Sunday, September 13, 2015

Every Person Is Created in God's Image

Keeping in line with the recent news from Spain regarding transsexual godparents that I posted about a few days ago, I was thinking about a conversation I had had with a transsexual on the com box of another prominent Catholic blog, Shameless Popery. The article itself is great, and I highly recommend it to anyone trying to understand more about transgenderism and how it relates to Catholic theology. Not to mention it will give you more background on our discussion. Through this, I got into a great, amicable discussion with a male who has had surgery to become, and live, as a woman.

As you'll see below, we both cite several studies and essays in our discussion. While we are both Christians, this person's Episcopalian faith leads one in a different theological direction as this person tries to rationalize transgenderism with Christianity. The main focus of our discussion stems from my question, (which I go into much greater detail as you will see) which can be summed up as:

"...why does the mental feeling of womanhood override what growth is happening, and is reflected, both outside the body and inside the body?"
Carl Heinrich Bloch- Christ and Child

As you'll see, the answer to this question has many mitigating factors, but once we reach the end of the dialogue, we will be able to see more clearly how the narrative in the media about "gender fluidity" is false and doesn't conform with God's plan for the human race. But let's keep in mind, it's good to have thoughtful dialogue with this, and it's good to know the position of those that disagree with us. That way, we can give intelligent, informed responses to their arguments. And we must always do so with gentleness and reverence, as St. Peter tells us.

My words will be in blue, and my opponent's in red:

First a disclosure…I am a male to female transsexual. I respect your beliefs but think a philosophical approach is unhelpful. It ignores the emerging science. Researchers are admittedly uncertain of the mechanism but are tending towards a biological cause of transgenderism. Some have studied brain structure and found that trans persons brains are more similar to those of the gender with which they identify than with those of their biological gender.

Others have focused on the human genome and found 53 genes that determine gender identity. They postulate that exposure to hormones in utero can cause a child to identify with a gender other than that of his birth. Bottom line is that no philosophical approach can change a genetically hard wired gender identity any more than such an approach could change the color of my eyes. So the only approach that has been found to bring some measure of comfort is to change my outward appearance. Some people accept me as a woman, others do not. All that is really important to me is that I do.

I agree that Genesis 1:26-27 has an important message. God created us male And female. Not male OR female.

He created us in His image and His image is a blend of both genders.

I do have a question for Melissa, and for anyone else reading this who would like to provide insight on this matter. I believe that your use of “and” as well as “or” are a bit confused here. Since, as it says in that important message of Genesis 1:26-27, that God created us male and female, that does not exclude God creating “males or females” as you said. Quite simply, God created males and females. Both are humans. If God is going to create a human, that human will be either male… or female. Yes, there are the cases of intersex humans, however this is an abberation of nature, an exception; not the rule. That is why you say , “He created us in His image and His image is a blend of both genders,” classical theists (as well as myself) do not understand that the same way you do. God is neither male or female, but he did create all humans (the male and the female) in his image. So we (humans) are NOT a blend of both genders. We are in the image of God, who has no gender, however, we humans WERE created with a gender.

I would also like to see the emerging scientific studies that you have mentioned; I am curious to see the research from the other side as well in this debate. As you say, researchers are “tending” to a biological cause for transgenderism. That is still a far cry from definitive scientific proof on the matter, therefore not invalidating studies that show the opposite occurring. Also, I think what you said here, “Some people accept me as a woman, others do not. All that is really important to me is that I do,” is completely indicative of what Joe was talking about when he brought up the “Wonderland view of language” that is so common across the spectrum in our culture. This has ramifications that extend far beyond the scope of the discussion of transgenderism, i.e., is there an objective reality?

This brings me to my question then: I don’t know your personal situation regarding your transition, but in the case of those healthy men that undergo the male-to-female surgical transition (such as Bruce Jenner), does the fact that the sex organs (penis, testes, etc.) still work with no problems, the fact that testosterone is present in that person, and that the body (the outward appearance and the bodily systems inside the body) has grown, and currently is, in a masculine form (i.e., a bigger physique then women), have any bearing on determining what the gender and/or sex of that person is?

Note that I am not talking about intersex people at all or those with abnormal chromosomes. I am strictly referring to healthy males (such as Jenner) that would’ve been perfectly fine fathering children (and had fathered children in the past) if a sex change surgery had not occurred. In other words, why does the mental feeling of womanhood override what growth is happening and is reflected both outside the body and inside the body? I realize this question can be turned around as to why should only biological differences account for the gender or sex of a person. I think we have to look at both the mental and the physical without ignoring the other, and it seems all too common today, at to least to me, that the physical signs of sex and gender are ignored and a higher premium is placed on what is emotionally and mentally felt, what surgical alteration have been made to the body, and on what is going on in the brain only. This is something I’ve been wanting to ask and articulate for a long time, because frankly, I can’t wrap my head around how so many people can place that higher premium on the mental feelings of a person over their biology without at least considering not throwing all biological arguments to the wind, as I have seen so often done, unfortunately.

