Who Am I?: Thinking through Transgenderism – Part 2: The Science

Continues from Part 1

When ‘All of Us’, a document devised by the Safe Schools Coalition, was released in 2016, it propelled the issue of transgenderism into the Australian public sphere. No longer was the topic framed around a former athlete located on the other side of the globe, but rather about materials, of which ‘All of Us’ was just a part, which were intended, or at least hoped, to be rolled out in classrooms across the nation. While officially, it was classified as an ‘anti-bullying’ resource aimed to combat violence against LGBTI in schools, it advocated nothing less than, according to one chief proponent, the dismantling of heteronormativity.

Interestingly, despite the stated aim behind the development of these resources being about helping teachers communicate the viewpoint that gender is no longer to be defined by an archaic understanding, there is little evidence or explanation within their pages supporting why this ought to be the case. Instead, this new redefinition of gender is assumed and advocated to be correct; the lack of supporting evidence, contrary to being an accidental omission, simply epitomises this new dynamic – where evidence is subordinate to assumptions of desire.

Assumptions are, after all, one of driving notions undergirding transgenderism. An assumption that one is in the wrong body, that they are better off in the body of the opposite sex, and an assumption that an individual must be supported in conforming to their own assumptions. Yet, do these assumptions hold up in front of scientific scrutiny? Does the data support not only that individuals may be in the wrong body, but that assisting them conforming to their preferred sex is beneficial?

The Science Behind Transgenderism: does it hold up?

Before I continue, it is helpful to again emphasis that transgenderism is an umbrella term which usually denotes those who either exhibit gender characteristics which strongly vary from their own biological sex or those who may undergo notable dissonance due to the perceived difference between one’s biological sex and one’s gender identity. This term, then, could be used to describe transsexuals, those who identify as genderless, those who cross-dress, and sometimes, through infrequently, those who are intersex.

The most common, and related, medical diagnosis concerning transgenderism is Gender Dysphoria.^[1]Although, it should be noted, not all who would identify themselves as transgender would meet the diagnostic criteria of the disorder. A diagnosis previously, and aptly, labelled as Gender Identity Disorder.^[2]This reclassification undertaken in the fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) in 2013 seems to have been done to avoid offense and stigmatisation of those … Continue reading Gender Dysphoria is when an individual is in significant distress due to being biologically different than the gender they identify as. Often, it has been summed up as “I’m in the wrong body, I am really a <Insert preferred sex here>“. It effectively means that there is a psychological and biological variation which has led to an internal conflict between how one identifies themselves as, and who they biologically are. As such, due to this disconnect, one suffers an extreme sense of displacement – which can, and often does, lead to a deterioration in mental health – with depression or suicidal thoughts being the norm. Whilst, 1 in 300, or 1 in 500, people feel some sense of psychological deviation from the traditional gender norms, it is only about 1 in 10,000 or 1 in 30,000 people that experience the high level of distress caused by the conviction that they really are the opposite gender to the body they were born into.^[3]Kenneth J. Zucker et al, “Gender Dysphoria in Adults” Annual Review of Clinical Psychology, vol. 12 (2016):217-247

Gender Dysphoria was identified as Gender Identity Disorder precisely because of this displacement, and was considered a form of body dysmorphia – a mental condition where people are convinced that their body is injured, deformed, or wrong in some way, while their body is observably healthy. It was seen as an ‘assumption disorder’, in that there is a disconnect between their subjective assumption (i.e. who they perceive themselves to be) and the physical reality. This is not dissimilar to disorders such as Bulimia Nervosa – where one thinks they are too fat, despite the fact that they are dangerously thin; or Hypochondriasis, where an individual has a debilitating anxiety about their health despite evidence to the contrary. However, where once gender dysphoria was treated by Psychologists as a disorder which, like the others, needed to be treated through the leading of individual to the understanding of the physical reality, or ‘objective’ truth. It is now treated through the affirmation of the individual’s preferred gender through hormone therapy, gender expression and role, or surgery.  This, of course, creates a logical inconsistency in treatment between Gender Dysphoria and other disorders of ‘assumption’. With the other, similar, disorders, such Bulimia Nervosa and Hypochondriasis, we assume that the objective reality of the person’s body trumps their subjective anxiety. But with gender dysphoria it is now assumed the opposite – it is no longer seen as a disorder but rather something to be affirmed. In all three cases, the person’s internal conviction is opposed to objective physical reality. Why do we assume we should affirm one and treat the others? Where do we draw the line? It becomes progressively difficult to logically be able to do so.

