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.