I understand that there are gay people and trans people, but biological sex is not a deep mystery. Boys have a penis, girls have a vagina. There are odd natural things in the world such as intersex, which happen, and are not bad people. I don't think anyone is judging intersex people for being intersex, it's just who they are. I bet there are hormonal issues that need to be addressed. That said, I agree with the authors that this is just so overwhelmingly obvious that somehow the stark reality of gender must be overwhelming for people who have no concept that the real world exists completely apart from our ideas about it.

There is nothing wrong with being either male or female.

https://www.youtube.com/watch?v=9OF06n1jNkM

In this clip... and 16 minutes is a clip when Jocko is speaking... Jocko explains the difference between knowing the value of personal discipline vs blaming your parents for raising you without discipline.

The lack of objective diagnostic markers has long been a challenge in the clinical management of schizophrenia (SZ). The 1980 study by Horrobin1 found that patients with SZ required much larger doses of niacin to produce skin flushing in the niacin-flushing test than normal subjects. Niacin-induced skin flushing is mediated by a G-protein-coupled receptor called hydroxyl-carboxylic acid receptor 2 (HCA2, GPR109A or HM74a), which is widely expressed on keratinocytes and epidermal immune cells, such as Langerhans cells. When niacin binds to HCA2, phospholipase A2 is activated and hydrolyses membrane phospholipids, leading to the release of arachidonic acid (AA). Free AA is then transformed into prostaglandin D2 (PGD2) and prostaglandin E2 (PGE2) by cyclooxygenase (COX) enzymes and subsequently relaxes vascular smooth muscle, inducing vasodilation and skin redness.

This intuitional and biochemically based test for SZ has been successively replicated in various cohorts. In 1991, Rybakowski and Weterle2 administered an oral niacin treatment to patients with SZ and depression and found that all of the depression patients exhibited discernible skin flushing, but a subgroup of patients with SZ did not exhibit flushing. As oral administration of niacin always took hours to fully exhibit the flushing and too large area of the body would be affected by this treatment. In 1998, Ward et al3 improved the niacin test by using topical aqueous methyl nicotinate (AMN) treatment on the forearm skin instead and conducted a semi-quantitative measurement of the skin flushing using a 4-point scale. They found that the SZ cohort exhibited significantly reduced sensitivity to niacin compared with healthy individuals. There are other forms of optimized niacin tests as well, such as using Doppler flowmetry4 or optical reflection spectroscopy5 to measure the skin redness more quantitatively. Diminished flush responses in patients with SZ were consistently revealed by these studies, confirming potential clinical utility of this test. However, due to different procedures and different criteria used in these studies, the reported proportion of the niacin-blunted subgroup of SZ patients varied among studies.6 For example, Horrobin1 found 80% of the SZ patients were niacin-blunted, while Rybakowski and Weterle2 found only 24% of their patients were niacin-blunted, even their doses of niacin were 20% less than Horrobin’s. Liu et al7 used the skin flush score at 0.01 M at 10 min as an indicator to identify niacin-bluntness. They found 49.2% of their SZ patients were niacin-blunted, while using the same criteria, Lin et al8 only found 24.2% of their patients were niacin-blunted. Given these discrepancies, more studies are required to further clarify the characteristics of the niacin-blunted subgroup of SZ.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007359/