The Transgender Movement: Addendum to the Review

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The Transgender Movement: Addendum to the Review

James R. Aist


In a previous article on the transgender movement, a comprehensive and scholarly review article by the Family Research Council was presented (13). The purpose of the present article is to touch on several important aspects of the topic that were either not dealt with at all, or deeply enough in my opinion, in that review. (The numbers in parentheses are keyed to the numbered references listed at the end of the article.)

What is Gender Identity Disorder?

Gender Identity Disorder (GID) – often called “Gender Dysphoria” to de-emphasize the mental delusion involved – is a mental disorder characterized by the feeling and belief that you are not really the gender of the body you were born in, but that of the opposite gender. Thus, a person born a male feels and believes that he is really a female trapped in a male body and identifies his gender as female, and a person born a female feels and believes that she is really a male trapped in a female body and identifies her gender as male. Such a person is said to be transgender, because he/she perceives their real gender to be opposite (trans) their birth gender. Conversely, a cisgender person feels and believes their real gender to be the same (cis) as their birth gender. Transgender people experience intense anxiety, distress and inner conflict, because their perceived gender does not match their actual, birth gender. These feelings and beliefs are, themselves, very real to the person experiencing them, but they do not correspond to the actual, biological gender. Therefore, they represent a virtual, rather than an actual, reality. That is to say, persons with GID are delusional with respect to their gender. The best estimates of the prevalence of GID put it in the range of 0.33%-0.47%, or less than one-half of one percent, of the general population (16). Thus, GID is not “normal.”

A Family of Psychoses

As Barber (5) and McHugh (10) have pointed out, GID belongs to a family of mental disorders, or “psychoses”, which are characterized, in part, by a mental departure from reality, referred to by psychiatrists as “delusion” (7). Perhaps the best known mental disorder of this family is anorexia. Anorexic people are actually skinny, but they feel and believe that they are grossly overweight. Transable is another mental disorder belonging to this family of psychoses. Transable people feel and believe that they are disabled, yet they are, in reality, physically whole and healthy people. And that brings us to transgender people. As mentioned above, they feel and believe that they are not really the biological gender of the body they were born in, but that of the opposite gender. This delusion has been likened to that of the Emperor in Hans Christian Andersen’s tale, “The Emperor’s New Clothes” (10). In that tale, the Emperor, believing that he wore an outfit of exquisite beauty imperceptible to the common man, paraded naked through the streets of his town for all to see. The people knew very well that the Emperor was deluded, but they were afraid to say anything to him about his nakedness, for fear of retribution.

So, how do we treat those who suffer from such delusional, mental disorders? Do we offer liposuction to anorexic people in order to affirm their delusion that they are fat and to ease their anxiety? Of course not; we feed them and get them therapy. Do we offer amputation to the transabled, or offer to poke their eyes out, in an attempt to bring their bodies into alignment with their transable delusion? Of course not; we get them therapy. Do we offer hormones and genital surgery to the transgendered to affirm their transgender delusions and help them feel better about themselves? Sadly, all too often, the answer to this question is “Yes”, when it should be “No.” The way to really help them is not to affirm their transgender delusions and assist them in mutilating their bodies, merely to help them feel better about themselves. Rather, we should refuse to affirm their gender delusion, treat them with dignity and respect, and encourage them to seek psychiatric help (10).

Perhaps the main reason that this particular psychosis is being dealt with differently than the other two is that transgender activists often seem to care more about helping the transgender people believe a lie to make them feel better about themselves than they care about the truth and the long-term psychological health of the transgendered (14). Who is really showing genuine love for transgender people, the one who affirms their delusional perception of their gender and encourages them to masquerade as a member of the opposite gender, or the one who challenges their delusion with the truth and encourages them to get the therapy they need to face the reality of their biological gender and begin to live comfortably, happily and honestly with it, if it persists? We don’t really help them by enabling them to add a life-long masquerade as a person of the opposite gender to a lifetime of mental delusion. Honesty and truth matter; there has to be a better way.

Children with GID

GID can begin to manifest when a child is just a few years old. In children, GID is highly treatable by psychotherapy (13). Nevertheless, transgender activists often recommend that parents affirm the child’s gender delusion and prepare the child to spend an entire lifetime living with this mental disorder, with the goal of going through the gender reassignment process at an “appropriate”, later age. Such an approach seems to ignore the fact that GID in children is not only treatable by psychotherapy, but that it resolves itself, spontaneously, 75% or more of the time by adulthood (11, 14). I can’t help but wonder how many lives are being ruined by this unthinkable travesty perpetrated on children and their parents by well-meaning mental health professionals, all in the name of political correctness and a misguided sense of compassion. Sadly, about 75% of the children whose GID resolves spontaneously identify as gay, lesbian or bisexual in adulthood (13, 16).

