Some years ago, at a conference on the Wheaton College campus on the life of Malcolm Muggeridge, I met Dr. David W. Virtue. David is not only became a friend but he has provided marvelous resources for me on issues within the Episcopal Church (USA). His regular posts are available at www.virtueonline.org. If you are an Episcopalian, or perhaps you are just interested in hearing an orthodox voice from within the present meltdown of this historic church family, David is your man. He collects articles and news reports and writes some truly remarkable stuff.
Though I was a bit surprised by a recent post of David's I found it provocative and insightful. This subject is almost never discussed by Christians. In the midst of the same-sex debate that now rages in the church-at-large David addresses a subject here that is often wrongly linked to the angst many feel about ecclesial approval of homosexual practice. I now reprint (with David's permission) the August 28 account he put on his site.
Little did I know what was in store for me when I accepted a lunch invitation from a VOL reader whom I had never met. Soon, I found myself seated at a nearby Chinese restaurant, opposite a lady who proceeded to tell me that she is a transgendered person.
Specifically, she believes she was born with a condition called gender dysphoria, commonly known as transsexualism. I have never had an in-depth, face-to-face conversation with a person who had had a sex change operation, a person who was once a man and is now very much a woman. This may well be a once-in-a-lifetime experience for me.
I won't lie to you. Unless she had told me, I would never have guessed that she was not born a woman biologically or that she had ever appeared to be a man.
The lady in question, whom we shall call M, as she wishes to protect her identity, is tall, of German American origin, an attorney who had worked for a number of high level financial firms. She had been married, raised two sons and is now divorced.
She described herself as an orthodox Anglican believer; she has had both evangelical and charismatic experiences, is a Cursillo graduate, and now considers herself part of the Anglo-Catholic wing of the church.
She said she has been reading VOL for a number of years and did not regard me or my writings as homophobic. She wrote me asking to meet with me regarding what she sees as a serious confusion in traditional Anglican circles regarding the differences between homosexuality and transsexuality.
Whatever you think of what M has to say in response to questions we posed to her below, we believe you will find her remarks intelligent and thought-provoking.
Chiefly, M asserts that, in a gender dysphoric individual, the person's biologically determined sex is different than the gender that person perceives himself or herself to be. And although psychological factors are involved in that perception, current science suggests that the causes for gender dysphoria are likely significantly physiological – i.e., that gender dysphoria is like a "birth defect," which is "a medical condition," M said.
Still – and this is important – she is not using that as any sort of excuse. M, who cares for her aging mother, says is living a celibate life, believing that, being single, that is the path she is called to follow in obedience to Holy Scripture.
Yet she has been tossed out of two churches, one Episcopal the other Anglican, when she told the pastors of her sex change. I found the actions of these priests shocking. As someone living a single and celibate life – not someone who was publicly challenging church teaching – M posed no threat to the church. No one in either parish knew her secret. The fact that any cleric – including one whose church constantly touts its inclusivity – would show her the door is reprehensible.
On a personal note, I found M very forthright and forthcoming in her answers to me over lunch. I was curious but not remotely threatened by her and apparently she was not threatened by me. As an evangelical I find nothing in Scripture to support what she has done to herself, but then I have never struggled with sexual identity issues. M agreed to answer some hard questions about what she had done and how she squared this with her being a Christian and with Holy Scripture.
VOL: Would you please explain to our readers what exactly a transgender person is?
M: The term "transgender" is a relatively recent invention, an attempt to gather under one umbrella all those whose current gender identity does not mesh with their gender assigned at birth. See Wikipedia for a more detailed description: http://en.wikipedia.org/wiki/Transgender. As with any large group of people, there are many different subgroups included within the "transgender" moniker.
For purposes of our discussion, these include both political and religious conservatives and liberals. Just because the liberal GLBT groups get all the press, it doesn't mean that there is not a larger, silent group of more traditional transgender people out there. I do not like the term "trans gender" because I believe that it is over-inclusive; it brings together too many people with too many different issues, related only by the fact that these issues have to do with gender.
Since my own specific issue concerns gender dysphoria, commonly known as transsexualism, I will try to limit my comments to that. Again, I would refer interested readers to Wikipedia: http://en.wikipedia.org/wiki/Transsexual.
