EXECUTIVE SUMMARY **
In recent decades, there has been an assault on the sexes. That is, there has been an attack on the previously undisputed reality that human beings are created either male or female; that there are significant differences between the sexes; and that those differences result in at least some differences in the roles played by men and women in society.
The first wave of this attack came from the modern feminist movement and the second from the homosexual movement. The third wave of this assault on the sexes has been an attack on a basic reality--that all people have a biological sex, identifiable at birth and immutable through life, which makes them either male or female.
The third wave ideology is known as the "transgender" movement. This paper offers a description and critique of that movement and ideology. Part I addresses the psychological and medical issues involved; Part II will address the public policy issues.
Part I: Gender vs. Sex
According to the new gender ideology, the word "sex" is restricted to the biological, while "gender" describes the social and cultural manifestation of sex: how a person feels and experiences his or her sexual identity and how it is shaped by culture.
If individuals are unhappy because they want to be the sex they were not born, they are, according to the American Psychiatric Association, suffering from "gender dysphoria." Some believe they were born with the body of one sex and the psyche of the other and want their bodies changed to match their internal "wiring." They want to convince others to see them as the other sex.
Family Research Council (FRC) affirms what has been accepted as both normative and indisputable: that the truth about sexual differences is objectively knowable and that redefining it will be harmful.
Sidebar: Intersex Conditions
A misleading distraction frequently is raised in the context of this issue. A tiny percentage of people suffer from disorders of sexual development (DSD), sometimes referred to as an intersex condition (or as hermaphroditism). True hermaphrodites -- those in whom sexual anatomy is ambiguous or clearly conflicts with their chromosomal make-up -- are rare, estimated by one expert as "occurring in fewer than 2 out of every 10,000 live births." The vast majority of "transgender" individuals are not "intersexed."
No one can change his or her sex.
No one can change his or her sex. The DNA in every cell in the body is marked clearly male or female. Hormones circulating in an unborn child's brain and body shape his or her development. Psychiatrists and surgeons who have served transsexual clients know surgery does not change sex. George Burou, a Moroccan physician, admitted: "I don't change men into women. I transform male genitals into genitals that have a female aspect. All the rest is in the patient's mind."
In this new era of deconstructing and redefining human sexuality, a new set of vocabulary emerges. One pro-transgender activist group has issued a glossary of terms and definitions, explaining the differences between terms such as transgender, transsexual, and transvestite [or cross-dresser].
"Gender Identity Disorder" Becomes "Gender Dysphoria"
Transgender activists, following the example of the homosexual activists in the 1970's, have objected to having their condition labeled a "disorder." They successfully lobbied the American Psychiatric Association to have the diagnosis of "Gender Identity Disorder" (GID) changed to "Gender Dysphoria."
Consequentially, the revised language in the APA's 2013 Diagnostic and Statistical Manual (DSM-5) says, "Gender dysphoria refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender." But, to avoid the stigma transgender activists say they wish to discourage, why not simply remove the diagnosis from the DSM altogether, as was done with homosexuality? The APA says, "To get insurance coverage for the medical treatments, individuals need a diagnosis."
Causes of "Gender Dysphoria"
Family Research Council believes that it is politics, not science, which has driven the conclusion that such a condition is not inherently "disordered" and is only problematic if it causes subjective distress.
Sander Breiner, a psychiatrist with clinical experience working with transsexuals at Michigan's Wayne State University, declares, "[W]hen an adult who is normal in appearance and functioning believes there is something ugly or defective in their appearance that needs to be changed, it is clear that there is a psychological problem of some significance." Paul McHugh, professor of psychiatry at Johns Hopkins, has declared bluntly, "It is a disorder of the mind. Not a disorder of the body." Another psychiatrist, Rick Fitzgibbons, describes gender dysphoria as "a fixed false belief . . . [which is a manifestation] of a serious thinking disorder, specifically a delusion."
What, then, causes a person to experience such "dysphoria?" While causality is difficult to determine, the transgendered are more likely to have been victims of child sexual abuse and to have a history of trauma, loss, and family disruption.
Patterns of Transgender Desires
There are three major patterns of transgender desire.
1) Males with childhood GID, who are usually sexually attracted to men.
2) Secret transvestites (also known by some researchers as "autogynephiles")
3) Females with childhood GID, who are usually sexually attracted to women.
Gender Dysphoria in Children
Susan Bradley, M.D., of the University of Toronto, has worked extensively with children with gender identity disorder (GID). She regards GID as one of a number of attachment disorders. Bradley and Kenneth J. Zucker, two of the world's leading experts in GID in children, have declared that "clinicians should be optimistic, not nihilistic, about the possibility of helping the children to become more secure in their gender identity."
