[This paper was written with a length requirement. Therefore. please observe footnotes. For the sake of length limitations, the footnotes provide not only citations, more detailed explanations are provided.]
WHAT IS GENDER DYSPHORIA?
Craig Kline M.D. emphasizes, “Gender dysphoria [GD] is defined as the ‘discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth.’”[1] Simple cross-dressing, transvestitism, attitudes and behaviors of the opposite sex, and gender-fluidity do not necessary fit this definition.[2] In other words, GD must cause the person a great amount of distress over their perceived predicament. Therefore, in approaching this sensitive subject, it is important to recognize mental and emotional distress require care. The born-this-way argument has produced an unethical-argument for many people to affirm gender reassignment surgery for persons distressed by gender dysphoria (GD). They believe they are alleviating GD persons from suffering. While representing their argument with care and compassion, I will conclude gender reassignment surgery as unethical, and argue for a biblical sexual ethic as the better alternative to alleviate distress associated with GD.
EMPATHY FOR SUFFERING ASSOCIATED WITH GENDER DYSPHORIA
Empathy is a key term in the current cultural movement for blind inclusion, as it were. A whole generation of persons within the LBGTQ…etc identifications are vocal about their horrid experiences concerning societal exclusion, a lack of empathy. Their concern, not only for their own future wellbeing in society, are laboring for change so that the next generation of LBGTQ…etc, may experience an accepting society. To argue against hormonal therapy and gender reassignment surgery as an ethical treatment for GD is to pose unempathetic. Michelle A. Cretella acknowledges, “The suffering of transgender adults was invoked to argue for the urgent rescue of children from the same fate by early identification, affirmation, and pubertal suppression.”[3] In agreement, Randi Ettner argues empathy is central to his supportive position for hormone suppressive medicines and gender reassignment surgery.[4] In light of this, much emphasis is now being placed on early intervention for children suffering due GD, namely, to prevent unnecessary distress from childhood into adulthood.[5]
BORN THIS WAY
The “born this way” argument is rather compelling, in theory. If we could prove without a doubt that people are born gay, whether that be brain plasticity,[6] effects of prenatal hormones,[7] proof that homosexual and heterosexual brain differences go beyond correlation to causation,[8] that homosexuality in twin studies moved further than correlation,[9] DNA research,[10] and other factors of research,[11] would change the foundation of sexual ethics. However, it is challengeable.
Correlation Does Not Equal Causation: “In a cause-effect relationship, the effect is unlikely to have occurred without the previous cause. No research to date proves a relationship like this exists between any biological or genetic factors and homosexual behavior.”[12] The born-this-way argument without concrete findings which prove causation for homosexuality nor transgenderism, sells fragmented correlations as a means to alleviate distress/suffering associated with GD. This alone is warrant for ethical red flags. Nevertheless, on the basis of correlation, medical science persists false-narrative to press onward with gender reassignment agendas. It should go without saying, one who believes in a concrete “born-this-way” argument in unfortunately misinformed. (Please take the time to view the footnotes.) There is a great deal in American media perpetuating hormone suppressive medicine surrounding “born this way” as conclusive, when it is not. Furthermore, it is paraded as the merciful (empathy), discourse of action. Is it really, though?
HORMONE SUPPRESSION AND GENDER-REASSIGNMENT SUGERY
Hormone Suppression: Ettner notes, “Transsexualism is considered by many to be a neurodevelopmental condition of the brain.”[13] Hormonal therapy “seeks to masculinize or feminize the opposite gender through the use of medications that suppress the native sexual hormones, and supplement the hormones of the opposite.”[14] To alleviate suffering, Ettner even supports hormone suppression in prepubescent children as a means to protect them from “a form of shame which results in a forced heterosexual decision.”[15] Even though there have been no sufficient randomized controlled trials to date which substantiate this claim, it is heralded as such (see footnote 14). Furthermore, there is, however, evidence and research that 80 percent to 95 percent of gender-dysphoric youth emerge physically and psychologically intact after passing through puberty without social affirmation (see footnote 3). Not only is there a lack plausible researchable evidence, there is wide-spread ignorance associated with hormone suppression risk.
