Tag Archives: Gender Dysphoria

Glimpsing the human cost of getting nature wrong

In February of the year, Ohio parents lost custody of their 17-year-old daughter because a judge ruled she should be allowed to receive therapy to identify as a boy.

Americans will see more cases like this as government officials align with transgender activists to promote a radical view of the human person and endorse entirely experimental medical procedures. At stake are not only parental rights, but the well-being of children who suffer from gender dysphoria.

Transgender activists maintain that when a child identifies as the opposite sex in a manner that is “consistent, persistent, and insistent,” the appropriate response is to support that identification. This requires a four-part protocol, as I painstakingly detail in my new book, When Harry Became Sally: Responding to the Transgender Moment.

First, a social transition: giving a child as young as three a new wardrobe, new name, new pronouns, and treating the child as a member of the opposite sex.

Second, puberty blockers to prevent the normal process of maturation and development. This means there is no progression of the pubertal stage, and a regression of sex characteristics that have already developed.

Third, around age 16, comes the administration of cross-sex hormones: Boys are given feminizing hormones such as estrogen, and girls are given masculinizing hormones such as testosterone. The purpose is to mimic the puberty process that would occur in the opposite sex.

Finally, at age 18, these individuals may undergo sex-reassignment surgery: amputation of primary and secondary sex characteristics and plastic surgery to create new sex characteristics.

Starting a young child on a process of “social transitioning” followed by puberty-blocking drugs was unthinkable not long ago, and treatment is still experimental. Puberty- blocking drugs are not FDA-approved for gender dysphoria, but physicians use them off-label for this purpose. No laws in the U.S. prohibit use of puberty blockers or cross-sex hormones for children, or regulate age at which they may be administered.

Normally, 80 to 95 percent of children will naturally grow out of any gender- identity conflicted stage. But all the children placed on puberty blockers in the Dutch clinic that pioneered their use persisted in a transgender identity, and went on to begin cross-sex hormone treatment.

This treatment protocol can interfere with the resolution of a gender- identity conflict. The rush of sex hormones and the natural bodily development during puberty may be the very things that help an adolescent actually identify with his or her biological sex.

And sadly, the medical evidence suggests that “transitioning” does not adequately address the mental health problems suffered by those identifying as transgender. Even when procedures are successful technically and cosmetically, and even in cultures relatively “trans-friendly,” people still face poor psychosocial outcomes.

A more cautious therapeutic approach begins by acknowledging the vast majority of children with a gender-identity conflict will outgrow it. An effective therapy looks into reasons for the child’s mistaken gender beliefs, and addresses the problems the child believes will be solved if his body is altered.

As I document in When Harry Became Sally, mental health professionals liken gender dysphoria to other dysphorias (serious discomfort with one’s body) such as anorexia. These tend to involve false assumptions or feelings that solidify into mistaken beliefs about oneself.

As a result, some mistakenly believe that a drastic body change will solve or minimize their psychosocial problems. But altering the body through hormones and surgery doesn’t fix the real problem, any more than liposuction cures anorexia nervosa.

The most helpful therapies do not try to remake the body to conform to misguided thoughts and feelings—which is impossible—but rather help people move toward accepting the reality of their bodily selves.

Biology isn’t bigotry. And there are human costs to getting human nature wrong.

RYAN T. ANDERSON, PH.D. (@ RyanTAnd) was a featured speaker at the Legatus 2018 Summit. He is the William E. Simon Senior Research Fellow at The Heritage Foundation and author of the book Truth Overruled: The Future of Marriage and Religious Freedom, and of the recently released When Harry Became Sally: Responding to the Transgender Moment.

