Understanding Gender Dysphoria

Navigating Transgender Issues in a Changing Culture

Mark A. Yarhouse

• Publisher: IVP Academic
• Year: 2015
• ISBN:
  9780830898602
• Topic: Psychology
• Subtopic: Human Sexuality in Psychology
• Index: Psychology

Foreword Reviews' INDIEFAB Honorable MentionFew topics are more contested today than gender identity.In the fog of the culture war, complex issues like gender dysphoria are reduced to slogans and sound bites. And while the war rages over language, institutions and political allegiances, transgender individuals are the ones who end up being the casualties.Mark Yarhouse, an expert in sexual identity and therapy, challenges the church to rise above the political hostilities and listen to people's stories. In Understanding Gender Dysphoria, Yarhouse offers a Christian perspective on transgender issues that eschews simplistic answers and appreciates the psychological and theological complexity. The result is a book that engages the latest research while remaining pastorally sensitive to the experiences of each person.In the midst of a tense political climate, Yarhouse calls Christians to come alongside those on the margins and stand with them as they resolve their questions and concerns about gender identity. Understanding Gender Dysphoria is the book we need to navigate these stormy cultural waters.Christian Association for Psychological Studies (CAPS) Books explore how Christianity relates to mental health and behavioral sciences including psychology, counseling, social work, and marriage and family therapy in order to equip Christian clinicians to support the well-being of their clients.

1

Gender Identity, Gender Dysphoria and Appreciating Complexity

Introduction

On May 30, 1926, George Jorgensen Sr. and Florence Jorgensen welcomed their son, George William Jorgensen, into the world. Danish Americans who had married only four years earlier, they would christen George Jr. in the Danish Lutheran Church a few weeks later.1 George Jr. grew up in New York City and graduated from Christopher Columbus High School in the Bronx. He was considered rather slight and frail and interpersonally shy. George Jr. avoided rough-and-tumble play, sports and other stereotypically male interests. He would go on to study photography at Mohawk College in Utica, and did a brief stint in the military. He later received training at a medical and dental assistance school in Manhattan.

Growing up in New York, George Jr. often felt that he had some kind of sexual and emotional disorder. In search of answers, he would investigate possible explanations by scouring books and articles at the New York Academy of Medicine library. His fear was he was homosexual; after all, he was sexually attracted to men. However, that did not appear to explain everything. George Jr. eventually experimented with the female hormone estradiol, and he learned during this time about a possible intervention taking place in Sweden that extended his experiments into a more meaningful and satisfying resolution. He went overseas and eventually found Dr. Christian Hamburger, an endocrinologist who was willing to provide him with hormonal replacement therapy. George Jr. would later have his testicles and penis removed; he also had vaginal plastic surgery. In 1952, George Jr. changed his name to Christine Jorgensen out of respect for Dr. Christian Hamburger.

We are talking about the 1950s. This course of events would make headlines. Indeed, the New York Daily News banner headline read in all capital letters: “EX-GI BECOMES BLONDE BEAUTY: OPERATIONS TRANFORM BRONX YOUTH.” Although Christine was not the first person to undergo sex-reassignment surgery, she noted in her autobiography that she was the most well known at that time.

Gender identity concerns were not that well understood in the 1950s. Frankly, they are not that well understood today. There are many questions left unanswered about what causes a person to have the psychological experience of being born in the wrong body.

Controversies also exist in the area of treatment or care: How should parents respond when a child displays behaviors more characteristic of the opposite sex? Should cross-gender identification be redirected toward identification with one’s birth sex? Should cross-gender identification be encouraged for a child who is already gender dysphoric? Should puberty be delayed to provide time for that kind of decision making? Or what options exist for teens and adults? Should they be encouraged to enter into therapy to resolve the conflict through psychological intervention? Is cross-gender identification to be avoided, or should it be facilitated? When people have tried different interventions, what has been helpful? What are the reasons people pursue hormonal treatment and sex-reassignment surgery? How often are these procedures helpful to people? What are the long-term effects of these kinds of interventions?

These are remarkable complicated questions that deserve our attention.

We are no longer answering these questions in a cultural context of the 1950s. One difference we can all acknowledge is that our culture has shifted toward more supportive and varied sexual and gender identity labels and communities that are very accessible to people and their families. There have certainly been increased attempts to understand and respond to this often bewildering experience.

The changing culture can be seen in both professional and popular treatment of the phenomenon. In the professional literature, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)2 reflected a shift away from Gender Identity Disorder toward the use of the phrase Gender Dysphoria3 to reduce stigma. Actually, several steps in the new nomenclature were intended to reduce stigma. The first is the shift from an emphasis on identity as the disorder to the emphasis on the dysphoria or distress associated with the gender incongruence for many people who report it. The other was the wording to allow for someone to no longer meet criteria following a transition.

Our culture has in some ways moved past the afternoon television shows that capitalized on “shock and awe” in their presentations, where you might see producers orchestrate a dramatic confrontation between a male-to-female transgender person who once dated a woman and is now surprising her with her true sense of self. These colorful presentations in the media were once an expression of almost gawking at the phenomenon, but they did not represent the kind of cultural sea change that would soon follow.

