Understanding Gender Dysphoria, page 22
28James T. Kimber, “Types of Crossdressers: A Typology of Transgender Persons with Behaviorally Significant Amounts of Internal Motivation,” unpublished manuscript.
29Ray Blanchard, “Gender Identity Disorders in Adult Men,” in Clinical Management of Gender Identity Disorders in Children and Adults, ed. Ray Blanchard and B. V. Steiner (Washington, DC: American Psychiatric Publishing, 1990), pp. 49-75; Ray Blanchard, “Gender Identity Disorders in Adult Women,” in Clinical Management of Gender Identity Disorders in Children and Adults (Washington, DC: American Psychiatric Publishing, 1990), pp. 77-91.
30Blanchard, “Gender Identity Disorders in Adult Women,” p. 81.
31Blanchard, “Gender Identity Disorders in Adult Men,” pp. 49-75.
32Ibid., p. 71.
33Ibid., pp. 49-75.
34Carroll, “Assessment and Treatment of Gender Dysphoria,” pp. 368-422.
35Ibid., p. 377.
36Anne A. Lawrence, Men Trapped in Women’s Bodies: Narratives of Autogynephilic Transsexualism (New York: Springer, 2013), p. 2.
37Ibid., p. 3.
38Blanchard, “Gender Identity Disorders in Adult Men,” p. 58.
39Lawrence, Men Trapped in Women’s Bodies, p. 95.
40Blanchard, “Gender Identity Disorders in Adult Men,” pp. 49-75.
41Zucker and Brown, “Gender Dysphoria,” p. 251.
42Ibid., pp. 251-52.
Chapter 5: Prevention and Treatment of Gender Dysphoria
1T. D. Steensma, R. Biemond, F. deBoer and P. T. Cohen-Kettenis, “Desisting and Persisting Gender Dysphoria After Childhood: A Qualitative Study,” Clinical Child Psychology and Psychiatry (2010): 1-18.
2See, for example, Jack Drescher, “Controversies in gender diagnoses,” LGBT Health 1, no. 1 (2014): 13.
3H. F. L. Meyer-Bahlburg, “Gender Identity Disorder in Young Boys: A Parent- and Peer-Based Treatment Protocol,” Clinical Child Psychology and Psychiatry 7, no. 3 (2002): 360-76.
4Ibid., p. 361.
5Kenneth J. Zucker, “Gender Identity Disorder in Children and Adolescents,” Treatments of Psychiatric Disorders, 3rd ed., ed. G. Gabbard (Washington, DC: American Psychiatric Press, 2001), pp. 2069-94; Kenneth J. Zucker and Susan L. Bradley, Gender Identity Disorder and Psychosexual Problems in Children and Adolescents (New York and London: The Guilford Press, 1995).
6Zucker, “Gender Identity Disorder in Children and Adolescents;” see also Meyer-Bahlburg, “Gender Identity Disorder in Young Boys.”
7H. F. L. Meyer-Bahlburg, “Gender Identity Disorder in Young Boys: A Parent- and Peer-Based Treatment Protocol,” Clinical Child Psychology and Psychiatry, 7 (2002), pp. 360-77; Zucker, “Gender Identity Disorder in Children and Adolescents.”
8Zucker, “Gender Identity Disorder in Children and Adolescents;” Kenneth J. Zucker, “Gender Identity Development and Issues,” Child and Adolescent Psychiatric Clinics of North America, 13 (2004), pp. 551-68.
9Meyer-Bahlburg, “Gender Identity Disorder in Young Boys: A Parent- and Peer-Based Treatment Protocol,” p. 365.
10Zucker, “Gender Identity Disorder in Children and Adolescents.”
11Meyer-Bahlburg, “Gender Identity Disorder in Young Boys;” Zucker, “Gender Identity Disorder in Children and Adolescents;” Zucker, “Gender Identity Development and Issues.”
12Meyer-Bahlburg, “Gender Identity Disorder in Young Boys,” pp. 360-76.
13Alix Spiegel, “Parents Consider Treatment to Delay Son’s Puberty,” National Public Radio, May 8, 2008. Available at: http://www.npr.org/templates/story/story.php?storyId=90273278.
14American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric Publishing, 2013).
15Steensma, Biemond, deBoer and Cohen-Kettenis, “Desisting and Persisting Gender Dysphoria After Childhood,” pp. 1-18.
16Ibid., p. 13.
17Ibid.
18Drescher, “Controversies in Gender Diagnoses,” pp. 10-14.
19See www.nytimes.com/2013/06/30/opinion/sunday/sunday-dialogue-our-notions-of-gender.html?pagewanted=all&_r=1&.
