The Ideology of Gender Harms Children
Defining Terms and Understanding the Issue
“Gender is a term that refers to the psychological and cultural characteristics associated with biological sex. It is a psychological concept….Gender identity refers to an individual’s awareness of being male or female, referred to as an individual’s ‘experienced gender’” (American College of Pediatricians, 2018). Sex is a biological term that refers to distinct and complementary roles for members of a species in relation to reproductive purpose. As there are only two gonads that contribute to human reproduction (testes and ovaries), sex is inherently binary. Gender awareness is based on thoughts and feelings whereas sex is a biological fact. The ideology of gender proposes the psychological awareness of an individual’s gender may not be aligned with the person’s biological sex. In cases of incongruence, the claim is made that psychological awareness predominates, negating the fact of the biological sex. Intersex is a term applied to disorders of sexual development. These disorders are very rare congenital defects frequently of genetic origin. It is a disease state, an objective medical condition. It is not an identity nor a third sex.
Dysphoria is defined as a state of dissatisfaction or unease about a given situation. Gender dysphoria (GD) is a psychological condition in which the individual feels an incongruence between his or her experienced gender and his or her biological sex. This condition is associated with varying levels of anxiety and unhappiness.
Human beings are born with a biological sex. The awareness of being male or female develops over time. As gender awareness develops during the early years of a child’s life, there may be a time when the child may show confusion about his or her gender awareness. These pre-pubertal children may be diagnosed with gender dysphoria. When GD occurs in the pre-pubertal child, it resolves in 80-90 percent of children by late adolescence as they naturally develop through puberty and gender awareness aligns with biological sex (Cohen-Kettenis, Delemarre-van de Waal, Gooren, 2008). Some of these adolescents may manifest same-sex attraction but without the desire to undergo sex reassignment.
The American Psychiatric Association (APA) explains in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that GD is listed as a mental disorder not because of the person’s belief that they are someone they are not –– a break from reality –– but because of the emotional distress that is felt by the person and how this affects social functioning.
Once the distress is relieved, GD is no longer considered a disorder. The APA claims that the distress will be relieved by sex reassignment. A more recent document (DSM5-TR) reiterates the claims made by the prior document and insists that GD is not a mental disorder.
There are probably many paths that could lead to GD. There is no single-family dynamic or social situation that appears to be causative. There may be an association with adverse events in childhood including sexual abuse. Social reinforcement, parental psychopathology, family dynamics, and social contagion may all contribute to the development of GD in some children (American College of Pediatricians, 2018).
The traditional understanding of childhood GD had been that it reflected confused thinking on the part of the child. The standard approach was watchful waiting by the parents with the advice of a mental health specialist. The goals of therapy were to address family pathology when present, treat any psychosocial co-morbidities in the child, and aid the child in aligning gender identity with biological sex (American College of Pediatricians, 2018).
Medical Evidence Lacking in New Standard of Care
The traditional approach is no longer recommended. It is alleged that mental illness and suicide will be the consequences of withholding social affirmation of the child’s confusion and allowing the child to grow through natural puberty. The American Academy of Pediatrics (AAP) has presented options for the suppression of normally timed puberty in affected children, and surgical interventions on a case-by-case basis for the adolescent child (Rafferty, 2018).
The American Medical Association (AMA) endorsed the Endocrine Society’s position in passing a resolution to protect access to gender-affirming care for transgender and gender-diverse persons, which did not exclude youths (American Medical Association House of Delegates 2023). AMA cites the United States Department of Health and Human Services (HHS) for this decision. HHS indicates that gender-affirming care for transgender and non-binary people consists of “an array of services that may include medical, surgical, mental health, and non-medical services for transgender and non-binary people” (HHS, 2022). The so called “treatment” for GD in the US includes affirmation of the child’s confusion, chemically blocking puberty, lifelong cross-sex hormones (testosterone for girls and estrogen for boys) and mutilating surgeries.