VOL: How did you know that you were transsexual? When did you find out? How did you handle what you discovered?
M: I only put the name to my situation about 10 years ago. However, I've always known that I was different. Growing up male in a traditional Christian family, I always knew deep inside that I wasn't the same as other men. I never fit into the club. In retrospect, I can see that my behaviors and language were more feminine. I started cross-dressing by the age of 7, well before puberty (so there was no sexual attraction involved, as there is with transvestites).
It made me feel better somehow, a more complete person. But as I grew up, I did all the "right" things, all the traditiona
l "male" things th
at were expected of me – college, law school, marriage, children, church volunteer, professional jobs, climbing the corporate ladder – yet that feeling never went away. I learned to hide the real me, to pretend to be someone that I was not. As I got older, pain of living a lie got stronger. Something was wrong inside me.
About 15 years ago I began to search for what might be wrong, and I learned about gender dysphoria. While it was a great relief to put a name to the symptoms that I had carried for most of my life, it was also extremely painful to realize that I carried a medical condition with severe social consequences: job loss, ostracism by friends and family, condemnation by that part of the Church I respected the most, lack of legal protections that others take for granted.
Nevertheless, I wanted to become healthy above all else, and I also believed that the Lord wanted me to be healthy. So I accepted the consequences as the cost of the solution. It's not always been easy, but I am now at peace with myself and the Lord, and that's no small thing. That alone was worth the price.
VOL: You said, over lunch that sex is what goes on between your legs, but gender is what goes on between your ears. Would you care to elaborate on that?
M: The comment that "sex is what goes on between your legs, but gender is what goes on between your ears" is a shorthand comment for distinguishing what I believe is a crucial concept in our discussion, the difference between biological sex and gender.
Biological sex refers to sexual characteristics (genitalia and breasts) and chromosomes.20It's generally how we classify people in our scientifically-oriented, dualistic western civilization. Like many classifications, however, it isn't completely accurate.
Modern science has shown us that it is overly simplistic, as variant chromosomal patterns (i.e. XXY) and ambiguous genitalia (i.e. intersexed individuals) are not as uncommon as many people think. Gender is an entirely different issue though we sometimes use the two words interchangeably.
It is a newer concept introduced by medical and psychological research, referring to how one perceives him or herself, whether we see ourselves as male or female. Gender resides in our inner selves (probably in that part of the brain called the hypothalamus) and is part of the essence of who we are. It is not quantifiable by any means we currently possess (other than through self-identification); though clinical studies of fetal development, brain structure and function, and our endocrine/hormonal systems do provide hope that this may change in the future.
The only external means of evaluating gender of which I am aware is the Minnesota Multiphasic Personality Inventory (MMPI). It is a test administered by trained professionals to assist in identifying personality structure and psychopathology. When used together with counseling, it can help to confirm gender in an individual, regardless of biological sex.
You'll find a discussion of the MMPI here: http://en.wikipedia.org/wiki/Minnesota_Multiphasic_Personality_Inventory. But, and here is the core of the issue, both sex and gender seem to be determined by specific (though different) physiological events.
Determination seems to occur during the 6th through 12th weeks of fetal development, with the activation of different hormones for the development of the body for sexual characteristics and the brain for gender characteristics.
Current studies seem to indicate the possibility of a hormonal/endocrine causation to gender dysphoria. Another possibility may be the effect of environmental chemicals on fetal development.
There's even a suggestion of a genetic influence. However, all this is extremely tentative, since the studies have just begun about 10 years ago. For those who are interested, here are links to the studies, though you can also Google them:
Unfortunately we don't know for sure what causes gender dysphoria, we just know that it does occur, that it is more common than most people think (between 1:5,000 and 1:25,000 individuals, see http://ai.eecs.umich.edu/people/conway/TS/Prevalence/Short%20summary%20re%20Prevalence%20of%20Transsexualism.html for details) and that it is most likely of physical origin.
The best way to think of it is as a birth defect. In other words, it is a medical condition. Neither sex nor gender has anything to do with sexual attraction or sexual orientation. Gender-variant individuals may be either heterosexual or homosexual.