I would also like to say that I respect your having opinions as well, and I post this question only out of hopes for dialogue and to understand more on a very tenuous subject that is coming more and more to a head in Western culture.

Ary Scheffer- Christus Consolator
Thank you for your questions. I will answer them as best I can. My purpose in quoting to Genesis was not so much to argue that we are all transgender or even that God made some of us transgender. It was more to point out that verses are open to interpretation. We read and interpret them in the context of our times. King James, in the 17th century, when he commissioned an English version of the Bible read and interpreted it in the context of his times as did the Catholics at the Council of Nicea in the Fourth Century A.D.

Many of the commenters on other sites, not so much this one, rely exclusively on the Bible to argue against the idea of transgenderism. An argument that is that shallow is one that does not carry a lot of weight with me because the Bible speaks to each of us in a manner and with a message that can differ.

When discussing issues of gender identity I prefer to leave the intersex issue out of it. Intersex persons have their own issues and when we appropriate the example of the intersex person to make our argument we are we are using them to advance our own cause, possibly at their expense. This is much like what Rachael Dolzeal is doing with her argument of being transracial and using the transgender community as her evidence that she should be considered black. Again, it is two different issues as I think you will see when you review the citations to the scientific studies I spoke about.

Now to the heart of the matter. Here is an article I cut and pasted from the internet that contains 15 studies and a reference to a site for many more:

Recently, Dr. Keith Ablow of the Fox News Medical A-Team dismissed any biological origins of gender dysphoria, stating:
I don’t believe we have definitive data (although many psychiatrists with very impressive credentials, who seem to mean well, assert that we do) that any male or female soul has ever in the history of the world been born into the wrong anatomic gender.
Let me put that more clearly: I am not convinced by any science I can find that people with definitively male DNA and definitively male anatomy can actually be locked in a cruel joke of nature because they are actually female.
One might ask, “So what sort of evidence is there that being transgender has some sort of biological origin, that indeed someone can be wired to be one gender, and physically another?”
Short answer: Lots. Here are 15 studies showing a biological origin of gender dysphoria.

1. “There is also evidence, albeit clinical, for a role of testosterone in the sexual differentiation of the human brain, in particular in inducing male gender role behavior and heterosexual orientation.” – Julie Baker, Focus on Sexuality Research, 2014

2. “…We conclude that there is sufficient evidence that EDCs modify behavioral sexual dimorphism in children, presumably by interacting with the hypothalamic-pituitary-gonadal (HPG) axis.” Winneke et al, Environmental health perspectives, 2013

3. “Gender-dependent differentiation of the brain has been detected at every level of organization–morphological, neurochemical, and functional–and has been shown to be primarily controlled by sex differences in gonadal steroid hormone levels during perinatal development.” Chung and Wilson, European Journal of Physiology, 2013

4. “Gender identity (the conviction of belonging to the male or female gender), sexual orientation (hetero-, homo-, or bisexuality), pedophilia, and the risks for neuropsychiatric disorders are programmed into our brain during early development. There is no proof that postnatal social environment has any crucial effect on gender identity or sexual orientation.” Swaab and Bao, Neuroscience in the 21st century, 2013

5. “Testosterone, estrogen and dihydrotestosterone are the main steroid hormones responsible for the organization and sexual differentiation of brain structures during early development.” Serkan Karaismailoğlu; Ayşen Erdem, Journal of the Turkish-German Gynecological Association, 2013

6. “In human males, we show that variation in fetal testosterone (FT) predicts later local gray matter volume of specific brain regions in a direction that is congruent with sexual dimorphism observed in a large independent sample of age-matched males and females from the NIH Pediatric MRI Data Repository.” Lombardo, et al., The Journal of Neuroscience, 2012

7. “Testosterone measured in infancy predicts subsequent sex-typed behavior in boys and in girls.” Lamminmäki, et al., Hormones and Behavior, 2012

8. “The finger length ratio between the second and fourth digits in transgender men was significantly lower than in female controls in the right hand in this study. 2D : 4D showed a positive correlation with GIS score. Because 2D : 4D influences are assumed to be established in early life and to reflect testosterone exposure, our results suggest a relationship between GID-FtM and perinatal testosterone.” Sasaki, Tsukamotoa, and Horie, The Journal of Sexual Medicine, 2012