Apparent Causes of GID

There are basically two schools of thought concerning the cause(s) of GID. The long-held and historical explanation is that this disorder is caused by unresolved psychological conflicts and issues and traumatic experiences which are treatable, to a greater or lesser extent, by psychotherapy (10). Valid goals of psychotherapy include improved mental health, living more comfortably with GID, and abandoning the trans-gender, psychological delusion in favor of the cis-gender, biological reality. The other, more recent, and widely assumed explanation is that the cause is, somehow, biological in nature, rather than psychological, and is, therefore, unchangeable. As with homosexuality, the biological hypothesis involves such things as brain differences, hormones and genetics. But, how strong are the postulated influences of biological factors, and could they even possibly be sufficient to cause GID?

To answer this question, one would prefer to look at the evidence from studies of GID in identical twins with data taken from large, identical twin registries, as has been done with homosexuality (1). But, apparently, no such studies exist yet. To date the most reliable results have come from a very limited number of clinical studies reported in the literature. These studies have produced very small sample sizes that limit their statistical power and are subject to large sampling errors that can strongly bias the results. Nonetheless, it is of some value to examine the results of such studies, if only for their heuristic value.

In a sample of identical twins pairs in which at least one twin has GID, the percentage of twin pairs with both twins having GID is referred to as the “concordance” and is generally accepted to be a measure of the genetic influence on the development of GID. Diamond (8) assembled the clinical results from a number of different clinical reports on GID in identical twins, and found a concordance value of 38.7%. This level of concordance suggests that there may be a weakly moderate, non-determinant (i.e., non-causal) genetic influence on the development of GID.

Results of twin studies of homosexuality have shown that when large, relatively unbiased, twin registries are used to obtain the data base, the apparent genetic influence on the development of homosexuality is found to be much less than previously thought (15). Therefore, I speculate that the same result will be found someday for transgenderism, when twin registries are used (i.e., the real level of genetic influence on the development of GID will likely be found to be weak, perhaps in the 15%-20% range).

There is reason to believe that identical twin studies actually tell us more than what the genetic influence per se is. Because identical twins share the same womb during pregnancy, these studies presumably reveal the combined influence of all possible prenatal, biological factors, not just the genetic factors. Therefore, these results (8) actually suggest that the influence of all biological factors combined is not sufficient to cause the development of GID. In other words, it appears that no one is born with GID. Rather, GID seems to result partially from pre-natal, biological influences and primarily from post-natal factors and influences, such as unresolved psychological conflicts and issues and traumatic experiences.

What is a Christian Response to GID?

What does the Bible say?

Let’s begin with Genesis 1:27 (with Mark 10:6) and Genesis 1:28. God makes mankind, including transgender persons, in His own image as male and female. Recall that God Himself created the first two human beings, Adam and Eve. Thus, as male and female, mankind can manifest the image of God by participating with God in the continuing creation of new, male and female, human beings. GID can prevent this manifestation of the image of God in us and keep us from being the complete man or woman God desires us to be. Therefore, GID is not natural.

Now, let’s move on to Deuteronomy 22:5, where God gives us instruction concerning a common manifestation of transgenderism; namely, “cross dressing”: “A woman must not wear man’s clothing, nor is a man to put on a woman’s clothing. For all that do so are abominations to the Lord your God.” (Note that this Old Testament instruction is a moral law, and, as such, is fully in force in today’s Christian church.) The Hebrew word translated “abomination” in the KJV and MEV translations is translated in many other modern English versions of the Bible as “detestable”, disgusting”, “abhorrent”, or “hateful” to God, leaving no room for doubt that God does not approve of transgender acts. But notice further that the verse says that “all that do so” are, themselves, abominations (hateful) to God. “But”, you may object, “doesn’t God love sinners?” Indeed He does, but, at the same time, He also hates those who are sinning (Psalms 5:5, Psalms 11:5, Proverbs 3:32, Proverbs 11:20). This may be a surprise to you, but remember the good news: God’s perfect love has made a way for His hatred of sinners to be cancelled, through repentance and faith in Jesus Christ. This good news is for all who sin against God in any way, including transgender people.

