Article Jun 23, 2017

Puberty suppression and the transgender movement: Why Christians ought to have concern

An important paper has been released that challenges the practice of puberty suppression in gender dysphoric children.

Christians need to pay attention to this report, because it captures many of the underlying problems bubbling underneath the surface of the transgender revolution that are at root incompatible with Christian teaching.

Titled “Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria” and published this week at The New Atlantis, the authors Paul W. Hruz, Lawrence S. Meyer, and Paul R. McHugh challenge medical consensus on the practice of delaying puberty in gender dysphoric children by suggesting that arguments in favor of the practice are based on “subjective judgments and speculation” rather than “rigorous empirical evidence.” After a thorough review of existing medical literature, the authors conclude “there remains little evidence that puberty suppression is reversible, safe, or effective for treating gender dysphoria.” This report comes months after Meyer and McHugh’s initial report challenged contemporary views related to sexual orientation and gender identity.

To those new to the topic, guidelines for treating young children who suffer from gender dysphoria suggest implementing hormonal treatment in order to delay the onset of secondary sex characteristics such as breast development in women or broadened shoulders in men. To this pattern of thinking, delaying puberty gives children uncertain of their gender identity time to determine their gender identity without the “consequences” of growing into their adult body. And, should the children persist in their dysphoria into adolescence and choose to live as a member of the opposite sex, suppressing the development of secondary sex characteristics makes “transitioning” by way of surgical intervention less invasive.

The report offers many to challenges to the medical community’s handling of puberty suppression in children.

Among them, the authors believe that puberty suppression encourages children who experience gender dysphoria to continue persisting in a cross-sex identity, despite the statistical reality that feelings of gender dysphoria reduce with age. Upwards of 80 percent of children grow comfortable in their bodies and no longer experience dysphoria. But puberty suppression, the authors state, “may drive some children to persist in identifying as transgender when they might otherwise have, as they grow older, found their gender to be aligned with their sex. Gender identity for children is elastic (that is, it can change over time) and plastic (that is, it can be shaped by forces like parental approval and social conditions). If the increasing use of gender-affirming care does cause children to persist with their identification as the opposite sex, then many children who would otherwise not need ongoing medical treatment would be exposed to hormonal and surgical interventions.” According to the authors, puberty suppression makes it more likely that children whose gender dysphoria may subside might continue to identify as a member of the opposite sex. In short, puberty suppression discourages its users from obtaining a healthy and normative gender identity.

The authors also find that puberty suppression does not resolve or address the causes of the underlying gender dysphoria. They write, “[W]e simply do not know what causes a child to identify as the opposite sex, so medical interventions, like puberty suppression, cannot directly address it.” At best, puberty suppression is a response to deeper ailments whose origin and cure are not yet known.

There is also concern about how normal patterns of puberty are resumed for those who stop using suppressants. Why? Because the research is “very weak” in such instances: “This is because there are virtually no published reports, even case studies, of adolescents withdrawing from puberty-suppressing drugs and then resuming the normal pubertal development typical for their sex. Rather than resuming biologically normal puberty, these adolescents generally go from suppressed puberty to medically conditioned cross-sex puberty, when they are administered cross-sex hormones at approximately age 16.” The authors are concerned that the lack of research on the effects of puberty suppression on those who stop taking suppressants is not robust, which could pose damaging consequences later on in their development.

There are also other harmful consequences of puberty suppression: stunting height development, reduced bone density, and infertility by harming gonadal health.

The authors conclude on a sobering note, observing, “It remains unknown whether or not ordinary sex-typical puberty will resume following the suppression of puberty in patients with gender dysphoria.” That last sentence needs emphasized because its importance cannot be understated. In the eyes of the report’s authors, a medical revolution is happening without solid evidence on the long-term effects. The authors summarize their conclusion by stating that an immense medical revolution is happening under the guise of “consensus” where no such consensus exists.

Whatever the research findings, Christians should be sensitive to the needs and realities of those who are afflicted with gender dysphoria and have nothing less than compassion for those who experience emotional distress. Such individuals experience disproportionate levels of anxiety, depression, thoughts of suicide, and suicide.

At the same time, Christians must be sober-minded about the type of medical revolution occurring under the guise of transgenderism. Furthermore, Christians should not encourage the use of puberty suppression in young children nor the use of hormonal therapies to nullify one’s biological sex. Such actions disrupt natural body rhythms and reject the goodness of one’s embodiment as a creature made in God’s image.

We are living at a time where what it means to be made male or female is hotly contested. Are humans divine image bearers, designed by God with an objective human nature? Or are men and women simply constructs made up by society that can be toyed with and manipulated at will?

This is indeed one of the most startling repercussions that follow from actions like puberty suppression: The transgender movement relies upon an unbiblical anthropology that sees natural bodily development as subservient to, and conquerable by, the sheer act of human will.

The authors criticize a 2016 report issued by the Human Rights Campaign demonstrating how the transgender movement treats healthy body development as a potentially “irreversible” obstacle to human fulfillment. “This turns the normal language of reversibility on its head, speaking of the natural process of biological development as an irreversible series of problems that medicine should seek to prevent,” the authors write, “while presenting the intervention — puberty suppression — as benign and reversible.” The transgender movement relies upon assumptions that the body is a roadblock to a person’s self-fulfillment, and thus mature body development impedes personal happiness and health. Christians must reject this type of thinking because it makes createdness and the design of the body a problem, rather than a blessing of God.

Puberty suppression is just one part of the much larger transgender revolution occurring in our midst. The act of puberty suppression signals that the body’s design bears no intrinsic, physical goal. By acting to disrupt the body’s natural design, the transgender movement signals that the goodness of God’s creation is something subjectable to man’s control. Actions, philosophies, and movements that subvert human nature will end up subverting human flourishing as well.

As I write about in my forthcoming book, God and the Transgender Debate, effort or action taken to suppress the truth of our natural biology, or to reverse our natural biology, runs contrary to God’s Word, since it makes man the Creator, rather than God.

The intention of hormone therapy is to interrupt or thwart natural development. Such therapy is aimed at contradicting otherwise healthy bodily development based on the view of someone’s mind or feelings. People who experience bouts of gender dysphoria are not necessarily destined to experience those bouts forever. So it’s unwise to take drastic, irreversible action to seek to “fix” what may have been temporary. Moreover, studies show that identifying as transgender or undergoing sex reassignment surgery does not resolve the underlying emotional duress, either.

Most consequential, at a time where political forces are converging on medical associations and pressuring them to affirm transgenderism, the research of Hruz, Meyer, and McHugh demonstrates the experimental nature of transgender medicine, suggesting that published guidelines are creating the “false impression” that medical consensus exists concerning gender dysphoria and puberty suppression where no such consensus really exists.

There will be debate about this new report, as its findings contradict and challenge the reigning orthodoxy of transgender medicine. But as Paul McHugh replied to his critics after the first report was issued in 2016, it is the duty of his critics to show him where he and his co-authors are wrong. How McHugh responded to his critics in the Daily Beast last year applies equally today: “What they’re saying here is that my reading is wrong but they don’t point out where it’s wrong,” he said.