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A Christian Survey of Sexual Reassignment Surgery

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A Christian Survey of Sexual Reassignment Surgery Pastoral Paper WRITTEN BY: MARK A. YARHOUSE, PSY.D. JULIA SADUSKY, M.A. 10 A CHRISTIAN SURVEY OF SEX REASSIGNMENT SURGERY AND HORMONE THERAPY WWW.CENTERFORFAITH.COM THE CENTER FOR FAITH, SEXUALITY & GENDER TABLE OF CONTENTS Introduction PG. 1 What are Hormone Therapy and Sex Reassignment Surgery? PG. 2 The Efectiveness of Hormonal Therapy and Sex Reassignment PG. 4 What about Detransition? PG. 7 Trends among Younger Teens PG. 9 Alternative Ways to Manage Distress PG. 11 Pastoral Recommendations PG. 13 Notes PG. 16 About the Authors PG. 18 PASTORAL PAPER 10 Introduction How should Christians respond to sex reassignment surgery and hormone therapy? There is no shortage of people weighing in on this question. Far too often, however, the answers we give (or the answers we choose to believe) are based more on assumptions and caricatures than they are on thoughtful investigation of the questions under discussion. Until Christians have taken the time to grapple with the complexities of gender identity questions and their physical and psychological implications, our biblical and pastoral responses are doomed to fall short of the wisdom, clarity, and compassion we seek. This paper ofers an introductory survey of psychological research on sex reassignment surgery and hormone therapy, as well as other approaches to managing gender identity conflict. Our focus here is not on expounding biblical approaches to sex and gender; rather, we want to provide accessible psychological data that will equip Christian leaders to respond to gender identity questions with wisdom, clarity, and compassion. We close by making some pastoral recommendations about what this research might mean for those of us seeking to respond with Christ-like love to transgender and gender dysphoric individuals. PG. 1 THE CENTER FOR FAITH, SEXUALITY & GENDER What are Hormone Therapy and Sex Reassignment Surgery? Hormone Therapy (HT), also called cross-sex typically produced by biological females—as well hormone therapy or hormone replacement as antiandrogens to block the production of therapy, is the name for a medical intervention in testosterone. which a person takes the hormones associated with the other sex. Most often, the goal of HT is Sex Reassignment Surgery (SRS) is also called to support or facilitate a cross-gender identity for Gender Reassignment Surgery, Gender people diagnosed with gender dysphoria—that is, Afrmative Surgery, or a number of other names. distress associated with a lack of congruence (Casually, it’s often called a “sex change.”) It refers between their experience of their gender identity not to any one surgery but to a number of and their biological sex. It’s important to surgeries that a person who adopts a distinguish HT from the use of hormone blockers cross-gender identity or other-gender identity at the onset of puberty. These are two separate might consider. interventions. The use of blockers can be a way of “buying time” before puberty begins. A young Some of the more common surgeries for a person just entering puberty (at what is called the biological female adopting a cross-gender “Tanner 2” stage of development or the initial identity or other-gender identity focus on onset of puberty) is provided blockers that keep removal of anatomy that is experienced as them from experiencing the physical changes distressing to the person, as when a biological associated with puberty. Puberty can thus be female undergoes chest reconstruction. In this delayed for one or two years so that the older surgery, female breast tissue is reconstructed to child, now a teenager, can make a decision about develop a male chest. Similarly, a biological which direction they want to go in terms of female may undergo a hysterectomy in which the gender identity. uterus is removed. Vaginectomy refers to the removal and/or closure of the vagina. HT itself, then, refers to the use of cross-sex Salpingo-oopherectomy refers to the removal of hormones by those who want to adopt a one or both ovaries and fallopian tubes. cross-gender identity or otherwise manage their symptoms of gender dysphoria. For a biological A biological female who adopts a cross-gender female, cross-sex hormone therapy entails the identity may also consider interventions such as use of testosterone and is most commonly done metaoidioplasty, the partial cutting loose of the by injection or through implants or patches clitoris (now enlarged from the use of HT) so that placed on the skin. Biological males who use it functions more like a penis. Others might cross-sex hormones to facilitate a cross-gender consider a more invasive procedure, phalloplasty, identity or to manage gender dysphoria typically which is the