There is a significant — and growing — body of evidence that medical transitioning is not good care.
There is a significant — and growing — body of evidence that medical transitioning is not good care.
T he U.S. Conference of Catholic Bishops Doctrine Committee’s recent statement “The Moral Limits to Technological Manipulation of the Human Body” has elicited some predictable wailing and gnashing of teeth among self-identified progressive Catholics. These critics complain that the document fails to take science seriously and overlooks the voices and experiences of transgender persons. In case we didn’t get that last point, Father James Martin, best known for his vociferous defense of half of the Church’s teaching on same-sex attraction (i.e., that such persons should be treated with “respect, compassion, and sensitivity”), tweeted out the story of a father of two, married for 29 years, who now identifies as a “transgender Catholic woman.”
What exactly did the bishops say or fail to say that has provoked such dismay?
Summarizing a basic tenet of Christian anthropology, the bishops note that the Church has always opposed “dualistic conceptions” that “do not regard the body as an intrinsic part of the human person.” Further, sexual difference is an intrinsic part of human embodiment and part of God’s plan “from the beginning” (cf. Gen. 1:27). Following Pope Francis, they note that we can distinguish the “socio-cultural role of sex (gender)” from biological sex rooted in the body — but not separate it (see Amoris Laetitia, no. 56).
On this anthropological foundation of the unity of body and soul, the Doctrine Committee overlays the principle of totality affirmed in modern church teaching. This principle allows technological modifications of the human body only in two cases: first, when the modification aims to repair a bodily defect, and second, when the sacrifice of some part of the body is necessary for the well-being of the whole (e.g., amputating a gangrenous limb). Chemical and surgical gender-transitioning procedures fail both tests. They aim to “exchange the sex characteristics of the patient’s body for those of the opposite sex or simulations thereof.”
That final phrase is key. Medical “gender transitioning” does not change a person’s sex — even on the biological level. Instead, it causes a person’s body to simulate the appearance of the other sex. Through a series of harsh and painful surgeries, a person’s genitalia are reconfigured to appear like those of the other sex, and his or her internal gonads are removed. Through cross-sex hormones (which a person will typically have to remain on for life), some of his or her genotypical sex characteristics will over time come to resemble those of the other sex. But a person’s basic body size, brain structure, and genetic sex are unchanged by these procedures. And even though the individual comes to resemble the other sex, he or she will never bear children, because transitioning leaves the person sterile. In short, while the suffering caused by gender dysphoria is real, the means used to treat it “must respect the fundamental order of the body.” Transitioning procedures fail to do so.
But, the critics object, what about the science? A review of the evidence suggests that the anthropology that the bishops point to is well grounded in scientific evidence. There is emerging evidence that off-label use of puberty blockers on children and of cross-sex hormones on adults carries significant health risks. Further, psychological outcomes do not improve for many people who transition. Rates of anxiety, depression, and suicide remain alarmingly high.
A recent study published in the British Medical Journal concluded that the standards of care used by the Endocrine Society, the American Academy of Pediatrics, and the World Professional Association for Transgender Health are not evidence-based. The so-called science behind medical transitioning as a treatment for gender discordance is anything but settled. For this reason, many countries — such as Finland, Sweden, France, the U.K., Australia, and New Zealand — are putting the brakes on these procedures for youth and adolescents. This is not because they have conservative religious assumptions; it is because they are looking at the science. They are looking at the evidence. And what the evidence shows is that patient outcomes from these treatments are bad.
But, the critics object again, if we take these options away from struggling young people, more of them may opt for suicide as a way out of their distress. In both individual settings and public debate, this argument can act as an emotional trump card, sweeping aside other objections.
It shouldn’t. Here, the evidence needs to be viewed even more carefully. There are significant data indicating that rates of suicide are higher for those who have gone through medical transitioning. A large peer-reviewed study by Sweden’s Karolinska Institute and Gothenburg University in 2011 found the rate of suicide attempts among those who have fully transitioned to be five times as frequent as in the wider population, and the rate of actual suicide to be 19 times as frequent. This was after adjusting for prior psychological illness and was conducted in what is by all accounts a trans-friendly culture.
The argument here is not about whether people struggling with the pain of gender dysphoria need care and compassion. They do. It’s about what constitutes good care that helps people flourish. There is a significant — and growing — body of evidence that medical transitioning is not good care. It creates a host of new physiological problems, leaving people scarred and medicalized for life. And for many people it fails to address the psychological pain that drove them to transition in the first place. This should be no surprise, because psychological distress is best treated psychologically — not medically.
While critics complain that the bishops have not listened to the voices of people who identify as transgender, they don’t realize that this argument cuts both ways. Such critics in turn have usually not listened to the stories and experience of those who have drunk the current medical cocktail of gender transitioning to its bitter dregs— the growing numbers of detransitioners. This oft-silenced group tells painful stories of people fully transitioning chemically and surgically only to find their gender discordance untouched and their bodies ravaged — sexual function greatly reduced, fertility destroyed, and even simple tasks like urination made painful and difficult. Returning their bodies to something closer to their original state, while it may bring some peace of mind, cannot erase all of what the medicalized self-harm has wrought.
Good treatment for the pain of gender dysphoria should indeed “respect the fundamental order of the body.” When we fail to do that, we unleash harm in ourselves and in God’s creation. The book of nature read with the help of science and the book of Scripture read with that of faith concur on this point. Of course, that should not surprise us — they have a common Author.