Love your neighbor as yourself

–Jesus

The Savior’s teachings were clear, but their applications are not always so clear. One thing I do know, however, is that the first step in loving someone is to understand where they are coming from. This post will be organized around five key questions about my brothers and sisters who are transgendered:

1) Is Gender Dysphoria treated as a mental illness?
2) What are the dangers of letting people use the restroom of the gender with which they identify?
3) What are the dangers of requiring people to use the restroom of the gender with which we think they should identify?
4) What about children? Should we be encouraging them to accept this life?
5) So, now what?

Is Gender Dysphoria, the technical name for what is experienced by trans* people, treated as a mental illness?

Some people will claim that my trans* brothers and sisters should be treated as if they have a mental illness. There are two problems with this, though. First, studies overwhelmingly demonstrate a biological basis for Gender Dysphoria. This is something medical, not psychological.[ref]One study, for example, found that the brain of a transgender man (female-to-male) is closer to the brain of a cisgender (not transgender) male brain than a cisgender female one: https://www.newscientist.com/article/dn20032-transsexual-differences-caught-on-brain-scan#.UhKQTBYx-5. And there are more where that came from. Here’s a collection of 15 more studies that come to the same conclusion: http://www.huffingtonpost.com/brynn-tannehill/how-much-evidence-does-it_b_4616722.htm. Even WebMD agrees: http://www.webmd.com/mental-health/gender-dysphoria[/ref]

The second problem with the idea that my trans* brothers and sisters should be treated as if they have a mental illness is simply the fact that the overwhelming majority of medical professionals disagree. Even though Gender Dysphoria is indeed listed in a manual of mental illnesses, the fact remains that the American Medical Association,[ref]http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/glbt-resources/lgbt-health-resources.page[/ref] the American Psychological Association,[ref]http://www.apa.org/about/policy/transgender.aspx[/ref] the American College of Obstetrics and Gynecology,[ref]http://www.ncbi.nlm.nih.gov/pubmed/22105293[/ref] the American Medical Student Association,[ref]http://www.amsa.org/advocacy/action-committees/gender-sexuality/transgender-health/[/ref] the American Public Health Association,[ref]http://www.apha.org/advocacy/policy/policysearch/default.htm?id=204[/ref] the World Professional Association for Transgender Health,[ref]http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1352&pk_association_webpage=3947[/ref] the American Academy of Family Physicians,[ref]http://www.aafp.org/about/constituencies/resources/glbt/transgender.html[/ref] the American Academy of Pediatrics[ref]https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/WhiteHouseTransgenderStudentLettertoSchools.aspx This group is not to be confused with the American College of Pediatricians, a tiny splinter group that broke away from the official industry association due to disagreements about the quality of same-sex parenting and stands in strident opposition to the medical consensus: http://www.acpeds.org/the-college-speaks/position-statements/gender-ideology-harms-children[/ref] all consider hormone therapy, surgery, and psychotherapy appropriate medical responses to Gender Dysphoria. In other words, all these associations of medical professionals are convinced that some trans men and women do in fact have a medical need for hormonal and/or surgical interventions.

And, the good news is, gender reassignment treatment has proven remarkably effective.[ref]”In over 80 qualitatively different case studies and reviews from 12 countries, it has been demonstrated during the last 30 years that the treatment that includes the whole process of gender reassignment is effective.” [footnote: Pfäfflin F, Junge A. (1998). Sex Reassignment. Thirty Years of International Follow-up Studies After Sex Reassignment Surgery: A Comprehensive Review, 1961-1991 (quotation from the Final Remarks section). (Translated from German into American English by Roberta B. Jacobson and Alf B. Meier)]. source: http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1352&pk_association_webpage=3947

“Their overall evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive.” Archives of Sexual Behavior [2015, 44(5):1321-1329] http://europepmc.org/abstract/med/25690443

“A marked reduction in psychopathology occurs during the process of sex reassignment therapy, especially after the initiation of hormone therapy.” J Sex Med. 2014 Jan;11(1):119-26. doi: 10.1111/jsm.12363. Epub 2013 Oct 28. http://www.ncbi.nlm.nih.gov/pubmed/24344788

“In conclusion, almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning.” Archives of Sexual Behavior December 2010, Volume 39, Issue 6, pp 1429-1437Source: http://link.springer.com/article/10.1007%2Fs10508-009-9551-1