20J. Olson, C. Forbes, and M. Belzer, “Management of the Transgender Adolescent,” Archives of Pediatrics and Adolescent Medicine, 165 (2) (2011), pp. 171-76.
21Drescher, “Controversies in Gender Diagnoses,” pp. 10-14.
22Olson, Forbes and Belzer, “Management of the Transgender Adolescent,” p. 173.
23Ibid., p. 174.
24See www.npr.org/templates/story/story.php?storyId=90273278.
25Spiegel, “Parents Consider Treatment to Delay Son’s Puberty.”
26See also deVries, Steensma, Doreleijers and Cohen-Kettenis, 2011, B. P. Kreukels and P. T. Cohen-Kettenis, “Puberty Suppression in Gender Identity Disorder: The Amsterdam Experience,” National Review of Endocrinology, 17 (7) (2011), pp. 466-72.
27Kreukels and Cohen-Kettenis, “Puberty Suppression in Gender Identity Disorder: The Amsterdam Experience.”
28In the same NPR report, it was noted that “taking testosterone or estrogen immediately after blocking puberty will make a teenage patient sterile.” Spack shared, “This is one of the most controversial aspects of this. At what age can a young person fully understand the implications of doing something that will make fertility for them, by today’s technology, virtually impossible?” Spack also noted that “there is no risk of infertility from the hormone-blocking treatment alone. Infertility only comes when the hormone-blocking treatment is paired with Stage 2, the use of opposite-sex hormones. And so, Spack says, hormone blockers should really be seen simply as a treatment that gives families more time to think about what to do” (www.npr.org/templates/story/story.php?storyId=90273278).
29Kreukels and Cohen-Kettenis, “Puberty Suppression in Gender Identity Disorder: The Amsterdam Experience.”
30See Eli Coleman, W. Bockting, M. Cohen-Kettenis et al., “Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7,” International Journal of Transgenderism 13 (2011): 174-75.
31Zucker, “Gender Identity Disorder in Children and Adolescents.”
32Ibid., p. 285.
33Zucker, “Gender Identity Development and Issues.”
34Olson, Forbes and Belzer, “Management of the Transgender Adolescent.”
35Ibid.
36Richard Carroll, “Assessment and Treatment of Gender Dysphoria,” in Principles and Practice of Sex Therapy, 3rd ed., ed. S. R. Leiblum and R. C. Rosen (New York: Guilford, 2000), pp. 368-422.
37Ibid., p. 380; Richard Carroll, “Gender Dysphoria and Transgender Experiences,” in Principles and Practice of Sex Therapy, 4th ed., ed. S. R. Leiblum (New York: Guilford, 2007), pp. 477-508. For the Standards of Care, see www.wpath.org.
38Carroll, “Gender Dysphoria and Transgender Experiences,” p. 490.
39Ibid., p. 380.
40Ibid., p. 491.
41Ibid.
42Ibid.
43Ibid.
44Some prefer to use the term “gender-affirming surgery” rather than “sex reassignment” or “gender reassignment.” See American Psychological Association’s proposed Guidelines for Psychological Practice with Transgender and Gender Non-Conforming Clients, p. 6; temporarily posted at http://www.apa.org, retrieved May 27, 2014.
45The Standards of Care are updated and currently available at www.wpath.org. Guidelines for hormonal treatment are published by the Endocrine Society. See “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline,” first published in the Journal of Clinical Endocrinology & Metabolism, September 2009, 94(9), pp. 3132–54, https://www.endocrine.org/~/media/endosociety/Files/Publications/Clinical%20Practice%20Guidelines/Endocrine-Treatment-of-Transsexual-Persons.pdf.
46Coleman, “Standards of Care,” p. 183.
47Ibid.
48Ibid., p. 184.
49Carroll, “Assessment and Treatment of Gender Dysphoria,” pp. 368-422; Carroll, “Gender Dysphoria and Transgender Experiences,” p. 491.
50Coleman, “Standards of Care,” p. 183.
51Ibid., p. 202.
52Ibid.
53A. I. Lev, “Transgender Communities: Developing Identity Through Connection,” in Handbook of Counseling and Psychotherapy with Lesbian, Gay, Bisexual and Transgender Clients, 2nd ed., ed. K. J. Bieschke, R. M. Perez and K. A. DeBord (Washington, DC: American Psychological Association, 2007), pp. 147-75.
54Trista L. Carr, Mark A. Yarhouse and Rebecca L. Thomas, “MtF Transgender Christians: An Exploratory Study with Milestone Events,” poster presentation at the National Transgender Health Summit, Oakland, California, May 17-18, 2013. See also Trista L. Carr, Mark A. Yarhouse and Rebecca Thomas, “Report on TG Christians’ milestone events,” in Beverly Miller, Gender Identity: Disorders, Developmental Perspectives and Social Implications (New York: Nova Science Publishers, in press).