Assessing the Risk: While hormonal suppression therapy advertises itself as an applicable treatment for postponing puberty in children, we must assess the risk.[16] Hormonal therapy in men include “increased venous blood clots and possible dislodgment of the clots that then may plug another blood vessel (such as in a heart attack, stroke, or pulmonary embolism), an increase in triglyceride levels, increased risk of cardiovascular disease and high blood pressure, and may contribute to the development of diabetes.”[17] The risk associated in women “include polycythemia (i.e., increased red blood cell counts in the blood), hyperlipidemia, and may contribute to worsening of psychiatric conditions, heart disease, diabetes, and high blood pressure.[18] Furthermore, Hormones do not have the ability to completely change a person’s biological sex to their desired sexual orientation.[19] And these risk come with the overwhelming reality of a lack of appropriate research given to the risk of the subject.[20] It is fair to speculate whether empathy is at play, or coercion toward voluntary experimentation is at work. Nevertheless, with no substantiated evidence, in the face of reliable research proving the horrible risk associated with hormonal suppression, proponents are advocating hormonal therapy as empathy without regard to any myriad of other subsequent mental, emotional, and physical health risk regularly experienced by patients. Ultimately, it is fair to question such an agenda as end means toward normalizing gender reassignment surgery for ethically acceptable treatment of Gender dysphoria.
Gender Reassignment Surgery: One’s like C.E. Roselli convince the general public with statements such as “Despite these limitations, the existing empirical evidence makes it clear that there is a significant biological contribution to the development of an individual’s sexual identity and sexual orientation.”[21] Meaning, to alleviate a patients GD suffering and distress, the patient must alter the cosmetic state of their genetic disposition, as it were. Essentially, if a biological male is GD the presence of their penis adds to their distress, and therefore must be surgically removed and altered to alleviate said distress and suffering. It must be stressed again, “Complete “gender reassignment,” or comprehensive transformation of one sex to the opposite, is impossible.”[22] However, several surgical techniques which produce genital mutilation and surgical operations for biological males to have a vaginal-opening, and for biological females to have a typically micro-penis attached, exists.[23] Not only must patients consider the fact that full transition by hormone and/or surgery is incomplete, there are other consequential risk.
Assessing the Risk. There is risk to “seek to provide functioning external genitalia to provide opportunity for intercourse.”[24] Male to female reassignment surgery risk a host of complications: “surgical site wound infections (more than 50% in one long-term study), massive bleeding, minor changes in urinary habits…, stricture of urethra (an abnormal scarring or tightening of the tube that carries urine out of the body)…fistula formation (abnormal connection of urethra to another organ, usually the rectum).”[25] In female to male it should be noted and worth considering, the complicated process for developing a small penis (phallus), “is not large enough for sexual penetration, and also may not allow a woman to urinate while standing up.”[26] One neo-phallus surgical technique “has a complication rate cited at over 40%.”[27] Overall, female-to-male reassignment often reports high satisfaction than male-to-female, however, while more than 50% suffer complications, most report an ability and satisfaction to “achieve orgasm.”[28] Immediate and ongoing complications with gender reassignment surgery are frequent and common. Hormonal suppression and gender reassignment surgeries may promise and even provide a host of psychological relief, the overarching risk associated with and experienced by patients deliver a host of other distressing issues. While I am certainly no scholar, after researching proponents for and against hormonal suppression and reassignment surgery, I cannot recommend enough: do not subject yourself to the experimentation of gender transitioning hormones and surgeries as a means to relive one’s distress for gender dysphoria. And yes, it is fair to say this is experimentation. I have provided, especially in the footnotes, citations to back this which come from persons who support such hormonal therapies and surgeries. The risk associated have far reaching consequences. While I do not wish to play down the awful treatment and experiences the LBTGQ…etc, community have endured-advocating hormonal therapy for children is an extreme. As an adult you are responsible to make such decisions. When 80 to 95 percent of gender-dysphoric youth emerge physically and psychologically intact after passing through puberty without social affirmation, one has to question the authenticity of medical proponents. One has to look at the force of narrative being pushed onto the cultural mindset. And while one’s experience may be marred by societal rejection and inability to understand what their struggle is like, it is a gross misconception to militantly propagate “born this way” arguments from correlations with unsubstantiated research claims. This experiment, in my opinion, will reveal consequential in the years to come. And although proponents for gender transition will gladly scoff and mock, the hope of gender dysphoric, notwithstanding many other challenging mental and emotional health issues of our day, will not find their empathy and relief without the help of the Holy Spirit, who is a proponent for God’s prescribed biblical sexual ethic.
