What's in a Name Part 2: In the Name of Gender

Apologies for the variations in font and spacing. Sometimes the computer makes up its mind for me on such things when I cut and paste text and/or quotations. I hope readers will find the research and content sound, even if the formatting is a bit off.

Gender “Transitioners”

In part one of this series, I discussed the relevance of names and noted with dismay the current practice among some youth who are casting off their birth names as part of a sociocultural trend that has developed over the last few years. This often occurs as part of an effort to change gender. A person attempting to change sex often refers to his or her birth name as a dead name, and asks acquaintances to refrain from using that name and henceforth substitute a new name of his or her choosing.

The idea of referring to one’s birth name as a dead name seems both harsh and antithetical to the self-esteem movement. If one’s name is dead, doesn’t it follow that one’s whole identity while bearing that name is dead as well? If one’s birth name is now meaningless, and the life an individual led while carrying that name spurned as inauthentic, such “broad brush” treatment represents a lot of years, experience, and even existence that count for nothing. With suicide numbers among youth ever rising, wouldn’t it be wise to reconsider encouraging members of this population to repudiate their former lives and identities? 

This practice of deadnaming ties into a bigger phenomenon which some young people are declaring malpractice – the “gender-affirming care” paradigm for gender dysphoria, which consists of chemically suppressing puberty, then administering opposite sex hormones, and ultimately performing gender reassignment surgery. A growing contingent of gender-affirming care recipients begs to differ with this protocol. 

"Detransitioners"

Rejecting one’s birth name to participate in a cultural trend seems but an extension of a larger rejection of a much larger entity – God Himself. If, as He claims, He fashions us in the womb, that creation would seem to include our gender. To refuse to accept the sex that He and He alone has a right to assign – without any help from the delivery team, despite the popular phrase “assigned female or male at birth” – seems a bold usurpation of divine authority. By rejecting birth gender, one is casting off one of the first and most fundamental gifts God has given. 

Furthermore, where is a person left if he or she later decides, as many do, to return to the name and gender of their birth? Experts agree the teen brain’s decision-making processes remain underdeveloped until the mid-20’s. Not surprisingly, therefore, a “detransition” movement among youth is gaining traction – young transitioners reverting back to their birth sex after undergoing varying degrees of gender-affirming treatment. Testimonies from individuals who have desisted from their transgender identities – many of whom started their transition journeys at very tender ages – include Chloe Cole, Laura Perry Smalts, Helena Kerschner, Walt Heyer, Sydney Wright, Oli London, Sophia Galvin, Scott Newgent, Soren Aldaco, Layla Jane, Prisha Mosley, Keira Bell and Ritchie Herron. Listening to their stories, one notices common threads in the lives of many who have undergone gender transition: heavy consumption of social media, past trauma, and comorbidities such as autism, anxiety, and depression. Given the uptick in lawsuits being brought by young detransitioners, is it a stretch to conclude that this population is falling victim to misdiagnosis at best or malpractice at worst?

Concerns to Ponder

Another question that ought to be asked in connection with the detransition movement centers around the mental and emotional status of individuals who have undergone gender-affirming treatment, then later desist from their new identities. Once someone has renounced his or her birth gender and identity as a cosmic mistake, wouldn’t it be logical for that person to feel very adrift upon renouncing the identity that was adopted to replace the original one? If both the old and new identities have proven unsatisfactory, wouldn’t it make sense to conclude there’s no hope?

Statistics would seem to confirm this conclusion. Sadly, this population is at greater risk of the ultimate expression of self-harm – which includes a higher than average percentage of suicide attempts and completed suicide. 

On that somber note, Lois Cardinal, a natal male who gender transitioned, is fighting for the right to receive “medical assistance in dying” due to unhappiness following transition. Although this scenario is playing out in Canadian courts, it’s important to realize that in the United States physician assisted suicide is currently legal in ten states and the District of Columbia. It wouldn’t be a far stretch geographically or philosophically for our country to emulate the scenario that is playing out with our northern neighbors. We must also remember that a transitioner in Belgium obtained assisted suicide “after a botched sex change operation… left him a ‘monster.’” I mention these stories at the risk of muddying the waters because assisted suicide is another outgrowth of the already tragically high self-harm statistics among the trans population.

