Jennifer Gruenke, a professor of biology at Union University (a Christian college in Tennessee), has written a piece in The Public Discourse challenging the "conservative approach to transgenderism," declaring that "there are good scientific reasons for supposing that subjective experience of gender is legitimate, even when it contradicts apparent biological sex."
One example of the "conservative approach" that Dr. Gruenke questions would be found in the Family Research Council's recent Issue Analysis, "Understanding and Responding to the Transgender Movement," which Dale O'Leary and I co-authored.
Only a day after Gruenke's piece appeared, The Public Discourse published a thoughtful and thorough response by Gregory Brown. I commend it (and the FRC paper mentioned above) to your attention, and will limit my comments here to only a few.
First, Dr. Gruenke is a biologist. Therefore, perhaps not surprisingly, her article has a strong bias toward seeking biological (rather than psychological) explanations for transgenderism -- the phenomenon of people experiencing an inner mental conviction that they are or should be of the gender opposite to their biological sex.
Because of this bias on the part of Dr. Gruenke, I am inclined to give more credence to the expertise of Dr. Paul McHugh, who as a psychiatrist can be expected to have insight into both the biological and psychological aspects of the issue. Dr. McHugh, former chief of psychiatry at Johns Hopkins University and Hospital, is perhaps the leading expert spokesman for the "conservative approach" that Gruenke questions. McHugh has declared bluntly, "It is a disorder of the mind. Not a disorder of the body." He has also lamented about his profession, saying, "We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it." McHugh has written about this issue in The American Scholar, First Things, The Wall Street Journal, and The Public Discourse itself.
Most of Gruenke's article deals with so-called "intersex" conditions (now also known as "disorders of sexual development," or DSDs). These are conditions in which some of the biological indicators of sex (such as internal sex organs, external genitalia, and chromosomal make-up) are inconsistent with each other or with what is typical of the individual's (apparent) sex.
Yet people on all sides of the transgender debate agree that true biological intersex conditions (which are rare) are not the same as the transgender phenomenon. In fact, until 2013, people with a DSD were explicitly excluded from a diagnosis of "gender identity disorder" according to the American Psychiatric Association. With the publication that year of the 5th edition of the APA's "Diagnostic and Statistical Manual" (DSM-5), people with DSDs were included under those with (the newly re-named) "gender dysphoria," but only in a separate sub-category. The World Professional Association for Transgender Health -- the leading pro-transgender professional organization -- agrees, saying, "In people with a DSD, gender dysphoria differs [from in most transgender people] in its phenomenological presentation, epidemiology, life trajectories, and etiology."
Gruenke's description of several such conditions, therefore, is interesting but ultimately irrelevant. The vast majority of people with "gender dysphoria" have no anatomical or chromosomal irregularity or inconsistency at all. In discussing such cases, all Gruenke is left with is pure speculation about some hypothetical "mutation" that might affect brain development but has no impact on either the sex chromosomes or any aspect of sexual anatomy, and is "only discernible through introspection." Such speculation is a rather weak read on which to lean.
Gruenke also notes an analogy that some critics of the transgender movement have made. They have argued that a man who perceives himself as a woman has a distorted self-concept of his body comparable to that of an anorexic -- a person who is underweight yet perceives herself as overweight. McHugh, for example, has said gender dysphoria "belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder. Its treatment should not be directed at the body as with surgery and hormones any more than one treats obesity-fearing anorexic patients with liposuction."
Gruenke seeks to rebut this argument by pointing out that anorexia can actually be fatal. However, this rebuttal is ultimately not convincing. It is true that the body's nutritional system is necessary to maintain life. While one can survive without reproducing, full sex reassignment surgery essentially destroys the reproductive system (and makes even sexual intercourse extremely difficult, unlike more modest forms of sterilization). It is hard to see how it could be considered consistent with the ethical principle of "do no harm."
There should be no objection to biologists continuing research to try to determine if there are genetic or biological disorders of sexual development (DSD) that have not been discovered or explained yet. However, the evidence seems clear that most people who identify as transgender have co-morbid psychological disorders which provide a better explanation for their "confusion" (and yes, even "delusion") than anything biological. And it is also clear that most people who counsel and do surgery for gender transition have an ideological bias which leads them to ignore these issues and simply support whatever solution (transition, hormones, and/or surgery) that the person requests.