Medical FAQs

“Sex” is the biological classification of an organism according to its reproductive role. A person’s sex is determined at conception when the human ovum (egg), carrying an X chromosome is fertilized by a sperm cell carrying either an X or Y chromosome. If the ovum is fertilized by a sperm cell carrying an X chromosome, then the new human being has XX chromosomes and is female.  If the ovum is fertilized by a sperm cell carrying a Y chromosome, then the new human being has XY chromosomes and is male. (Only the Y chromosome carries the Sry gene, which directs the organization of the developing human being as male; without the Sry gene, the child is female.)

The person’s chromosomes (XX or XY) direct bodily development so that, at maturity, the body is equipped to procreate. Males develop testes, which generate sperm cells, and females develop breasts, a womb, and ovaries, which produce human ova (eggs). When a child is born, the reality of the child’s sex is acknowledged, not arbitrarily “assigned.” In rare cases, something goes wrong during the child’s development in the womb, resulting in a Disorder of Sexual Development (DSD or Intersex Condition), which may make it more difficult initially to determine the child’s sex at birth. See “What does ‘intersex’ mean?” below.

From conception, then, “every cell [of the person’s body] has a sex” and a person’s sex—male or female—cannot change.¹

References

1. Institute of Medicine (US) Committee on Understanding the Biology of Sex and Gender Differences; Wizemann TM, Pardue ML, editors. Exploring the Biological Contributions to Human Health: Does Sex Matter? Washington (DC): National Academies Press (US); 2001. 2, Every Cell Has a Sex. Available from: https://www.ncbi.nlm.nih.gov/books/NBK222291/

Every person has a sexual identity (male or female) based on biological sex. The theory that a person has a “gender identity” distinct from bodily sex was first promoted in the 1950s by Dr. John Money, a psychologist who treated transsexuals and children with disorders of sexual development. Gender identity is described as “an internal sense of being male, female or something else, which may or may not correspond to an individual’s sex assigned at birth or sex characteristics” (APA 2018).¹ Gender identity is a subjective feeling, sometimes linked to a person’s sense of conformity to stereotypes or cultural norms; it cannot be tested, measured, or objectively validated. Proponents of this belief claim all gender identities, including “non-binary” or “gender-queer,” are healthy and normal and each person has the autonomy to discern or declare a unique gender identity, regardless of sex (male or female). This belief in a self-determined identity, however, creates an antagonistic relationship with the body, which is unhealthy and profoundly confusing. In contrast, the Church teaches that the person is a unity of body and soul, and that “[e]veryone, man and woman, should acknowledge and accept his sexual identity” (CCC, 2333).²

References

1. American Psychological Association. (2018). A glossary: Defining transgender terms. Monitor on Psychology, 49(8), 32. Retrieved from https://www.apa.org/monitor/2018/09/ce-corner-glossary

2. Catechism of the Catholic Church, 2nd ed. (Washington, DC: United States Catholic Conference, 2000), 2333.

The term “transgender” is used by advocacy groups as “an umbrella term encompassing those whose gender identities or gender roles differ from those typically associated with the sex they were assigned at birth.”¹ Activists similarly describe people who identify as “nonbinary” as being “born with bodies that may fit typical definitions of male and female, but their innate gender identity is something other than male or female.”² The common thread is that persons who identify as transgender or nonbinary or something else reject their sexual identity as male or female in favor of a self-determined identity.

The Church teaches that everyone must accept his or her sexual identity as a gift from our Creator (CCC, 2333).³ Scientifically, it is not possible for a person to “be” or become the opposite sex. No person should repudiate his or her sexual identity by asserting a transgender, non-binary or gender fluid identity. Catholics should avoid language that appears to support the idea that a person can “be” something other than male or female, or that suggests people are defined by their feelings or desires. Instead of saying a person “is” transgender or nonbinary, it is more accurate to describe the person as a “person who identifies as transgender” or as a “transgender-identified person.”

Pastoral and professional care for persons struggling to accept their sexual identity should aim to harmonize their subjective experiences with their objective biological reality (male or female). For some people, therapy to address past trauma or underlying mental health issues may prove helpful. It is also important to affirm that there are many different ways to flourish as a man or a woman; the rejection of overly rigid sex roles does not entail a rejection of sex itself. See “What about a person who has interests, preferences, or behaviors typically associated with the opposite sex?” below.