It also makes sense to consider a seeming inconsistency being propagated by no less an authority than the National Institutes of Health (NIH), which is the source of the suicide statistics and definition of gender dysphoria linked above. This organization’s self-proclaimed mission is “to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.” This agency, an arm of the U.S. Department of Health and Human Services, condemns female circumcision as mutilation, yet endorses mastectomies and hysterectomies on healthy dysphoric women as gender-affirming care. The incongruity in these two positions seems obvious, yet many physicians who would never consider performing female circumcision are irreparably damaging young women’s bodies in accordance with the NIH’s misguided gender policy.

Physicians and Experts Question Gender-Affirming Care Among Minors

Thankfully, a broad group of physicians representing various specialties and not a few countries is sounding an alarm on the gender-affirming care model for treating dysphoria in young people. These entities cite a dearth of long-term evidence to support current protocols, particularly among minors. Dr. Armand Antommaria, “a professor at Cincinnati Children’s Hospital Medical Center, who serves as an expert witness for the LGBT groups… concedes that of the 28 recommendations in the Endocrine Society’s guidelines [for transgender care], ‘three are backed by moderate-quality evidence, fourteen are backed by low-quality evidence, five are backed by very low-quality evidence, and six are backed by no evidence at all.’”

Is it any wonder that psychiatrist Miriam Grossman urges the medical establishment to pump the brakes on hormones and surgery, and instead probe underlying issues and root causes behind a desire to change gender? Similarly, Dr. Lisa Littman’s research into the disturbing trend of “rapid onset gender dysphoria” among youth (most notably young girls) suggests a social contagion factor; this possibility ought to spur practitioners to thoroughly investigate young would-be transitioners’ full mental health profiles, as opposed to fast tracking minors into hormones and surgery. 

On an interesting side note, Dr. Littman draws a comparison between the socializing tendencies of young people with gender dysphoria and those suffering from eating disorders. She describes a ranking component (those with the most extreme conditions are awarded hero status, while those with less pronounced behaviors draw less recognition) as well as a teaching and modeling phenomenon (sufferers with more experience coach neophytes on ways to persist in the behavior instead of complying with treatment interventions). 

Given these similar patterns, one might ask if it is any kinder to affirm gender confused individuals than it is to agree with those experiencing eating disorders. Since both conditions can cause irreversible harm to patients, why are the treatment models so far apart? No reputable doctor would assist an anorexic patient with weight loss strategies, yet many whisk out drugs and scalpels when dealing with gender dysphoria. The difference seems to be the credence afforded to a patient’s self-diagnosis: with eating disorders, an objective standard (healthy weight guidelines) is contrasted with a patient’s self-perception of being overweight, and objectivity prevails when rendering treatment; with gender dysphoria, a person’s self-perception of having been born in the wrong body is accepted as fact, despite millennia of scientific understanding regarding gender being a fixed chromosomal reality.

When did the scientific community start subjugating objective health data to patients’ subjective beliefs about their bodies? 

More Voices

Dr. Jennifer Bauwens, a clinician who specializes in providing care for trauma survivors and teaches on this subject in several graduate programs, has also raised concerns about assisting young people to gender transition. Bauwens, who holds a PhD in clinical social work from NYU, testified before Congress this past July, stating that “compared to other psychological disorders found in the DSM V-TR, gender-affirming care is the most invasive and unnecessary physiological intervention connected to a psychological issue. Gender-affirming care is also in direct opposition to the basic practices of good mental health treatment.” Bauwens went on to cite the findings of UCLA’s Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy that “45 percent of transgender-identifying people reported childhood sexual abuse… 44 percent of transgender-identifying people reported childhood physical abuse… 75 percent of transgender-identifying people reported childhood emotional abuse.” Such soaring numbers ought to prod practitioners to probe and treat underlying factors that may contribute to a young person’s desire to change gender, as opposed to offering a one-size-fits-all gender-affirming protocol.

Jamie Reed, former case manager at Washington University’s Transgender Center at St. Louis Children’s Hospital, also advises against pediatric gender transitioning. Reed echoes the concerns about fast tracking treatment and ignoring comorbidities already mentioned. After four years in her position, Reed left the gender clinic, and now speaks out against gender-affirming care for minors.

The aforementioned list of practitioners calling peers to rethink the current model of gender care among minors is far from exhaustive. The Society for Evidence Based Gender Medicine (SEGM) describes itself as “an international group of over 100 clinicians and researchers concerned about the lack of quality evidence for the use of hormonal and surgical interventions as first-line treatment for young people with gender dysphoria.”