CONCLUSION: A BIBLICAL ALLEVIATION OF GENDER DYSPHORIA
The great challenge of the church today is to remain biblically faithful, without simultaneously treating others as subhuman. Realistically, however, simply holding a biblical sexual ethic has already crossed the line. Feinberg conveys, “Anyone who even hints that homosexuality is immoral is branded an extremist.”[29] What does the Bible have to say about this? To this purpose we will examine the usage yāda’ in Genesis 19:5; the issue of cross-dressing in Deuteronomy 22:5; homosexuality in Romans 1:26-27; and briefly conclude with some thoughts on mind renewal in Romans 12:1-2.
Genesis 19:5: In chapter 19 one finds Lot and his family living in Gomorrah. Upon the arrival of two visitors to Lot’s house, many towns people show up to Lot’s house. In verse 5 we discover their intent is “to know” the two visitors. “To know” is derived from the Hebrew verb, yāda.’ Pro-homosexual supporters and born-this-way advocates love to emphasize the meaning of “to know” as anything but the condemnation of homosexuality.[30] Nevertheless, yāda’ is used as an euphemism with sexual connotation at least ten times in the Old Testament.[31] Moreover, though contested, if the all the local men wanted was to honor hospitality codes or ensure the visitors were good people, Lot would not have felt the need to offer up his daughters in their stead.[32]
Deuteronomy 22:5: 22:5 deals with God’s displeasure over cross-dressing. DeRouchie emphasizes, while “Deuteronomy 22:5 was not originally given to the church, it contains a portrait of God and a principle of love that can guide the church today when read in light of the finished works of the cross…This affirmed, Deuteronomy 22:5 becomes instructive for the church in helping us recognize the appropriate path for gender expression and the sinfulness of gender confusion.”[33] Cross-dressing is not the appropriate gender expression, biblically. And as noted above, simple cross-dressing and transvestitism, at this juncture is not seen as an associated distress to warrant GD diagnosis required for hormone therapy and reassignment surgeries. On to the new Testament…
Romans 1:26-27: The premises of Romans chapter-one is a set tone of humanity, which has given up the glory of God’s wisdom for salvation (vs. 16, 17), for the so-called wisdom of humankind (vs. 22, 23), and consequently, in our exchanging of the truth of God for our lie, God gave us over to writhe in subjectivity to our lies (vs. 24, 25). And now the immediate implication of the consequence of subjection to our lies, homosexuality became an extreme end of dishonorable passion in the futility of our ways (vs. 26-28). Subsequently, in what follows in verses 29-32, a vice list of the depraved mind which is subject to death. Feinberg centralizes homosexuality as the primary sin, conveying, “It seems straightforward and clear. Romans 1:26 deals with lesbianism, while 1:27 treats male homosexuality.”[34] To quote DeSilva, “The Gentiles, then, provoked God by refusing to honor God or show gratitude as God deserves. This leads to God’s diminishing of the ungrateful, causing them to forfeit their own honor as they are “handed over” to the darkened mind, the grip of ‘dishonorable passion.’”[35] Even if a born-this-way causation should ever emerge, which it has not, this does not contradict God’s sexual ethic. And just as God gave over sinful humanity to their propensity of adultery and debased minds, God is Lord even to restore one’s mind through salvation. And should one’s mind sustain a sexual deviation from a biblical sexual ethic, this does not make practicing the deviation an acceptable practice.