Finally, we come to 1 Corinthians 6:9-10, “Do you not know that the unrighteous will not inherit the kingdom of God? Do not be deceived. Neither the sexually immoral, nor idolaters, nor adulterers, nor male prostitutes, nor homosexuals, nor thieves, nor covetous, nor drunkards, nor revilers, nor extortionists will inherit the kingdom of God. Such were some of you. But you were washed, you were sanctified, and you were justified in the name of the Lord Jesus by the Spirit of our God.” Professor Robert Gagnon, one of our most prominent, contemporary, evangelical Bible scholars, had this to say about this passage, and I quote: “Paul includes “soft men” (malakoi) in the offender list in 1 Cor 6:9-10, which in context designates men who attempt to become women (through dress, mannerisms, makeup, and sometimes castration), often to attract male sex partners. The fact that Paul includes such persons among those who “shall not inherit the kingdom of God” suggests that acting on a desire to become the opposite sex can in fact affect one’s redemption” (9). Fortunately (for them and us), the same passage goes on to say that the power and authority (i.e., the “name”) of Jesus is able to both rid them of their sinful behavior and save their souls!

Let’s look into this aspect a bit further. I see a parallel here with the condition of homosexuality. God does not hate homosexuals because they develop same-sex attractions; they do not choose to have them. But He does hate them when they choose to act on those feelings by having homosexual sex (a sin). Likewise, God does not hate transgender persons because they develop GID; they did not choose to be gender confused. But, when they choose to act contrary to His design and purposes (sin, e.g., by cross dressing, undergoing so-called “gender re-asssignment”, etc.), that’s when He hates them. And, this is the same manner in which God deals with mankind concerning any other kind of sin, is it not? We sin and trigger God’s hatred, not by being tempted to sin, but by giving in to the temptation and choosing to commit sinful acts. With that perspective, it should be easier for us to refrain from condemning transgender persons; for we all have sinned and come short of the glory of God (Romans 3:23).

And, here is a further, often overlooked, ramification of Deuteronomy 22:5 and 1 Corinthians 1:6-9. If a male-to-female transgender person has sex with a man, he is committing a homosexual sin, because he is, in reality, still a man. Likewise, if a female-to-male transgender person has sex with a female, she is committing a homosexual sin, because she is, in reality, still a woman. Do not be deceived: God will not be mocked by anyone masquerading as a member of the opposite gender. After all, He is the one who created man with the XY sex chromosome configuration and woman with the XX sex chromosome configuration, and no amount or manner of pretending will ever change that.

That brings us to my final point in this section. Some transgender activists accuse God of making people gender confused. So, let me be very clear about this: God does not make anyone transgender! What kind of a “god” would create human beings that he purposely made to be an abomination to himself?! The God of the Bible is neither sadistic nor self-defeating. While it is true that God does not make mistakes, it is also true that God, for the time being at least, does allow mistakes to be made. For example, does He not allow us to sin? So then, how is it that transgenderism developed in a world created by a sovereign, morally perfect God? The answer is right before our eyes: like homosexuality (2), transgenderism came about as the result of original sin (16) and the resultant curse under which all of creation will continue to be compromised until the return of Jesus Christ to restore God’s creation to its original, perfect condition. Until then, let us not slander God by accusing Him of creating in us the sin nature that we struggle against, regardless of how that sin nature is manifested!

How should Christians respond?

In short, we should not condemn transgender persons themselves, and, at the same time, it seems to me, we should not affirm their gender delusion. In this regard, however, Yarhouse (16) recommended the following approach : “If Sara shares her name with me, as a clinician and Christian, I use it. I do not use this moment to shout “Integrity!” by using her male name or pronoun, which clearly goes against that person’s wishes. It is an act of respect, even if we disagree, to let the person determine what they want to be called. If we can’t grant them that, it’s going to be next to impossible to establish any sort of relationship with them.”  In any case, we must treat transgender persons with dignity and respect, be honest with them, have compassion for their suffering, and pray earnestly for them. We should not try to “fix” them (16). If the opportunity arises, we should encourage them to seek God’s help through prayer and/or psychotherapy in order to work through their underlying psychological issues and concerns. As with all ungodly conditions and behaviors that afflict fallen mankind, God can say the word, and healing will come. Of course, whether, or how, He chooses to heal is up to Him.