55Tom Mazur, Melissa Colsman and David E. Sandberg, “Intersex: Definition, Examples, Gender Stability and the Case Against Merging with Transsexualism,” in Principles of Transgender Medicine and Surgery, ed. Randi Ettner, Stan Monstrey and A. Evan Eyler (New York: Hayworth, 2007), p. 251.
56Carroll, “Gender Dysphoria and Transgender Experiences,” pp. 477-508.
57Carroll, “Assessment and Treatment of Gender Dysphoria,” pp. 368-422. See also Luk Gijs and Anne Brewaeys, “Surgical Treatment of Gender Dysphoria in Adults and Adolescents: Recent Developments, Effectiveness, and Challenges,” Annual Review of Sex Research, 18 (1) (2007), pp. 178-224, REF; A. J. Kuiper and P. T. Cohen-Kettenis, “Sex Reassignment Surgery: A study of 141 Dutch Transsexuals,” Archives of Sexual Behavior, 17 (1988), pp. 439-57.
58Zucker and Brown, “Gender Dysphoria,” p. 257.
59C. Dhejne, O. Öberg, S.Arver and M. Landén, “An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960–2010: Prevalence, Incidence, and Regrets,” Archives of Sexual Behavior 43, no. 8 (2014): 1535-45.
60Ibid., p. 249. As Zucker and Brown note, the current Standards of Care have moved away from the language of “real-life experience,” viewing it as coming across as too “paternalistic” and creating “undue hardship”; instead, the current language is that of “a continuous gender-role experience for genital surgery only, opening up alternatives for people to document their lives and understanding of the social consequences of transition, offering time to adjust and adapt to the challenges inherent within” (pp. 249-50).
61Carroll, “Assessment and Treatment of Gender Dysphoria.” See also Anne A. Lawrence, “Factors Associated with Satisfaction or Regret Following Male-to-Female Sex Reassignment Surgery,” Archives of Sexual Behavior 32, no. 4 (2003): 299-315.
62Blanchard, “Gender Identity Disorders in Adult Men,” p. 59.
63Anne A. Lawrence, Men Trapped in Women’s Bodies: Narratives of Autogynephilic Transsexualism (New York: Springer, 2013).
64Carroll, “Gender Dysphoria and Transgender Experiences,” pp. 477-508.
65See A. Johansson, E. Sundborn, T. Hojerback and O. Bodlund, “A Five-Year Follow-Up Study of Swedish Adults with Gender Identity Disorder,” Archives of Sexual Behavior 39 (2010): 1429-37; Louis J. Gooren, Erik J. Giltay and Matthijs C. Bunck, “Long-Term Treatment of Transsexuals with Cross-Sex Hormones: Extensive Personal Experience,” Journal of Clinical Endocrinol Metabolism 93, no. 1 (2008): 19-25.
66Cecilia Dhejne, Paul Lichtenstein, Marcus Boman, Anna L. V. Johansson, Niklas Langstrom, Mikael Landen, “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” PLoS ONE 6, no. 2 (2011): e16995. Doi: 10.1371/journal.pone.0016885. See also Annette Kuhn, Christine Bodmer, Werner Stadlmayr, Peter Kuhn, Michael D. Mueller and Martin Birkhauser, “Quality of Life 15 Years After Sex Reassignment Surgery for Transsexualism,” Fertility and Sterility 92, no. 5 (2009): 1685-89.
67Dhejne et al., “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” p. 7.
68Ibid.
69Paul R. McHugh, “Psychiatric Misadventures,” American Scholar 61, no. 4 (1992): 502.
70Ibid., p. 503.
71Ibid.
72Paul McHugh, “Transgender Surgery Isn’t the Solution,” The Wall Street Journal, June 12, 2014, http://online.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120. These are powerful images. However, in a recent discussion about this parallel a colleague mentioned that the professional consensus around the etiology of anorexia is that while causal pathways are multifaceted, it is one of the mental health issues believed to be most influenced by culture in terms of beauty/self-worth, perfectionism and competition. It is unclear that environmental influences on Gender Dysphoria would function in any way similar to what we see in the various eating disorders.
73Kevin D. Williams, “Laverne Cox Is Not a Woman: Facts Are Not Subject to Our Feelings,” The Chicago Sun-Times, May 30, 2014. Although printed and subsequently retracted, the original article is available here: www.nationalreview.com/article/379188/laverne-cox-not-woman-kevin-d-williamson. The fact that the article was officially retracted gives the reader a sense of what is open to debate in our current cultural discourse on gender identity.
74McHugh, “Psychiatric Misadventures,” p. 503.
75Lawrence, Men Trapped in Women’s Bodies.