The shift in the popular media can also be seen in journalism. A few years ago Barbara Walters aired a special in which she interviewed a young biological male who was being raised as a girl.4 In discussing the decision of the parents to raise their son as a daughter, there was tremendous compassion generated around the challenges those parents and that family faced. In that same story, Walters interviewed an adolescent female who identified as male (or, more accurately, as a female-to-male transgender person). Walters interviewed his parents and they shared the challenges they faced, particularly for the mother in terms of wanting this to resolve in a way that would return her daughter to her. These are heartbreaking stories and challenging for every­one involved.

In response to this increased coverage, I asked the questions above: When a child is gender dysphoric, how should parents respond? Should parents raise a gender dysphoric child in the identity of the child’s biological sex? Should they facilitate cross-gender identification? Or should they take a “wait and see” posture with the assumption that the right direction for that child is what will unfold?

In addition to questions about gender dysphoric children, What are the obligations for employers who have transgender employees? How should bathrooms be designated? Should medical coverage extend to hormonal treatment and sex-reassignment surgery? What about room assignments at campgrounds and at colleges and universities? What about hiring policies at churches, faith-based ministries, and at Christian colleges and universities?

As churches consider relating to a dramatically changing culture, what steps should be taken to reach unchurched persons who identify as transgender or who are part of the transgender community? Are there specific steps that could be considered to accommodate the experiences of gender dysphoric persons who visit churches?

In all of these discussions it should be noted, too, that the transgender experience is not one experience; it is best understood as an umbrella term for the many ways in which people might experience their gender identities differently from people whose gender identity is congruent with their birth sex. The experiences vary considerably and are only matched by presentation and expression or the living out of one’s gender identity, which can range from pushing against gender norms (gender “bending”) to cross dressing for sexual arousal to show/performance/ entertainment (drag) to transsexuality.

The transgender community, then, is broadly defined, and it has positioned itself alongside sexual minorities in the broader cultural discourse. Sexual minorities are people who experience their sexual identity in ways that are different than those in the majority (gay, lesbian, bisexual). When we speak of sexual minorities, then, we are typically referring to how people navigate sexual identity and convey their sexual preferences to themselves privately or to others publicly (e.g., frequently using the self-defining attribution “I am gay”).

To enter into an informed discussion of transgender issues is to switch gears a little away from a discussion about sexual orientation. We can return to it, but it is not the focal point in the way it is when discussing homosexuality, heterosexuality and bisexuality.

To discuss being transgender is to discuss one’s experience of gender identity, one’s sense of oneself as male or female, and how that psychological and emotional experience is not aligning with one’s birth sex.

Background

To begin to understand gender dysphoria, it can be helpful to back up and discuss a broader context based on our understanding of sex and gender. When we refer to a person’s sex, we are commonly making reference to the physical, biological and anatomic dimensions of being male or female.5

These facets include chromosomes, gonads, sexual anatomy and secondary sex characteristics.

Key Terms

Biological sex: As male or female (typically with reference to chromosomes, gonads, sex hormones, and internal reproductive anatomy and external genitalia).

Primary sex characteristics: Features that are directly part of the reproductive system, such as testes, penis and scrotum in males, and ovaries, uterus and vagina in females.

Secondary sex characteristics: Have no direct reproductive function, for example, facial hair in males and enlarged breasts in females.

Gender: The psychological, social and cultural aspects of being male or female.

Gender identity: How you experience yourself (or think of yourself) as male or female, including how masculine or feminine a person feels.

Gender role: Adoptions of cultural expectations for maleness or femaleness.

Sex is frequently distinguished from gender. Gender refers to the psychological, social and cultural aspects of being male or female. When we refer to someone’s gender identity, we are thinking of how a person experiences him- or herself (or thinks of him- or herself) as male or female, including how masculine or feminine a person feels. Gender identity is often associated with gender role. Gender role, then, refers to ways in which people adopt cultural expectations for maleness or femaleness. This includes but is not limited to academic interests, career pursuits and so on.

For most people, these various facets or dimensions of sex and gender align in ways that are essentially taken-for-granted realities. Most people you have met have a relatively unremarkable experience (or remarkable in the sense of all of these facets coming into alignment) of being born male or female (with the alignment of the various biological/physical/anatomical features noted above), identifying as a man or a woman, and feeling masculine or feminine within the cultural context in which they are raised.

But variations occur in these areas. For example, there is likely greater variability in how masculine or feminine a person feels, and that is often a reflection of whether they are reared in an environment with rigid gender roles and how well that person’s experiences line up with those expectations.

These variations occur in other areas as well and are often discussed as intersexuality or an intersex condition.6 In the area of biological/physical/anatomical sex, we can note several deviations from the norm of being born male or female. For example, a former client of mine had been diagnosed with Klinefelter Syndrome, a genetic disorder of gonadal differentiation in which that person had an extra X chromosome (XXY).7 Another person could be born with either incomplete or mixed ovarian and testicular tissues, a condition that has often been referred to previous...