9. “…growing evidence shows that testosterone exposure contributes similarly to the development of other human behaviors that show sex differences, including sexual orientation, core gender identity, and some, though not all, sex-related cognitive and personality characteristics.” Hines, Annual review of neuroscience, 2011

10. “There is strong evidence that high concentrations of androgens lead to more male-typical behavior and that this also influences gender identity. “Jürgensen, et al., Journal of Pediatric Endocrinology and Metabolism, 2010

11. “However, when the process of genital development and of brain sexual development does not match the same sex, females with a male brain and vice versa can arise. These transsexual people have problems with their gender identity and have the conviction of being born in the wrong body.” Worrell, Master Thesis, Faculty of Medicine, Universiteit Utrecht, 2010

12. “In this study, more than 150 individuals with confirmed or suspected prenatal diethylstilbestrol (DES) exposure reported moderate to severe feelings of gender dysphoria across the lifespan.” Kerlin, Paper prepared for the International Behavioral Development Symposium, 2005

13. “Secondly, as predicted twin girls where one displayed gender dysphoria had a more masculine pattern of cerebral lateralization, than non-transgender girls. These findings support the notion of an influence of prenatal T on early brain organization in girls.” Cohen-Bendahan; Buitelaar; van Goozen; and Cohen-Kettenis, Psychoneuroendocrinology, 2004

14. “It thus appears conceivable that due to local hormone dependent changes during development at least some areas of the brain may follow a different course than the genitals during the process of sexual differentiation. A partial or even complete brain-body sex reversal may eventually be the result.” Kruijver, Dissertation, Faculty of Medicine, University of Amsterdam, 2004

15. “Results support the notion that the gender identity is related to the sex steroid-driven sexual differentiation of the brain, and that certain genetic variants of three of the genes critically involved in this process, may enhance the susceptibility for transsexualism.” Landén, Doctoral Thesis, University of Gothenburg, 1999

The 15 studies listed above is a very small, partial list. V.S. Ramachandran has published a number of studies showing transgender individuals are wired to physically experience bodies of the opposite sex as well.

I’m not sure what would convince Dr. Ablow. It’s very unlikely that we will develop a “soul-o-meter” that measures the gender of a person’s inner essence. However, the body of evidence showing biological origins of gender dysphoria, of having a mis-matched brain and body, is overwhelming. Given his ability to ignore the evidence, perhaps Dr. Ablow should probably look at a board position with the Flat Earth Society membership. Or climate change denial. Either way, it gets him away from practicing psychiatry, a job for which he is obviously unqualified.
(A much larger list of studies can be found here.)
Follow Brynn Tannehill on Twitter:
Transgender Dr. Keith Ablow Transsexual Fox NewsResearch LGBT Medicine Keith Ablow

The evidence is admittedly not definitive. They all contain small samples. The largest I am aware of is one from Australia that studied 125 transpersons. If transgenderism were psychological in nature, like “transableism” then it is amenable to traditional psychotherapy. The studies cited above indicate that there is a physical cause. That cause may be in the genes. It may be in the structure of the brain. In any event, it is not one that can be cured by psychotherapy.

So, we have two possible models. The first is one that says that transgender persons suffer from a mental disorder and should be cured by what has been termed ‘reparative therapy”. This was the operative theory up until the mid-eighties. Transpeople were encouraged to get help to banish their feelings of being in the wrong body. This approach did not work. Yes, there are a very small number of persons who underwent the therapy and were cured. But they are a very small portion of the total that tries and I suspect they were not transgender to begin with.

Opinions began to change in the eighties. Then, in 2012 the American Psychiatric Association published the Diagnostic and Statistical Manual–5. (DSM-5) In it the APA acknowledged that being transgender was not a mental disorder. The mental disorder is being in anguish over the incongruence between biological sex and gender identity. This condition is Gender Dysphoria. The DSM directs mental health professionals that the treatment is to relieve the person of the anguish, not to try to remove the incongruence. This relief can come through counseling, hormones and/or surgery. The American Psychological Association and the World Health Organization concur.

Again, there are a number of different theories on the cause of transgenderism. The ones I find intriguing involve the exposure of the fetus to hormones in utero. There is a characteristic called the 2nd to 4th digit ratio. It compares the length of your ring finger to the length of your index finger. In men, the ring finger is longer than the index finger. In women the index finger is the same length as or longer than the ring finger. Now, there is a natural variance in this but it is very small–less than the variance for left hand dominance. We know for a fact, there is not question, no scientist will dispute this, that the reason for the difference in finger length is caused by hormones. If the fetus is exposed to testosterone the he/she will be born with a longer ring than index finger. If he/she is exposed to estrogen then the baby will be born with a longer index finger or the two fingers the same length.