Perhaps you would like to read what several, prominent, evangelical Christian leaders have recently written about a Christian response to transgenderism. If so, I refer you to references (6, 9, 12, and 16) at the end of this article. These are all potentially helpful articles for anyone who sincerely wants to be Christ-like in their response to the transgender movement. I especially recommend that you read the article by Yarhouse (16) and then the article by Gagnon (9), which is a response to it. As Christians, we must be careful to reach out to transgender people on our own terms, not theirs, if we want to help them find redemption in Jesus Christ. And that should be our end game.

A good, Christian website with personal testimonies and lots more information on GID is “Help 4 Families” (18).

Unrestricted Public Facilities: A Freedom Way Too Far!

For purposes of clarity, let me first point out that I am using the term “public facilities” to refer to all shared restrooms, locker rooms, changing rooms, dressing rooms and shower rooms (Did I leave anything out?) in the public arena (i.e., outside of private residences).

The review article (13) touched on this issue briefly, pointing out that male-to-female transgendered “females” are perceived to be less of a threat to real females in public facilities than are gender-normal males pretending to be transgendered, and that may be true. The threat is not only regarding actual sexual assault, but also voyeurism, where a gender-normal male would behave as a “peeping Tom” (a person who gets pleasure, especially sexual pleasure, from secretly watching others), as it were, and thus invade the bodily privacy of unsuspecting females.

And here’s an eye opener for you. I have discovered a couple of little-known fact that should, perhaps, be of even greater concern than the “transgender pretender.” Let’s assume, for a moment, that transgender activists are correct in asserting that the male-to-female transgendered “females” using women’s public facilities are going to outnumber the transgender pretenders. Then, the greatest threat could come, hypothetically, from the male-to-female transgendered “females” themselves, based on sheer numbers. But, you may ask, “Why would the male-to-female transgendered “females” pose a threat to the real females in women’s public facilities?” Here’s why: scientific studies (3, 4) have found that 73%-81% of male-to-female transgendered “females” are still sexually attracted to females! Moreover, only 25%-30% of transgender people having undergone gender re-assignment have had any kind of gender-confirming surgery, meaning that more than two-thirds of male-to-female transgendered “females” using women’s public facilities will still have their God-given genitals intact(17). Think about that for a moment, and then let me ask you this: Do you want male-to-female transgendered “females” with fully functional male genitals getting “turned on” sexually by your wife or daughter while using women’s public facilities? I didn’t think so. Moreover, it’s not difficult to guess what else they might feel compelled to do once they are sexually “turned on.” This is why I believe that male-to-female transgendered “females”, rather than transgender pretenders, could prove to be the greatest threat to women using unrestricted public facilities.

At present, we have laws against “peeping Toms.” They are arrested, tried in a court of law, and, if found guilty, given an appropriate jail sentence. But if male-to-female transgendered “female” peeping Toms can legally be in women’s public facilities and are, somehow, “caught in the act” by the victim, they could get off scot free, because it would be virtually impossible to prove that they were actually peeping, and they would have a legal right to be in the facility. Thus, legally enforced, unrestricted access to public facilities, in effect, legalizes voyeurism. And that just isn’t right!

The absurdity of shared public facilities has to stop! Gender-normal persons outnumber gender-deluded persons by a ratio of about 250:1. It makes no sense to put the personal interests of such a tiny minority above the personal interests of such a vast majority. Gender-normal persons’ safety and feelings matter too! Accommodating the needs of transgender persons by providing gender-neutral facilities is going far enough. Surely they can deal with their feelings and distress privately for a few minutes while they “do their business”, without having to victimize the gender-normal public to accommodate their mental disorder in the process! Furthermore, a policy of shared public facilities opens the door to sexual perverts and sexual offenders, making it easier for them to gain access to their potential victims and, potentially, to get away with it. No one is even allowed to ask about their perceived gender status. To force the gender-normal majority to compromise their safety (real or imagined) and their very real right to bodily privacy in public facilities is clearly “a freedom way too far!”

Transgender activists accuse gender-normal activists of creating an anti-transgender hysteria based on fear mongering, rather than real-life events, concerning unrestricted public facilities. So that you will know the truth, I have assembled just a few of the many recent reports where real-life conflicts have been caused by unrestricted public facility policies. You can decide for yourself if you think this is just anti-transgender hysteria based on fear mongering:

  • Sexual assault victims speak out (click HERE)
  • Man lounging around naked in girl’s locker room at college (click HERE)
  • Man strips in front of girls in locker room at pool (click HERE)
  • Nine-year-old girl in boys bathroom at school (click HERE)
  • Store lets men use women’s dressing room (click HERE)
  • “Transgender” sexual predator in women’s shelter (click HERE)
  • Men in women’s restroom prompts ACLU leader to resign (click HERE).