Lest the assertion be made that this issue is only troubling to conservatives, let the record show that many who question the wisdom of performing these procedures on children hold more progressive beliefs. Jamie Reed describes herself as “left of Bernie Sanders.” Dr. Julia Mason, pediatrician and cofounder of SEGM, is a “lifelong democrat.” Two parental groups that are “critical of the dominant paradigm regarding transgender politics and treatment” – Transgender Trend and 4thwavenow – refer to themselves as “left-leaning and liberal.” Gays Against Groomers, who identify themselves as “a nonprofit organization of gay people and others within the community” have joined the chorus of voices opposing “the sexualization, indoctrination and medicalization of children under the guise of LGBTQIA+.”

Clearly, critics of gender-affirming protocols for children fall on both sides of the political aisle.

Final Thoughts

The turmoil that must precede a decision to alter one’s body chemistry and appearance in an effort to conform to a perceived gender identity is beyond my comprehension – yet it is not beyond my compassion. As I have stated elsewhere, I believe many who are providing gender-affirming treatment do so out of a desire to help those suffering from the anguish of dysphoria. Nevertheless, it behooves us as a society to consider the long-term consequences of such well-meaning “care” and to heed the warnings of the many voices urging caution in this largely uncharted area.

That said, many contend that gender-affirming care for minors is intellectually dishonest and morally indefensible. 

Let’s take these one at a time.

A skilled physician may be able to alter a patient’s body and make it appear like that of the opposite sex, but no procedure can change the person’s chromosomal makeup. Since most of us aren’t geneticists, let’s compare this to something to which we can all relate – food. Suppose I declare a stalk of celery a mozzarella stick, and even make it look like one by encasing the vegetable in cheese. However, one bite will alert the eater that he is, in fact, gnawing on a crunchy, stringy veggie that is only dressed up to look like a gooey cheese stick. Also, the two foods contain different vitamins and minerals and metabolize in the body differently; regardless of appearance, the essence of the edible remains unchanged.

Is it any more accurate to assert that biological realities of gender can be changed than that celery can morph into mozzarella?

Secondly, gender treatment for minors is morally indefensible because of the immaturity of young minds. A case could be made that no one under age 25 should be a candidate for gender-affirming care, which would give the brain a chance to fully develop before making a decision of such magnitude; it might be an easier sell to pair the legal age for gender transitioning with the legal age for consuming alcohol (21), which would still be an improvement over the current state of affairs. At the very least, this risky treatment should be denied to minors.

The NIH, which we have referenced frequently throughout this discussion, combines these final points well. The NIH’s chromosome fact sheet asks, “Do males have different chromosomes than females?” The publication answers that question by stating that humans “differ in a pair of chromosomes known as the sex chromosomes. Females have two X chromosomes in their cells, while males have one X and one Y chromosome.” The piece goes on to explain that “serious problems” such as “mental disability…  impaired fertility… [or] kidney or heart problems” arise when variations occur in the numbers of sex chromosomes people inherit. Furthermore, in the NIH’s paper on benefits and risks of genetic therapies, the organization declares it “does not perform or fund studies on genome editing targeting sperm, eggs, or embryos in humans. These changes would be passed on to the patient’s children and could have unanticipated effects.”

In other words, the NIH acknowledges that underlying chromosomal differences exist between males and females, and in an abundance of caution veers away from attempts to alter those differences as they manifest themselves in reproduction.

Bottom Line

In a previous article on this topic, I stood with Martin Luther. Now I cast my lot with the brave detransitioners who are speaking out against the harm done to them by the silence and complicity of adults. These young people aren’t hiding behind pseudonyms as I once wished to do; they are facing the issue square in the face and speaking the truth. 

If adults won’t ally themselves with these young people, where can they turn? 

There’s a reason the silent majority is so named. There are precious few things in life that require individuals to rouse themselves and fight for what they believe is right. When such issues beckon, too many of us stand alone with our principles conveniently obscured by daily chores and obligations. I submit that few responsibilities are more pressing than pushing back against the gender identity movement which is threatening the minds, bodies, and futures of our kids. There is definitely a “Children’s Crusade” component to this fight, as so many young people who have suffered as a result of gender-affirming procedures are taking action to prevent the same thing from happening to their peers.

Will we leave them to battle alone, or will we sideline our fears and enter the fray alongside them? If we turn our backs on our youth who are looking to us for support, future generations will judge us just as they have other historical figures. Surely, we are called off the sidelines for such a time as this.

“Open your mouth for the mute, for the rights of all who are destitute. Open your mouth, judge righteously, defend the rights of the poor and needy.” – Proverbs 31:8-9