CCBI News: Gender Dysphoria – Part 4

December 8, 2023

Dear Friends of CCBI,

Gender Identity – Part 4

The number of young people who now think they made a mistake about choosing the opposite gender and want to detransition is growing. This phenomenon begs the question of encouragement of early transitions, discussed last week, which can result in long-lasting physical problems and the likelihood that the dysphoria has not been dispelled, as young people had hoped or were led to expect. We noted that serious flaws had been discovered in the Dutch studies that had influenced so many countries and that some have shifted their policies away from what is known as ‘gender-affirming care’ to advising psychiatric or psychological counselling for these youngsters, many of whom have other underlying mental health conditions. That is, countries are returning to the use of monitoring and counselling for gender dysphoria, treatments which were effective but were then disparaged without evidence. It would appear that, for a time, sociopolitical advocacy took precedence over scientific objectivity in research.

The Catholic Medical Association of the United States stated in September 2023 that “…the American Psychiatric Association (APA) explains in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that gender dysphoria is listed as a mental disorder not because of the person’s belief that they are someone they are not –– a break from reality –– but because of the emotional distress that is felt by the person and how this affects social functioning.” That means that if the distress is relieved, gender dysphoria is no longer considered a disorder by the Association, which also claims that the distress will be relieved by sex reassignment. In an update to its practice manual, the DSM5-TR, the Association reiterates its claims that gender dysphoria is not a mental disorder.

Dysphoria itselfis defined as a state of dissatisfaction or unease about a given situation. Gender dysphoriais a psychological condition in which the individual feels an incongruence between his or her experienced gender and his or her biological sex. This condition is associated with varying levels of anxiety and unhappiness.

Commenting on this, the Catholic Medical Association reminds us:

Human beings are born with a biological sex. The awareness of being male or female develops over time. As gender awareness develops during the early years of a child’s life, there may be a time when the child may show confusion about his or her gender awareness. These pre-pubertal children may be diagnosed with gender dysphoria. When GD occurs in the pre-pubertal child, it resolves in 80-90 percent of children by late adolescence as they naturally develop through puberty and gender awareness aligns with biological sex. (Cohen-Kettenis, Delemarre-van de Waal, Gooren, 2008).

If there are medical interventions, however, the CMA notes that puberty blockers “…arrest bone growth, decreases bone density…and inhibit fertility.” Its comments agree with others, including those in a study that was instrumental in the closure of the Tavistock Clinic in England, the main centre in the UK for treatment of children with gender dysphoria. The latter had relied on research from earlier advisors who had said: “It is not clear what the long term effects of early suppression may be on bone development, height, sex organ development, and body shape and their reversibility if treatment is stopped during pubertal development.” A paediatrician on the study team, Russell Viner, frankly acknowledged the risks. ‘If you suppress puberty for three years the bones do not get any stronger at a time when they should be, and we really don’t know what suppressing puberty does to your brain development. We are dealing with unknowns.’ (Daily Mail, 25 February 2012).

Despite this evidence, along with research by the American College of Pediatricians showing spontaneous resolution of gender dysphoria at a certain age, a second pediatric association in the U.S., the American Academy of Pediatricians, continues to promote ‘gender affirming care’ that includes puberty blockers and hormone treatment. This highlights a serious fracture in the practice of medicine, presenting yet another danger for youngsters seeking reliable help for gender dysphoria.

Medical Intervention and Mental Health

Relief of distress is the major focus of treatments for gender dysphoria, but some studies have found no mental health benefits after hormonal interventions. Regnerus writes:

Given the surge in interest, demand, and supply of hormonal therapies to self-identified transgender persons today, you would think that it is a solution that pays obvious benefits in reduced subsequent need—over time—for treatment of mood or anxiety disorder, or hospitalization after a suicide attempt. Yet there was no statistically significant effect. In fact, the confidence intervals actually reveal a nearly significant aggravating effect of hormonal treatment on subsequent mental health needs.