Chapter 6: Toward a Christian Response: At the Level of the Individual
1J. L. Zimmerman and V. C. Dickerson, “Using a Narrative Metaphor: Implications for Theory and Clinical Practice,” Family Process, 33 (3) (1994), pp. 233-45.
2Ibid., p. 235.
3Mark A. Yarhouse, Trista L. Carr and Emma Bucher, Gender Identity Journeys (Virginia Beach, VA: Institute for the Study of Sexual Identity, 2014).
4Ibid., p. 43.
5Ibid., pp. 45-46.
6Anne A. Lawrence, Men Trapped in Women’s Bodies: Narratives of Autogynephilic Transsexualism (New York: Springer, 2013), p. 27.
7Ibid.
8Stanton L. Jones, “Is Sex or Gender a Choice?,” in forthcoming Holman Worldview Study Bible.
9M. Griffith, “Opening Therapy to Conversations with a Personal God,” Spiritual Resources in Family Therapy, ed. Froma Walsh (New York: The Guilford Press, 1999), pp. 209-22.
10Ibid.
11Yarhouse, Carr and Bucher, Gender Identity Journeys, p. 65.
12Ibid., pp. 64-65.
13Mark Yarhouse and Trista L. Carr, “MtF Transgender Christians’ Experiences: A Qualitative study,” Journal of LGBT Issues in Counseling 6, no. 1 (2012): 18-33. See also Trista L. Carr, Mark A. Yarhouse and Rebecca L. Thomas, “MtF Transgender Christians: An Exploratory Study with Milestone Events,” poster presentation at the National Transgender Health Summit, Oakland, California, May 17-18, 2013.
14Ibid., p. 24.
15Ibid.
16Ibid., p. 25.
17Oliver O’Donovan, Resurrection and Moral Order: An Outline for Evangelical Ethics, 2nd ed. (Grand Rapids: Eerdmans, 1994), p. 260.
18Ibid.
19Ibid., p. 262.
20An exchange between two social conservatives on Crosstalk touched on the experience of transsexuals in the US military:
I can only imagine the confusion that would be there if here is some guy dressed in a big skirt trying to look feminine climbing into the left seat in a bomber or into a jetfighter and getting his dress all snarled up trying to climb in. We’re talking about guys running jackhammers and making bunkers and things like that, if there’s anything disgusting it’s to see, and I mean this kindly but women are made of God to be very special, and one day I was driving down the street and I saw this, well this lady was pretty hefty, but she was operating a jackhammer and what it did to her was absolutely astounding, it was wicked, it was a violation of the very purpose of the wonderful gift of femininity.
If we’ve got people here now suddenly all on the altar of being able to—it’s not just the transgenders [sic], now if you feel like you’re feminine one day and feel like you’re masculine the next day, you can change back and forth, switch-hitter. (www.vcyamerica.org/blog/2014/04/08/the-price-of-citizenship)
21O’Donovan, Resurrection and Moral Order, p. 264.
Chapter 7: Toward a Christian Response: At the Level of the Institution
1See www.theclause.org/2013/09/theology-professor-to-leave-university-over-transgender-identity.
2Elizabeth Redden, “Spring Arbor and Transgender Dean Settle,” Inside Higher Ed, March 14, 2007, www.insidehighered.com/news/2007/03/14/springarbor.
3Sarah Pulliam Bailey, “Transgender Student Denied On-Campus Male Housing at Christian University,” Religion News Service, April 9, 2014, www.religionnews.com/2014/04/09/transgender-student-denied-campus-male-housing-christian-university.
4Representatives attending the Southern Baptist Convention recently adopted a resolution titled “On Transgender Identity” that reflected on cultural changes, such as the removal of Gender Identity Disorder from DSM-5, trends in services to gender dysphoric persons (such as “cross-sex hormone therapy, gender reassignment surgery, and social and legal transition to the desired gender”), and affirmations and accommodations based on a person’s “self-perception of [his or her] own gender.” The resolution affirms that gender identity is “determined by biological sex and not by one’s self-perception”; “the reality of human fallenness which can result in such biological manifestations as intersexuality or psychological manifestations as gender identity confusion”; “efforts to alter one’s bodily identity (e.g., cross-sex hormone therapy, gender reassignment surgery) to refashion it to conform with one’s perceived gender identity”; and “oppose steadfastly all efforts by any governing official or body to validate transgender identity as morally praiseworthy.” There are also several affirmations of transgender persons as made in the image of God that include the denunciation of abuse toward transgender persons (“we regard our transgender neighbors as image-bearers of Almighty God and therefore condemn acts of abuse or bullying committed against them”) and affirmations of transgender persons as welcome in church (“we love our transgender neighbors, seek their good always, welcome them to our churches and, as they repent and believe in Christ, receive them into church membership”). See www.sbc.net/resolutions/2250/on-transgender-identity.
