Article

3 questions to ask when considering transgender minors and medical transitioning

Aug 1, 2019

The Star Tribune ran an opinion piece drawing attention to the recent launch of a clinic for transgender and “gender diverse” young people at the flagship facility, Children’s Minnesota.[1] The opening of this gender clinic highlights the current trend within the country to normalize the experience of gender dysphoria. Social programs are presenting a transgender identity—where someone comes to the realization that their conscious gender does not match their birth sex—as another way of expressing personal identity along with the traditional binaries for gender and sexuality, “man” and “woman.” 

The Tribune’s article points to the fact that the present-day transgender push upon minors in medicine and psychology has not been without its protestors. The secular armor defending this new ideology has a few cracks and weak points. Rather than taking the offensive in debates with defenders of transgenderism and these medical practices, Christians can respond to those who are defending these practices by asking a few simple questions. 

Here are three questions that anyone considering transgender minors and medical transitioning should consider: 

1. Have these practices been tested and verified? 

Imagine if you were approached by a stranger on the street who said, “I’m looking for some people to participate in some experimental surgeries and hormone treatment, are you interested?” 

Are you ready to sign-up? 

Now that might sound like a crude analogy, but find someone who is proposing these practices, and ask them a simple question, “Do doctors know the long-term effects of hormone treatment and surgery on minors?” 

They don’t. 

Do some simple math. The first sex-reassignment surgery was performed in the 1930s. It started to pick up steam in the 1950s–1970s, meaning that we may have a few individuals who are in their 50s to 70s who have been living with these processes. So, we are only beginning to see the long-term effects of these practices on a relatively small pool. 

But we are talking about minors, who have only recently begun to receive these treatments. These minors are individuals who have not reached physiological maturity, whose bodies are having to process strong sex-hormones not natural to their endocrine systems, in addition to hormone blockers, a new treatment within the last decade used to freeze minors in pre-puberty development. 

What does a minor who receives hormone blockers, sex-hormones, and sex-reassignment surgery look like in 40, 50, 60, or 70 years? 

Simply put, we don’t know.[2]

2. Are these practices safe? 

Safe is a squishy term in this discussion. What is safer, a minor committing suicide or being put on drugs that will alter the course of their physiological development and removing healthy body parts? 

In this conversation, we need to be constantly reminded of the fact that we are talking about children, not adults. Let’s say that a 30-year-old transgender woman (biologically male) begins receiving hormone treatment. It is often overlooked that this individual has benefited from natural sex-hormones to reach this point of physical maturation for 30 years. For this individual, all the years of hormone fluxes and major developments have passed. Even if this individual completely transitions over with hormones and surgery, this person has benefited from his or her natural sex-hormones for 30 years. 

The process of hormone therapy is radically different for a developed adult than a minor facing the most important development years of his or her life. 

As the Tribune article referenced earlier reports, there is great cause for concern about the administration of hormone blockers and sex-hormones in healthy adults, not to mention in minors. These hormone blockers stop 95% of sex-hormones in minors, render the child infertile, and halt the maturation of the child, impacting areas such as bone growth and brain development.[3]

Are these practices safe? Three questions must be answered: (1) What are the long-term results of hormone blockers on physiological development? (2) How does a maturing body respond to hormone blockers and sex-hormones opposite of its birth sex and physiology in puberty? (3) How does a developed post-transitioned adult compare in health to his or her pre-transitioned adult form?

We do not have the luxury of watching someone naturally develop, then rewinding the clock and administering hormones and noting the differences. The reality of those pesky sex-chromones and natural development seems to place every man and woman on a track toward physiological maturity. While we may think that we can redirect sexual development through hormone blockers, doctors are unable to reverse natal sexual development and change our chromosomes. The body will attempt to revert to its birth sex if hormones treatment ceases. 

If we are freezing minors in pre-puberty and administering to them the other sex’s hormones, what are we really doing to these minors? 

Again, we don’t know. We do not know the long-term effects of a physiologically frozen pre-pubescent individual with cross-sex hormones. But do the proponents of these practices have confidence—based upon minimal long-term research—that this treatment is truly safe? 

3. Are these practices working?

It’s important to note that these treatments are attempting to alleviate feelings of gender dysphoria, where the body does not align with a self-perception of gender. There is a dissonance between body and consciousness that rings constantly in one’s experience of self. Hormones and surgery are trumpeted as the only viable option for these individuals, lest they pursue suicide.

But what happens on the other side? 

Studies are beginning to show that transgender minors are not completely “cured” from gender dysphoria by these practices, and the risk of suicide still exists.[4] Many people want to silence the voices of those who have deconversion stories, regretting surgery and previous choices.

Is hormone therapy and surgery really the silver bullet to gender dysphoria? 

Or do we stop and ask another question: Don’t we all experience some level of dysphoria? 

