Quaeritur: Transgender follow-up

Img credit: Bill Barrett, Wikimedia Commons

Some time ago a medical student and I had a great interchange on
care of patients with gender dysphoria. The student followed up some time later with the following email:

I’ve come to the conclusion that nobody can change their gender. ...[O]ur maleness and femaleness are defined by our participation in the ability to create life within the marital act. So, “maleness” shouldn’t be defined as a Y chromosome, male genitalia, or a “male brain” (whatever that means). This means that if a man who has fathered a child suddenly claims that he is actually a woman “on the inside", this is an impossibility. The same would probably apply to all people who are born with functioning and properly developed reproductive organs.

With all that being said, I consider all the proposed treatment options for transgender persons not as actually changing someone’s sex or gender, but providing a coping mechanism for their gender dysphoria, which is a mental illness with a biological component. So, I would probable propose the least irreversible “treatments” first such as maybe wearing clothes typical of the opposite gender, and then if the gender dysphoria does not resolve and their mental health worsens, I would even consider some more drastic, irreversible steps such as hormones and/or gender-reassignment surgery.

I understand that many theologians see the concept of changing one’s gender an impossibility and I agree! However, I think that in some cases, especially for a patient with severe gender dysphoria the more drastic measures could be taken following all other options fail.

I know that many moral theologians have difficulties with this topic, and I understand why! I’m still exploring and keeping an open mind, and I know that if the Church were to propose an answer that definitely concluded that these “treatments” are immoral then I will gladly stand behind her judgement!

I really admire that you're committed to obeying the Church's judgment should she speak in a definitive way on this topic. I wish more Catholics were like that. I'm that way about embryo adoption: I think it's licit, and I'm going against some big names in that. But if the Church were to come out and say that I am wrong, I would accept that.

Women with AIS and related DSD.
Credit: Ksaviano, Wikimedia Commons

I agree with you that gender is not modifiable. It's really interesting how you define it! You define it by a person's ability in the marital act. (Did I read you correctly?) If a person is able to father a child with a woman, he is male. If a person is able to conceive a child with a man, she is female. For some reason I think that's amazing. I struggle to identify exactly what gender is. It's not a phenotype, or a set of traits/likes, or even (I hesitate) a genotype. (AIS, anyone?)

I think we disagree on whether medical and surgical transition therapies are good for men and women. (I'm not sure about dressing differently but I even think complete cross-dressing is not a good treatment.) Dysphoria should be addressed at its root and a man helped to love his masculinity, a woman helped to love her femininity. In the process of helping this love, societal roles should be tossed if necessary and clothing/hair should be evaluated objectively and not with too many cultural attachments. But I don't think dysphoria should be palliated by altering or amputating parts of the body or creating imitations of genitalia. Mutilation is wrong.

Quick Takes as Fellowship Comes Closer

#1

Professionals of all stripes use LinkedIn. Basic science researchers use ResearchGate. Private physicians use Doximity. And, of course, everyone still needs a paper CV or resume. This sets up an obvious problem for the (hopeful) academic physician with a strong community presence. Aware that tl;dr has its own meaning, I affectionately call this resume problem "TLDR." Whenever I have something to put on my CV, it has to go in four places: Text, LinkedIn, Doximity, and ResearchGate. (And I haven't even mentioned the fact that NRMP, the "common app" for residency and fellowship, makes you build yet another CV in its system.)

#2

This month I went to wedding, two conferences, and a strategic planning meeting. One of the conferences overlapped with call, so I flew back through recently-flooded Houston the night before I showed up for a 24-hour shift. I feel like I'm always leaving friends and family behind, never present to them. All in all, I am traveling 4 out of the 5 weekends of this month. (I spent the other weekend TLDRing.)

#3

Hello Internet is a podcast by CGP Grey and Brady Haran. I used to watch a lot of YouTube science, so I knew the creators and listened to a bunch of the podcast while collecting data for a research project. One interesting episode talked about time management across four categories: work, family, health, and friends. Grey made these categories analogous to four lightbulbs, and posed the question of time management in terms of how bright (or dim) each bulb is or should be, given limited wattage for all four. He related personally that his "health" bulb hadn't been on in the early years of starting a successful YouTube channel. As I listened to the podcast, madly collecting data, I felt similar. I, too, am self-employed in a way. I'm in that phase in my career that involves aggressive self-improvement. I'm looking for excellent skills, rare opportunities, good connections, advantageous relationships, and strategic projects. And that "health" bulb is really dim! I'm trying to turn it up a little, but the wattage limit and my chronic ambitious habits are making it really hard.

#4

I'm homesick. When I applied to residency, I had few incentives to stay in my hometown because the public hospital rejected my ethical choices, the good private hospital had residents I didn't want to work with, and I thought the other private hospital was a dead-end career choice. Now I might be able to wedge my way back in, and I'd really like to. I don't like being the stranger at Christmas, that "older sister" who is never present to my siblings' lives. I want to be near my parents and be in the city I know and love. I can't tell how important these feelings are, though. Should I prioritize training in this important stage in my career? Should I go somewhere for the sake of a key mentor or a key set of experiences? And the all-important question: will they take me?

#5

You know the fable of the man who started with a piece of straw and ends up a millionaire? I feel that way sometimes. I started in homeschool and traded up to a good private elementary school. This allowed me to trade up to an academically decent but philosophically terrible private high school. From there, I could have jumped academically higher (and philosophically lower) into college, but instead traded overall "up" to TAC. But TAC is a "straw" in terms of the rest of the world. (All the Thomists may now laugh at TAC being straw.) But I was still able to trade up to get into medical school. From a community program, I traded up again to an academic residency. I wonder whether fellowship will be another trade "up," or whether I've maxed out my potential. 

#6

Can I admit something? It relates to "maxing out potential." There is a barely perceptible but real glass ceiling over me because of my moral choices. I can't go to top places because they don't want someone with my "limits." I am not comfortable putting a list of places I'm blocked from online, because I still have steps left in my training and don't want to close doors. But I have this long-lasting frustration with being inferior. I guess it started at TAC: I felt like I took the moral high road, and my high school classmates who had gone to better colleges were getting into better med schools. Then from my state med school, I felt that again I was getting fewer competitive interviews. In any given city, there's a glass wall between me and the big hospital and the big research projects. It makes me irrationally hungry to go to those places and do that research. There is a lot more funding and networking in those places, and I could do more. Wouldn't it be good if I could do some animals studies to further the possibility of ectopic rescue? Wouldn't it be good if I could study methotrexate more?

#7

I look at the last quick take and part of me thinks: "Networking and funding are fancy words for power and money. Don't look to those things. The Lord doesn't want you to do things independently. He wants you to be His Bride and He will make all the rest possible for you, even if it requires more work and you do not meet with success." There is more purity of heart in this response, I think. Less slavishness to ambition and outward things. More peace. Please pray for me, that I can have this peace and trust in the Lord, rather than anxiety over worldly things that I miss because of adherence to the truth. Please join me in that trust, in whatever opportunity you have in your life.

I will start applying for fellowships in July of 2018. I will start preparing my application around December, when interview season for the entering intern class of 2018 is over. Please pray for me! If there are priests reading, please consider saying a Mass for me.