use of skin grafts to construct/attach take estrogens and progestogens—hormones a penis. PG. 2 PASTORAL PAPER 10 Biological males who adopt a cross-gender identity or other-gender identity will often undergo electrolysis or laser hair removal for facial hair. Some may consider breast augmentation or the use of breast implants to enhance the results that have already begun to occur with HT. Still others may consider removal of the penis (penectomy) and removal of the testicles (orchiectomy). Some may also undergo vaginoplasty, a surgery in which the penis is essentially inverted and shaped into a neo-vagina. PG. 3 THE CENTER FOR FAITH, SEXUALITY & GENDER The Efectiveness of Hormonal Therapy and Sex Reassignment Do medical and/or surgical interventions relieve single point in time instead of collecting the distress of someone diagnosed with gender longitudinal data. This limits the robustness of the dysphoria?1 Though many people answer this findings from this research.2 Another challenge question using only anecdotal evidence, this with the data is that many of the earlier studies paper surveys the available research to discuss involved research subjects who also had what we know (and what we don’t know) about undergone sex reassignment surgeries. This these strategies to cope with gender dysphoria. makes it difcult to determine the precise impact of HT for those who do not also undergo SRS. There are a number of limitations to existing studies on the psychological efects of HT and The more recent research in this area ofers SRS. First of all, most available studies do not insight into people’s satisfaction with HT compare those who receive hormonal treatment interventions, their quality of life following those or pursue surgery to control groups—that is, interventions, and their levels of psychological groups of people who have similar psychological distress and morbidity. These last variables are experiences but do not undergo those particularly important because those who treatments. Further, all the available studies are experience gender dysphoria are at increased risk observational in nature. The samples tend to be for psychopathology, report significant levels of convenience samples and small in size, which distress, and are at increased risk for suicide, all of limits our ability to generalize the findings. Of the which are often motivators for pursuing medical studies which are labeled longitudinal—that is, interventions.3 Many of the clients we work with studies taking place over an extended period of are cautious when considering steps to manage time—the participants were followed for, in most dysphoria, particularly because they do not want cases, only one year. This underscores our their symptoms of gender dysphoria or any current lack of understanding of the long-term co-occurring symptoms to worsen. It’s important impacts of hormonal treatment and sex for people to understand the likely impact of reassignment surgery. hormonal treatment as they make informed decisions about managing gender dysphoria. First, let’s review research on hormonal treatment outcomes. What is the efect of HT, both Several short-term longitudinal studies have short-term and long-term, on people’s compared psychological distress among psychological and physical health and on their transsexual individuals before and after hormonal overall quality of life? Published studies to date intervention. (The word “transsexual” is reserved have not been evaluated through controlled for people who have adopted or plan to adopt a clinical trials, and most of the research is cross-gender identity through medical cross-sectional in nature—that is, it focuses on a interventions.) A retrospective study of 84 PG. 4 PASTORAL PAPER 10 patients found that the number of attempted first year of hormonal treatment.9 While some suicides following the start of hormonal treatment patients may experience complications or dropped from 10 to 4 after patients received their side-efects from using cross-sex hormones, even first dose of hormonal treatment.4 The study doesn’t these complications do not lead most people to help us determine whether continued hormonal stop treatment prematurely.10 Among the possible treatment would continue to have that efect on the side efects is the risk of sterility. Few studies have number of suicide attempts. However, it supports weighed the risks associated with various treatment the expectation that many patients’ distress options (or no treatment) for people with gender decreases when they receive hormonal treatment. dysphoria who want to remain fertile, and this The patients in another study showed statistically would bring up additional moral concerns for some significant decreases in scores on measures of Christians. anxiety, depression, psychological symptoms, and functional impairment after
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