The protocol consists of affirming the child’s confusion by using name and pronoun changes and facilitating the impersonation of the opposite sex as early as ages 3-4 years old. Then puberty is suppressed with GnRH (gonadotropin releasing hormone) analogues at ages 10- 11 years old. Puberty blocking hormones “arrest bone growth, decrease bone density, prevent the sex steroid dependent organization and maturation of the adolescent brain, and inhibit fertility” (American College of Pediatricians, 2018). Recently, the FDA placed a warning on the use of hormone puberty blockers because of several cases of pseudotumor cerebri (FDA, 2022). The pathological effects of puberty blockers are not easily reversed. The noxious psychological effect of not growing into adolescence together with one’s peers is not reversible.
In 2018, the AAP in a statement from the Committee on Bioethics recognized that the research on the long-term effects of puberty blockers on children is limited. However, the AAP indicated it can cause harm to refrain from using puberty blockers on children with GD because of the resulting emotional distress of the children as they develop through physiologic puberty (Rafferty, 2018).
However, Great Britain, Sweden, Finland, France, and Denmark have recently restricted the use of puberty blocking drugs in children with GD (Lawless 2023; Nainggolan 2021; Smith 2021; Smith, 2022 and SEGM). Researchers in these countries posed the question that the treatment protocol could be ideology driven and not evidence based (Ludvigsson 2023). It was noted that children were given the diagnosis of GD with little clinical psychological oversight and rapidly placed on the sex reassignment protocol. This protocol is frequently set in motion by the demand and insistence of the children and their parents. Most children who undergo puberty suppression transition to cross-sex hormones and mutilating surgeries.
Cross-sex hormones are associated with dangerous health risks. Estrogen administration to boys will place them at risk of developing thromboembolism, elevated lipids, hypertension, decreased glucose tolerance, cardiovascular disease, obesity, and breast cancer. Girls provided with high-dose testosterone will be at risk of developing elevated lipids, insulin resistance, cardiovascular disease, obesity, polycythemia, and unknown effects on breast, endometrial, and ovarian tissues (American College of Pediatricians, 2018). Children who receive puberty blocking hormones followed by cross-sex hormones prior to completion of gonadal maturation risk permanent sterilization.
Mutilating surgeries for girls include bilateral mastectomy, hysterectomy, and removal of the ovaries. Girls as young as 14 have had completely healthy breasts removed (Rowe, 2016). Girls may undergo removal of skin from another part of the body for attachment to the pelvis to simulate a penis. Genital surgery for males includes removal of the testes and dissecting the penis and inverting it into a pelvic wound (American Society of Plastic Surgeons).
The claim that children with sexual confusion will commit suicide if they are not quickly affirmed and set on the path of sex reassignment is not scientifically supported. Sexually confused children frequently show significant psychiatric co-morbidities; the incidence of suicidality in this group corresponds to the psychiatric co-morbidities these children show. Scientific evidence suggests that the transgender interventions do not reduce the risk of suicide. In fact, puberty blockers are associated with depression and other emotional disturbances related to suicide. Furthermore, data support that in the long run transitioning may even exacerbate the psychological distress that could lead to suicide (Robbins & Broyles).
Is the anxiety and suffering exhibited by persons with GD relieved by sex reassignment? Surveys show transgender adults express an initial sense of relief and satisfaction following the use of cross-sex hormones and sex reassignment surgery. Cross-sex hormone administration and surgeries to align appearance with a sex-discordant gender identity have been used in Sweden for many years. A thirty-year follow-up study of 324 sex reassigned adults found “substantially higher rates of overall mortality, death from cardiovascular disease and suicide, suicide attempts and psychiatric hospitalizations in post-surgical transsexuals as compared to a healthy control population” (Dhejne, et al., 2011).
Evidence of regret from so called de-transitioners, who have undergone sex reassignment procedures as children or adolescents is surfacing. These individuals claim they were coerced into sex reassignment when most vulnerable and immature, and when uninformed of consequences. Some are initiating lawsuits against medical practitioners and medical organizations who provided such interventions (Independent Women’s Forum).
Children are the victims of this disturbing and irresponsible experiment, as misguided adults impose a confused ideology on the most innocent and vulnerable. Children cannot legally consent; they have neither the maturity nor the life experience to make decisions that will permanently affect them for the rest of their lives. A parent who convinces his or her child that he or she was born into the wrong body is committing a grievous error.