Opting for the intervention approach, however, the U.S. Department of Health and Human Services Organization stated in 2022: “For transgender and non-binary children and adolescents, early gender affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the health care system.” (HHS, 2022). Faced with this federal government non-response to evidence that indicates the opposite, the anti-intervention American College of Pediatricians and American Catholic Medical Association publicly stated their opposition that “… promoting sex reassignment via public education and legal policies will further harm children and confuse parents.”

Concern Over Possible Suicide

One of the claims made by proponents of gender affirmation is that children will be more likely to commit suicide if they are not quickly treated medically, which in turn prepares the way for sex reassignment surgery. The evidence is far from unilateral regarding claims for this serious possibility. We noted last week that gender dysphoric children also frequently show significant psychiatric co-morbidities and it has been shown that the rate of suicidality in this group corresponds to the rate of suicidality in other groups with similar co-morbidities, except for gender dysphoria. Those with gender dysphoria are, therefore, not more at risk for suicide. Beyond that, some studies say transgender interventions not only do not reduce the risk of suicide but that puberty blockers can be associated with depression and other emotional disturbances related to suicide. Furthermore, some data claim that, in the long run, transitioning may even exacerbate the psychological distress that could lead to suicide.

There is clearly a need for more long-term research to confirm claims on both sides, but ‘reasonable doubt’ is evident in important treatment claims. Children’s interests should come first as it is their future that is at stake.

Gender Dysphoria and Sex Reassignment Surgery

Since sex-reassignment surgery is more readily approved now than before, has it been shown that the distress, anxiety and suffering exhibited by those with gender dysphoria are relieved by surgery? Surveys show transgender adults express an initial sense of relief and satisfaction following the use of cross-sex hormones and sex reassignment surgery, but that this can fade. Cross-sex hormone administration and sex reassignment surgery were allowed in Sweden long before most other countries, therefore Sweden has more long-term studies than any other country. One of them (Dheinje et al) is a thirty-year follow-up study of 324 sex reassigned adults. Results revealed,“…substantially higher rates of overall mortality, death from cardiovascular disease and suicide, suicide attempts and psychiatric hospitalizations in post-surgical transsexuals as compared to a healthy control population.” These conclusions do not sit well with advocates for this kind of surgery, but contrary evidence is hard to find or is inapplicable, since more recent studies have worked with small numbers, yielding questionable results. (Cf. Regnerus article). Encouraging children to take the transitioning path leading to sex reassignment surgery in light of known results is unethical and irresponsible, given that these treatments are ineffectual in ridding people of their dysphoric distress. The Catholic Medical Association says, “Children are the victims of this disturbing and irresponsible experiment, as misguided adults impose a confused ideology on the most innocent and vulnerable…A parent who convinces his or her child that he or she was born into the wrong body is committing a grievous error.”

Parental Rights

Two Canadian jurisdictions, New Brunswick and Saskatchewan, now require that children receiving counselling or treatment for gender identity questions require parental consent. They have legislated that parental consent should also be sought if children with gender dysphoria decide to use their preferred pronouns. Resistance to parental rights is strong in the transgender community and in many school boards, who claim that if parents refuse consent their children will be affected emotionally and their mental health will suffer. This is a brewing battle between advocates for transgender rights and the child’s primary advocates, the parents. Children are more resilient than some may think, long-term evidence having shown they can weather gender crises with the right type of counselling. It is natural that parents should be recognized as primary decision-makers on issues involving their children. Catholic teaching certainly tells us that parents are the first educators of their children, and that applies to religious, sexual, cultural and educational matters. The bond between parent and child is one of the foundations of Catholic natural law, which recognizes the reality of the sexual drive where man and woman in procreative unity give birth to children and form family units. These basics of human nature evolved and established themselves long before there were such things as schools, governments or even organized religion. The family is, as Pope John Paul said, part of God’s plan. Catholic organizations must keep that in mind, especially since it seems that ‘family’ can now be interpreted to mean anything the law decrees.