Even without treatment, the cross-gender behavior generally resolves itself in either self-identification as homosexual or heterosexual. Roughly 75 percent will later self-identify as gay or lesbian. Only a tiny percent will become transsexual. However, today trans-positive therapists encourage parents to accept GID as normal and allow the child to live as the other sex. As the child matures the therapists prescribe puberty blocking drugs, preparing the child for a total sex change.
Social acceptance is seen as a panacea, but there is no evidence these children will avoid the negative outcomes associated with transgender identification, including higher rates of suicide attempts, completed suicides, overall mortality, and need for psychiatric inpatient care. Zucker and Bradley view failure to treat children in an effort to prevent a transsexual outcome as "irresponsible." Referring to medical interventions to block puberty in gender-variant children, Dr. McHugh of Johns Hopkins says bluntly, "This is child abuse."
Who Gets Approved for "Gender Reassignment"?
An association of doctors who perform gender reassignment surgery, the World Professional Association for Transgender Health (WPATH), has developed Standards of Care for Gender Identity Disorders. Transgender persons seeking hormone therapy or surgery are supposed to be examined for undiagnosed disorders of sexual development or co-morbid psychological disorders. While the former (DSD) are rare, the latter are common yet necessary and appropriate psychotherapy may not always be offered, and may be resisted by clients determined to obtain surgery. In addition, only a handful of doctors in the U.S. actually perform gender reassignment surgery, leading some transgender people to seek it in other countries, such as Thailand, where conditions are more lenient.
Gender Reassignment Surgery
Full transition involves hormone treatments, breast surgery (removal or implants), other cosmetic surgery, genital reconstruction, and a change of personal identification. However, not every person seeking to live as the other sex will decide to have full reconstructive surgery.
Problems after Surgery
Gender reassignment surgery often does not achieve what patients hope for. Transgender individuals want to "pass" as the other sex. According to a large study of transgendered persons, only 21 percent are able to "pass" all the time.
The surgical procedures are not always successful and can be extremely painful. A lifetime of hormone treatments can also have profound physical and psychological consequences. Jon Meyer, M.D., Associate Professor of Psychiatry and Behavior Science at Johns Hopkins University, concluded, "My personal feeling is that surgery is not a proper treatment for a psychiatric disorder and it is clear to me that these patients have severe psychological problems that do not go away following surgery."
However, not all those who demand that society recognize them as the other sex have or even intend to have surgical alterations to their bodies. The position of transgender activists is that people should be recognized as belonging to whatever gender they choose, regardless of the physical condition of their bodies.
Transgender people are more likely than the general public to engage in high-risk behaviors, which may result from or contribute to psychological disorders (or both). Some of the high-risk behavior is directly related to their desire to change sex. For example, some transsexuals self-mutilate or undergo procedures in non-medical settings. Others engage in high-risk sexual behavior such as prostitution, which places them at risk.
High rates of suicide exist even among those who have already received gender reassignment surgery, which suggests that suicidal tendencies result from an underlying pathology. Ironically, however, some applicants threaten suicide or self-mutilation as an argument for the approval of surgery.
"GenderQueer" vs. "the Gender Binary"
To most Americans, it may seem radical to assert that a man can become a woman or a woman can become a man. However, the transgender movement has moved into even more radical territory--attacking what they call "the gender binary," that is, the idea that everyone should identify as either male or female. Those who adopt this approach sometimes refer to themselves as "genderqueer."
One of the reasons for the rise of "genderqueer" is that the state of being transgendered is extremely unstable. One source listed over 70 different gender identities.
Rebellion against Reality
Transgender activists blame their problems on "transphobia." Feminist author Janice Raymond says, "I accept the fact that transsexuals have suffered an enormous amount of psychical and emotional pain. But I don't accept the fact that someone's desire to be a woman, or a man, makes one a woman or man." She refers to "transsexualism" as "the falsification of reality." Terri Webb was a transgender activist who came to the conclusion that her activism was little more than "an unsuccessful attempt to get others to legitimize my fantasy."
Mental Health Treatment Options for Gender Identity Issues
A psychologically healthy person accepts the reality of his or her sexual identity. Grief, discomfort, and anger over one's genetic makeup signal problems that can and should be addressed through counseling. The academic literature includes some clinical accounts of successful efforts to overcome gender identity problems.
Decades ago, there were already findings pointing "to the possibility of psychosocial intervention as an alternative to surgery in the treatment of transsexualism." One of the most unfortunate results of the transgender movement is that this possibility has not been more thoroughly explored and developed.
Part II: Public Policy Implications of the Transgender Movement
1) Should the government itself (local, state, and/or federal) accept and recognize so-called changes in someone's sex or "gender identity?"
