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

June 23, 2017

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.

Andrew T. Walker

Andrew T. Walker is Associate Professor of Christian Ethics at The Southern Baptist Theological Seminary and a Fellow with The Ethics and Public Policy Center. Read More

Article 12: The Future of AI

We affirm that AI will continue to be developed in ways that we cannot currently imagine or understand, including AI that will far surpass many human abilities. God alone has the power to create life, and no future advancements in AI will usurp Him as the Creator of life. The church has a unique role in proclaiming human dignity for all and calling for the humane use of AI in all aspects of society.

We deny that AI will make us more or less human, or that AI will ever obtain a coequal level of worth, dignity, or value to image-bearers. Future advancements in AI will not ultimately fulfill our longings for a perfect world. While we are not able to comprehend or know the future, we do not fear what is to come because we know that God is omniscient and that nothing we create will be able to thwart His redemptive plan for creation or to supplant humanity as His image-bearers.

Genesis 1; Isaiah 42:8; Romans 1:20-21; 5:2; Ephesians 1:4-6; 2 Timothy 1:7-9; Revelation 5:9-10

Article 11: Public Policy

We affirm that the fundamental purposes of government are to protect human beings from harm, punish those who do evil, uphold civil liberties, and to commend those who do good. The public has a role in shaping and crafting policies concerning the use of AI in society, and these decisions should not be left to those who develop these technologies or to governments to set norms.

We deny that AI should be used by governments, corporations, or any entity to infringe upon God-given human rights. AI, even in a highly advanced state, should never be delegated the governing authority that has been granted by an all-sovereign God to human beings alone. 

Romans 13:1-7; Acts 10:35; 1 Peter 2:13-14

Article 10: War

We affirm that the use of AI in warfare should be governed by love of neighbor and the principles of just war. The use of AI may mitigate the loss of human life, provide greater protection of non-combatants, and inform better policymaking. Any lethal action conducted or substantially enabled by AI must employ 5 human oversight or review. All defense-related AI applications, such as underlying data and decision-making processes, must be subject to continual review by legitimate authorities. When these systems are deployed, human agents bear full moral responsibility for any actions taken by the system.

We deny that human agency or moral culpability in war can be delegated to AI. No nation or group has the right to use AI to carry out genocide, terrorism, torture, or other war crimes.

Genesis 4:10; Isaiah 1:16-17; Psalm 37:28; Matthew 5:44; 22:37-39; Romans 13:4

Article 9: Security

We affirm that AI has legitimate applications in policing, intelligence, surveillance, investigation, and other uses supporting the government’s responsibility to respect human rights, to protect and preserve human life, and to pursue justice in a flourishing society.

We deny that AI should be employed for safety and security applications in ways that seek to dehumanize, depersonalize, or harm our fellow human beings. We condemn the use of AI to suppress free expression or other basic human rights granted by God to all human beings.

Romans 13:1-7; 1 Peter 2:13-14

Article 8: Data & Privacy

We affirm that privacy and personal property are intertwined individual rights and choices that should not be violated by governments, corporations, nation-states, and other groups, even in the pursuit of the common good. While God knows all things, it is neither wise nor obligatory to have every detail of one’s life open to society.

We deny the manipulative and coercive uses of data and AI in ways that are inconsistent with the love of God and love of neighbor. Data collection practices should conform to ethical guidelines that uphold the dignity of all people. We further deny that consent, even informed consent, although requisite, is the only necessary ethical standard for the collection, manipulation, or exploitation of personal data—individually or in the aggregate. AI should not be employed in ways that distort truth through the use of generative applications. Data should not be mishandled, misused, or abused for sinful purposes to reinforce bias, strengthen the powerful, or demean the weak.

Exodus 20:15, Psalm 147:5; Isaiah 40:13-14; Matthew 10:16 Galatians 6:2; Hebrews 4:12-13; 1 John 1:7 

Article 7: Work

We affirm that work is part of God’s plan for human beings participating in the cultivation and stewardship of creation. The divine pattern is one of labor and rest in healthy proportion to each other. Our view of work should not be confined to commercial activity; it must also include the many ways that human beings serve each other through their efforts. AI can be used in ways that aid our work or allow us to make fuller use of our gifts. The church has a Spirit-empowered responsibility to help care for those who lose jobs and to encourage individuals, communities, employers, and governments to find ways to invest in the development of human beings and continue making vocational contributions to our lives together.

We deny that human worth and dignity is reducible to an individual’s economic contributions to society alone. Humanity should not use AI and other technological innovations as a reason to move toward lives of pure leisure even if greater social wealth creates such possibilities.