A study out of Germany compared the 2nd to 4th digit finger ration in trans-women to that in cis-gender women and found that the frequency of occurrence of a feminine ration was the same. For me, my indes finger is longer than my ring finger. This means that I was exposed to estrogen in utero.

Another study found that there are 53 genes on the human genome that determine gender identity. My favorite theory, and I am not a biologist, is that those genes were exposed to estrogen and were “switched on” in such a way as to cause me to see myself as a woman.

So, I do not see transgenderism as a philosophical question. It is also not a mental health issue. The overwhelming weight of opinion by mental health professionals confirms this. It is a medical issue and a fact of life.

Let me leave you with this thought. I see myself as a woman. Someone who is color blind sees the world in shades of gray. I know that physically I am not a woman. A color blind person knows that there are colors in the world. Neither of us are crazy. We both have a physical characteristic that we deal with as best we can.

Here is a link to one more article you might find interesting. It is a review of a research paper by doctors at Boston Medical University that surveyed the available studies of transgenderism.

Oh…and one other thing…I provided you with cites to studies that tend to show a biological origin for transgenderism. Since science seems to be a recurring theme throughout this blog, will you please refer me to studies that show transgenderism is a mental disorder treatable by psychotherapy?

Thank you for taking the time to give me this information. In response to your view that Bible verses are open to interpretation, you are right to an extent. I’m not sure where you fall in the religious spectrum, perhaps Protestant? As Catholics, we believe that since Christ founded the Church, and gave the keys (earthly dominion) of that Church to his vicars, the Church definitively interprets the Bible to fit ALL times as the Word of God is timeless itself. However, I’ll leave it at that at this time as it detracts from the main subject matter here.

I agree that relying exclusively on the Bible to argue against transgenderism is weak. There are many other sources to consider, including scientific ones. I’m glad that you leave the intersex issue out of these discussions; it’s something I attempt to do myself, because of the reasons you stated. It’s better to focus on the specific situation (transgendered men and women) exclusively and save the discussion of very rare aberrations for another time.

As for the 15 sources you gave me, there’s some very good information here. I have to do more in depth studying, but as of this time, I don’t deny the fact that transgenderism has a biological origin. The studies you provided show that there is some evidence for that. My problem isn’t so much that I think gender identity disorder/dysphoria has to be either biological or psychological; whatever the cause, it goes back to my point that there are objective truths in nature all around us, including what goes on in our bodies. Yes, it’s entirely possible that, “Testosterone measured in infancy predicts subsequent sex-typed behavior in boys and in girls.” I’m not going to outright deny it, but what these studies don’t address is what DEFINES maleness and what DEFINES femaleness, much less what maleness is and what femaleness is.

There are certain things our culture ascribes to being a male or female. When I see what you pointed out in your 10th citation, “There is strong evidence that high concentrations of androgens lead to more male-typical behavior and that this also influences gender identity,” I can’t help but think to myself, “Well hey, what exactly is ‘male-typical behavior’, and who gets to make that definition?” In other words, if gender/sex can be fluid, what makes “male-typical behavior concrete, definitive, and set in stone? To me, this dissonance between the choice and fluidity of changing genders, and what is defined as male or female-typical behaviors is striking.

Something that is usually called “female-typical behavior” is the nurturing aspect a mother will give to her child. I’ve been told I’ve been very nurturing of my son, much more so then other fathers. I don’t like being “rough” with my son in a certain sense. I want to show him that he’s loved with embraces, kisses, etc. Many males don’t go this far, as I’ve seen by many males in my life and in loved one’s lives. This is why I question who is making these distinctions of what is male and female-typical behavior.

I also would like to take exception to your 4th citation. It reads, “There is no proof that postnatal social environment has any crucial effect on gender identity or sexual orientation.” I have also seen no definitive proof that social environment does NOT have a “crucial” effect (how they qualify “crucial”, I’m not sure) on gender identity or sexual orientation. By saying that there is no societal effect on gender identity or sexual orientation, we must then conclude that there is only a natural cause for it, and that has not been proven.

As Dr. Marc Breedlove, professor of neuroscience at Michigan State University said, “[My] findings give us proof for what we theoretically know to be the case- that sexual experience can alter the structure of the brain, just as genes can alter it. It is possible that differences in sexual behavior cause, rather than are caused by, differences in the brain.” 

