Recent headlines trumpet presidential orders banning federal payment for gender transition and freeing female athletes from competition with transgender students. But quieter determinations go on daily in medical offices where young patients request gender transition hormones or other transition treatments.
Christian doctors practice on the frontlines of tensions over gender dysphoria and transition. CT agreed not to use the name of one—call him Dr. J—because he doesn’t want protesters filling his northeastern US waiting room. What’s key: Dr. J resists a busy doctor’s pressure to rush through an appointment. Instead, he begins with mundane but essential questions about the patient’s social and familial history.
He’ll say, “Talk to me about what’s happened. What brought you to this place in life?” When patients express dissatisfaction with their status as men or women, Dr. J doesn’t suggest transitioning. Instead, he asks questions: “Who lives at home? How are your relationships? What do you do for a living? Have you experienced past abuse?”
Dr. J said it’s “about loving patients well, caring for them well, seeing them with God’s eyes.” Good questions help patients open up about their reasons for detaching from their male or female identity. They can form a bridge to help patients move beyond seeing medical transition as the answer to past trauma.
Dr. J. lives out what the Christian Medical & Dental Associations (CMDA) call “winsome advocacy.” CMDA senior vice president Jeff Barrows calls for encouraging “meaningful dialogue” that could lead to changed opinions. Dr. J offers medical and scriptural arguments: He explains to patients requesting gender transition hormones that up to 85 percent of youth experiencing gender dysphoria later move beyond it and also encourages them to consider God’s design for their lives.
The CMDA statement on transgender identification, passed by the association’s leadership—54 approvals, 0 opposed, 0 abstentions—says, “Christian healthcare professionals should not initiate hormonal and surgical interventions that alter natural sex phenotypes. Such interventions contradict one of the basic principles of medical ethics, which is that medical treatment is intended to restore and preserve health, and not to harm.”
The statement says, “CMDA believes that prescribing hormonal treatments to children or adolescents to disrupt normal sexual development for the purpose of attempting gender reassignment is ethically impermissible, whether requested by the child, the adolescent, or the parent.”
Medically, Dr. J said treating gender dysphoria has parallels to treating anorexia nervosa: “Clinically, they’re thin, they’re underweight, but still think they need to lose weight.” Anorexic patients present challenges to their medical teams because the condition has both physical and mental factors. Even when patients become starved enough to need hospitalization for careful refeeding, they may be convinced that more calories are the last thing they need.
Prescribing weight-loss drugs might gain a patient’s short-term gratitude while causing serious harm. Seeing the patient with God’s eyes means addressing the body-image problem behind the nutritional problems. He starts with asking a patient, “Why do you see yourself the way you do?”
Just as he’d say no to an anorexic patient insisting on dieting help, Dr. J says no to prescribing gender transition hormones. But the two situations are different theologically—Genesis 1:27 states that God made mankind male and female—and practically, given cultural pressures. A refusal to go along with gender transition requests could cost Dr. J his job. But Christian doctors have historically placed what both the Bible and medical science say above the requests of a patient.
Historically in family medicine, doctors have not been prescription-dispensing machines. Instead, they ask themselves, “Is this in the best interests of the patient?” Should a doctor dispense expensive new drugs because a television commercial has touted them? What if a patient with a viral cold asks for antibiotics meant to treat bacterial infections? Should a patient at risk for a stomach ulcer take painkillers like ibuprofen, which risk aggravating the ulcer?
Caring for patients well can mean saying no. Ultimately, Dr. J said, his medical practice is not about him. He doesn’t tell patients he’s “not comfortable” dispensing gender transition hormones, because “it isn’t about my comfort. It is about the patient’s needs.” Patients’ rejection of their biological sex can stem from physical, social, and even spiritual needs.
Doctors may have to unmask underlying needs gently. Dr. J said seeing patients with God’s eyes means recognizing and addressing each need with grace.
Here are excerpts from the CMDA statement published (with 88 footnotes to medical articles):
“At the heart of disagreement over transgenderism is a difference in worldviews. If the human body is nothing more than the product of mindless, random, purposeless physical forces, then one may do with it what one wishes, even to demand medical and surgical cooperation in projects to alter, amputate, or reconstruct normal tissue to conform to the patient’s revised psychological sense of identity. If, on the other hand, our bodies are an inseparable aspect of our true selves and are a good gift from God, who has designed the sexes to be wonderfully paired, and who has a purpose for humanity, then respecting the gift of given sexual identity and the ensuing moral obligations to our neighbors is the surest path to human flourishing ….
“CMDA considers ‘sex’ (i.e., male or female) to be an objective biological fact …. CMDA cannot support the recent usage of the term ‘gender’ to emphasize an identity other than one’s biological sex, that is, a subjective sense of self based on feelings or desires leading to identifying somewhere on a fluid continuum of gender identity. CMDA cannot support the prevailing culture’s acceptance of an ideology of unrestrained sexual self-definition that, in celebrating gender fluidity and gender transition efforts, is indifferent to biological reality and opposed to the biblical understanding of human sexuality.