References Cited:

1. Aist, J. 2014a. What Twin Studies Tell Us about Homosexuality: Nature vs. Nurture. (click HERE)

2. Aist, J. 2014b. God Does Not Make Anyone Homosexual! (click HERE)

3. Auer, M., et al., 2014. Transgender Transitioning and Change of Self-Reported Sexual Orientation. PloS One. (click HERE)

4. Author unspecified. 2016. Transgender sexuality, References 7 and 8. Wikipedia. (click HERE)

5. Barber, M. 2015. Transwhatever. RenewAmerica. (click HERE)

6. Brown, M. 2015. Can the Church Embrace the Transgender Community? Charisma News. (click HERE)

7. Definition of Psychosis, New York Times Health Guide. (Click HERE)

8. Diamond, M. 2013. Transsexuality Among Twins: Identity, Concordance, Transition, Rearing, and Orientation. International Journal of Trandgenderism 14:1, pages 24-38. (click HERE)

9. Gagnon, R. 2015. How Should Christians Respond to the Transgender Phenomenon? First Things. (click HERE)

10. McHugh, P. 2015. Transgenderism: A Pathogenic Meme. The Public Discourse. (click HERE)

11. McHugh, P. 2016. Transgender Surgery Isn’t the Solution. Wall Street Journal. (click HERE)

12. Moore, R. 2015. What Should the Church Say to Bruce Jenner? The Christian Post. (click HERE)

13. O’Leary, D. and P. Sprigg. 2015. Understanding and Responding to the Transgender Movement. Family Research Council. (click HERE)

14. Sprigg, P. 2016. Transgender Activists Put Ideology Above Safety. Family research Council. (click HERE)

15. Whitehead, N. and B. Whitehead. 2012. Chapter 10. Twin studies: The strongest evidence. (click HERE)

16. Yarhouse, M. 2015. Understanding the Transgender Phenomenon. Christianity Today. (click HERE)

17.  Bernstein, L. 2015. Here’s how sex reassignment surgery works. The Washington Post. (click HERE)

18. Help 4 families. (click HERE)

The Transgender Movement: A Comprehensive Review

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While I was in the process of writing a number of articles on the homosexual movement (click HERE), some of my friends kept asking me if/when I was going to write similarly about the transgender movement. At the time, I was not sufficiently motivated to read up on that topic and publish on it here. However, current events have forced my hand, so I spent a considerable amount of time doing the “library research” in anticipation of publishing a somewhat comprehensive article of my own on the topic. However, after I had begun writing, I ran across an excellent, fully comprehensive and scholarly article published recently by the Family Research Council. So, I decided that everyone would be best served if I simply reposted their article here in its entirety. I strongly recommend that you use the link at the end of this article to access the PDF version of the article, which includes all of the 144 references cited and other important information not included here.

Understanding and Responding to the Transgender Movement

By Dale O’Leary and Peter Sprigg



In recent decades, there has been an assault on the sexes. That is, there has been an attack on the previously undisputed reality that human beings are created either male or female; that there are significant differences between the sexes; and that those differences result in at least some differences in the roles played by men and women in society.

The first wave of this attack came from the modern feminist movement and the second from the homosexual movement. The third wave of this assault on the sexes has been an attack on a basic reality–that all people have a biological sex, identifiable at birth and immutable through life, which makes them either male or female.

The third wave ideology is known as the “transgender” movement. This paper offers a description and critique of that movement and ideology. Part I addresses the psychological and medical issues involved; Part II will address the public policy issues.

Part I: Gender vs. Sex

According to the new gender ideology, the word “sex” is restricted to the biological, while “gender” describes the social and cultural manifestation of sex: how a person feels and experiences his or her sexual identity and how it is shaped by culture.

If individuals are unhappy because they want to be the sex they were not born, they are, according to the American Psychiatric Association, suffering from “gender dysphoria.” Some believe they were born with the body of one sex and the psyche of the other and want their bodies changed to match their internal “wiring.” They want to convince others to see them as the other sex.

Family Research Council (FRC) affirms what has been accepted as both normative and indisputable: that the truth about sexual differences is objectively knowable and that redefining it will be harmful.