Romans 12:1-2: I.H. Marshall writes, “The practical response to the doctrinal teaching about the grace of God is a thank offering: believers must dedicate themselves to God and live in a new way, not dictated by this (sinful) world but by minds transformed by God.”[36] The mercy and grace of God for salvation, though free through faith in Christ requires actively walking in sacrificial obedience in partnership with God’s Word as a continual renewal and transformation of the mind. The concluding factor here lies in that it is a wrong assessment to assume the minds conversion to Christ is any riskier a treatable solution to GD than gender reassignment surgery. Afterall, real faith in Christ is a supernatural adoption into the family of God by regeneration.[37] Therefore, in congruence with Paul’s prayer in Ephesians 1:17-19, a prayer for the revelation of Christ Gospel to enlighten the eyes of our understanding. That those suffering with what is perceived as GD would day in and day out cry out to God for such a spirit of wisdom and revelation in the knowledge of him.[38]We have this hope and faith in Christ, and He still regenerates the unrenewed mind. My petition to the church is not to lower its standard of Christian sexual ethic, rather, let us respond graciously and biblically in the days ahead. With confidence that God still resurrects dead humans into the life of His’ kingdom love. Teach persons distressed by GD to trust in grace, to abstain from acting upon sexual impulses. And who knows, may the Lord have mercy on the darkest of minds.
In terms of mental health associated with societal acceptance and/or religious objection, I see two things as helpful: (1) the church has every right to object all sexual deviations from a biblical sexual ethic, and to do so, namely, as in regard to sin. Paul instructs the church to “Purge the evil person from among you.”[39]This is not an oversimplification to justify a type of Christian license for wrong behavior, it is rather a basis of protecting the church, and it is a much-neglected element of pastoral ministry. (2) While the church must certainly protect itself from this incursion, it must do so with Spirit wrought discernment. Many persons affected by GD are not necessarily militant in such a way as commissioned to destroy the church. There are those among them who are elect, meaning, they too are but knocking on the door for hope. And, notwithstanding, in the years and decades to come, there will likely be a great fallout of many persons who transition with hormone suppression and/or gender reassignment surgery. I believe the church will be a haven for post gender transition in the days to come. If the church is really good at protecting itself in such a means which is not prepared to take in and disciple those searching for hope in Christ in the days to come; we have a problem. Pastors, you have a commission to protect your flocks, and you also have a commission to fashion your church and its members to be a city on a hill, to be a light where darkness has previously devoured. Be wise as serpents, gentle as doves. Hormones and gender reassignment surgery are not the answer to human mental health; Christ is. And though it is not as simple as saying Christ is the answer, we must lean upon Christ alone for the road ahead.
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[1]Kline, Craig and David Schrock. “What is Gender Reassignment Surgery? A Medical Assessment with A Biblical Appraisal.” Journal for Biblical Manhood and Womanhood 20.1 (Spring 2015): 35-47. Kline notes, writing, “In America, candidates for sex reassignment therapies and surgery must meet this definition.” (Ibid., 36).
[2]Ibid., 36.
[3]Cretella, Michelle A. “Gender Dysphoria in Children and Suppression of Debate.”
Journal of American Physicians and Surgeons 21.2 (Summer 2016): 50-54. However, on the basis of “the fact that 80 percent to 95 percent of gender-dysphoric youth emerge physically and psychologically intact after passing through puberty without social affirmation refutes this claim,” she is speculative of exaggeration. (Ibid., 51, 52).