References

1. “A Glossary: Defining Transgender Terms.” Monitor on Psychology 49, no. 8 (September 2018): 32. https://www.apa.org/monitor/2018/09/ce-corner-glossary.

2. “Understanding Non-Binary People: How to Be Respectful and Supportive.” National Center for Transgender Equality, October 5, 2018. https://transequality.org/issues/resources/understanding-non-binary-people-how-to-be-respectful-and-supportive.

3. Catechism of the Catholic Church, 2nd ed. (Washington, DC: United States Catholic Conference, 2000), 2333.

Sometimes children, adolescents, or adults experience feelings of dislike for their bodies or feel like their bodies are “wrong” or don’t “fit” who they are. These feelings may persist in ways that interfere with a person’s functioning. This “disconnect” between objective reality and a person’s subjective self-perception is common to a number of psychological conditions (e.g. anorexia nervosa, body integrity identity disorder, body dysmorphia). The sources of these various disorders are complex and not very well understood.

Until recently a person expressing a sense of being “in the wrong body” would have been understood as suffering a similar psychological disorder and in need of treatment to help align self-perception with objective reality. This phenomenon was described as gender identity disorder (GID) in the Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) and listed as a mental health diagnosis in the DSM-IV of 1994.

In 2013, the DSM-V replaced GID with a new diagnosis, gender dysphoria, that characterizes a person’s distress over an identity at odds with biological sex as pathological but validates the underlying identity as normal.¹ In 2019, the World Health Organization classified this experience as “gender incongruence,” describing it as a normal human variation to be affirmed and, if desired, supported with medical or surgical interventions to align the body’s appearance with the desired identity.²

In other words, over a short period of time and under social and political pressure, medical and psychological organizations have radically shifted their treatment approach towards anyone who asserts an identity at odds with biological sex. They no longer treat a perceived mismatch between body and identity as a psychological disorder requiring psychological treatment, but as a normal human variation that deserves validation and “on-demand” medical interventions to modify the body to match the person’s felt-identity. This change is not supported by sound psychology or medical research. From the Catholic perspective, the truth about the human person as a body-soul unity is non-negotiable. Catholics can neither support the view that a person is born “in the wrong body” nor facilitate medical or surgical body modifications as a remedy for distress over sexual identity or as an expression of personal autonomy. (Gender dysphoria is different from the situation of a person with a Disorder of Sexual Development/Intersex condition. For more information see “What does ‘intersex’ mean?” below.)

References

1. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf

2. International Statistical Classification of Diseases and Related Health Problems (11^th ed,; ICD-11; World Health Organization, 2019). https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f90875286

“Intersex” is the informal description for conditions diagnosed as Disorders of Sexual Development (DSD). These rare conditions occur during fetal development and may include chromosomal, hormonal, or organ abnormalities. Research indicates that the impact of a DSD varies greatly, ranging from minor effects diagnosed later in life to serious anomalies causing infertility or requiring immediate surgery or lifelong hormonal treatment. Among the most common “intersex” disorders are: Klinefelter Syndrome, affecting an estimated 1 in 500-1000 males; Congenital Adrenal Hyperplasia, affecting an estimated 1 in 10,000 to 15,000 live births, impacting males and females in significantly different ways; and Androgen Insensitivity Syndrome, affecting an estimated 1 in 99,000 males.^1,2,3

Transgender activists and proponents of gender theory often cite DSDs as evidence that sex is not binary (male or female). They argue that intersex disorders “prove” the existence of a “third sex” or that sex exists on a “spectrum.” This is nonsense. A disorder of sexual development is not evidence of a “spectrum” of normal sexual identity any more than a defect in the development of the heart is evidence of a “spectrum” of normal heart structures. Medical or surgical interventions to address intersex conditions can be legitimate means to restore the body’s healthy functioning. Some persons born with DSD rightly protest the treatment protocol developed decades ago under the influence of Dr. John Money. He maintained that a child’s identity was not innate but dependent on socialization; thus whether and what kind of surgery to perform on the genitals of a child with DSD would be decided not on predominant chromosomal makeup or optimal bodily function but on the basis of which genitals (male or female) would be easiest to surgically construct. Such surgeries often caused harm, both physical and psychological. Unlike a person with DSD, a person who identifies as transgender and seeks a “gender transition,” using medical or surgical interventions to modify the body, has a healthy body to begin with. Taking hormones or having surgery as part of a gender transition damages or destroys the healthy body and is not morally permissible.