Sidebar: Intersex Conditions

A misleading distraction frequently is raised in the context of this issue. A tiny percentage of people suffer from disorders of sexual development (DSD), sometimes referred to as an intersex condition (or as hermaphroditism). True hermaphrodites — those in whom sexual anatomy is ambiguous or clearly conflicts with their chromosomal make-up — are rare, estimated by one expert as “occurring in fewer than 2 out of every 10,000 live births.” The vast majority of “transgender” individuals are not “intersexed.”

No one can change his or her sex.

No one can change his or her sex. The DNA in every cell in the body is marked clearly male or female. Hormones circulating in an unborn child’s brain and body shape his or her development. Psychiatrists and surgeons who have served transsexual clients know surgery does not change sex. George Burou, a Moroccan physician, admitted: “I don’t change men into women. I transform male genitals into genitals that have a female aspect. All the rest is in the patient’s mind.”

Transgender terminology

In this new era of deconstructing and redefining human sexuality, a new set of vocabulary emerges. One pro-transgender activist group has issued a glossary of terms and definitions, explaining the differences between terms such as transgender, transsexual, and transvestite [or cross-dresser].

“Gender Identity Disorder” Becomes “Gender Dysphoria”

Transgender activists, following the example of the homosexual activists in the 1970’s, have objected to having their condition labeled a “disorder.” They successfully lobbied the American Psychiatric Association to have the diagnosis of “Gender Identity Disorder” (GID) changed to “Gender Dysphoria.”

Consequentially, the revised language in the APA’s 2013 Diagnostic and Statistical Manual (DSM-5) says, “Gender dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.” But, to avoid the stigma transgender activists say they wish to discourage, why not simply remove the diagnosis from the DSM altogether, as was done with homosexuality? The APA says, “To get insurance coverage for the medical treatments, individuals need a diagnosis.”

Causes of “Gender Dysphoria”

Family Research Council believes that it is politics, not science, which has driven the conclusion that such a condition is not inherently “disordered” and is only problematic if it causes subjective distress.

Sander Breiner, a psychiatrist with clinical experience working with transsexuals at Michigan’s Wayne State University, declares, “[W]hen an adult who is normal in appearance and functioning believes there is something ugly or defective in their appearance that needs to be changed, it is clear that there is a psychological problem of some significance.” Paul McHugh, professor of psychiatry at Johns Hopkins, has declared bluntly, “It is a disorder of the mind. Not a disorder of the body.” Another psychiatrist, Rick Fitzgibbons, describes gender dysphoria as “a fixed false belief . . . [which is a manifestation] of a serious thinking disorder, specifically a delusion.”

What, then, causes a person to experience such “dysphoria?” While causality is difficult to determine, the transgendered are more likely to have been victims of child sexual abuse and to have a history of trauma, loss, and family disruption.

Patterns of Transgender Desires

There are three major patterns of transgender desire.

1) Males with childhood GID, who are usually sexually attracted to men.

2) Secret transvestites (also known by some researchers as “autogynephiles”)

3) Females with childhood GID, who are usually sexually attracted to women.

Gender Dysphoria in Children

Susan Bradley, M.D., of the University of Toronto, has worked extensively with children with gender identity disorder (GID). She regards GID as one of a number of attachment disorders. Bradley and Kenneth J. Zucker, two of the world’s leading experts in GID in children, have declared that “clinicians should be optimistic, not nihilistic, about the possibility of helping the children to become more secure in their gender identity.”

Even without treatment, the cross-gender behavior generally resolves itself in either self-identification as homosexual or heterosexual. Roughly 75 percent will later self-identify as gay or lesbian. Only a tiny percent will become transsexual. However, today trans-positive therapists encourage parents to accept GID as normal and allow the child to live as the other sex. As the child matures the therapists prescribe puberty blocking drugs, preparing the child for a total sex change.

Social acceptance is seen as a panacea, but there is no evidence these children will avoid the negative outcomes associated with transgender identification, including higher rates of suicide attempts, completed suicides, overall mortality, and need for psychiatric inpatient care. Zucker and Bradley view failure to treat children in an effort to prevent a transsexual outcome as “irresponsible.” Referring to medical interventions to block puberty in gender-variant children, Dr. McHugh of Johns Hopkins says bluntly, “This is child abuse.”

Who Gets Approved for “Gender Reassignment”?