“Further, CMDA is alarmed that some proponents of transgender ideology, through activism and intimidation, are insisting that healthcare professionals cooperate with and affirm their beliefs in gender fluidity, even if the healthcare professionals believe that such cooperation and affirmation would be doing harm to their patients. This violates the most fundamental core value of medicine since Hippocrates, that of caring only for the good and benefit of the patient while abstaining from all unnecessary harm. The evolving scientific and medical facts demonstrate that the mutilation of normal tissue and profound disruption of normal physiology that occur during gender transition procedures are very difficult to justify, as this constitutes deliberate harm ….
“Sex is an objective biological fact that is determined genetically at conception by the allocation of X and Y chromosomes to one’s genome, is observable at birth, is found in every nucleated cell, and is immutable throughout one’s lifetime. Sex is not a social construct arbitrarily assigned at birth and cannot be changed at will. Human beings are sexually dimorphic. Male and female phenotypes are the outworking of sex gene expression, which shapes sex anatomy, determines patterns of sex hormone secretion, and influences sex differences in the development of the central nervous system and other organs …. CMDA recognizes that exceedingly rare congenital abnormalities exist …. Anomalies of human biological sex are conditions rather than identities, something one has rather than who one is. Disorders of sex development … do not constitute a third sex.
“Gender dysphoria, the condition of experiencing discomfort or distress at one’s sex and preferring a different ‘gender’ identity … should not be confused with transient gender-questioning that can occur in early childhood …. In our current social context, there is a prevailing view that removing traditional definitions and boundaries is a requirement for self-actualization. Thus, Christian healthcare professionals find themselves in the position of being at variance with evolving views of gender identity in which patients or their subcultures seek validation by medical professionals of their transgender desires and choices through medical or surgical solutions to gender dysphoria. Although such desires may be approved by society at large, they are contrary to a biblical worldview and to biological reality and thus are disordered ….
“There is a social contagion phenomenon luring young people into the transgender culture. CMDA opposes efforts to compel healthcare professionals to grant medical legitimacy to transgender ideologies. Cooperation with requests for medical or surgical gender reassignment threatens professional integrity by undermining our respect for biological reality, evidence-based medical science, and our commitment to non- maleficence. Promotion of transgender ideology by educational institutions and teachers to children as young as 5 years of age is a danger to the health and safety of minor children ….
“Hormones prescribed to a previously biologically healthy child for the purpose of blocking puberty inhibit normal growth and fertility, cause sexual dysfunction, and may aggravate mental health issues. Continuation of cross-sex hormones, such as estrogen and testosterone, during adolescence and into adulthood, is associated with increased health risks including, but not limited to, high blood pressure, blood clots, stroke, heart attack, infertility, and some types of cancer ….
“Among individuals who identify as transgender, use cross-sex hormones, and undergo attempted gender reassignment surgery, there are well-documented increased incidences of depression, anxiety, suicidal ideation, substance abuse, and risky sexual behaviors in comparison to the general population …. Evidence increasingly demonstrates that there is no reduction in depression, anxiety, suicidal ideation, or actual suicide attempts in patients who do undergo surgical transitioning compared to those who do not. The claim that sex-reassignment surgery leads to a reduction in suicide and severe psychological problems is not scientifically supported.
“Restoring and preserving physical and mental health are goals of medicine, but assisting with or perpetuating psychosocial disorders are not. Accordingly, treatment of anomalous sexual anatomy is restorative. Interventions to alter normal sexual anatomy and physiology to conform to identities arising from gender dysphoria are disruptive to health. Medicine rests on science and should not be held captive to desires or demands that contradict biological reality. Sex reassignment operations are physically harmful because they disregard normal human anatomy and function. Normal anatomy is not a disease; dissatisfaction with natural anatomical and genetic sexual makeup is not a condition that can be successfully remedied medically or surgically.
“CMDA is especially concerned about the increasing phenomenon of parents enabling their gender-questioning children or adolescent minors to receive hormones to inhibit normal adolescent development. Children and adolescents lack the developmental cognitive capacity to assent or request such interventions, which have lifelong physical, psychological, and social consequences. Facilitating hormonal or surgical transitioning interventions for those who have not reached the age of majority is a form of child endangerment and abuse. Highly affirming parents have been shown to not improve the mental health statistics of transgender-identified children.
“Since Christians are to love their neighbors as themselves, they are to love those struggling with gender dysphoria or incongruence of desired gender with biological sex. Love for the person does not condone or facilitate gender transitioning treatments.”
Dr. Charles Horton is a graduate of Baylor College of Medicine and has been in practice for more than 20 years.
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