References

1. “Klinefelter Syndrome.” NORD (National Organization for Rare Disorders), 2017. https://rarediseases.org/rare-diseases/klinefelter-syndrome/.

2. “Congenital Adrenal Hyperplasia.” NORD, 2018. https://rarediseases.org/rare-diseases/congenital-adrenal-hyperplasia/

3. “Partial Androgen Insensitivity Syndrome.” NORD, 2019. https://rarediseases.org/rare-diseases/androgen-insensitivity-syndrome-partial/

The term gender transition is a catch-all phrase that describes different steps a person might take to modify external appearances to reflect the desired “gender identity.” A social transition can include changes in clothes, hair, and behavior to assert an identity that differs from the person’s biological sex. A medical transition involves off-label use of medication to block the normal process of puberty or to induce the development of secondary sex characteristics of the opposite sex. Surgical transition involves surgery to remove reproductive organs or genitals, create a “neovagina” or “neophallus” (simulated genitals), or modify the body’s appearance in other ways.^1,2 A legal transition occurs when a person changes his or her name or sex on legal documents such as a birth certificate or passport.

In reality, however, a person cannot actually “transition” to “become” someone other than the male or female person God created them to be. The Catholic Church, supported by reason and science, teaches that a person’s sex (male or female) is innate (from conception) and immutable. A so-called “gender transition” is premised on the erroneous theory that a person can reject his or her sexual identity (male or female) and assert a self-defined “gender identity” at odds with bodily reality. This is harmful and not conducive to human flourishing.

Social, medical, and surgical interventions to facilitate a person’s “transition” actually pathologize healthy bodies, disrupt natural developmental processes, and carry serious lifelong consequences. For example, a child who “transitions” using puberty blockers followed by cross-sex hormones as an adolescent becomes infertile forever. The medical and surgical interventions now used to affirm a child or adolescent’s gender identity amount to dangerous medical and psychological experiments, based on scant, low-quality evidence, with little research on long-term effects or medical harm. Neither adolescents nor the parents of children or adolescents undergoing transition procedures can give meaningful informed consent, because the long-term complications and consequences of these interventions are unknown.

It is neither compassionate nor loving to support or affirm a person’s desire to transition. Accommodating a person’s “transition,” at any stage, validates the person’s false belief that it is possible to have an “authentic” identity that contradicts bodily reality. Even a child’s social transition, however minimal, is harmful because it conveys adult approval of the child’s desired identity and reinforces the child’s false belief that he or she really “is” someone other than the male or female God created. See below for FAQs on specific “stages” of “transition.” 

References

1. Dreher, P. C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S., & Rumer, K. L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clinical anatomy (New York, N.Y.), 31(2), 191–199. https://doi.org/10.1002/ca.23001

2. Frey, J. D., Poudrier, G., Chiodo, M. V., & Hazen, A. (2016). A Systematic Review of Metoidioplasty and Radial Forearm Flap Phalloplasty in Female-to-male Transgender Genital Reconstruction: Is the “Ideal” Neophallus an Achievable Goal?. Plastic and reconstructive surgery. Global open, 4(12), e1131. https://doi.org/10.1097/GOX.0000000000001131