The U.S. Department of Health and Human Services Organization has stated that: “For transgender and non-binary children and adolescents, early gender affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the health care system” (HHS, 2022). Promoting sex reassignment via public education and legal policies will further harm children and confuse parents.
Additional Considerations
Theological
Church doctrine is clear that human beings are created by God, male and female (Gn 1:27; CCC, nos. 355–357, 369, 373, 1604, 1701–1702, 2331). The two sexes are complementary; the union of their bodies results in a third human person; the species thrives (Gn 1:28, 2:18–24; CCC, nos. 369–372, 1604–1605, 1643, 1652, 2331–2335, 2360–2370). The body is an intrinsic dimension of our human nature (CCC, nos. 362, 364, 2289). To reject the essentiality of the body is to reject God’s gift and reflects the pretense of the confused human being through a pure act of the will. It is the ultimate form of rebellion against creation (CCC, nos. 2280, 2290).
Human beings are a body-and-soul unity with a single nature (USCCB 2023, no. 4). The body is a gift of God, created in His image, and therefore, declared to be very good (USCCB 2023, no. 7). The body is to be respected and cared for since it is intrinsic to the person. Sexual differentiation is an essential part of this embodiment (USCCB 2023, no. 5). All must respect the order and finality of this embodiment. No one, including patients, physicians, and researchers, have unlimited rights over the body. We are not owners of our bodies to use them as tools according to our will, to be manipulated just because we can (USCCB 2023, no. 7). Just because it can be done does not mean it should be done.
Ethical
The present “treatment” of GD is contrary to the nature of medicine. It denies the very essence of the human person who is an integrated entity of body and soul. Such a denial is perpetuated by language that negates this reality by the erroneous use of pronouns, and the fostering of dress and behaviors that are intended to affirm this denial. New developments in addressing gender dysphoria in children are concerning in terms of violating fundamental parental rights and upending long standing jurisprudence. Policies to undermine the rights and obligations of parents or guardians, particularly in the public-school systems, in no way are to be endorsed. Children lack the full decisional capacity for such serious issues and are dependent upon engaged parents/guardians to consent or refuse potentially life-altering psychological, medical, or surgical actions.
Technological
Furthermore, technology should never be used to mutilate the human person. Technology, whether medical or surgical, is properly used when repairing a defect caused by injury or illness or to sacrifice a part for the whole. To allow a part to be sacrificed, three conditions must be fulfilled: (1) “The retention or functioning of a particular organ causes serious damage to it or constitutes a threat” to the whole organism. (2) “This damage cannot be avoided, or at least appreciably diminished, otherwise than by the mutilation in question and the effectiveness of the mutilation is well assured.” It is a last resort. (3) “It can reasonably be expected that the negative effect, i.e., the mutilation and its consequences, will be compensated for by the positive effect: removal of the danger for the whole organism, lessening of suffering, etc.” (USCCB 2023, no. 12). This loss is recognized as an evil to be tolerated.
The present medical and surgical “treatments” of GD do not meet these criteria. The organs are not causing serious damage nor threatening the whole organism and so none of the conditions are fulfilled. There is no defect because the organs are physiologically healthy and functioning normally. Nor is this a reluctant sacrifice of a body part, such as orchiectomy to treat prostate cancer. It is a deliberate, intentional attempt to transform the body to mimic the characteristics of the opposite sex by mutilating it. In effect, the functioning of the healthy organs (reproduction) is destroyed, and the mutilation effects a cosmetic function if any at all. It is the refusal to recognize that the sexual organs have essential roles within the embodiment of the human person.
Authentic Health Care
This attempt to address surgically and with hormones what should be treated psychiatrically with counseling is not authentic health care. Health care professionals must not affirm what is not true. Cognitive Based Therapy (CBT) has been shown to be useful in treating other body dysphoria disorders associated with increased risk of death, such as anorexia nervosa. Persons with GD would benefit from such treatment of depression and anxiety along with aggressive counseling and medications directed to those conditions.