An association of doctors who perform gender reassignment surgery, the World Professional Association for Transgender Health (WPATH), has developed Standards of Care for Gender Identity Disorders. Transgender persons seeking hormone therapy or surgery are supposed to be examined for undiagnosed disorders of sexual development or co-morbid psychological disorders. While the former (DSD) are rare, the latter are common yet necessary and appropriate psychotherapy may not always be offered, and may be resisted by clients determined to obtain surgery. In addition, only a handful of doctors in the U.S. actually perform gender reassignment surgery, leading some transgender people to seek it in other countries, such as Thailand, where conditions are more lenient.

Gender Reassignment Surgery

Full transition involves hormone treatments, breast surgery (removal or implants), other cosmetic surgery, genital reconstruction, and a change of personal identification. However, not every person seeking to live as the other sex will decide to have full reconstructive surgery.

Problems after Surgery

Gender reassignment surgery often does not achieve what patients hope for. Transgender individuals want to “pass” as the other sex. According to a large study of transgendered persons, only 21 percent are able to “pass” all the time.

The surgical procedures are not always successful and can be extremely painful. A lifetime of hormone treatments can also have profound physical and psychological consequences. Jon Meyer, M.D., Associate Professor of Psychiatry and Behavior Science at Johns Hopkins University, concluded, “My personal feeling is that surgery is not a proper treatment for a psychiatric disorder and it is clear to me that these patients have severe psychological problems that do not go away following surgery.”

However, not all those who demand that society recognize them as the other sex have or even intend to have surgical alterations to their bodies. The position of transgender activists is that people should be recognized as belonging to whatever gender they choose, regardless of the physical condition of their bodies.

High-Risk Behavior

Transgender people are more likely than the general public to engage in high-risk behaviors, which may result from or contribute to psychological disorders (or both). Some of the high-risk behavior is directly related to their desire to change sex. For example, some transsexuals self-mutilate or undergo procedures in non-medical settings. Others engage in high-risk sexual behavior such as prostitution, which places them at risk.

High rates of suicide exist even among those who have already received gender reassignment surgery, which suggests that suicidal tendencies result from an underlying pathology. Ironically, however, some applicants threaten suicide or self-mutilation as an argument for the approval of surgery.

“GenderQueer” vs. “the Gender Binary”

To most Americans, it may seem radical to assert that a man can become a woman or a woman can become a man. However, the transgender movement has moved into even more radical territory–attacking what they call “the gender binary,” that is, the idea that everyone should identify as either male or female. Those who adopt this approach sometimes refer to themselves as “genderqueer.”

One of the reasons for the rise of “genderqueer” is that the state of being transgendered is extremely unstable. One source listed over 70 different gender identities.

Rebellion against Reality

Transgender activists blame their problems on “transphobia.” Feminist author Janice Raymond says, “I accept the fact that transsexuals have suffered an enormous amount of psychical and emotional pain. But I don’t accept the fact that someone’s desire to be a woman, or a man, makes one a woman or man.” She refers to “transsexualism” as “the falsification of reality.” Terri Webb was a transgender activist who came to the conclusion that her activism was little more than “an unsuccessful attempt to get others to legitimize my fantasy.”

Mental Health Treatment Options for Gender Identity Issues

A psychologically healthy person accepts the reality of his or her sexual identity. Grief, discomfort, and anger over one’s genetic makeup signal problems that can and should be addressed through counseling. The academic literature includes some clinical accounts of successful efforts to overcome gender identity problems.

Decades ago, there were already findings pointing “to the possibility of psychosocial intervention as an alternative to surgery in the treatment of transsexualism.” One of the most unfortunate results of the transgender movement is that this possibility has not been more thoroughly explored and developed.

Part II: Public Policy Implications of the Transgender Movement

1) Should the government itself (local, state, and/or federal) accept and recognize so-called changes in someone’s sex or “gender identity?”

Sex is a biological reality, and is immutable. In reality, a “sex change” is impossible. Biological sex is a more fundamental, more important, and more accurate measure of a person’s intrinsic identity than the purely subjective and often shifting concept of “gender identity.” Ideally, the law would forbid government recognition in any way (whether on birth certificates, driver’s licenses, passports, or any other government-issued identification) of any change in an individual’s biological sex as identified at birth.