Dysphoria and disorder: a tale of two disturbances

If a friend is debilitated by significant anxiety, stress, low self-esteem, and depression, we naturally want to help alleviate this dangerous dysphoria (profound state of unease, anxiety or dissatisfaction). But first we need to find out why our friend is unhappy. Dysphoria is usually a symptom of an underlying problem: tension at home, traumatic experience, sense of meaninglessness, chemical imbalance, pathogen, or other factor(s). It could also result from a combination of factors, which may be more or less severe and more or less persistent. We might say that dysphoria results from disorder: problematic symptoms arise from something that is out of its properly ordered state.

John A. Di Camillo, PH.D., BE.L.,

None of this suggests that our friend is at fault for causing the underlying disorder. It is likely that he or she has been victimized in some way, perhaps even by happenstance. There is nearly always some contributing cause outside a person’s own will or desires. So “disorder” is not a term that ascribes culpability to the person, but an objective identification of a problem. If we want to help our friend we need to know the underlying disorder.

When diagnosing mental health issues, psychologists and psychiatrists in the U.S. refer to a volume created and updated by the American Psychiatric Association (APA) called the Diagnostic and Statistical Manual of Mental Health Disorders, now in its fifth edition (DSM- 5). The World Health Organization maintains a comprehensive International Classification of Diseases (ICD). Health care providers and insurance companies in the United States currently make use of its tenth revision (ICD- 10) for diagnostic coding, and the DSM-5 classifications identify which ICD-10 codes to use for billing.

So let’s consider gender dysphoria, which is a lasting discrepancy between experienced gender and assigned gender. It is not mere gender nonconformity. The diagnostic term “gender dysphoria” was formally introduced in the DSM-5 only in 2013. In the previous edition of the DSM, the term was “gender identity disorder.” Why the change?

According to the APA, the rationale for the change was twofold. First, it aimed to remove any implication that the patient is “disordered.” Nonetheless, other mental health diagnoses with the term “disorder” remained unchanged, and the DSM-5 still uses the term “mental disorders” in its title. Second, it aimed to retain a diagnostic term without compromising the first aim. In fact, following the rationale of eliminating “disordered” connotations, the complete removal of gender identity disorder had been proposed; but a psychiatric diagnosis was still needed to enable access to and insurance coverage for “gender transitioning” counseling, hormonal interventions, and surgeries.

So the term “gender dysphoria” purposefully mutes the disorder and emphasizes the distress that results. The psychiatric problem is no longer lack of identification with one’s bodily sex, but rather the unhappiness associated with it. “Treatment” can therefore mean eliminating the dysphoria—not the underlying identification issue—by reinforcing the perceived gender through “gender-affirming” counseling, hormones, surgery, or all of these. Affirm the conviction and change the body to make the person feel better.

Masking the problem of an identity disorder by focusing on the consequence of dysphoria gravely undermines the possibility of authentic healing for vulnerable persons experiencing gender confusion. It reflects a fundamental misunderstanding of what it means to be a human person, who is a unity of body and soul. Maleness or femaleness is found in the unified, embodied person. There is no “inner self” that can be a distinct source of personal identity over and against bodily sex; rather, the convictions or desires of the mind might be at odds with the person’s embodied sexual identity. In fact, the DSM- 5 lists six criteria that can be invoked for a gender dysphoria diagnosis, five of which reference a “desire” or “conviction.”

Focusing on the dysphoria while attempting to deny the disorder demands reinforcing the disorder and mutilating the body to meet an imagined version of the “self” at odds with the person’s body-soul reality. This cannot bring authentic joy and fulfillment. The pastoral constitution Gaudium et spes of the Second Vatican Council reminds us that “man is not allowed to despise his bodily life, rather he is obliged to regard his body as good and honorable since God has created it and will raise it up on the last day.” Let us bear in mind the need to love and understand people experiencing gender identity confusion, while also helping them to understand and love their male or female bodies as beautiful manifestations of their authentic selves.

JOHN A. DI CAMILLO, PH.D., BE.L., is a staff ethicist at The National Catholic Bioethics Center in Philadelphia. He earned his bioethics doctorate and licentiate degrees at the Pontifical Athenaeum Regina Apostolorum in Rome.