VOL: The Episcopal Church has endorsed LGBT behavior and that includes transgender behavior. Do you agree with that decision?
M: Firstly, let's be clear that there is no such thing as "transgender behavior". Transgender, by definition, has nothing to do with behavior. It has to do with who one perceives oneself to be.
Secondly, and to the point of your question: I do not endorse any sexual behavior that does not comport with traditional Christian teaching. This includes not only homosexuality, but also adultery and fornication. They are all sin, and neither is better or worse than any other. All separate us from God.
The biblical standard for sexual behavior is chastity outside of traditional male-female marriage, monogamy and fidelity within it; and it applies to everyone, including transgender folks. Seen in this context, excessive concern about homosexual behavior by traditional Christians is a bit of a red herring since it distracts us from what I believe should be the true issue: the drastic decline of heterosexual morality over the past 60 years.
Perhaps we should work on removing the log of heterosexual immorality from our own eyes before we become overly e
xercised about removing the splinter of homosexual immorality from the eyes of the much smaller group of others.
Thirdly, as Christians, it is vitally important that we separate behavior (which is determined by individual actions) from biological issues (which are not determinable by individuals). The Bible and church teaching are absolutely clear that we will be judged, not by the body that God has given us, but by what we have done with the body that God has given us.
The story of the talents in Matt. 25:14-30 and Luke 19:12-28 should suffice as an example (although there are others): God gives the talents, he holds us responsible for what we do with them As mentioned previously, the existence and treatment of gender dysphoria/transsexuality is a medical/biological issue, not a behavioral one.
VOL: You assert that, though psychological factors are involved, current science suggests that the causes for gender dysphoria are largely organic/physiological – like a birth defect. But what you don't address is whether you think homosexual orientation arises from the same factors as gender dysphoria. This is an important issue for you to answer, since for years homosexuals have tried to claim their orientation is caused by genetic/biologic factors.
M: I don't usually address this particular question because I am not an expert in homosexuality. However, since you asked, here's my response as a thoughtful, traditional Christian: Again, I would draw a distinction between biology and behavior, between who we are and how we act. I have homosexual friends who swear that their sexual attraction is organic/physiological.
So far, there's no scientific of that fact, but that doesn't make it potentially untrue. However, regardless of what science turns up as it studies this issue, God's word and the Church's teaching are both clear on the issue of homosexual behavior: homosexual physical relationships are a serious sin.
In other words, people with the same genitalia should not have sexual relationships with each other. Acceptance of the theology behind homosexual sexual relationships and "gay marriage" also does serious violence to other, long-settled theological concepts. On the other hand, God's word and the Church's teaching are silent on gender dysphoria/transsexualism.
The proper understanding of it and the potential of transsexual marriage does no violence to other theological concepts. And unlike homosexuality, gender dysphoria/transsexualism isn't even mentioned anywhere in the Scriptures.
VOL: TEC does not believe that people who are transgendered need to remain celibate. Do you agree with the posture?
M: I believe that all unmarried individuals, heterosexual, homosexual or transsexual, should remain celibate.
VOL: What then of marriage between transsexuals?
M: The Christian marriage of transsexuals is an entirely different question from homosexuals and marriage, because we're talking about sex and gender and not sexual attraction. The question of Christian marriage for transsexuals who have completed the full process of treatment for gender dysphoria is a very difficult one, and one for which, quite frankly, I do not believe an answer yet exists.
The theological consequences of current medical research will have to be hammered out by the Church in the years to come. But I believe that the issue will revolve around our definitions of "man" and "woman", which are even now being affected by the new information coming out of medical research. I can see four possible solutions, none of which are perfect:
First, if you define "man" and "woman" on the basis of genitalia (the historic position of society and most protestant Christians), then a post-operative transsexual with genitalia and a legal identity that conforms to gender should be allowed to marry a person with the opposite genitalia regardless of birth sex. This is probably the most "pastoral" outcome.
Second, if you define "man" and "woman" on the basis of birth sex (at least two US states take this position), then a post-operative transsexual with genitalia and a legal identity that conforms to gender will not be allowed to marry a person with the opposite genitalia. However, this transsexual could marry a person with the same genitalia, a same-sex marriage, as it were, because the birth sex would be different. Personally, I find this to be an absurd result, but its the logical conclusion based on that definition.
