Wednesday, September 30, 2015

Ask Tony: What does the Catholic Church teach about sex changes?

Caitlyn Jenner, the face of transgenderism.
A couple of weeks ago, in Outside the Asylum, I addressed Pope Francis’ recent letter on the Holy Year of Mercy. Today, I received a question there from Charles: “I know a man who recently decided to undergo a sex change procedure. What is the Church’s position on this?”

A Not-So-Obvious Answer

This question comes at a sensitive time for my family and me, as one of my cousins is “transitioning” from a male to a female identity. The answer would seem to be obvious to many people; the best course of action, then, is to research the question to make sure the obvious answer isn’t wrong.

Surprisingly, the answer doesn’t lie in one single Vatican-issued document such as the Catechism of the Catholic Church or a papal encyclical like Deus Caritas Est. According to the Catholic News Service, in 2000 the Congregation for the Doctrine of the Faith did issue a sub secretum letter to the various papal legates, and again in 2002 to the presidents of bishops’ conferences. Strangely enough for a secret document, this letter has remained secret — unlisted with other CDF letters and ad dubitum documents, unmentioned in the USCCB website, and not readily available through Google or Bing. (Apparently Wikileaks hasn’t gotten around to it yet.)

Nevertheless, various Catholic people and sources have addressed the questions of sexual identity and gender reassignment surgery. In lieu of any formal definitive statement, I can attempt an informed provisional answer. And it turns out the answer isn’t as obvious as you may think.

Sexual Identity and Human Dignity

So God created man in his own image, in the image of God he created him; male and female he created them. And God blessed them, and God said to them, “Be fruitful and multiply, and fill the earth and subdue it; and have dominion over the fish of the sea and over the birds of the air and over every living thing that moves upon the earth.” (Genesis 1:27-28)

In the first “creation narrative”, from which the Genesis citation was drawn, God created both man and woman equally in His own image, and yet with separate identities. From this passage and others the Catholic Church takes the principle of the complementarity of the sexes, in that both sexes by themselves are incomplete even as reflections of God, but when united have the potential to complete this reflection of God’s image even as they complete each other. (Compendium of the Social Doctrine of the Church 146-147; see also Catechism of the Catholic Church 2331-2336) In turn, these separate yet equal identities are tied into sexual reproduction, making sex both unitive (two halves of God’s image combining to make a whole) and procreative (Man as participant in God’s ongoing creative act) — the foundation of family.

Catholic social doctrine stresses the intrinsic dignity of the human being, and condemns violations of that dignity according to the nature and severity of the act. This is a development over the centuries from the Law of Moses, which placed heavier restrictions on the physical force masters, patriarchs and judges could use, especially physical mutilation, than was common in other cultures and other eras. (The oft-quoted “eye for an eye” was not a mandate of like-for-like vengeance, but rather a limitation on the degree to which retributive action could be imposed: the plaintiff could seek no greater damage to the defendant than had been done to himself.) Of particular interest to us is this: “Except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations, and sterilizations performed on innocent persons are against the moral law” (CCC 2297; bold font mine).

Some Definitions

The question is not whether sex-change (or “gender reassignment”) surgery (GRS) is intended to be therapeutic — of course it is; no one with any knowledge of the subject can reasonably deny it. There is, however, considerable question whether it is a proper intervention. Unfortunately, this is where the bright line between fact and fiction is lost in a tangle of social agendas, political demagoguery, and philosophical incoherence.

First, let’s make some distinctions in terms. GRS is only specified as therapy for two conditions. One is a spectrum of genetic errors resulting in intersex disorders, more informally (and misleadingly) called hermaphroditism, which lead to incomplete or incorrect development of the sexual organs. The other is a psychological condition formerly known as gender-identity disorder (GID), now known since the issue of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-V) as gender dysphoria syndrome, in which a person is convinced s/he has the psychological and social attributes of the opposite sex, and can’t identify with the sex with which s/he was born.

Nota bene: Gender dysphoria syndrome should not be confused with simple transvestitism. Transvestites suffer no confusion or illusions about their sexual identity; their penchant for dressing up in the clothes of the opposite sex is part homoerotic fetish, part social satire.

Intersex Disorders and Sexual Identity

Contrary to feminist and transgender dogma, there’s significant evidence that the different biologies of men and women do affect the way we think and feel, to an as-yet-undetermined degree. Intersex disorders shed some light on this.

Consider “Natalie”, who was born with Swyer syndrome: born a genotype XY, her testes never developed, which meant that the process which would ordinarily have turned the Müllerian ducts into a penis and vasa deferenses instead developed into a vagina, uterus and fallopian tubes. Like many intersex people, Natalie’s condition means she will never bear or beget children.

Also because of the undeveloped testes (“streak gonads”), Natalie “physically is a pre-pubescent girl who grew to adult size but didn’t go through puberty,” explains “Zoe”, another person born with an intersex disorder. “[Natalie’s] been brought up as female, looks mostly female ... but doesn’t ‘get’ being female any more than a 6-year-old girl ‘gets’ what she will feel like at age 16. She’s not male, though; she doesn’t ‘get’ that either.” When surgical intervention became possible, victims of intersex disorders were “assigned” female identities by default at or near birth. Today, GRS waits for a few years, and takes in psychological and social considerations before the patient chooses a gender to live with.