“We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies [admittedly very low quality evidence] suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life. Source: https://mayoclinic.pure.elsevier.com/en/publications/hormonal-therapy-and-sex-reassignment(8e0020c1-2f99-49e4-92ea-869b25ccd85a).html

“During and after transition, participants reported experiencing good social support and satisfaction with the surgical treatment and outcomes. Any difficulties reported by participants are related to either sexual relationships or internalized transphobia. The results also demonstrate the potentially protective role that a lengthier process of transition plays in countries such as Croatia.” The Scientific World Journal Volume 2014 (2014), Article ID 960745, 12 pages http://dx.doi.org/10.1155/2014/960745 Source: http://www.hindawi.com/journals/tswj/2014/960745/

“Results of the current study indicate transsexual men generally have a good quality of life and experience satisfactory sexual function after [sex reassignment surgery].” J Sex Med. 2011 Dec;8(12):3379-88. doi: 10.1111/j.1743-6109.2011.02348.x. Epub 2011 Jun 23. source: http://www.ncbi.nlm.nih.gov/pubmed/21699661

“In this prospective, noncomparative, cohort study, the current results suggest that the gains in breast satisfaction, psychosocial well-being, and sexual well-being after male-to-female transsexual patients undergo breast augmentation are statistically significant and clinically meaningful to the patient at 4 months after surgery and in the long term.” Plast Reconstr Surg. 2013 Dec;132(6):1421-9. doi: 10.1097/01.prs.0000434415.70711.49. Source: http://www.ncbi.nlm.nih.gov/pubmed/24281571

“Our results suggested that untreated patients suffer from a higher degree of stress and that attachment insecurity negatively impacts the stress management. Initiating the hormonal treatment seemed to have a positive effect in reducing stress levels, whatever the attachment style may be.” J Sex Med. 2013 Dec;10(12):3049-58. doi: 10.1111/jsm.12155. Epub 2013 Apr 9. source: http://www.ncbi.nlm.nih.gov/pubmed/23574768

“The results revealed that the majority of transsexual patients have no psychiatric comorbidity, suggesting that transsexualism is not necessarily associated with severe comorbid psychiatric findings. The condition, however, seemed to be associated with subthreshold anxiety/depression, psychological symptoms and functional impairment. Moreover, treated patients reported less psychiatric distress. Therefore, hormonal treatment seemed to have a positive effect on transsexual patients’ mental health.” Psychoneuroendocrinology. 2014 Jan;39:65-73. doi: 10.1016/j.psyneuen.2013.09.029. Epub 2013 Oct 10.  http://www.ncbi.nlm.nih.gov/pubmed/24275005[/ref]

That’s not to say that all medical professionals agree. Dr. Keith Ablow,[ref]Ablow doesn’t believe there is evidence that anyone is naturally trans: http://www.foxnews.com/opinion/2014/01/14/all-wrong-in-california-girls-can-use-urinals-in-boys-restroom.html. Fellow psychiatrists have distanced themselves from Dr. Ablow’s extreme and purposefully antagonistic views: http://mediamatters.org/blog/2014/11/06/medical-experts-condemn-foxs-keith-ablow-shamef/201486.[/ref] a frequent Fox News contributor, and Dr. Paul McHugh,[ref]You can read McHugh’s article here, if you have access to the other side of the WSJ paywall: http://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120. You should then read this takedown of McHugh’s article, which exposes its many errors: http://www.transadvocate.com/clinging-to-a-dangerous-past-dr-paul-mchughs-selective-reading-of-transgender-medical-literature_n_13842.htm and then read this second critique: http://thinkprogress.org/lgbt/2015/06/10/3668041/paul-mchugh-transgender/[/ref] who authored a widely circulated article in the Wall Street Journal, are two of the most prominent opponents of the medical consensus.[ref]McHugh and a small number of other socially conservative medical professionals broke away from the industry’s official association, the American Academy of Pediatrics, to form a splinter group that calls themselves the American College of Pediatricians. This group recently made a strongly-worded statement in support of McHugh’s anti-transgender policies, and promises a larger statement during the summer of 2016: http://www.acpeds.org/the-college-speaks/position-statements/gender-ideology-harms-children.[/ref]

What are the dangers of letting people use the restroom of the gender with which they identify?