29Ray Blanchard, “Gender Identity Disorders in Adult Men,” in Clinical Management of Gender Identity Disorders in Children and Adults, ed. Ray Blanchard and B. V. Steiner (Washington, DC: American Psychiatric Publishing, 1990), pp. 49-75; Ray Blanchard, “Gender Identity Disorders in Adult Women,” in Clinical Management of Gender Identity Disorders in Children and Adults (Washington, DC: American Psychiatric Publishing, 1990), pp. 77-91.
30Blanchard, “Gender Identity Disorders in Adult Women,” p. 81.
31Blanchard, “Gender Identity Disorders in Adult Men,” pp. 49-75.
32Ibid., p. 71.
33Ibid., pp. 49-75.
34Carroll, “Assessment and Treatment of Gender Dysphoria,” pp. 368-422.
35Ibid., p. 377.
36Anne A. Lawrence, Men Trapped in Women’s Bodies: Narratives of Autogynephilic Transsexualism (New York: Springer, 2013), p. 2.
37Ibid., p. 3.
38Blanchard, “Gender Identity Disorders in Adult Men,” p. 58.
39Lawrence, Men Trapped in Women’s Bodies, p. 95.
40Blanchard, “Gender Identity Disorders in Adult Men,” pp. 49-75.
41Zucker and Brown, “Gender Dysphoria,” p. 251.
42Ibid., pp. 251-52.
Chapter 5: Prevention and Treatment of Gender Dysphoria
1T. D. Steensma, R. Biemond, F. deBoer and P. T. Cohen-Kettenis, “Desisting and Persisting Gender Dysphoria After Childhood: A Qualitative Study,” Clinical Child Psychology and Psychiatry (2010): 1-18.
2See, for example, Jack Drescher, “Controversies in gender diagnoses,” LGBT Health 1, no. 1 (2014): 13.
3H. F. L. Meyer-Bahlburg, “Gender Identity Disorder in Young Boys: A Parent- and Peer-Based Treatment Protocol,” Clinical Child Psychology and Psychiatry 7, no. 3 (2002): 360-76.
4Ibid., p. 361.
5Kenneth J. Zucker, “Gender Identity Disorder in Children and Adolescents,” Treatments of Psychiatric Disorders, 3rd ed., ed. G. Gabbard (Washington, DC: American Psychiatric Press, 2001), pp. 2069-94; Kenneth J. Zucker and Susan L. Bradley, Gender Identity Disorder and Psychosexual Problems in Children and Adolescents (New York and London: The Guilford Press, 1995).
6Zucker, “Gender Identity Disorder in Children and Adolescents;” see also Meyer-Bahlburg, “Gender Identity Disorder in Young Boys.”
7H. F. L. Meyer-Bahlburg, “Gender Identity Disorder in Young Boys: A Parent- and Peer-Based Treatment Protocol,” Clinical Child Psychology and Psychiatry, 7 (2002), pp. 360-77; Zucker, “Gender Identity Disorder in Children and Adolescents.”
8Zucker, “Gender Identity Disorder in Children and Adolescents;” Kenneth J. Zucker, “Gender Identity Development and Issues,” Child and Adolescent Psychiatric Clinics of North America, 13 (2004), pp. 551-68.
9Meyer-Bahlburg, “Gender Identity Disorder in Young Boys: A Parent- and Peer-Based Treatment Protocol,” p. 365.
10Zucker, “Gender Identity Disorder in Children and Adolescents.”
11Meyer-Bahlburg, “Gender Identity Disorder in Young Boys;” Zucker, “Gender Identity Disorder in Children and Adolescents;” Zucker, “Gender Identity Development and Issues.”
12Meyer-Bahlburg, “Gender Identity Disorder in Young Boys,” pp. 360-76.
13Alix Spiegel, “Parents Consider Treatment to Delay Son’s Puberty,” National Public Radio, May 8, 2008. Available at: http://www.npr.org/templates/story/story.php?storyId=90273278.
14American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric Publishing, 2013).
15Steensma, Biemond, deBoer and Cohen-Kettenis, “Desisting and Persisting Gender Dysphoria After Childhood,” pp. 1-18.
16Ibid., p. 13.
17Ibid.
18Drescher, “Controversies in Gender Diagnoses,” pp. 10-14.
19See www.nytimes.com/2013/06/30/opinion/sunday/sunday-dialogue-our-notions-of-gender.html?pagewanted=all&_r=1&.
20J. Olson, C. Forbes, and M. Belzer, “Management of the Transgender Adolescent,” Archives of Pediatrics and Adolescent Medicine, 165 (2) (2011), pp. 171-76.