The premise of “gender affirmative care” or “gender affirmation” is that all “gender identities” are normal and healthy, and that gender identity and expression are “basic human rights.” According to The Gender Affirmative Model,¹ “gender may be fluid, and is not binary, both at a particular time point and if and when it changes within an individual over time.” Advocates of the gender affirmative model say that every child should have the “opportunity to live in the gender that feels most real or comfortable to that child and to express that gender with freedom from restriction, aspersion, or rejection.” This approach tells parents, professionals, and others to encourage gender “exploration” and to affirm a child or adolescent’s asserted gender identity, regardless of whether it aligns with the person’s biological sex. Although research shows that children and adolescents identifying as transgender or nonbinary are significantly more likely than their peers to have serious mental health issues, the affirmative care model attributes “any pathology” to “cultural reactions to gender diversity” rather than to underlying mental health disorders. Although the gender affirmative model is heavily promoted by several U.S. medical associations and by physicians who specialize in gender transitions, it is highly controversial and not well-accepted internationally. (In April 2020, the U.K. announced plans to prevent minors under 18 from taking “gender-affirming” hormones.) “Gender-affirming care” is unsupported by quality scientific research and is incompatible with the Catholic view of the person.²

As Catholics, we affirm each person’s unconditional dignity and value, which come from being loved by God and formed in God’s image and likeness, but we cannot affirm a person’s “transition” or an asserted gender identity in opposition to the person’s sex. True affirmation acknowledges not only the person’s inherent dignity but also the truth of their situation—their unchangeable identity as male or female. Even if well-intended, “affirmative care” is not an authentic expression of care and compassion, as it denies the truth and is not oriented towards the genuine good of the person.

References

1. The Gender Affirmative Model: An Interdisciplinary Approach to Supporting Transgender and Gender Expansive Children, C. KeoMeier and D. Ehrensaft (Editors) American Psychological Association (2018).

2. Malone, William J., Gender Dysphoria Resource for Providers, 3^rd edition (2019).

The phrase “conversion therapy” is an imprecise umbrella term that originally was applied to a wide range of psychological interventions for persons experiencing same-sex attraction. The term fails to distinguish traditional talk therapy that explores, at the client’s request, unwanted feelings of sexual attraction or behavior from unethical, coercive practices of the past, which tried to force “change” in a person’s sexual orientation. In recent years, several states have passed “conversion therapy” laws that not only restrict talk therapies for same-sex-attracted clients but also restrict talk therapies for clients, including minors, who are experiencing identity issues. These “conversion therapy bans” attempt to dictate the goals of therapy by permitting only therapy that affirms LGBTQ identities and behaviors, while preventing therapists and their clients from exploring underlying reasons for a person’s feelings in hopes of resolving them. These laws not only impose a one-size-fits-all approach to therapy, but also restrict the free speech and religious rights of both therapists and clients. It is particularly damaging for children and adolescents to be denied sound psychological treatments to help them accept their bodies, integrate feelings with sexual identity, and find healing for underlying traumas or wounds. And it is unconscionable for the government or gender experts to dictate the use of gender-affirming therapies on children and adolescents, and effectively consign those who transition to lives characterized by medical dependency, mental health diagnoses, and elevated risks of suicide.

It is critically important to note that there is no scientific evidence that psychological interventions to help a child accept his or her bodily sex are harmful. In fact, research shows that children experiencing identity confusion or “gender dysphoria” typically resolve those issues with therapy that addresses underlying psychological issues or family dysfunction, or even with no treatment at all.¹  Activists sometimes claim that research has shown that “conversion therapy” to help a child or adolescent accept his or her biological sex is harmful. This is completely false, as no research has ever shown that therapies to help children or adolescents integrate their feelings with their biological sex are harmful. Further, no research has even been conducted regarding the relative harm or success of gender-affirming therapy versus talk therapy (erroneously described as “conversion therapy”) to help children or adolescents experiencing “gender identity” issues. Past research evaluating “conversion therapy” pertained only to the outcomes of specific treatments for sexual orientation in adults, not “gender identity” in children. Unfortunately, these “conversion therapy” bans are part of a larger ideological campaign to change our cultural beliefs about the human person, replacing the truth that we are created by God as male or female, forever, with the lie that each person is self-defining and all “gender identities” are normal and healthy.

References

1. Steensma, T. D., Mcguire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors Associated with Desistance and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study. Journal of the American Academy of Child & Adolescent Psychiatry,52(6), 582-590.