Genesis 1:27; 2:5; 2:15; Isaiah 65:21-24; Romans 12:6-8; Ephesians 4:11-16

Article 6: Sexuality

We affirm the goodness of God’s design for human sexuality which prescribes the sexual union to be an exclusive relationship between a man and a woman in the lifelong covenant of marriage.

We deny that the pursuit of sexual pleasure is a justification for the development or use of AI, and we condemn the objectification of humans that results from employing AI for sexual purposes. AI should not intrude upon or substitute for the biblical expression of sexuality between a husband and wife according to God’s design for human marriage.

Genesis 1:26-29; 2:18-25; Matthew 5:27-30; 1 Thess 4:3-4

Article 5: Bias

We affirm that, as a tool created by humans, AI will be inherently subject to bias and that these biases must be accounted for, minimized, or removed through continual human oversight and discretion. AI should be designed and used in such ways that treat all human beings as having equal worth and dignity. AI should be utilized as a tool to identify and eliminate bias inherent in human decision-making.

We deny that AI should be designed or used in ways that violate the fundamental principle of human dignity for all people. Neither should AI be used in ways that reinforce or further any ideology or agenda, seeking to subjugate human autonomy under the power of the state.

Micah 6:8; John 13:34; Galatians 3:28-29; 5:13-14; Philippians 2:3-4; Romans 12:10

Article 4: Medicine

We affirm that AI-related advances in medical technologies are expressions of God’s common grace through and for people created in His image and that these advances will increase our capacity to provide enhanced medical diagnostics and therapeutic interventions as we seek to care for all people. These advances should be guided by basic principles of medical ethics, including beneficence, non-maleficence, autonomy, and justice, which are all consistent with the biblical principle of loving our neighbor.

We deny that death and disease—effects of the Fall—can ultimately be eradicated apart from Jesus Christ. Utilitarian applications regarding healthcare distribution should not override the dignity of human life. Fur- 3 thermore, we reject the materialist and consequentialist worldview that understands medical applications of AI as a means of improving, changing, or completing human beings.

Matthew 5:45; John 11:25-26; 1 Corinthians 15:55-57; Galatians 6:2; Philippians 2:4

Article 3: Relationship of AI & Humanity

We affirm the use of AI to inform and aid human reasoning and moral decision-making because it is a tool that excels at processing data and making determinations, which often mimics or exceeds human ability. While AI excels in data-based computation, technology is incapable of possessing the capacity for moral agency or responsibility.

We deny that humans can or should cede our moral accountability or responsibilities to any form of AI that will ever be created. Only humanity will be judged by God on the basis of our actions and that of the tools we create. While technology can be created with a moral use in view, it is not a moral agent. Humans alone bear the responsibility for moral decision making.

Romans 2:6-8; Galatians 5:19-21; 2 Peter 1:5-8; 1 John 2:1

Article 2: AI as Technology

We affirm that the development of AI is a demonstration of the unique creative abilities of human beings. When AI is employed in accordance with God’s moral will, it is an example of man’s obedience to the divine command to steward creation and to honor Him. We believe in innovation for the glory of God, the sake of human flourishing, and the love of neighbor. While we acknowledge the reality of the Fall and its consequences on human nature and human innovation, technology can be used in society to uphold human dignity. As a part of our God-given creative nature, human beings should develop and harness technology in ways that lead to greater flourishing and the alleviation of human suffering.

We deny that the use of AI is morally neutral. It is not worthy of man’s hope, worship, or love. Since the Lord Jesus alone can atone for sin and reconcile humanity to its Creator, technology such as AI cannot fulfill humanity’s ultimate needs. We further deny the goodness and benefit of any application of AI that devalues or degrades the dignity and worth of another human being. 

Genesis 2:25; Exodus 20:3; 31:1-11; Proverbs 16:4; Matthew 22:37-40; Romans 3:23

Article 1: Image of God

We affirm that God created each human being in His image with intrinsic and equal worth, dignity, and moral agency, distinct from all creation, and that humanity’s creativity is intended to reflect God’s creative pattern.

We deny that any part of creation, including any form of technology, should ever be used to usurp or subvert the dominion and stewardship which has been entrusted solely to humanity by God; nor should technology be assigned a level of human identity, worth, dignity, or moral agency.

Genesis 1:26-28; 5:1-2; Isaiah 43:6-7; Jeremiah 1:5; John 13:34; Colossians 1:16; 3:10; Ephesians 4:24