A Mind and Body at War

Gender dysphoria, however, presents a greater complex of problems. First, the causes aren’t fully known, let alone “settled science”. The example of intersex disorders does give cause to speculate a biological component; however, no biological cause has been identified as such to date. Second, precisely because of its complexity, gender dysphoria is reputed to be a largely intractable disorder to treat by standard psychotherapeutic measures.

Sexual identity is not merely a matter of gonads; our sexes are encoded throughout our whole bodies. GRS merely changes the body’s appearance to that of the opposite sex, and introduces a life-long course of hormone treatments to suppress or modify secondary sexual characteristics, such as the voice and body hair; in the case of woman-to-man transitions, penile erections must be produced by a subcutaneous air pump. In essence, rather than integrating the mind and the body, GRS sets mind and body at war with each other.

All too often, the mind loses. A population-based matched-cohort study of Sweden’s sex-reassigned persons performed in 2011 found a mind-boggling 19:1 difference in suicide rates between post-op transsexuals and the general population, as well as a 4.9-times higher risk of suicide attempts and a 2.8-times higher rate of inpatient psychiatric care. And this is in what’s commonly considered the world’s most tolerant country!

Regrets, I Have a Few

In 2004, a University of Birmingham (England) review of over 100 international medical studies “found no robust scientific evidence that gender reassignment surgery is clinically effective,” according to David Batty at The Guardian (which sponsored the review); the university’s Aggressive Research Intelligence Facility “found that most of the medical research on gender reassignment was poorly designed, which skewed the results to suggest that sex change operations are beneficial.”

Studies suggest that around 20% of post-op transsexuals regret their sex changes. Says Walt Heyer, who lived for awhile as a woman named Laura Jensen and now runs the website Sex Change Regrets: “I’ve heard reports of people regretting it after three weeks, but I’ve also heard of those who took thirty years to admit they regretted it. Because it’s such an enormous change, people don’t want to admit it. Not an easy thing to do.”

In another example, a 17-year-old British boy who made headlines in 2011 as the youngest person to start the GRS process, cancelled the surgery and withdrew from hormonal therapy less than a year later. According to psychiatrist Richard Fitzgibbons, research shows that 70 – 80% of children recover from gender identity issues; if this is true, then psychiatrists ought to be hypercautious about signing off on a drastic surgical intervention that time may well render unnecessary and even counterproductive.

As “Mrs. Izzy” said on the transgender resource site Susan’s Place when asked if the Sweden study was “a load of baloney”: “It’s sad and true. [GRS] is not the fix all. Will not make all the troubles with work, relationships, or family just fall to the way side. That’s why surgery is the last process one should take after everything is settled [bold font mine.—ASL]. A [vagina] is not that magical thing. It’s just genital.”

Unfortunately, many if not most transsexuals and GSR advocates hold to a theory of sexuality which denies the biological reality of sexual identity — indeed, it holds reality itself to be a social and linguistic construct — and that it’s the mind, not the body, which determines one’s sexual identity. The American Psychiatric Association hasn’t been a politically neutral body for over forty years, and has shown itself unwilling to admit any flaws or bias in research which supports the LGBT lobby’s beliefs. As a result, therapists often start suggesting GRS at the very beginning of treatment, and tend to wave away post-operative regrets with, “You just need more time to adjust.”

GRS “could be morally acceptable”

Having said all that — that is, having noted that the evidence for its effectiveness is debatable at best, and that it should be contraindicated for anyone under twenty-five — having said all that, the double-secret letter that the CDF sent the bishops’ conferences and papal legates conceded that “the procedure could be morally acceptable in certain extreme cases if a medical probability exists that it will ‘cure’ the patient’s internal turmoil.” The fact is, such a probability does exist, which potentially makes this provision a loophole big enough to drive a supercarrier through. A similarly-huge loophole provides that a marriage to a transsexual can be invalidated if it can be determined that “a transsexual disposition predated the marriage” (unless you’re married as an infant, this is a given).

From the standpoint of canon law, while a person’s civil gender may change, his canonical gender does not and cannot. Again, the surgery doesn’t effect a true change of sexual identity; as the National Catholic Bioethics Center puts it, “A person can mutilate his or her genitals, but cannot change his or her sex.” Because of this, GRS rules out the sacraments of Ordination and Holy Matrimony, as the mental health issue introduces reasonable doubts germane to the sacraments. In any event, you should include your parish priest and/or spiritual counselor in your therapeutic process before making the decision to undergo GRS.

The bottom line: Gender-reassignment surgery is both spiritually deficient, as it denies a fundamental truth of our beings, and of questionable therapeutic value. Therefore, a person suffering from gender dysphoria syndrome should first pursue normal psychotherapeutic avenues in conjunction with regular spiritual counseling. However, as a last resort, and with considerable adult reflection and consent, GRS can be morally licit.

Oh, and by the way: I haven’t mentioned my cousin’s name, because he — or, rather, she — is in control of the transition, and these are sensitive things to manage. But she’s still my cousin.