With all the furor over recent “bathroom bills,” some people suggest that allowing transgender individuals to use the restroom that matches their gender is dangerous. They bring up all kinds of scenarios that might happen, but the problem is that places with the transgender bathroom protection don’t actually see an uptick in violence, assaults, or harassment.[ref]”We haven’t found any instances of criminals convicted of using transgender protections as cover in the United States. Neither have any left-wing groups or right-wing groups.” http://www.charlotteobserver.com/news/politics-government/article70255967.html#storylink=cpy[/ref]

With that being said, there is no doubt that there are perverts out there.[ref]http://www.redstate.com/brandon_morse/2016/04/11/need-transgender-bathroom-laws/[/ref] But forcing people to use a restroom that others want them to use won’t stop the perverts. We go into dangerous territory when we create laws to ban situations in which bad things MAY happen, rather than just banning the bad things themselves. For example, we don’t ban Boy Scouts just because (quite a few) scout leaders have taken advantage of that situation, nor do we ban Catholic Priests just because (huge numbers of) them have taken advantage of that situation. We ban sexual assault, voyeurism, and harassment.

In fact, according to the Justice Department, in 8 in 10 cases of sexual assault the victim already knows the person who assaulted them.[ref]http://abcnews.go.com/US/sexual-assault-domestic-violence-organizations-debunk-bathroom-predator/story?id=38604019[/ref] So, the literal bogeyman in the bathroom is just that–a myth used to scare people.

“It’s problematic to conflate in examples when a person, who is not transgender identified, is trespassing in a restroom exploiting that position to harm others,” – Laura Palumbo, communications director at the National Sexual Violence Resource Center.[ref]http://abcnews.go.com/US/sexual-assault-domestic-violence-organizations-debunk-bathroom-predator/story?id=38604019. While we’re at it, maybe we don’t even need gendered bathrooms at all. This article makes an interesting case in that direction: http://www.huffingtonpost.com/entry/gender-neutral-bathrooms_us_56fd6ccbe4b083f5c607262c[/ref]

What are the dangers of requiring people to use the restroom of the gender with which we think they should identify? 

Most importantly, forcing someone to use the bathroom we think they should identify with is disrespectful, harmful, and (often) outright harassment. Discrimination like this is directly harmful to trans* people in a number of ways, including physical symptoms, social stigmas (if a trans* person is legally required to use a restroom of the opposite gender, it could “out” them to others, increasing social discrimination and harassment), and emotional trauma.[ref]See this study by a UCLA Law professor: http://williamsinstitute.law.ucla.edu/wp-content/uploads/Herman-Gendered-Restrooms-and-Minority-Stress-June-2013.pdf and the National Transgender Discrimination Survey: http://www.transequality.org/sites/default/files/docs/resources/NTDS_Report.pdf. A recent survey has found similar results: “Overall, 65% of respondents reported discrimination in one or more public accommodations settings in the past 12 months. . . .Those who reported public accommodation discrimination in the past 12 months had an 84% increased risk of adverse physical symptoms (such as headache, upset stomach, tensing of muscles, or pounding heart) in the past 30 days and 99% increased risk of emotional symptoms (including feeling emotionally upset, sad, or frustrated) in the past 30 days.” http://fenwayfocus.org/2014/07/the-fenway-institute-mtpc-release-project-voice-report-on-transgender-discrimination-in-public-accommodations/[/ref]

In many cases the law ends up creating the exact situation its proponents are so worried about: grown men being legally required to use the women’s restroom, for example.[ref]http://www.thedailybeast.com/articles/2016/03/25/gop-wants-men-to-use-women-s-bathrooms.html. Also, this man was forced to use the women’s restroom in North Carolina: http://www.motherjones.com/politics/2016/04/north-carolina-bathroom-law-transgender-man-tells-his-experience–humiliating for him, and incidentally the very situation so many of the law’s proponents claim to want to stop: a man using a women’s restroom.[/ref]

When our society starts policing bathroom as if they were exclusive clubs, we create a climate of judgment, harassment, and hatred. One woman, for example, was approached by another woman in the restroom:

[S]he was approached by a complete stranger in the bathroom and was told that “You’re disgusting!” and “You don’t belong here!” The 22-year-old Toms posted a video on Facebook talking about how the experience opened her eyes to the abuse that transgender people face every day.[ref]http://www.rawstory.com/2016/05/woman-who-donated-hair-to-cancer-patients-mistaken-for-transgender-man-and-harassed-in-restroom/[/ref]

The woman who was harassed wasn’t, in fact, a transgender man after all. She just had a very short haircut because she had just donated her long hair to cancer patients.

Is that really the society we want to be creating?

What about children? Should we be encouraging them to accept this life?