There are many other studies showing that this immutability theory regarding one’s notion of their perceived sex/gender or their sexual orientation has no science to support it. There simply isn’t the empirical data for it. This is most apparent in those that claimed to have a homosexual orientation at one time, in adolescence. The National Health and Social Life Survey’s (NHSLS) study of sexuality found that “7.1% of the men [we studied, more than 1,500] had at least one same-gender partner since puberty… [but] almost 4% of the men had sex with another male before turning 18 and not after. These men constitute 42% of the total number of men who report ever having a same gender experience.” Dr. Jeffrey Satinover, who testified before the Massachusetts Senate Judicial Committee back in 2003 on this issue had to this say about the NHSLS’ study:

“Most of these [men in the study] will have identified themselves as gay before turning 18 and will have acted on it. But by age 18, a full half of them no longer identify themselves as gay and will never again have a male sexual partner. And this is not a population of people selected because they went into therapy; it’s just the general population. Furthermore, by age 25, the percentage of gay identified men drops to 2.8%. This means that without any intervention whatsoever, three out of four boys who think they’re gay at age 16 aren’t by 25.” For more on that study and for the source of the comments, check here:

The parallel I see here to those males who have transitioned to female, is that there are many documented cases where there has been regret in the sex change and that even after the sex change, those persons still feel depressed, or do not feel as fulfilled as they thought they would be following surgery. I can provide citations to those if need be.

So as you said, all of your sources are not definitive, but some of them are convincing. As I previously stated though, I don’t necessarily think that there being either a biological cause or a psychological cause dismantles Joe’s philosophical argument from Nature. There needs to be more studies and more empirical data on BOTH sides. So I think when you say that, “Yes, there are a very small number of persons who underwent the [reparative] therapy and were cured. But they are a very small portion of the total that tries and I suspect they were not transgender to begin with,”… I honestly think that’s a little disingenuous. You don’t have any scientific proof to back up your suspicion that these people were not truly transgender, so I think it’s best to give them the benefit of the doubt and take them at face value unless you have proof to the contrary.

Also, I do find the theories involving the exposure of hormones to the fetus interesting, especially this “2nd to 4th digit ratio”… but perhaps I find that one interesting for a different reason than you do. The index finger of my left hand is longer than the ring finger of my left hand. The index finger of my right hand is the same length of the ring finger on my right hand. It would appear that, I too, was exposed to estrogen in-utero. However, I am most certainly attracted to women, I am married to a woman, I identify as a male, and my male sexual organs work just fine. Perhaps this is where the variance comes into play, but nonetheless, this is one thing we share in common that has been shown to be a sign of gender identity disorder/dysphoria, yet we have ended up leading very different lives.

"The Hand"
Also, going back to a point you made early in your post, I don’t think that it’s fair that those who claim to be “transracial” or transabled” cannot fall into the same category as those that are transgendered. Up until DSM-V (5th edition of the Diagnostic and Statistical Manual of Mental Disorders) was released, gender dysphoria was called gender identity disorder. I don’t much about the “transracial”, as this seems to be something VERY new, but as far as the transabled go, who’s to say new research won’t show that there is a biological cause to what they suffer through, and that is NOT just psychological?

Up until three years ago, gender identity disorder/dysphoria was classified as a psychological disorder. If that can be renamed, and if gender or sex are just social concepts, effectively saying that men and women have no true physical existence, who is to say the concept we have of a “healthy” person is also not just a social construct or concept? If a transgendered person can have a mastectomy to become a male, why can’t a person who is capable of walking, one who identifies as a paraplegic since they feel their limbs are not right for them, receive a similar surgery by severing their spinal cord or amputating said limbs? Again, the logical dissonance astounds me. Especially since there isn’t much research on the transabled for LGBT persons to say with definite proof that said transabled persons don’t suffer a similar biological condition as is claimed by those in their (LBGT) community.

As for giving you studies that show transgenderism as a mental disorder treatable by psychotherapy, I found a few relevant studies, but the studies are very few, and the sample sizes are small, just as you said the studies you provided were. That’s why I think we need more studies on these subjects. As it says in the study I’m about to source for you: “There is scarce literature available on the provision of psychotherapy for individuals presenting with gender identity disorders. A National Library for Health literature search limited to papers on ‘transsexual’, ‘transgender’ and ‘psychotherapy’ of any modality yielded just 29 papers, most published over three decades ago.”

So here is what I can provide you that I found:

The Royal College of Psychiatrists: Psychotherapy for gender identity disorders:

I don’t agree with everything this study states, as it advocates sex reassignment surgery, but it does say that psychotherapy can be pursued by itself for people with gender identity disorder/dysphoria, and does not necessarily have to be partnered with sex reassignment surgery or hormone treatment.

John Paul II Institute for Marriage and Family: Gender Reassignment

So while I must disagree with you that transgenderism is not DEFINITIVELY a mental health issue, some of these studies you posted are enlightening. There is a lot that we must learn still, on both sides, but that doesn’t mean this discussion can’t be taken on philosophically. As much as I am a man of faith, I must also have reason intertwined with that. That’s why this issue of transgenderism is part of a bigger question as I mentioned in my first post; is there an objective truth or reality? You conceded you are not physically a woman, so my question from my first post still stands:

“…in the case of those healthy men that undergo the male-to-female surgical transition (such as Bruce Jenner), does the fact that the sex organs (penis, testes, etc.) still work with no problems, the fact that testosterone is present in that person, and that the body (the outward appearance and the bodily systems inside the body) has grown, and currently is, in a masculine form (i.e., a bigger physique then women), have any bearing on determining what the gender and/or sex of that person is?”