In states where such recognition is too deeply entrenched in the law or in judicial precedent for policy-makers to have a serious hope of undoing it, such recognition should be limited to cases where gender reassignment surgery already has been performed. Policy-makers should strenuously resist efforts to legally recognize changes of sex or “gender identity” that are based only on personal choice, psychological feelings, or social experience, rather than on a physical change.

2) Should the government force other, private entities to accept and recognize so-called “sex changes” through the use of non-discrimination laws that include “gender identity” as a protected category?

This question relates to the efforts to pass laws or ordinances at the local, state, and federal level which would outlaw “discrimination” on the basis of so-called “gender identity” in employment, housing, public accommodations, education, and business transactions.

Some of the bills or laws that seek to protect “gender identity” acknowledge the importance of appearance, dress and grooming standards in the workplace. However, most ordinary Americans would consider dressing in ways that are culturally appropriate for one’s biological sex to be the most fundamental “appearance, grooming, and dress standard” that could be conceived of.

“Bathroom Bills”

The most extreme application of the principle of “non-discrimination” based on “gender identity” would be to the use of gender-separated restrooms, locker rooms, and showers. Even former U.S. Rep. Barney Frank (D-MA), the homosexual Congressman who sponsored the Employment Non-Discrimination Act (ENDA), acknowledged that what transgender activists want “is for people with penises who identify as women to be able to shower with other women.”

Here are some additional reasons to oppose laws purporting to outlaw “discrimination” based on “gender identity:”

  • Such laws increase government interference in the free market.
  • “Gender identity” is unlike other immutable characteristics protected in civil rights laws.
  • Such laws would lead to costly lawsuits against employers.
  • Such laws mandate the employment of “transgendered” individuals in inappropriate occupations, such as education.

3) Should the government pay for medical treatment designed to create the appearance one is other than the sex he or she was born?

One context in which taxpayers could be forced to pay for “gender reassignment” procedures is through the health insurance provided for public employees. Another avenue is government health insurance programs for the poor and the elderly (Medicaid and Medicare). On May 4, 2015, the federal courts decided a claim by a convicted murderer that the Massachusetts Department of Corrections should pay for his gender reassignment surgery–and that failure to do so was “cruel and unusual punishment.” Fortunately, the court rejected that claim.

Government should not pay for gender reassignment (hormone treatments and surgery). Such treatments–involving, as they do, the amputation of healthy body parts–are, arguably, a violation of medical ethics. These are elective procedures rather than necessary health care–just like any other form of cosmetic or plastic surgery.

4) Should the government force other entities to pay for changes in sexual appearance?

The Affordable Care Act (also known as “Obamacare”) has greatly expanded the role of the federal government in dictating to insurance companies (and those who purchase insurance policies, whether employers or individuals) what must be included in those policies. There is no explicit “sex change” mandate in Obamacare. However, some aspects of the law have increased the chances that insurance companies will offer such coverage. Late in 2014, the state of New York imposed a mandate upon insurance companies throughout the state to fund sex reassignment surgery (SRS).

5) Should the federal government permit “transgender” individuals to serve in the military as their preferred sex?

Historically, transgendered persons have not been permitted to serve in the U.S. military. Transgender status has been considered a disqualifying psychiatric condition, and having had gender reassignment surgery has been a disqualifying physical condition. However, transgender activists are pushing for a change to the policy.

The story of America’s most famous transgender service member tends to reinforce concerns that such individuals are not fit for military service. Bradley Manning is the soldier convicted of espionage in 2013 for turning over confidential documents to the website Wikileaks. The day after Manning was sentenced to prison, he “came out” as transgendered.


A person’s sex (male or female) is an immutable biological reality. In the vast majority of people (including those who later identify as “transgender”), it is unambiguously identifiable at birth. There is no rational or compassionate reason to affirm a distorted psychological self-concept that one’s “gender identity” is different from one’s biological sex.

Neither lawmakers nor counselors, pastors, teachers, nor medical professionals should participate in or reinforce the transgender movement’s lies about sexuality–nor should they be required by the government to support such distortion.

** The Executive Summary does not contain citations as these are embedded in the text of this paper.

Dale O’Leary is a freelance writer and lecturer and the author of The Gender Agenda and One Man, One Woman. Her blog can be found at

Peter Sprigg is Senior Fellow for Policy Studies at Family Research Council in Washington, D.C. and the co-author of Getting It Straight: What the Research Shows about Homosexuality and author of Outrage: How Gay Activists and Liberal Judges are Trashing Democracy to Redefine Marriage.

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June 2015 Issue Analysis IS15F01



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