21Drescher, “Controversies in Gender Diagnoses,” pp. 10-14.
22Olson, Forbes and Belzer, “Management of the Transgender Adolescent,” p. 173.
23Ibid., p. 174.
24See www.npr.org/templates/story/story.php?storyId=90273278.
25Spiegel, “Parents Consider Treatment to Delay Son’s Puberty.”
26See also deVries, Steensma, Doreleijers and Cohen-Kettenis, 2011, B. P. Kreukels and P. T. Cohen-Kettenis, “Puberty Suppression in Gender Identity Disorder: The Amsterdam Experience,” National Review of Endocrinology, 17 (7) (2011), pp. 466-72.
27Kreukels and Cohen-Kettenis, “Puberty Suppression in Gender Identity Disorder: The Amsterdam Experience.”
28In the same NPR report, it was noted that “taking testosterone or estrogen immediately after blocking puberty will make a teenage patient sterile.” Spack shared, “This is one of the most controversial aspects of this. At what age can a young person fully understand the implications of doing something that will make fertility for them, by today’s technology, virtually impossible?” Spack also noted that “there is no risk of infertility from the hormone-blocking treatment alone. Infertility only comes when the hormone-blocking treatment is paired with Stage 2, the use of opposite-sex hormones. And so, Spack says, hormone blockers should really be seen simply as a treatment that gives families more time to think about what to do” (www.npr.org/templates/story/story.php?storyId=90273278).
29Kreukels and Cohen-Kettenis, “Puberty Suppression in Gender Identity Disorder: The Amsterdam Experience.”
30See Eli Coleman, W. Bockting, M. Cohen-Kettenis et al., “Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7,” International Journal of Transgenderism 13 (2011): 174-75.
31Zucker, “Gender Identity Disorder in Children and Adolescents.”
32Ibid., p. 285.
33Zucker, “Gender Identity Development and Issues.”
34Olson, Forbes and Belzer, “Management of the Transgender Adolescent.”
35Ibid.
36Richard Carroll, “Assessment and Treatment of Gender Dysphoria,” in Principles and Practice of Sex Therapy, 3rd ed., ed. S. R. Leiblum and R. C. Rosen (New York: Guilford, 2000), pp. 368-422.
37Ibid., p. 380; Richard Carroll, “Gender Dysphoria and Transgender Experiences,” in Principles and Practice of Sex Therapy, 4th ed., ed. S. R. Leiblum (New York: Guilford, 2007), pp. 477-508. For the Standards of Care, see www.wpath.org.
38Carroll, “Gender Dysphoria and Transgender Experiences,” p. 490.
39Ibid., p. 380.
40Ibid., p. 491.
41Ibid.
42Ibid.
43Ibid.
44Some prefer to use the term “gender-affirming surgery” rather than “sex reassignment” or “gender reassignment.” See American Psychological Association’s proposed Guidelines for Psychological Practice with Transgender and Gender Non-Conforming Clients, p. 6; temporarily posted at http://www.apa.org, retrieved May 27, 2014.
45The Standards of Care are updated and currently available at www.wpath.org. Guidelines for hormonal treatment are published by the Endocrine Society. See “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline,” first published in the Journal of Clinical Endocrinology & Metabolism, September 2009, 94(9), pp. 3132–54, https://www.endocrine.org/~/media/endosociety/Files/Publications/Clinical%20Practice%20Guidelines/Endocrine-Treatment-of-Transsexual-Persons.pdf.
46Coleman, “Standards of Care,” p. 183.
47Ibid.
48Ibid., p. 184.
49Carroll, “Assessment and Treatment of Gender Dysphoria,” pp. 368-422; Carroll, “Gender Dysphoria and Transgender Experiences,” p. 491.
50Coleman, “Standards of Care,” p. 183.
51Ibid., p. 202.
52Ibid.
53A. I. Lev, “Transgender Communities: Developing Identity Through Connection,” in Handbook of Counseling and Psychotherapy with Lesbian, Gay, Bisexual and Transgender Clients, 2nd ed., ed. K. J. Bieschke, R. M. Perez and K. A. DeBord (Washington, DC: American Psychological Association, 2007), pp. 147-75.
54Trista L. Carr, Mark A. Yarhouse and Rebecca L. Thomas, “MtF Transgender Christians: An Exploratory Study with Milestone Events,” poster presentation at the National Transgender Health Summit, Oakland, California, May 17-18, 2013. See also Trista L. Carr, Mark A. Yarhouse and Rebecca Thomas, “Report on TG Christians’ milestone events,” in Beverly Miller, Gender Identity: Disorders, Developmental Perspectives and Social Implications (New York: Nova Science Publishers, in press).