[4]Ettner, Randi. Stan Monstrey and Eli Coleman. Principles of Transgender
Medicine and Surgery. 2nd Ed. New York, NY: The Hawthorn Press, 2007. Pp. 227, 228. Print. Ettner cautions against naïve diagnosis, however, once a diagnosis is established, he fully supports hormone therapy and gender reassignment surgery within morality. (Ibid., 84-87).
[5]Ibid., 85. “The rationale for hormonal interventions in gender-dysphoric juveniles is similar to the one in gender-dysphoric adults: The indication is not based on traditional concepts of endocrine pathology, but rather is aimed at alleviating the tormenting condition of gender dysphoria.” (Ibid. 85).
[6]Branch, Dr. J. Alan. Born This Way? Homosexuality, Science, and the Scriptures.
Bellingham, WA: Lexham Press, 2016. Pp. 41-49. Print. Branch explains, “Brain plasticity refers to the manner in which the human brain builds new pathways between neurons and discards old connections. Research in brain plasticity is helping us learn how the brain adapts and changes in response to our experiences.” (Ibid., 41).
[7]Ibid., 50-65. “Born-this-way arguments often assert that particular patterns of exposure to prenatal hormones can cause children to be born with a homosexual orientation. In other words, the hypothesis is that gender and sexual orientation are prenatally determined by hormonal influences.” (Ibid., 51).
[8]Ibid., 66-84. Differences between the male and female brain has led many to research brain related data between heterosexual and homosexual brains. While fascinating, the research in inconclusive and certainly does not warrant the celebration given it by the culture. (Ibid., 66-84).
[9]Ibid., 85-92. “Put most simply, a twin study is a genetic study performed to determine the heritability of specific traits. Since identical twins (also known as “monozygotic twins”) share the same DNA, the assumption is that any major differences between the twins must be the result of other non-genetic factors.” (Ibid., 86).
[10]Ibid., 93-107. “Is homosexuality an innate trait like our skin color? Does our DNA itself code for same-sex attraction in the same way it codes for the color of our eyes? Attempts have been made in recent decades to discover a gene or genes which code for same-sex attraction. While twin studies attempted to trace the heritability of homosexuality via family histories, examining DNA itself is an effort to find a location on the human genome which codes for homosexuality.” (Ibid., 93).
[11]Ibid., 108-117.
[12]Ibid., 140. Branch. “No genetic sequence, biological structure, sequence of hormone exposure, personality temperament, or pattern of family history has yet been discovered which is both necessary and sufficient to cause homosexuality.” (Ibid., 140).
[13]Ibid., 227. Ettner. Ettner believes, “Genetic factors obviously pilot sexual differentiation.” (Ibid., 227).
[14]Ibid., 37. Kline reports, “No randomized controlled trials have been performed to date comparing different hormone regimes, and thus the individual regimes may vary.” (Ibid., 37).
[15]Ibid. 265.
[16]Ibid., 38. Kline. “Hormonal therapy for adolescents may have the goal of simply delaying the onset of puberty. This would allow the young person to explore their sexual identity prior to undergoing the irreversible sexual changes associated with puberty, such as the deepening of the male voice in response to testosterone.” (Ibid., 38).
[17]Ibid. 38.
[18]Ibid., 38. There are currently some researches leaning toward puberty suppression treatments as a harm to bone mass and brain development. (Ibid., 38).
[19]Ibid., 37. In men, feminizing hormones will “increase the proportion of body fat, decrease muscle mass, initiate breast enlargement, induce atrophy of testicles, create skin changes including softening of the skin, and decreased oil production, decrease libido and spontaneous erections, decrease sperm production, produce thinning and slowed growth of facial and body hair, and initiate male pattern hair loss.” (Ibid., 38). And in women, “masculinizing hormones will experience increased muscle mass and strength, a decreased proportion of body fat, deepening of the voice, clitoral enlargement, cessation of menstrual periods, vaginal atrophy, scalp hair loss, and increase in acne and skin oil.” (Ibid. 38).