However, this shift and change in thinking in the treatment of those who struggle with gender dysphoria is not necessarily because such treatment is effective in helping these people manage their distress. Rather, there has been research conducted in the United States, Australia, and several countries in Europe. which all evidence that treatment through the affirmation of one’s desired gender, including surgical treatment, does not necessarily lessen the psychological distress, which remains just as prevalent for those who underwent surgery, as for those who did not.^[4]Henk Asscheman et al, “A Long-Term Follow-Up Study of Mortality in Transsexuals Receiving Treatment with Cross-Sex Hormones,” European Journal of Endocrinology, no. 164 (2011): 635–642; Cecilia … Continue reading Likewise, there has also been some studies which show that those who struggle with gender dysphoric feelings have a heightened risk of also having certain other mental disorders, not limited but including, eating disorders. There hasn’t been any conclusive proof that helping individuals who wrestle with their gender identity through the affirmation of them, or through surgical intervention, helps get through the distress that they feel. Sadly, the research also indicates that those who have made had sex-reassignment surgery still have a higher than average mortality rate.^[5]Ibid; Pandya A, “Mental Health as an Advocacy Priority in the Lesbian, Gay, Bisexual, and Transgender Communities.” Journal of Psychiatric Practice, no. 20(3) (2014): 225-227; DM Skerrett, K … Continue reading

It is because of similar results that Dr. Paul McHugh, the former psychiatrist-in-chief at Johns Hopkins Hospital, which was the first American medical centre to venture into “sex-reassignment surgery” stopped such surgery.^[6]Paul McHugh, “Transgender Surgery Isn’t the Solution” The Wall Street Journal (13 May, 2016): https://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120 Because, even though many patients described themselves as satisfied with the surgery, subsequent psycho-social adjustments were shown to be no better than those who didn’t have the surgery.^[7]Ann P. Haas et al, “Suicide Attempts among Transgender and Gender Non-Conforming Adults” American Foundation for Suicide Prevention. 2014 So, it is demonstratively clear that the treatment of those with gender dysphoria by affirmation is inconclusive at best. Indeed, there are plenty of stories of those who have surgically transitioned who regret their decision to have done so. Indeed, from research available from both the United States and the Netherlands, it has been argued that at least 20% of individuals regret the surgery that they’ve undertaken; and reversal surgeries are steadily on the climb.^[8]Miroslav Djordjevic et al, “Reversal Surgery in Regretful Male-to-Female Transsexuals After Sex Reassignment Surgery” The Journal of Sexual Medicine, no 13(6) (2016); Olivia Peter, “Gender … Continue reading

Yet, tragically, it is becoming increasingly easier to undergo the path towards transitioning. Adults struggling with Gender Dysphoria can now see a doctor and be helped in slowly transitioning to their preferred gender. However, the issue is overwhelmingly problematic when it comes to Children, which, while there is some form of regulation, is not tightly monitored nor are children necessarily screened as thoroughly as they ought. Indeed, a few years ago, I had the opportunity in speaking to a leading, secular, clinical psychiatrist who operated one of Australia’s most reputable clinics in this field. She purported that theirs was one of the few to properly screen children against the stringent diagnostic criteria for Gender Dysphoria. However, many medical practices, they stated, do not – and it is very easy for children, as young as four, to be treated as having gender dysphoria and be eventually prescribed what is known as puberty blockers, which as the name implies halts the onset of puberty before looking at the surgical options.