The Affirmative Care model promotes the practice of treating prepubescent children who question or express confusion about their identity with medicines called GnRH agonists or “puberty blockers.” These medicines, which stop the normal processes of puberty, are prescribed when the child reaches Tanner Stage 2, as he or she begins to show signs of maturation, but before the development of secondary sex characteristics. Puberty blocking medications are FDA approved only as a treatment for precocious puberty; their use in treating gender dysphoria (where the body is healthy and developing normally) is an off-label use. Although they are promoted as harmless and reversible (like pressing a “pause” button), puberty blockers can have serious consequences, including decreasing bone density and arresting bone growth, hindering normal maturation and brain organization, and blocking the development of the child’s reproductive organs and gametes (sperm and ova). The use of puberty blockers sometimes increases the child’s feelings of not fitting in with peers: the physical immaturity of the “blocked” child creates a gulf between the child and the child’s peers who are progressing through normal puberty.

The Catholic Church teaches that it is unethical to use medication to induce a diseased state in a healthy body. Prescribing puberty blockers induces a diseased state (hypogonadotropic hypogonadism) in which the normal development of the body is blocked from proceeding. In addition, the long-term physical consequences of using puberty blockers are unknown. Instead, each child should be helped to accept his or her body and sexual identity as a gift, while still understanding each person is an individual, free to express a unique personality.

In “gender-affirming” care, the administration of cross sex hormones to a child follows administration of puberty blockers, but it also can be the initial step of medically transitioning an adolescent or adult. Cross-sex hormones such as estrogen or testosterone are used off-label in order to induce the appearance of secondary sex characteristics of the opposite sex.¹ Males use female hormones such as estradiol (often along with anti-androgens to reduce testosterone) in order to modify the body to appear more feminine. Females use testosterone to modify the body to appear more masculine. A person who identifies as non-binary might receive low levels of cross-sex hormones to create an ambiguous appearance. Gender-affirming protocols call for cross-sex hormones to be administered at 16, but increasingly advocates promote the use of cross-sex hormones at earlier ages. In fact, the protocol for an observational study funded by the NIH expressly states that cross-sex hormones were used on at least one child at age 8.² Changes induced by cross-sex hormones, including changes to voice, hair and genitals (atrophying or shrinking) are irreversible; even worse, the combination of puberty blockers and cross-sex hormones leads to sterility. Use of these hormones comes with many associated health risks, including venous thromboembolic events, metabolic syndrome and abnormal lipid profiles, and decreases in bone density. Moreover, physicians have noted that use of cross-sex hormones often increases, rather than resolves, distress about the body, and the risk of suicide remains (see “What about suicide?” below). The Catholic Church teaches that mutilation of a healthy body either surgically or hormonally is never permissible. Cross-sex hormones involve modifying a healthy body to project an appearance that denies the gift of one’s sexual identity and seeks to create the appearance of an identity that is untrue.

References

1. Cavanaugh, T. Gender Affirming Hormone Therapy. National LGBT Health Education Center, Fenway Institute. Retrieved from https://fenwayhealth.org/wp-content/uploads/Friday-Session-5a.pdf

2. Olson-Kennedy, J., et al. (2019). Impact of Early Medical Treatment for Transgender Youth: Protocol for the Longitudinal, Observational Trans Youth Care Study. JMIR Research Protocols, 8(7). doi: 10.2196/14434

Surgical transition involves body modifications that include “top surgery” (mastectomies), “bottom surgery” (removal of the genital and reproductive organs), and surgical reconstruction of the genital area to construct neo-genitals or change its appearance in other ways. Additional surgical modifications include facial feminization surgery and surgical voice modification. Both top and bottom surgeries are offered at increasingly younger ages, with mastectomies performed on females as young as 13, and bottom surgery increasingly performed on males as young as 16. These surgeries can have serious complications, and often require repeat surgeries and hospitalizations. The suicide rates remain high even after surgical transition.

According to Catholic teaching, it is never permissible to mutilate a healthy body. Moreover, surgical transition seeks to destroy the gift of one’s sexual identity by mutilating the body in order to create an appearance that differs from one’s sexual identity. Genital surgeries typically destroy the capacity for reproduction and amount to intentional sterilization. Direct sterilization procedures also are not permissible and are gravely unethical.