I do believe there is objective truth, so while I know there is no perfect analogy, I don’t think I can totally accept your analogy with those that are color blind as a good one. If we don’t determine our own reality, that is, if there is already a reality present that is binding on all creatures of the universe, I have to find myself calling what is black, black, and what is white, white. Granted, shades of gray exist, but that doesn’t exclude the definitive existence of certain things in the universe. 

Thank you for your very thoughtful post. I can see that you engaged in a great deal of research with an open mind. That is all anyone can ask. I will respond to your points as fully as I can.

First, I am an Episcopalian. I have heard us described as Catholics who flunked Latin. So, we share a lot of the same beliefs, though I think the Pope should have allowed Henry VIII to divorce Katherine of Aragon.

You talk about the nature of being male and being female. I wonder, how did you know you were male? Did your father tell you when you were a lad, “Nicholas, you are a boy”? And you said “okay”, and moved right along with your life. When my parents told me that, I knew they were wrong. This was at about age five.

I agree that gender-specific activities and behavior are largely a social construct. And, they are independent of the gender that you are. They are also irrelevant.

For me it is not a philosophical question. It is a fact of life. When I consider myself, I think of myself as female. I have since age 5. It is inconsistent with the existence of that pesky “Y” chromosome in my cellular structure, but it is true nevertheless. You ask if there are absolute truths. Yes there are and this is one of them. I am anatomically male but I see myself as female.

The next question then is why? I know intellectually that it is an inconsistency so why do I intuitively know, with every bit of certainty I have in my intellectual conclusion, that I am female?

It seems to me that there are three possible explanations. The first is moral. I am a sinner and fight the will of God because I am deluded by Satan. I reject this possibility out of hand and choose not to argue with people of a different opinion about it. The truth will come out on judgment day and I am content to wait until then.

The second possibility is that it is a mental disorder and amenable to classical psychotherapy. As you noted, the APA in DSM-5 disagrees. Being transgender (an incongruence between biological gender and gender identity) is not a mental disorder. Gender Dysphoria is experiencing extreme anguish over being transgender. This is a mental disorder and is treated with counseling then hormones then surgery. A bit more about that later.

The third possibility is that it is a result of a physical/biological condition. The weight of scientific inquiry from the last ten years is that this is the most likely cause. I agree. More research needs to be done. But, I am sixty one years old. I cannot wait.

This is what I know from my personal experience. I fought who I was for fifty years. I engaged in hyper-masculine activities to prove to myself that I was a man…that what I intuitively knew was nonsense. I played a lot of football in high school I attended an all-male very macho military college–The Citadel. I entered the Army as an officer and commanded a platoon of tanks. I ran a multi-million dollar business. I was a trial attorney. All of these are traditionally male activities.

In October, 2006 I was getting drunk every night. I was not sleeping. I was smoking heavily. I was stuttering. I had thoughts of suicide (I went on line and learned how to tie a noose, though it never really reached the point where I seriously considered carrying out my thoughts)

I realized that I needed to resolve this dissonance between my gender and how I saw myself or I was not going to see Christmas, 2007. I got into counseling.

As soon as I started talking about it with someone who was experienced in Gender Dysphoria, I felt like a weight had been lifted off me. She diagnosed me as having Gender Dysphoria and referred me to a physician experienced with transgender issues for hormones. I continued counseling for a year on an individual and group basis. My doctor started me on hormones and everything has fallen into place for me. I am happy and I am a lot more fun to be around. I do not believe I will need the Gender Affirmation Surgery to maintain the quality of life that I now enjoy.

I have fully transitioned as much as I need to. I live my life as a trans-woman. Some people see me as a woman and some read me as transgender. It truly does not matter to me because I am not fighting who I am. That has made all the difference.

I also know that there are some who have had the surgery and lived to regret it. I know that I have spoken of a very few and you have spoken of a number of instances. I do not know what your conception of a large number is when there are 700,000 of us.

Anyway, I think that a very large number of those who have lived to regret their decision were not trans to begin with. I say this because I am very familiar with what the Standard of Care protocol is for transgender persons. In the United States we have what has been called the Harry Benjamin Standard of Care which was named for the endocrinologist who formulated the SOC. It has since been adopted by the APA.