Yet, when such decisions are permitted to be made by children, we seem to forget that they, and also teenagers, are in a stage of development, and lack the cognitive capacity to make and rationalise decisions like adults. Often lacking the intellectual capacity of thought for consequences.^[9]Kornelia N. Balogh et al, “Risk-Taking and Decision-Making in Youth: relationships to addiction vulnerability” Journal of Behavioral Addictions, no. 2(1) (2013): 1-9 This is the why criminal justice systems in the West treat children and adult offenders differently: children do not think like adults and are tremendously more likely to make decisions which are immature or brash. Yet, an inconsistency forms when we assume that on one hand, children are unable to comprehend the ramifications from their decisions when they commit a crime, but that they can understand the implications of changing gender.

It’s absurd to assume that we should treat children not as children, but as much more mature decision makers, regarding this one subject. Affirming this kind of conviction while children are still undergoing considerable psychosexual development is tantamount to recklessness – especially as such feelings of distress may not be held in a consistent fashion throughout childhood. A study, released earlier in 2016, concluded, after reviewing several follow-up studies of children with GD, that “gender dysphoric feelings eventually desist for the majority of children with GD”.^[10]Jiska Ristoria and Thomas D. Steensma, “Gender Dysphoria in Childhood” International Review of Psychiatry, no. 1(28) (2016): 13-20 Only a minority of children who struggled with some semblance of gender dysphoria actually persisted past childhood. Thus, to affirm the subjective conviction of children who may, temporarily, identify as the opposite gender is likely to be detrimental to their psychosexual development, if not outright harmful through the encouragement of them to disconnect from their objective, anatomical, reality.

As to what causes gender dysphoria – there is too little research available. Whilst, one of the most prevalent theories is the brain-sex theory, that those with gender dysphoria have the ‘brain’ of their preferred gender as opposed to one that ‘fits’ with the rest of the body. The research is tentative, and some of the methodologies are questionable.^[11]One of the main issues, and largest criticisms, concerning the ‘brain sex’ theory is that the originating research which sought to demonstrate that certain men who suffered Gender Dysphoria had … Continue reading It does, however, leave open the possibility that transgender identity might have some as-yet-undiscovered neuro-biological cause.^[12]There are other potential theories which abound, autogynephilia being one such possibility. At the end of the day, we don’t entirely know – research continues into gender dysphoria, and its cause or causes are a long way from being fully understood.

Ultimately, despite the general lack of supportive evidence, the advancement of the notion that gender fluidity is something to be embraced, and those considering crossing the gender divide ought to be encouraged, is being intensely promoted within the Western media as the only correct approach. Such advocacy, combined with the ceaseless lobbying by the LGBTI community, has not only helped to sway many in the more sympathetic political parties, but has meant that this new assumption regarding gender is becoming entrenched within the psyche of the everyday person. Consequently, cases of children being referred to paediatric hospitals have escalated rapidly as children are now questioning their gender identities at earlier and earlier ages, and parents are under the assumption that the best thing they can do is to be supportive of such questioning and, eventually, transitioning if required.

It cannot be stressed enough that those who suffer from gender dysphoria do experience significant and genuine distress, yet such assumptions, presented within society, regarding approach and treatment simply do not hold up to scrutiny. Whilst this psychological distress needs to be legitimately affirmed and needs to be treated^[13]Like many others, I think it is beneficial not to adhere to too rigid a structure of ‘gender expression’. This is not to deny biblical notions of ‘masculinity’ and ‘femininity’, but to … Continue reading; It needs to be understood and undertaken in a way which is consistent with Scripture. Subsequently, in the next part, I will endeavour to present such a framework to demonstrate that gender, as opposed to its supposed ‘fluidity’, is not only an important part of God’s creation, but that God, in his manifold wisdom, utilises gendered language to speak about redemption of humanity to himself.

Continues to Part 3

Written for and published in Evangelical Action.