We have frequently stated our concern about minor children’s capacity to consent and to think long-term. Society should remember that minors are not adults and do not have the reasoning power and experience of adults to help their decision-making. Surely having ‘rights’ demands the capacity to exercise those rights properly? The consent of a six-, nine- or thirteen-year-old is not full consent.

Theological

In this series of articles on gender dysphoria we have considered many factors, realizing there is much more to be said and more research to be done and analyzed. We ‘kept the good wine to the end,’ knowing that Catholic teaching is clear and unambiguous that human beings are created by God, male and female, i.e., binary. ( Cf., Gn 1:27; CCC, nos. 355–357, 369, 373, 1604, 1701–1702, 2331). We agree with the following succinct account of human nature, written by the USCCB:

The two sexes are complementary; the union of their bodies results in a third human person; the species thrives (Gn 1:28, 2:18–24; CCC, nos. 369–372, 1604–1605, 1643, 1652, 2331–2335, 2360–2370). The body is an intrinsic dimension of our human nature (CCC, nos. 362, 364, 2289). To reject the essentiality of the body is to reject God’s gift and reflects the pretence of the confused human being through a pure act of the will. It is the ultimate form of rebellion against creation (CCC, nos. 2280, 2290).

The USCCB continues:

Human beings are a body-and-soul unity with a single nature (USCCB 2023, no. 4). The body is a gift of God, created in His image, and therefore, declared to be very good (USCCB 2023, no. 7). The body is to be respected and cared for since it is intrinsic to the person. Sexual differentiation is an essential part of this embodiment (USCCB 2023, no. 5). All must respect the order and finality of this embodiment. No one, including patients, physicians, and researchers, have unlimited rights over the body. We are not owners of our bodies to use them as tools according to our will, to be manipulated just because we can (USCCB 2023, no. 7). Just because it can be done does not mean it should be done.

CCBI will continue research into this complex issue and report on significant changes in the field. Meanwhile, we can encourage civil society to be open to evidence-based information and discourage ideological approaches to treatments for gender dysphoria where expectations are not borne out and, therefore, harmful to those receiving them.

Resources

https://www.cathmed.org/resources/the-ideology-of-gender-harms-children/
Early Pubertal Suppression in a Carefully Selected Group of Adolescents with Gender Identity Disorder, 4 November 2010, Research Ethics Committee number 10/H0713/79. In Briggs, below.
Dr Russel Viner, quoted in an article on the Tavistock Clinic, Daily Mail, 25 February 2012
Adolescent Health | HHS Office of Population Affairs
New Data Show “Gender-Affirming” Surgery Doesn’t Really Improve Mental Health. So Why Are the Study’s Authors Saying It Does? – Public Discourse (thepublicdiscourse.com)
J. Michael Bailey, Ph.D  and Ray Blanchard, Ph.D. ‘Suicide or transition: The only options for gender dysphoric kids?’ https://4thwavenow.com/2017/09/08/suicide-or-transition-the-only-options-for-gender-dysphoric-kids/
SUICIDE-MYTH-HANDOUT.pdf (childparentrights.org)
Cecilia Dhejne Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden PLoS One. 2011; 6(2): e16885. doi: 10.1371/journal.pone.0016885
The 41% trans suicide attempt rate: A tale of flawed data and lazy journalists | 4thWaveNow
Michael Briggs. March 2, 2019. Tavistock’s Experimentation with Puberty Blockers: Scrutinizing the Evidence – Transgender Trend
Mark Regnerus. November 13, 2019.New Data Show “Gender-Affirming” Surgery Doesn’t Really Improve Mental Health. So Why Are the Study’s Authors Saying It Does? – Public Discourse (thepublicdiscourse.com)

Pope Francis’ Intentions for December
For People with Disabilities

“Let us pray that people with disabilities may be at the center of attention in society, and that institutions offer inclusion programs that enhance their active participation.”

Moira and Bambi