Third, if you define "man" and "woman" on the basis of genetic testing or chromosomes (nobody does this as of this time), then only those who have a "normal" genetic pattern would be allowed to marry. This would prevent a substantial number of heterosexual marriages, as well as prohibiting transsexual ones between individuals with different genitalia.
Fourth, if you define "man" and "woman" on the basis of one's ability to procreate (the current Catholic position), then anyone who cannot procreate cannot be married, whether heterosexual, homosexual or transsexual. I don't find this result to be either pastoral or merciful, but it is consistent and in keeping with what I see as the Catholic penchant for theological legalism. What's the best answer? I haven't a clue. This issue is still very much open to debate on the secular as well as the theological level.
VOL: The Catholic Church, based on the Church's theology of the body, holds that each person is a unity of body and soul made in the image and likeness of God. Because of this, the Second Vatican Council's pastoral constitution Gaudium et Spes (The Church in the Modern World) states that "man may not despise his bodily life. Rather he is obliged to regard his body as good and to hold it in honor since God has created it and will raise it up on the last day." What is your response to this?
M: I agree completely. We are a unity of body and soul made in God's image. We should honor our bodies as the temple of the Holy Spirit and treat them accordingly; cf. I Cor. 6:19-20.
VOL: As well, in Catholic theology there is no such thing as being "trapped in the wrong body." Human beings are created male and female and although humanity's fallen nature can result in psychological disunity and confusion regarding an individual's sexual identity, every person's body reveals his or her God-given gender. Consequently, the Catechism of the Catholic Church teaches that, "except w hen performed for strictly therapeutic medical reason, directly intended amputations, m
utilations and sterilizations performed on innocent persons are against the moral law" (No. 2297). What is your response to this?
M: The fact that Catholic theology does not address an issue does not mean that it does not exist, simply that the church has not yet addressed the issue. The term "trapped in the wrong body" is popular shorthand for the situation that one's biological body is different from one's gender. This difference is a medical condition, not a spiritual one. The phrase "human beings created male and female" (cf. Gen. 1:26-28 and Matt. 19:4) refers to pre-fall creation. After the fall, illness entered the world, including biological and psychological disunity. Unfortunately, after the fall, every person's body no longer reveals his or her God-given gender (though most do). Those whose sex and gender are not congruent are those who are called gender dysphoric or transsexual.
When transsexuals proceed to reassignment surgery, it is based on medical advice and in accord with the Catechism. The surgery is performed for therapeutic and medical reasons, with informed consent and not against innocent persons, and not against the moral law. I see no conflict.
VOL: If supposing that you believe that God "made a mistake" or because we are fallen creatures – our bodies, minds, emotions and will are all fallen, does this give you the right to change what God initially made?
M: A two-part answer is in order. Firstly, I do not believe that God "made a mistake". The Bible clearly states that God knows all about us before we were born (Psalm 139:14, Matt. 10:30). Therefore he knew who I was, and what I would be. Secondly, because this world is a fallen world, we have to deal with issues such as birth defects and illnesses that were not part of God's original plan. Sometimes that requires that we change what was originally created.
VOL: Catholic mental-health professionals opt for another approach, (other than surgery) one they say has a proven record of helping people overcome confusion about their gender identity. They argue that effective therapy brings to an end the suffering of people like yourself which hormones and surgery do not. This comes from Richard Fitzgibbons, a Catholic psychiatrist in Conshohocken, PA, who has counseled many individuals with Gender Identity Disorder to appreciate the bodies they were born in. What is your response to this and why did therapy not work for you?
M: Another good question which requires a complex answer.
Firstly, the individual you mention above and the treatment he espouses is in the minority when it comes to treatment of gender disorders. From what I read on his website, most of his work with gender disorders seems to have been with children (this makes a difference), an issue which I will address below. For adults, and for a medical issue of this gravity, I'd rather put my faith in the consensus of the medical experts than just one small group of individuals.
Secondly, the term "gender confusion" is a misnomer. An individual who has gender dysphoria/transsexualism is not gender confused. We know who we are, even if what we know does not match with what the world sees when it looks at our bodies.
