Keeping Up with the Conversation
The transgender conversation moves at an incredible pace. There is so much going on that it’s pretty much impossible to keep up. But it’s an important conversation. Important because it is about the difficult, real-life experiences of people made and loved by God, and also important because it is a prominent cultural conversation where a number of significant issues converge. My perception is that there have been some significant developments in the conversation over the last year, so here’s a quick summary of some of these and some reflections on how we should respond as Christians.
One of the big debates in terms of legislation has been what should be required for an individual to be able to change their legal gender and to gain an updated birth certificate. Under the 2004 Gender Recognition Act (for England and Wales), there are fairly strict criteria that must be met before someone can legally change their gender, including a medical diagnosis of gender dysphoria and at least two years living in the new gender.
In 2018 the government launched a consultation on the Gender Recognition Act with one of the potential changes being the introduction of a self-ID system in which individuals would be able to change their legal gender without a medical diagnosis. The consultation sparked quite a response as people expressed concerns about the impact on single-sex spaces and the safety of women.
Despite considerable support for self-ID in the consultation responses, the government has decided not to make changes to the Gender Recognition Act, arguing that the legislation as it stands strikes the right balance. They have, however, committed to making the process cheaper and to reducing waiting times for the NHS gender identity service.
Continued Debate Over Support for Transgender Teens
The question of how best to care for children and teenagers who are diagnosed with gender dysphoria is one of the most debated in the ongoing conversation, and the NHS Gender Identity Development Service (GIDS) has been an area of controversy for a number of years.
Staff have raised concerns, and some have even resigned, unhappy about the treatment that is being offered, often expressing concerns that little attempt is made to offer a proper psychological evaluation to patients and that the service is being shaped by trans activists rather than by good medicine. Internal investigations confirmed these claims, but little has been done in response and the investigation findings were later rejected.
A lawsuit against the GIDS was started by a parent and nurse concerned about the misleading way puberty blockers are presented and the lack of thorough psychological assessment given before blockers are offered to patients. An ex-patient of the GIDS, Keira Bell, later joined as the lead claimant, and last week the court ruled that those under 16 are not old enough to give informed consent to what is effectively an experimental treatment that is likely to have life-long impacts. They also suggested that these factors mean a court should probably be involved in the decision to prescribe puberty blockers for 16- and 17-year olds.
This is a hugely significant ruling that will affect the international conversation on this topic and will cause a change to the shape of the treatment offered to young people with gender dysphoria. In turn, this will hopefully protect many young people from embarking on life-altering treatment that often doesn’t, in the long run, deliver the results it promises and will ensure better support for these young people, as factors which lie behind their distress will be further explored and addressed.
In September, the NHS announced that they were commissioning an independent review into the GIDS, and the recent legal case will no doubt feed into that review. This part of the conversation has seen some significant moments recently, but it is far from over.
Long Term Impact of an Affirming Approach
One of the most difficult questions in the transgender conversation has been about the long-term effectiveness of an affirming approach in which individuals are encouraged and helped to live in line with gender identity rather than biological sex. Is transitioning, often culminating in sex reassignment surgery (SRS), effective in improving the lives of those with gender dysphoria?
The reality is, despite the clear perspectives put forward on both sides, it is hard to say. While there have been a number of studies that found positive outcomes, these have tended to be based on fairly small sample sizes, without any form of control group, and covering only a short period of time. Reliable, long-term studies based on good methodology have been few and far between.
This year has seen a few significant publications in this area. Interestingly this has included a couple that openly challenge the conclusions of previous publications, a positive sign that true discussion and debate are being increasingly allowed.
The first was a correction to a paper published last year. The original paper claimed that SRS led to a decrease in transgender people seeking treatment for mental health problems such as depression, especially when the individuals were a number of years past surgery. This was widely reported in the media as proof of the effectiveness of SRS. However, after the paper was published, many academics challenged the conclusions of the study observing problems with its methodology. As a result, in August this year, a correction was published which acknowledged the weaknesses of the methodology used and the fact that these meant the conclusions drawn were ‘too strong’. It also acknowledged that further consideration of the data ‘demonstrated no advantage of surgery’ in relation to mental health.
The second significant publication was a letter challenging the claims of an earlier paper which had concluded that, when it comes to psychological support, anything other than an affirming approach is harmful to those with gender dysphoria. Again, this claim was widely reported in the media and was even referenced in a paper from the UN Human Rights Council. The letter published in the Archives of Sexual Behaviour highlighted the methodological problems in the original study and noted that the same data could be explained in different ways. The authors acknowledge that there is as of yet little good research into the potential positive impact of psychological interventions, but note that this needs to be allowed so that the best ways of helping those with gender dysphoria can be found.
This year also saw the publication of a significant study that looked at rates of depression, anxiety, and adjustment and somatoform disorders in those who have undergone SRS and, importantly, compared this group with a parallel group of people who hadn’t had SRS. The study found considerably increased experiences of mental health problems among those who had undergone SRS, suggesting that the treatment may not be as effective in producing positive outcomes as has sometimes been claimed.
None of these letters or studies gives us a one-time, clear-cut answer to the question of whether an affirming approach is effective in improving the life experience of people with gender dysphoria, but they are significant contributions to the ongoing research, and they highlight the importance of good methodology in any studies we look to in seeking to answer this key question.
A Christian Response
How should we as Christians respond to these developments?
First, I think there are some things to give thanks for. One of the primary concerns for Christians should be to seek the safety and wellbeing of those who are vulnerable. We should therefore be particularly concerned about safeguarding children and young people. The scrutiny under which the GIDS is currently being placed is a positive thing if it ensures that vulnerable young people are being protected from potentially unhelpful treatments and ideology. We can also give thanks that there is an increasing willingness among academics to engage in a true debate about the effectiveness of an affirming approach as this could potentially also feed into protecting a vulnerable group – adults experiencing the pain of gender dysphoria.
There is, however, also still much to pray for. The recent court ruling on puberty blockers may protect young people from being fast-tracked to treatment that is experimental and possibly harmful, but we must remember that the young people seeking the support of the GIDS are still experiencing distress. We must pray for good, evidence-based care to be provided for these young people. Likewise, if evidence is growing that an affirming approach does not bring long-term peace to adults with gender dysphoria we must pray for better support to be offered to help them navigate life. Ultimately, we must pray because we know that this is a conversation about real people.
I think these developments also provide an encouragement for us to keep on holding fast to what the Bible teaches us about our identity as men and women. We are seeing the beginning of what may be a turning of the tide in cultural opinion on this topic. We are seeing evidence that the Bible’s call to us to live in line with our biological sex is actually the best thing for us, even if there are sometimes difficulties in this. We are seeing an increasing realisation that gender stereotypes are often not helpful, that our biological sex is unchanging and unchangeable, and that this gives us the freedom to be how we are without changing who we are.
It does look like we could, in the long term, be heading towards a change in the dominant perspective on transgender in our culture, at very least in relation to children and teenagers. If when this change does come, we as Christians are those who throughout the cultural debate have put forward a perspective which is later proved to be the most loving and life-giving, it will be a glorious demonstration to those around us of God’s wisdom and compassion and of the goodness of God’s word. We need to hold fast to what God says, trusting and proclaiming that it is good news. And we do this both out of love for God and love for our neighbour.