Remember, there are a number of different “flavors” of transgenderism. In addition to transsexuals (that’s me), there are drag queens. There are “fetishistic transvestites”, cross-dressers, gender fluid, gender variant, gender queer and there seem to be new ones popping up every two or three days. The only ones for whom Gender Affirmation Surgery may be appropriate are transsexuals.

The problem is that many transgender persons (transgender is the umbrella term for all of these various “flavors”) do not know what flavor they are. So, the first step in the SOC is to seek counseling with a mental health counselor experienced in transgender issues. After three months of weekly counseling the counselor can certify that you are a transsexual and refer you to a physician who is experienced in the care of transgender patients. She can prescribe hormones. Then comes the hardest part.

The candidate for surgery must live in the gender with which they identify for one year. That is 24/7. So, for me, I had to spend a year waking up every morning, put on make up, women’s clothing a wig and spend all day presenting female. Then, when I got home, change into a woman’s night shirt, go to bed and wake up the next day and do it all over again…365 times.

The intent of this exercise is to make very sure that you do indeed see yourself as that gender and are able to walk the walk. The ones who are most eligible for the surgery are the ones for whom this “Real Life Experience” was a piece of cake. It was for me.

Then, you get letters from two mental health professionals and your doctor and you are ready for the surgery. The problem is that this protocol is applicable only in the United States. There are plenty of physicians outside our borders, and probably some inside our borders, who do not require that these standards be followed.

I had a friend, Ally, who I first met in April 2012. She had the chiseled, classic, masculine features of someone you would expect would be a deep sea diver and a mountain climber. Ally was both. She had climbed the highest peaks on each of the continents except for one–Asia. And I have no doubt that she would have summited Everest except that the day before she began her ascent, she went deep sea diving (300 feet down) and got the bends when she started her climb.

Well, by October 2012 she had gotten breast implants, Gender Affirmation Surgery and full facial feminization surgery. Easily $100,000 worth of treatment. She was able to bypass the SOC because she had her surgery done in Canada. In May, 2013 she was found hanging in her garage.

Ally was a definite Type A++++ personality. She ignored her friends. She ignored the Standards of Care. Typical of Type A people she substituted her judgment on what was right for her for that of skilled professional’s and she paid the price for her hubris.

I believe this is likely the case for many who have felt post-surgery remorse. They are type A and they went forward with surgery because they diagnosed themselves as transsexual when they were probably cross-dressers. They went to Canada or Thailand for their surgery.

The source most frequently cited by those supporting a psycho therapeutic approach is Walt Heyer. I am not familiar with his entire story, but it appears he found a psychologist who ignored the SOC and referred Walt for immediate surgery.

Again, I cannot emphasize enough that the one year Real Life Experience is absolutely critical before you submit yourself for surgery that is irreversible. I believe it likely that if everyone who opted for surgery had strictly complied with those SOCs then you would see a much, much smaller number of persons who regret their surgery.

Walt Heyer’s story is not everyone’s story. It is not mine. It is tragic, but he acknowledges himself that he is a type A personality. Other stories he tells involve drag queens who had the surgery and regretted it. Of course they did. Drag Queens should not have the surgery. They are performers. They imitate women. They do not identify themselves as women.

That is really all I can think to write about right now. I have enjoyed the exchange. I wish you and yours all the best.

Grace Hudson- The Watermelon
Glad to see you are a fellow Christian! For what it’s worth, even though I attend a Latin mass sometimes… my Latin isn’t all that sharp either!

Anyways, as to your question on how I “knew” if I was a male… I don’t really recall having such a hypothetical conversation with my father at age 5. One reason I knew I was a boy was because I was addressed as such. I never had a desire to wear girls clothes, although I did play with Barbies on some occasions, and thought doll houses were cool for a short time because I didn’t have anything similar for my toys to play in. But through that, I still knew I was a boy. Another reason I knew, was because I had a penis. When I was 9, my dad told me about how sex worked. That year in school, we learned the basic of sexual reproduction in biology. I learned that males impregnated females, and this typically only happens once the male’s penis becomes erect. Since males of all ages get erections, and this phenomenon happened to me too, I knew I was a boy at age 10 in a different way. My little sister could not be a boy because she could not impregnate a woman. Perhaps I wouldn’t have articulated it in that way as a ten year old, but nonetheless, it is true.

Now, I’m glad we can agree that gender-specific activities and the like are mostly social constructs. So obviously, these behaviors and actions can be performed by either males or females; they’re independent of that gender, as you said. But you’re next sentence, “They are also irrelevant,” gives me pause. How? I don’t ask facetiously, but HOW can it be irrelevant, since the behaviors and actions of the male, for instance, are the same behaviors and actions the female who identifies as transgender desperately wants to emulate as they feel in every fiber of their being they are male?

