Offer of sex change drugs to nine year olds should make us question therapists’ ideological presuppositions

Children as young as nine are to be prescribed drugs which delay the onset of puberty as the first step towards a sex change operation (Mail on Sunday and Daily Telegraph).

Doctors at the Tavistock and Portman NHS Foundation Trust said a trial of the treatment on ‘gender dysphoria’ patients aged 12 to 14 had been successful and it could now be offered even earlier.

Monthly injections of the drugs, known as hypothalamic blockers, are used to slow the development of the children’s sexual organs by blocking the production of the hormones testosterone and oestrogen.

The rationale is that by delaying the onset of sexual maturation this gives more time for gender conflicted youngsters to decide whether they wish to embark on hormone treatment and surgery aimed at changing their gender. 

Most people will be shocked at this news but it is actually a logical consequence of accepting four prior ideological presuppositions – that gender is a social construct, that personal autonomy should trump other considerations, that emotional suffering should be avoided at all costs and that technology should be used to achieve these ends. 

There are obvious safety concerns - although the gender treatment is reversible, the long-term effects on brain development, bone growth and fertility have not yet been fully evaluated.

But safety considerations aside, using hormones to suppress puberty in transgender children is highly controversial, not least because of deep societal disagreements about the causes and nature of transsexuality and the effectiveness and appropriateness of transgender therapies per se.  This means that therapists remain strongly divided about the best way of handling the issue.

Transgender people are born with the anatomy and physiology of one sex but believe that they belong to the opposite sex.  Should therapy therefore be aimed at changing bodies (using hormones and surgery) to match a person’s beliefs or should it rather be aimed at helping people to adjust mentally to accepting the bodies they were born with? Even more fundamentally, is ‘gender dsyphoria’ a mental disorder or is it just a normal variant like eye or skin colour?

Up until recently ‘gender identity disorder’ was classified as a mental disorder (in the Psychiatric diagnostic inventory DSM-IV) but it has now been reclassified and renamed ‘gender dysphoria’ (in the DSM-V).  This change was strongly ideologically driven and many psychologists and psychiatrists dispute the reclassification. They still see ‘gender identity disorder’ as a kind of body dysphoria, whereby a person has an unshakeable false belief that they are one sex when in fact they are the other. It has been likened to anorexia nervosa, where the affected individual is convinced she is fat whilst being grossly underweight.

Those who supported the reclassification however, take the view that gender identity is biologically fixed and determined and that it is harmful to affected individuals to deny them sex change therapy or to 'force' them to live with the body they were born with. Some even hold to the strongly postmodern view that gender, regardless of what one’s genes or hormones suggest, is simply a social construct, even a matter of choice. If you wish to appreciate how passionately these views are held, then try expressing a traditional understanding on twitter using the hashtag #lgbt!  

Is gender identity fixed as male or female or is it more of a spectrum or continuum? Can it change over time? How effective is therapy is changing the strength and orientation of one’s beliefs? How might suppression of puberty using hormonal treatment affect bone, brain and sexual development?

Research is still at an early stage with many of these questions and strong ideological convictions one way or the other mean that scientific objectivity about the real effects of sex change therapy may always be a matter of contention.  It is perhaps not surprising that both opinion and research in this whole area is often driven by powerful ideological vested interests.

Complicating this is the fact that gender identity may change in an individual over time, and that it may be very difficult to predict the outcome of for any particular person. Some children are much more appropriately described as ‘gender nonconforming’ or ‘gender-fluid’ rather than transgender. In many others gender identity may change with time.

Toronto specialist Ken Zucker, who opposes the use of sex change therapies, claims that only about 12% of boys and girls with gender dysphoria will still have persistent dysphoria as adults. This fact alone should lead even the most committed supporters of early intervention to err strongly on the side of caution.

The CMF File ‘Gender Identity Disorder’ goes into the issue in more detail and also looks at biblical principles which can be applied.

The Bible teaches that human beings are created in God's image and of two sexes – male and female (Genesis 1:27). Jesus drew on this when he commented, 'haven't you read, that at the beginning the Creator “made them male and female”, and said, “For this reason a man will leave his father and mother and be united to his wife, and the two will become one flesh” (Matthew 19:4-5).

The Old Testament command 'you shall not commit adultery' also indicates that sexual intercourse should only occur within the framework of marriage (Exodus 20:14). Sex outside the marriage bond is wrong, whether with someone of the same or opposite sex (Leviticus 18:22, 20:10).

The ideal pattern for existence was spoilt at the Fall when mankind rebelled against God's rules. One consequence of this is that moral values, sexual patterns and also biology (genes and hormones) have become distorted.

The good news at the centre of Christianity is that Jesus, through his death and resurrection, gives people new life and power to change. On top of this, there will be a time in the future when all rebellion against God's plans will come to an end and a perfect relationship with God can be fully restored. This brings the hope that transsexual people may find support as they seek to live in ways that are honest to the way God made them, and open to God's ideals.

It's worth noting that the Bible regards celibacy as a high calling. Jesus was fully human and male, but never married nor had sexual intercourse. He also taught that marriage is not for everyone (Matthew 19:12).  It is important to acknowledge this, as for some people, battling with gender conflict may be a life long process.