Christians recognize something that the world wants to ignore: that the world is broken and subject to futility (Rom. 8:19-22). Our desires are constantly at war with ourselves and each other, and it all stems back to our disobedient parents who wanted to become something that they were not, God. 

Have you ever noticed what happened right after Adam and Eve ate the fruit of the tree? “Then the eyes of both were opened, and they knew that they were naked” (Gen. 3:8).

Nakedness, the introduction of experiencing alienation and discomfort about one’s body. Adam and Eve no longer had perfect pre-fallen bodies, but ones that were exposed, open to abuse and harm in a broken world. Since then, the body has become a liability to us. Adam, Eve, and every individual to come from them experiences some level of suffering in our sexuality, in either warped desires, scars of abuse, or self-hatred. Many of us would rather not have bodies that remind us of hurt, mistakes, and regrets. All of us are prone to desire what we do not have or what appears to be better, the allure of transgenderism. 

But instead of a gospel that promises to fix us from the outside-in through surgeries and hormones, the gospel transforms us from the inside-out. The hope of the gospel is that the pierced body of man, born of a woman, restores our brokenness. Christ not only saves us from our sins—those committed in the body—but Christ redeems our bodies and will one day give all of us glorified bodies. This is available to all who repent of their rebellion against God and his design for human flourishing and submit to the lordship of Jesus by faith. 

The sexually broken can hope in the truth that God can restore what sin has destroyed (Joel 2:25), in this life and the life to come. The promise of a life to come, marked by renewal and resurrection, halts the fury of those scrambling to make this short, futile life meet all their hopes and dreams. 

Christian, do not feel pressured by the culture to be silent on these issues. The flourishing of many minors and future adults depends upon how we respond in this cultural moment. You may find out that you have more in common with those pursuing these practices. You may even gain something, a brother or sister who will share eternity with you—with glorified, resurrected, dysphoria-free bodies. 

Notes

  1. ^ As a quick medical summary, sex-reassignment treatment for minors involves a three-step process. Step 1, minors on the verge of puberty (ages 10-12) will receive hormone blockers to stop the natural development of their sex hormones which would naturally develop secondary-sex characteristics (i.e., breasts, hair, deep voice). Step 2, the minor (age 16) receives hormones of the opposite-sex to develop desired secondary-sex characteristics. Step 3, the minor (age 16-18) receives surgeries to finish up the sex-reassigning, surgery on the top and bottom. We can refer to the sex-reassignment process in two stages: the hormone treatment stage (steps 1-2) and the surgery stage (step 3). For more information, see E. Coleman et al., Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 (World Professional Association for Transgender Health (WPATH), 2012), https://www.wpath.org/publications/soc.
  2. ^ The use of PBT (puberty-blocking treatment) in transgender children has increased dramatically; however, it is a relatively new treatment in this population, and outcomes specifically related to the social and biological implications of treatment remains largely unknown.” Harris et al., “Decision Making and the Long-Term Impact of Puberty Blockade in Transgender Children,” 67. They also caution within this article: “While transgender patients are often counseled on the benefits and reversibility of PBT, many impacts are largely unknown. These issues are highlighted in guidelines recently published by the Endocrine Society, which state that ‘endocrine treatment protocols for gender dysphoria/gender incongruence should include careful assessment of the following: effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain.’” Harris et al., 67; “There are limited data on the consequences of puberty suppression for bone mineral density and executive brain function but much remains unknown about the long-term effects of [puberty suppression].” Lieke Vrouenraets et al., “Perceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth,” Archives of Sexual Behavior 45, no. 7 (October 2016): 1700. “The strongest argument against cross-sex therapy lies in the lack of knowledge of its long-term effects, which means that more studies and follow-up information are necessary.” Bizic et al., “Gender Dysphoria,” 3.
  3. ^  “Sex-steroid hormones are involved in sexual differentiation, development and behaviour and play a pivotal role in the development and function of the central nervous system. They exert varied effects on the brain and the body and are thought to alter several processes related to cognition and emotion.” Rene Seiger et al., “Subcortical Gray Matter Changes in Transgender Subjects after Long-Term Cross-Sex Hormone Administration,” Psychoneuroendocrinology 74 (December 2016): 371. “PBT halts exposure to endogenous sex hormones during a critical window of bone accrual; therefore, PBT may negatively impact adult bone density.” Rebecca M. Harris et al., “Decision Making and the Long-Term Impact of Puberty Blockade in Transgender Children,” American Journal of Bioethics 19, no. 2 (2019): 67.
  4. ^ See American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Arlington, VA: American Psychiatric Association, 2013), 454.

Jared Poulton

Jared Poulton (M.Div.) is a graduate of Columbia International University and The Southern Baptist Theological Seminary. He is currently pursuing his Ph.D. in Biblical Counseling and Christian Ethics at The Southern Baptist Theological Seminary. He resides in South Carolina with... Read More