55Tom Mazur, Melissa Colsman and David E. Sandberg, “Intersex: Definition, Examples, Gender Stability and the Case Against Merging with Transsexualism,” in Principles of Transgender Medicine and Surgery, ed. Randi Ettner, Stan Monstrey and A. Evan Eyler (New York: Hayworth, 2007), p. 251.
56Carroll, “Gender Dysphoria and Transgender Experiences,” pp. 477-508.
57Carroll, “Assessment and Treatment of Gender Dysphoria,” pp. 368-422. See also Luk Gijs and Anne Brewaeys, “Surgical Treatment of Gender Dysphoria in Adults and Adolescents: Recent Developments, Effectiveness, and Challenges,” Annual Review of Sex Research, 18 (1) (2007), pp. 178-224, REF; A. J. Kuiper and P. T. Cohen-Kettenis, “Sex Reassignment Surgery: A study of 141 Dutch Transsexuals,” Archives of Sexual Behavior, 17 (1988), pp. 439-57.
58Zucker and Brown, “Gender Dysphoria,” p. 257.
59C. Dhejne, O. Öberg, S.Arver and M. Landén, “An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960–2010: Prevalence, Incidence, and Regrets,” Archives of Sexual Behavior 43, no. 8 (2014): 1535-45.
60Ibid., p. 249. As Zucker and Brown note, the current Standards of Care have moved away from the language of “real-life experience,” viewing it as coming across as too “paternalistic” and creating “undue hardship”; instead, the current language is that of “a continuous gender-role experience for genital surgery only, opening up alternatives for people to document their lives and understanding of the social consequences of transition, offering time to adjust and adapt to the challenges inherent within” (pp. 249-50).
61Carroll, “Assessment and Treatment of Gender Dysphoria.” See also Anne A. Lawrence, “Factors Associated with Satisfaction or Regret Following Male-to-Female Sex Reassignment Surgery,” Archives of Sexual Behavior 32, no. 4 (2003): 299-315.
62Blanchard, “Gender Identity Disorders in Adult Men,” p. 59.
63Anne A. Lawrence, Men Trapped in Women’s Bodies: Narratives of Autogynephilic Transsexualism (New York: Springer, 2013).
64Carroll, “Gender Dysphoria and Transgender Experiences,” pp. 477-508.
65See A. Johansson, E. Sundborn, T. Hojerback and O. Bodlund, “A Five-Year Follow-Up Study of Swedish Adults with Gender Identity Disorder,” Archives of Sexual Behavior 39 (2010): 1429-37; Louis J. Gooren, Erik J. Giltay and Matthijs C. Bunck, “Long-Term Treatment of Transsexuals with Cross-Sex Hormones: Extensive Personal Experience,” Journal of Clinical Endocrinol Metabolism 93, no. 1 (2008): 19-25.
66Cecilia Dhejne, Paul Lichtenstein, Marcus Boman, Anna L. V. Johansson, Niklas Langstrom, Mikael Landen, “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” PLoS ONE 6, no. 2 (2011): e16995. Doi: 10.1371/journal.pone.0016885. See also Annette Kuhn, Christine Bodmer, Werner Stadlmayr, Peter Kuhn, Michael D. Mueller and Martin Birkhauser, “Quality of Life 15 Years After Sex Reassignment Surgery for Transsexualism,” Fertility and Sterility 92, no. 5 (2009): 1685-89.
67Dhejne et al., “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” p. 7.
68Ibid.
69Paul R. McHugh, “Psychiatric Misadventures,” American Scholar 61, no. 4 (1992): 502.
70Ibid., p. 503.
71Ibid.
72Paul McHugh, “Transgender Surgery Isn’t the Solution,” The Wall Street Journal, June 12, 2014, http://online.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120. These are powerful images. However, in a recent discussion about this parallel a colleague mentioned that the professional consensus around the etiology of anorexia is that while causal pathways are multifaceted, it is one of the mental health issues believed to be most influenced by culture in terms of beauty/self-worth, perfectionism and competition. It is unclear that environmental influences on Gender Dysphoria would function in any way similar to what we see in the various eating disorders.
73Kevin D. Williams, “Laverne Cox Is Not a Woman: Facts Are Not Subject to Our Feelings,” The Chicago Sun-Times, May 30, 2014. Although printed and subsequently retracted, the original article is available here: www.nationalreview.com/article/379188/laverne-cox-not-woman-kevin-d-williamson. The fact that the article was officially retracted gives the reader a sense of what is open to debate in our current cultural discourse on gender identity.
74McHugh, “Psychiatric Misadventures,” p. 503.
75Lawrence, Men Trapped in Women’s Bodies.
