, still available online at Reddit, is illuminating) and of course to have National Review banished as well. A petition and social-media campaign was launched to have the Sun-Times fire me, and the Sun-Times eventually announced its compliance, which was amusing, inasmuch as I did not work for the Sun-Times. The newspaper has since memory-holed the episode. What’s notable here is that much of what I wrote relied upon an essay by Dr. Paul R. McHugh published in the 1993 volume of Best American Essays, edited that year by Joseph Epstein, who was himself the subject of a protest and sit-in in response to his 1970s Harper’s essay “The Struggle for Sexual Identity.” It is very difficult to believe that a man such as Epstein would be permitted to edit such a volume today (he is now associated with explicitly conservative outlets such as The Weekly Standard and The New Criterion) or that McHugh’s essay would be published in it, despite his expertise as the former chairman of the psychiatry department at Johns Hopkins, where he eventually ended the practice of sex-reassignment surgery. Criticism of the assumptions underpinning transgenderist rhetoric — that sex is “assigned at birth,” that there exists a “social construct” known as “gender” that is entirely independent of sex, that the male–female “binary” is the result of a sort of conspiracy — is effectively silenced outside of explicitly conservative organs.

Which is to say, the cultural police power here is tripartite: Official political power backed by state violence threatens to visit ruination on pronoun nonconformists and on noncompliant state and local powers; cultural institutions and activism silence nonconforming views; and the medical community uses its prestige to limit the range of acceptable political opinion.

It is not as though the APA is immune to political persuasion, or even pretends to be: One of the refreshingly honest aspects of the campaign to abolish “gender-identity disorder” from the DSM was the frank acknowledgment that it was, in fact, a lobbying campaign. There had been no great breakthrough in the scientific understanding of the phenomenon the APA now calls “gender dysphoria”: Transgender advocates objected to the term “disorder” but also demanded that the APA keep some sort of diagnosis on the books in order to compel insurance companies to subsidize sex-change operations, now known as “gender-affirmation” treatment. Concurrent reports in The Advocate were open about this being a political campaign — the word “lobbying” was commonly used — rather than a reevaluation of scientific evidence. Transgender advocate Dana Beyer (formerly Wayne Beyer), who advised the Washington Psychiatric Society on related questions, also was explicitly political, insisting that the APA change meant that “a right-winger can’t go out and say all trans people are mentally ill.” If the standard is “dysphoria,” or feeling at odds with one’s sex, then, as Beyer put it, “it no longer matters what your body looks like, what you want to do to it — all of that is irrelevant as far as the APA goes.” In his critical paper on the subject, McHugh asked: “Is it ethical to perform a surgery whose purpose is to make a male look like a female or a female to appear male? Is it medically appropriate?” The question, so far as the APA is now concerned, is irrelevant.

And the answer is officially unspeakable: “To perform surgery on a healthy body involves unnecessary risks; therefore, [sex-reassignment surgery] violates the principle primum non nocere, ‘first, do no harm.’”

Such surgery often is harmful, or produces harmful results, whereas its general therapeutic value still has not been established. People who undergo sex-reassignment surgery have in several studies been found to have low scores on several measures of physical and psychological health. A 2004 review of the literature conducted by researchers at the University of Birmingham found little evidence of therapeutic value and cast doubt on prior scholarship, which the study argued was skewed toward positive outcomes by simply ignoring those patients whom doctors lost track of — the ones most likely to be experiencing serious problems. Several patients who have undergone sex-change surgery have become vocal critics of the sometimes superficial evaluation process and the generally lax standards of care.

Which, strangely enough, brings us to the good news: There is an increasing number of people, particularly in the English-speaking world and in Europe, who identify themselves as transgender but who do not pursue irreversible surgical alteration. Indeed, under the ruthlessly enforced code of etiquette surrounding this issue, it is considered bad form to inquire about such matters, even of a public figure: Katie Couric got a lecture from Laverne Cox when she sympathetically inquired about “transition,” and a thousand enraged commentaries followed. Among the transgender population at large, most do not seek genital surgery. Many, though by no means all, of those identifying as non-binary regard such surgery as irrelevant, or in some cases as a cultural reinforcement of the very binary sexual assumptions that they reject.

That attitude probably should be encouraged. As silly and dishonest as our rhetoric about the “gender binary” can be, the fact that there exist people whose taste and behavior is at odds with classical sex roles would not have been news to a man of the 19th century. Lytton Strachey wasn’t Stone Cold Steve Austin. As a question of public policy, how a man or woman chooses to conduct his or her life is a much lower-order concern than the specific and, thanks to the deep involvement of government in the health-care system, unavoidably political questions of whether our medical professionals engage in radical surgeries of questionable therapeutic value and whether hormone regimes and the like are extended to prepubescent children. On the matter of accommodations in changing rooms and bathrooms, we might be tempted to say that there’s no real need to make a federal case of it, if the Obama administration hadn’t already made a federal case of it.

But, as North Carolina has learned, toleration and accommodation are not sufficient for the culture warriors of the Left. What’s demanded instead is positive affirmation, which is why culture war is war instead of conversation.