Thirdly, let's talk about who the patient is. Children, whose personalities are still in development, often act in ways that vary from acceptable societal norms when it comes to behavior.
Examples: boys playing with dolls, girls playing with guns, etc. These are normal examples of the diversity of individual personalities, and of children "trying out" different roles to determine where they fit. Most children who exhibit what you term "gender confusion" grow out of it over time and without help, or else they integrate their behaviors into a healthy personality.
Any diagnosis and medical treatment in children should be approached with extreme care due to rapid changes in the child's developmental process.
After puberty, when individuals' personalities have stabilized and they perceive themselves as gender dysphoric (although they may not use that term), a more robust form of treatment may be indicated.
Studies to date have determined that there continues to be a very limited success rate in treating individuals who have a firm diagnosis of gender disorder other than the sort of intervention envisioned by the existing Standards of Care promulgated by experts: counseling, hormone therapy, transition and surgery being the most common. For further information, please see the Endocrine Society treatment Guidelines: http://www.endo-society.org/_MDDocReviewFiles/Transgender%20Guideline%20%281st%20Draft%2011.17.08%29.pdf. and the Standards of Care for Treatment of Gender Disorders, 6th Version: http://wpath.org/Documents2/socv6.pdf Lastly, and personally, I actually did have several years of therapy with a gender specialist. It was designed to determine whether or not a diagnosis of gender dysphoria/transsexualism was appropriate. It was, and it was confirmed through the independent scoring of an MMPI done by another specialist. My choice of treatment was determined in consultation with my therapist, my medical doctor, my parents and my religious advisors (at that time I was a member of a Catholic parish).
All were in agreement that hormones, transition and surgery were the course of action that would provide the greatest opportunity for my return to full health.
In retrospect, I still agree with that decision although the results of it continue to be painful. All of my "so-called" Christian friends turned their backs on me. My employer fired me without cause. I was thrown out of two Episcopal/Anglican churches. I lost contact with half of my family for a number of years.
But to continue to live in a gender dysphoric state is not something that I would wish on my worst enemy. It produces huge stresses in one's daily life, increases the potential of dysfunctional behavior like substance abuse, increases the likelihood of suicide by 500% and dramatically reduces the quality of one's life.
VOL: If sexual reassignment surgery was so important for your gender identity, why do you live celibately? Isn't it self defeating to spend a lot of money and not to enjoy the change with another person?
M: The surgery was to fix a birth defect, to make it possible for me to live as normal a life as possible. It had nothing to do with sexual activity.
VOL: What about the argument that this is your "thorn in the flesh&q
uot; (that St. Paul talks about) and that you should carry the cross of this infirmity as a good soldier of Jesus Christ. Our Lord's call to pick up the cross and follow him is a standing invitation to all, why should you be called out to change that or be an exception not to carry your "special" cross?
M: If you accept this argument, then you must also toss out most of modern medicine and all of Jesus' teachings about healing the sick. No medical treatments, no vaccinations, no pharmaceuticals, nothing artificial to interfere with the "thorns in our flesh" that God requires us to bear.
Would any Christian seriously suggest that an individual who had a birth defect or illness not seek healing for it? If healing requires a change in what God originally allowed to be made, how is that sinful? Do we not do this all the time in modern medicine? Who would require that an individual with a cleft palate or club foot remain "as God created him"? Who would tell a person with cancer not to seek healing? This concept runs completely counter to our understanding of Jesus as healer and redeemer of the whole world. I don't believe that such a position can be justified either from Scripture or church teachings.
VOL: Thank you M.
NOTE: This story is the intellectual property of Virtueonline. Permission to publish it on blogs, newspapers, or magazines must be sought from David W. Virtue, DD: firstname.lastname@example.org.
David informed me, when I wrote to get his permission to reprint this article, that his readers have responded favorably, about 3 to 1, to his publishing this story. But the opposition is quite serious and even threatens his ministry in some ways. Why, I ask you my readers, is a careful and thoughtful dealing with such a sensitive issue so anathema to some people? Perhaps this issue creates deep fear inside of us, I am just not sure. This is clearly not a left or right issue, this is a human issue and Christians ought to speak about such matters with real care joined with honesty and love.