Sex is a biological reality, and is immutable. In reality, a "sex change" is impossible. Biological sex is a more fundamental, more important, and more accurate measure of a person's intrinsic identity than the purely subjective and often shifting concept of "gender identity." Ideally, the law would forbid government recognition in any way (whether on birth certificates, driver's licenses, passports, or any other government-issued identification) of any change in an individual's biological sex as identified at birth.
In states where such recognition is too deeply entrenched in the law or in judicial precedent for policy-makers to have a serious hope of undoing it, such recognition should be limited to cases where gender reassignment surgery already has been performed. Policy-makers should strenuously resist efforts to legally recognize changes of sex or "gender identity" that are based only on personal choice, psychological feelings, or social experience, rather than on a physical change.
2) Should the government force other, private entities to accept and recognize so-called "sex changes" through the use of non-discrimination laws that include "gender identity" as a protected category?
This question relates to the efforts to pass laws or ordinances at the local, state, and federal level which would outlaw "discrimination" on the basis of so-called "gender identity" in employment, housing, public accommodations, education, and business transactions.
Some of the bills or laws that seek to protect "gender identity" acknowledge the importance of appearance, dress and grooming standards in the workplace. However, most ordinary Americans would consider dressing in ways that are culturally appropriate for one's biological sex to be the most fundamental "appearance, grooming, and dress standard" that could be conceived of.
The most extreme application of the principle of "non-discrimination" based on "gender identity" would be to the use of gender-separated restrooms, locker rooms, and showers. Even former U.S. Rep. Barney Frank (D-MA), the homosexual Congressman who sponsored the Employment Non-Discrimination Act (ENDA), acknowledged that what transgender activists want "is for people with penises who identify as women to be able to shower with other women."
Here are some additional reasons to oppose laws purporting to outlaw "discrimination" based on "gender identity:"
- Such laws increase government interference in the free market.
- "Gender identity" is unlike other immutable characteristics protected in civil rights laws.
- Such laws would lead to costly lawsuits against employers.
- Such laws mandate the employment of "transgendered" individuals in inappropriate occupations, such as education.
3) Should the government pay for medical treatment designed to create the appearance one is other than the sex he or she was born?
One context in which taxpayers could be forced to pay for "gender reassignment" procedures is through the health insurance provided for public employees. Another avenue is government health insurance programs for the poor and the elderly (Medicaid and Medicare). On May 4, 2015, the federal courts decided a claim by a convicted murderer that the Massachusetts Department of Corrections should pay for his gender reassignment surgery--and that failure to do so was "cruel and unusual punishment." Fortunately, the court rejected that claim.
Government should not pay for gender reassignment (hormone treatments and surgery). Such treatments--involving, as they do, the amputation of healthy body parts--are, arguably, a violation of medical ethics. These are elective procedures rather than necessary health care--just like any other form of cosmetic or plastic surgery.
4) Should the government force other entities to pay for changes in sexual appearance?
The Affordable Care Act (also known as "Obamacare") has greatly expanded the role of the federal government in dictating to insurance companies (and those who purchase insurance policies, whether employers or individuals) what must be included in those policies. There is no explicit "sex change" mandate in Obamacare. However, some aspects of the law have increased the chances that insurance companies will offer such coverage. Late in 2014, the state of New York imposed a mandate upon insurance companies throughout the state to fund sex reassignment surgery (SRS).
5) Should the federal government permit "transgender" individuals to serve in the military as their preferred sex?
Historically, transgendered persons have not been permitted to serve in the U.S. military. Transgender status has been considered a disqualifying psychiatric condition, and having had gender reassignment surgery has been a disqualifying physical condition. However, transgender activists are pushing for a change to the policy.
The story of America's most famous transgender service member tends to reinforce concerns that such individuals are not fit for military service. Bradley Manning is the soldier convicted of espionage in 2013 for turning over confidential documents to the website Wikileaks. The day after Manning was sentenced to prison, he "came out" as transgendered.
A person's sex (male or female) is an immutable biological reality. In the vast majority of people (including those who later identify as "transgender"), it is unambiguously identifiable at birth. There is no rational or compassionate reason to affirm a distorted psychological self-concept that one's "gender identity" is different from one's biological sex.
Neither lawmakers nor counselors, pastors, teachers, nor medical professionals should participate in or reinforce the transgender movement's lies about sexuality--nor should they be required by the government to support such distortion.
** The Executive Summary does not contain citations as these are embedded in the text of this paper.
Dale O'Leary is a freelance writer and lecturer and the author of The Gender Agenda and One Man, One Woman. Her blog can be found at daleoleary.wordpress.com.
Peter Sprigg is Senior Fellow for Policy Studies at Family Research Council in Washington, D.C. and the co-author of Getting It Straight: What the Research Shows about Homosexuality and author of Outrage: How Gay Activists and Liberal Judges are Trashing Democracy to Redefine Marriage.