A health care professional who counsels a parent and child seeking support in the sex reassignment process needs to inform the parent of the risks and side effects of puberty blockers and cross-sex hormones, and of sex-reassignment surgeries. The plan of care should involve both physician and mental health specialist. It is inappropriate to refer the child to a “Gender Clinic.” This likely will result in rapid enrollment of the child into the sex reassignment process, frequently with little mental health oversight.
Sex reassignment does not respect the fundamental order of the human person with a body-and-soul unity. Treatments that do not respect this unity ultimately harm the human person. The ideology underlying GD is harmful since it declares that people can remake themselves according to how they feel. Solutions must be found that promote human flourishing, respect one’s own bodily integrity and are in concordance with the sex inscribed in one’s body. This is especially true for Catholic health care which is part of the healing ministry of Jesus. That means providing treatments directed to the healing of the whole person: physical, mental, and spiritual.
A first principle of medicine is “First, do no harm.” The sex reassignment movement is a vast, unregulated experiment based on studies with a high drop-out rate, non-randomized control studies, and no long-term studies past the first five years for interventions that are structurally and/or functionally mutilating and have long term and irreversible consequences.
Responding with Unconditional Love
Parents and guardians must show unconditional love if confronted with a child who professes to be transgender and demands affirmation which denies the reality of biological sex. Parents and guardians must be free to determine how best to address lovingly this challenge through informed consent that is not obstructed by policies that deny that right. It is best to enter into dialogue and allow the child to tell his or her story. At the same time, the parent should gently inform the child of the correct scientific data.
It is essential that concurrent treatment be given by a mental health specialist who will address the mental disorder of the child according to correct understanding of the nature of the human person. Parents should unite and work together to advocate for appropriate and effective treatments that affirm truths about the integrity of the human person as a sacred unity of body and soul.
Call to Action
The Catholic Medical Association calls on the medical organizations that promote the practice of sex reassignment of children with GD to reverse their decision. These organizations should consider the profoundly harmful long-term physical and psychological damage that awaits these children as they grow into adulthood.
GD is a psychiatric disorder that should be treated by a mental health specialist with the cooperation of loving parents. The practice of sex reassignment as the treatment of choice for children who show confusion with their sexuality is not ethically permissible and should be discontinued.
Furthermore, physicians and other health care professionals of conscience, who wish to promote the best interest of their patients, must be free to do so without policies that threaten their ability to practice medicine (Catholic Medical Association, 2021). As with all conflicts in medical ethics, the conscience of a clinician, enlightened by Catholic teaching on the sacredness of human life and the dignity of human persons, should never be coerced to violate the clinician’s medical and moral judgement in the care of a patient.
Sources and Suggested Reading
American College of Pediatricians, acpeds.org
American College of Pediatricians. 2018. “Gender Dysphoria in Children.” https://acpeds.org/position-statements/gender-dysphoria-in-children.
American Medical Association House of Delegates. 2023. “Protecting Access to Gender Affirming Care. Resolution: 223 (A-23). June 12.
American Society of Plastic Surgeons. 2023. Gender Affirmation Surgeries. Available at https://www.plasticsurgery.org/reconstructive-procedures/gender-affirmation-surgeries.
Catholic Medical Association. 2021. “Conscience,” Policy Statement developed by Ethics Committee, Approved by Board of Directors. October 6.
https://www.plasticsurgery.org/reconstructive-procedures/gender-affirmation-surgeriesCatechism of the Catholic Church (CCC). 2003. trans. USCCB. Vatican City: Libreria Editrice Vaticana. https://www.vatican.va/archive/ENG0015/_INDEX.HTM.
Cohen-Kettenis P.T., H.A. Delemarre-van de Waal, L.J. Gooren. 2008. “The Treatment of Adolescent Transsexuals: Changing Insights.” J Sexual Med 5: 1892–1897.
Cretella, M. 2016. “Gender Dysphoria in Children and Suppression of Debate.” Journal of American Physicians and Surgeons 21, no. 2 (Summer): 50-54.