[20]Ibid. 38.
[21]Roselli, C. E. “Neurobiology of Gender Identity and Sexual Orientation.”
Journal of Neuroendocrinology 30.7 (July 2018): 1-14.
[22]Ibid., 37. Kline. “No treatment may alter the genetic genotype, and sex-linked traits will always be expressed by the native genome.” (Ibid., 37).
[23]Ibid., 39-41. “Neo-vagina.” (Ibid., 40).
[24]Ibid., 40. “The most complicated step in male to female genitalia reassignment surgery involves creation of tissue resembling a vagina, or “neo-vagina.” Interestingly, the vagina may be fashioned from a segment of colon, as the colon lining is similar to the mucous lining of the vagina.” (Ibid., 40).
[25]Ibid., 40. “In a long-term follow-up study, 90% of patients were satisfied with their surgery and capacity for orgasm, but only 58% actually reported ever having sexual intercourse after their gender reassignment surgery.” (Ibid. 40).
[26]Ibid., 41.
[27]Ibid. 41. Of interesting note, “The labial skin may be enlarged, and implants resembling testicles can be inserted to simulate the male external genitalia.” (Ibid., 41).
[28] Ibid., 41.
[29]Feinberg, John S. and Paul D. Feinberg. Ethics for a Brave New World. 2nd Ed.
Wheaton, IL: Crossway Books, 2010. P. 308. Print. “Even more, many pro-gays believe they can prove that scripture doesn’t actually condemn homosexuality and lesbianism-at least not as we understand this sexual orientation and these acts today.” (Ibid., 208).
[30]Ibid., 312-324. Pro-homosexuality proponents point to a violation of hospitality code, or even a simple checking of the two visitors credentials for community safety purposes in hopes to dismiss any sexual connotation. (Ibid., 312, 314).
[31]Ibid., 314. “Baily says there are only ten uncontested uses of yāda’ with a sexual meaning in the whole OT (if 19:5, 8 are added, that would make twelve instances of sexual connotation.” (Ibid., 313, 314).
[32]Ibid., 314. Feinberg elaborates this connection of sexual connotation use of yāda’ between 19:5 and vs. 8. Yāda’ is used in both inferences, and the context clearly reveals the intended use of the word as sexual. (Ibid., 314).
[33]DeRouchie, Jason S. “Confronting the Transgender Storm: New Covenant Reflections on Deuteronomy 22:5.” Journal for Biblical Manhood and Womanhood 21.1 (Spring 2016): 58-69. While NT Christians are under NT law of grace, 22:5 finds meaning in its relationship to the overarching subject of sexuality within NT sexual ethic context.
[34]Ibid., 332. Feinberg. “Clearly, no one who takes Scripture seriously can afford to ignore or dismiss this passage as irrelevant to homosexuality.” (Ibid., 333).
[35]DeSilva, David A. An Introduction to the New Testament: Contexts, Methods & Ministry Formation. Downers Grove, Ill: InterVarsity Press, 2004. p. 608. Print. Furthermore, “Idolatry destroys the whole life just as the worship of the one God reinvigorates and restores life (Rom. 12:1-2).” (Ibid., 608.)
[36]Marshall, I Howard. A Concise New Testament Theology. Downers Grove, Ill:
InterVarsity Press, 2008. P. 125. Print. Furthermore, these commands are all moral commandments, and obedience by love is how to fulfil the commandment. (Ibid., 125).
[37]Grenz, Stanley A. David Guretzki & Cherith Fee Nordling. Pocket Dictionary of Theological Terms: Over 300 Terms Clearly & Concisely Defined. Downers Grove, Ill: InterVarsity Press, 1999. P. 101. Print.
[38]ESV. English Standard Version. Wheaton, Ill: Crossway, 2001. Print.
[39]Ibid., ESV. 1 Corinthians 5:13.