Chapter 6: Toward a Christian Response: At the Level of the Individual
1J. L. Zimmerman and V. C. Dickerson, “Using a Narrative Metaphor: Implications for Theory and Clinical Practice,” Family Process, 33 (3) (1994), pp. 233-45.
2Ibid., p. 235.
3Mark A. Yarhouse, Trista L. Carr and Emma Bucher, Gender Identity Journeys (Virginia Beach, VA: Institute for the Study of Sexual Identity, 2014).
4Ibid., p. 43.
5Ibid., pp. 45-46.
6Anne A. Lawrence, Men Trapped in Women’s Bodies: Narratives of Autogynephilic Transsexualism (New York: Springer, 2013), p. 27.
7Ibid.
8Stanton L. Jones, “Is Sex or Gender a Choice?,” in forthcoming Holman Worldview Study Bible.
9M. Griffith, “Opening Therapy to Conversations with a Personal God,” Spiritual Resources in Family Therapy, ed. Froma Walsh (New York: The Guilford Press, 1999), pp. 209-22.
10Ibid.
11Yarhouse, Carr and Bucher, Gender Identity Journeys, p. 65.
12Ibid., pp. 64-65.
13Mark Yarhouse and Trista L. Carr, “MtF Transgender Christians’ Experiences: A Qualitative study,” Journal of LGBT Issues in Counseling 6, no. 1 (2012): 18-33. See also Trista L. Carr, Mark A. Yarhouse and Rebecca L. Thomas, “MtF Transgender Christians: An Exploratory Study with Milestone Events,” poster presentation at the National Transgender Health Summit, Oakland, California, May 17-18, 2013.
14Ibid., p. 24.
15Ibid.
16Ibid., p. 25.
17Oliver O’Donovan, Resurrection and Moral Order: An Outline for Evangelical Ethics, 2nd ed. (Grand Rapids: Eerdmans, 1994), p. 260.
18Ibid.
19Ibid., p. 262.
20An exchange between two social conservatives on Crosstalk touched on the experience of transsexuals in the US military:
I can only imagine the confusion that would be there if here is some guy dressed in a big skirt trying to look feminine climbing into the left seat in a bomber or into a jetfighter and getting his dress all snarled up trying to climb in. We’re talking about guys running jackhammers and making bunkers and things like that, if there’s anything disgusting it’s to see, and I mean this kindly but women are made of God to be very special, and one day I was driving down the street and I saw this, well this lady was pretty hefty, but she was operating a jackhammer and what it did to her was absolutely astounding, it was wicked, it was a violation of the very purpose of the wonderful gift of femininity.
If we’ve got people here now suddenly all on the altar of being able to—it’s not just the transgenders [sic], now if you feel like you’re feminine one day and feel like you’re masculine the next day, you can change back and forth, switch-hitter. (www.vcyamerica.org/blog/2014/04/08/the-price-of-citizenship)
21O’Donovan, Resurrection and Moral Order, p. 264.
Chapter 7: Toward a Christian Response: At the Level of the Institution
1See www.theclause.org/2013/09/theology-professor-to-leave-university-over-transgender-identity.
2Elizabeth Redden, “Spring Arbor and Transgender Dean Settle,” Inside Higher Ed, March 14, 2007, www.insidehighered.com/news/2007/03/14/springarbor.
3Sarah Pulliam Bailey, “Transgender Student Denied On-Campus Male Housing at Christian University,” Religion News Service, April 9, 2014, www.religionnews.com/2014/04/09/transgender-student-denied-campus-male-housing-christian-university.
4Representatives attending the Southern Baptist Convention recently adopted a resolution titled “On Transgender Identity” that reflected on cultural changes, such as the removal of Gender Identity Disorder from DSM-5, trends in services to gender dysphoric persons (such as “cross-sex hormone therapy, gender reassignment surgery, and social and legal transition to the desired gender”), and affirmations and accommodations based on a person’s “self-perception of [his or her] own gender.” The resolution affirms that gender identity is “determined by biological sex and not by one’s self-perception”; “the reality of human fallenness which can result in such biological manifestations as intersexuality or psychological manifestations as gender identity confusion”; “efforts to alter one’s bodily identity (e.g., cross-sex hormone therapy, gender reassignment surgery) to refashion it to conform with one’s perceived gender identity”; and “oppose steadfastly all efforts by any governing official or body to validate transgender identity as morally praiseworthy.” There are also several affirmations of transgender persons as made in the image of God that include the denunciation of abuse toward transgender persons (“we regard our transgender neighbors as image-bearers of Almighty God and therefore condemn acts of abuse or bullying committed against them”) and affirmations of transgender persons as welcome in church (“we love our transgender neighbors, seek their good always, welcome them to our churches and, as they repent and believe in Christ, receive them into church membership”). See www.sbc.net/resolutions/2250/on-transgender-identity.