Skipping ahead a bit towards the end of your post, you said this: “So, for me, I had to spend a year waking up every morning, put on make up, women’s clothing a wig and spend all day presenting female. Then, when I got home, change into a woman’s night shirt, go to bed and wake up the next day and do it all over again…365 times.”

Despite you saying gender-specific behaviors are irrelevant, it’s very clear here that such behavior ARE relevant to the transgendered person. Otherwise, why not identify as a female without wearing a wig and makeup? I just think it’s disingenuous to say it’s irrelevant, and then show a few paragraphs later how very relevant these behaviors and actions are.

Now back to the biological factors of one’s sex… I disagree with your assessment of “that pesky Y chromosome”. This is reducing your biological sex to a mere triviality, and it is much more than that if we are truly made in the image of God. Having that Y chromosome is a part of who you are, a part of who I am as well. To dismiss something so integral to your own being is a bit misguided, I must say.

I do like the three possibilities you’ve presented for your incongruence between your biological sex and your intellectual conclusion of seeing yourself as female. I’ll come back to that later. I see in your explanation, you’ve suffered a lot, and I am glad you aren’t having those suicidal thoughts anymore, But as you go deeper into justifying your transition, I have a problem once again with this comment:
“Anyway, I think that a very large number of those who have lived to regret their decision were not trans to begin with.”

This is a very, VERY big assumption. I realize the difference between transsexuals and transgenders. However, you are making a very broad claim with no real evidence. Remember all those studies you cited me in your previous post? Did the researchers take into account all this criteria. Were the people in these studies only transsexuals? Were some of them gender fluid, or some drag queens? I ask because you cite your friend’s suicide being due to the fact that A. They didn’t follow the SOC guidelines, and B. They weren’t truly transsexual, just as you claim Walt Heyer to be due to their Type A personalities. Unless you have evidence to the contrary, I think it’s pretty obvious that those studies included all the different types of people you listed under the transgender umbrella, not just transsexuals. So when you show me a study that says a trans-male’s brain looks more like a female’s, that must include the gender fluid, the transvestite, as well as the transsexual such as yourself.

Therefore, saying these people aren’t in the same boat as you, that they didn’t feel as strongly as you do right now that they were the opposite sex, is unfair. I think the reason that your friend, and many others in the transgender culture have these thoughts of suicide, yourself admittedly included, is found in this 2011 study by the Karolinska Institute in Sweeden. In this study, for, “…30 years—[the study]followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population.”

Now I understand that correlation does not necessarily imply causation. However, the data cannot be denied, and it would seem there is some kind of correlation between the depressing thoughts that many transgendered people feel, which could lend credence to the psychotherapy approach. These are reasons why I can’t dismiss people like Walt Heyer so easily. If I take you at face value (and I am), then I have to take them at face value to. They FELT in every fiber of their being that they were the opposite sex, just as you do. I see no scientific backing here to make me think they aren’t being just as honest as you are.

Now back to your three possibilities… I have to say I agree with your first and second scenarios. I know you said you wish to not argue with people who might choose your first option about going against God’s will, but something you posted later made me think. You said, regarding your friend: “She ignored her friends. She ignored the Standards of Care. Typical of Type A people SHE SUBSTITUTED HER JUDGEMENT ON WHAT WAS RIGHT FOR HER for that of skilled professional’s and she paid the price for her hubris.”

The capitalized part stands out for me. We agree there is absolute truth. We agree that your biological sex is male. We agree that you truly believe you are female. Where we disagree, is in how that immutable, absolute truth regarding our bodies is reconciled with what God has revealed to us. I feel like when you say that you have decided for yourself you are female, despite evidence to the contrary that you are male… this is doing something similar to what your friend did when she didn’t listen to the advice of those that knew better. Lots of times on the Internet, people forget they are talking to a real person on the other end. I realize you are a person, made in the image of God, and we are both united in Christ through our common baptism. That means something! That means we’re called to love each other, and when you see someone you love going down a path that might be “fight[ing] the will of God” as you said earlier, you should want to do something to help that person. So please, I hope you realize I say everything in my posts with the best of intentions, I truly mean that.

I know you’ve suffered for a lot, but I don’t believe that changing one’s gender is what God call us to do. To quote St. Paul, ““I rejoice in my sufferings for your sake, and in my flesh I complete what is lacking in Christ’s afflictions for the sake of his body, that is, the Church” (Col. 1:24)

There is good in suffering, and I try to offer up all my sufferings as best I can every day. I’ve taken a lot from our discussion, and I’ve learned much more about transgendered people, thanks to you. I hope that I sounded somewhat coherent through this, and I can only hope that your journey with Christ is fruitful. God bless.

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