This question will need to be answered on a case-by-case basis by parents in consultation with a trained therapist. Some children begin life exhibiting characteristics of gender nonconformity and eventually reach a stage in their development where that is no longer a factor.[ref]Some people claim that 80% of trans children will “grow out” of it, but others point out that statistic comes from an almost humorously flawed Netherlands study, and from a 1995 study that classified boys as “transgender” if they were even a little gender nonconforming–a drastic oversimplification that clouds the study’s results. Here’s more on that study: http://www.wired.com/2015/06/big-problem-outlawing-gender-conversion-therapies/. Here’s a short video of a woman describing this debate: https://vimeo.com/132256588[/ref] Other children play with the “wrong” toys or wear the “wrong” colors–and when you really stop to think about it, what’s so bad about a boy playing with Barbies or a girl playing with monster trucks? The fact is, there is a wide spectrum of behaviors, as the head of a major study of transgender children argues here:

The central problem . . .  treats all children who violate cultural gender norms as a single category, when in fact there is a wide range of such children in the world. On one end of the spectrum are children who enjoy toys and clothing that are stereotypically associated with the opposite sex (imagine a girl who loves G.I. Joes and rough-and-tumble play or a boy who love Barbies and ballet). In the middle are children who express a lot of unhappiness about being a member of their gender group. For example, a boy who says he wishes he were a girl because then no one would tease him about his preference for nail polish or the fact that he only plays with girls. At the other end of the spectrum are children who consistently, persistently, and insistently assert that they are members of the opposite sex and who are beside themselves when they are not allowed to live as such. Such children sometimes resort to self-harm or become anxious and depressed that others will not recognize their gender identity. Importantly, while some children in the last group undergo social transitions, we see no evidence that anyone believes that children elsewhere on the spectrum should do so. We believe these recent articles, whose authors, to our knowledge, do not work with transgender children, overlook key differences within the spectrum of children who do not conform to gender norms, misinterpret past research, and misconstrue interventions to help transgender children.[ref]http://www.slate.com/blogs/outward/2016/01/14/what_alarmist_articles_about_transgender_children_get_wrong.html[/ref]

The fact that experiences land on a spectrum is incredibly important when evaluating policies at the K-12 level. If bureaucrats make a blanket decree about every child, they will harm a great number of children who don’t fit the mold. The central policy should, on the other hand, encourage parental involvement, and leave the final decision up to them and their child in consultation with a trained therapist. This is what the Obama Administration’s recent guidance letter does.[ref]Here is the “Dear Colleague” letter: http://www2.ed.gov/about/offices/list/ocr/letters/colleague-201605-title-ix-transgender.pdf. It’s also important to read the supplement provided with the letter–25 pages summarizing what school districts from Alaska to Rhode Island have done to help children in public school: http://www2.ed.gov/about/offices/list/ocr/letters/colleague-201605-title-ix-transgender.pdf[/ref]

So, now what?

We are taught to leave the ninety and nine to focus our help on the one. There are concrete and time-tested actions that can be taken to lighten the load of those suffering from the societal disapproval and peer pressure that can weigh down on transgender children of God. Spoiler alert: boycotting a chain of stores because they let transgender people use the restroom of the gender with which they identify does not lighten anyone’s load.[ref]Here’s a Mormon therapist explaining why she will proudly use trans-friendly facilities: http://www.drjuliehanks.com/2016/05/15/10-reasons-im-not-afraid-to-use-trans-friendly-bathrooms/[/ref] Reaching out and trying to help, on the other hand, has significant positive impact:

A new study from Canada[ref]http://www.torontosun.com/2015/06/08/suicide-rate-much-higher-for-transgender-canadians-study[/ref] similarly found high rates of suicide attempts among transgender people, but specifically found that those suicide attempt rates significantly declined when trans people were supported by their parents, when they were able to update their legal documents to match their gender, when they endured less trans-based hate, and when they were able to transition their bodies to match their identities. In other words . . . it is affirming transgender people’s gender identities and supporting their traditions that helps them do best in society.[ref]http://thinkprogress.org/lgbt/2015/06/10/3668041/paul-mchugh-transgender/[/ref]

I have no idea what it must be like to grow up in this society as transgender. I’ve never been there. But the research suggests that support, affirmation, and acknowledgement go a long way.

At this point, we’re back to the simple answers about how to love our neighbor. Talk to each other. If you’ve never spoken with an openly transgender person, do. If you are making policy decisions that will directly impact this population, go out of your way to listen first. If you don’t understand, ask.

It’s the neighborly thing to do.

(Footnotes can be found after the post recommendations)

J

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