Dhejne, Cecilia, Paul Lichtenstein, Marcus Boman, Anna L. V. Johansson, Niklas Långström, and Mikael Landén. 2011. “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden.” PLoS One 6, no. 2: e16885. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/.
Food and Drug Administration (US) (FDA). 2022. “Risk of Pseudotumor Cerebri Added to Labeling for Gonadotropin-Releasing Hormone Agonists.” https://www.fda.gov/media/159663/download.
Furton, E. J., ed. 2023. Transgender Issues in Catholic Health Care. Philadelphia, Penn.: National Catholic Bioethics Center.
Independent Women’s Forum. ND. “Identity Crisis: Stories the transgender movement doesn’t want you to hear.” https://www.iwf.org/identity-crisis/. Accessed August 13, 2023.
Lawless, Jill. 2023. “England’s Health Service Says It Won’t Give Puberty Blockers to Children at Gender Clinics.” Associated Press, June 11. https://apnews.com/article/uk-transgender-puberty-blockers-abd9145484006fea23de6b4656c937da.
Littman, L. 2017. “Rapid onset of gender dysphoria in adolescents and young adults: A descriptive study.” Abstract, Journal of Adolescent Health, 60:2, Supplement 1, S95-S96, February. https://doi.org/10.1016/j.jadohealth.2016.10.369.
Ludvigsson, JF, Adolfsson, J, Hoistad, M, Rydelius, PA, Kristrom, B, Landen, M. 2023. A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. Acta Paediatr., November 112 (11): 2279-2292. https://pubmed.ncbi.nlm.nih.gov/37069492/
Mayer, L.S., P.R., McHugh. 2016. “Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences.” The New Atlantis, special report (Fall).
Nainggolan, Lisa. 2021. “Hormonal Tx of Youth with Gender Dysphoria Stops in Sweden.” Medscape, May 12. https://www.medscape.com/viewarticle/950964.
Rafferty, J. 2018. “Ensuring Comprehensive Care and Support for Transgender and Gender Diverse Children and Adolescents.” Policy Statement, American Academy of Pediatrics, Pediatrics, vol 142, issue 4. October.https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring- Comprehensive-Care-and-Support-for?autologincheck=redirected
Robbins, J. W., Broyles, V. R. (N.D.). The Myth about Suicide and Gender Dysphoric Children, Child and Parental Rights, American College of Pediatricians. https://childparentrights.org/wp-content/uploads/2020/05/SUICIDE-MYTH-HANDOUT.pdf.
Rowe, Peer. 2016. “Surgery Unburdens Transgender Boy.” Los Angeles Times. April 14. https://www.latimes.com/local/california/la-me-transgender-teen-20160414-story.html.
Smith, Wesley J. 2021. “Finns Turn against Puberty Blockers for Gender Dysphoria.” National Review, July 25. https://www.nationalreview.com/corner/fins-turn-against-puberty-blockers-for-gender-dysphoria/.
Smith, Wesley J. 2022. “France’s Academy of Medicine Urges ‘Great Medical Caution’ in Blocking Puberty.” National Review, April 26. https://www.nationalreview.com/corner/frances-academy-of-medicine-urges-great-medical-caution-in-blocking-puberty/.
Society for Evidence Based Gender Medicine. Aug. 17, 2023. “Denmark Joins the List of Countries that have Sharply Restricted Youth Gender Transitions.” https://segm.org/Denmark-sharply-restricts-youth-gender-transitions.
United States Conference of Catholic Bishops, Committee on Doctrine. 2023. “Doctrinal Note on the Moral Limits to Technological Manipulation of the Human Body.” March 20. https://www.usccb.org/resources/Doctrinal%20Note%202023-03-20.pdf.
United States Department of Health and Human Services (HHS), Office of Population Affairs. 2022. “Gender Affirming Care and Young People.” March. https://opa.hhs.gov/adolescent-health.
World Professional Association of Transgender Health (WPATH). 2022. “Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.” International Journal of Transgender Health, 23, no. S1: S1-S260.
Revised and Approved by the Executive Committee – October 16, 2023
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