On Gender Identity Trends

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Gender identity is a trending topic today. There is actually a phrase for it: “trans trending.” But it is being discussed by many people in many circles, including Christian circles, where the focus is on identifying the best and most faithful response.

As I write about in my book, Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture, I do see Gender Dysphoria and the broader transgender discussion as quite complex. The complexity requires a thoughtful, naunced response from the Christian community.

A quick primer: Transgender is an umbrella term for the many ways people express gender identity when they have gender identity that is does not align with their biological sex as male or female. Some people who identify as transgender also experience distress over this lack of alignment between their identity and their biological sex. When that occurs, mental health professionals have called the distress “gender dysphoria.”

I am concerned that “transgender” as an umbrella term is becoming home to many other identity questions that naturally arise in adolescence and are being explored by younger teens, some of who request serious medical interventions. This is in part why we see a growing number of emerging gender identities (e.g., agender, bigender, genderfluid, gender creative).

In my book, I introduce the reader to three frameworks that function as “lenses” through which people “see” the research in this area, the broader topic, and the people who are navigating gender identity concerns. The three frameworks are integrity, disability, and diversity.

Let me review these three frameworks briefly.

The integrity lens emphasizes the importance of a biblical foundation for norms of sex and gender and sets a standard for the Christian who seeks to be faithful to what God has revealed in Scripture. It says that there are real, God-given differences between males and females that were intended by God from creation (Gen 1, 2). These differences lay the foundation for morally permissible sexual behavior. When a male and female come together in the context of a marriage covenant, sexual behavior is morally permissible. Outside of that foundation and covenant, sexual behavior is morally impermissible. This lens is concerned that the integrity of male/female distinctions is forfeited if a person were to adopt a cross-gender identity or pursue medical interventions, such as hormonal treatment or sex reassignment surgery.

The second lens through which people see this topic is called the disability lens. When people experience a lack of fit between gender identity and biological sex, it is thought of as an unfortunate departure from what typically happens—not everything is lining up properly—but is not considered a moral issue by people who think this way. They argue that transgender concerns should be addressed with compassion. Christians might be drawn to aspects of the disability lens because of the reality of the fall (Gen 3) which has resulted in all sorts of consequences for human life. A biblical Christian drawing from the disability lens would likely see “trans trending” as a misguided search for identity. But they would also still likely want to respond with compassion to the distress people with these concerns face, especially when people struggle with life-threatening dysphoria. Different strategies might be seen as permissible and might include more invasive steps, since a person could see it as a way of coping with something after the Fall that was not as it ought to be, as opposed to seeing it as a rejection of male/female sexual difference.

The third lens is the diversity lens. This is the lens that is captivating the culture today. Those who see through the diversity lens see differences in gender identity as signaling a group of people (transgender persons) who should be embraced and celebrated. To be transgender is to be part of the larger lesbian, gay, bisexual, and transgender community. Adherents of the diversity lens help people adopt and celebrate a cross-gender identity (for example, a biological male who experiences himself as a woman) and would not be concerned with the morality of more invasive medical procedures, as they may see these as appropriate steps to accomplish greater self-realization. Diversity advocates may also see “trans trending” as an improvement over traditional views of male and female that they believe are hurtful to transgender persons.

In my role as a psychologist, I try to understand these different experiences of gender identity and the different lenses people may be drawn to, and find ways to work with clients who seek my help. This is not unlike how I would with other clients whose experiences and decisions may be similar or different from aspects of my own personal Christian beliefs.

But where does the Christian begin in ministry or pastoral care? There is a tendency among some Christians to see the three frameworks as competing in such a way that they have to choose one over the other, or that drawing on some of the frameworks or learning from some of the other frameworks means diluting the one they view as primary. I do see the three frameworks as each providing important insights, so let me unpack this a little further.

Integrating the three lenses has potential great value in ministry, and I think there are elements of all three that can be understood as biblical. The theological foundations that come from the integrity lens are a critical starting point. It addresses what is morally permissible sexual behavior, but it also reminds us of the significance of male/female differences. This gives Christians pause when they see the broader culture encouraging individuals to move towards strategies for managing dysphoria that manipulate the body in some way. Since gender identity concerns can vary in intensity, a number of people with these concerns will be open to a discussing how to cope with and respond to gender identity conflicts in light of one’s biological sex. For many (most?) people that is apparently what happens.

Can Christians who uphold the integrity lens find anything of value in the disability or diversity lenses, even if not prepared to adopt every application of them? While we have to be careful here to avoid sacrificing biblical authority in this effort, I think we can. I would say that, for example, from the disability lens, we can appreciate the compassion that is present. We can appreciate being reminded of the reality of Gen 3, which has clear implications throughout Scripture and thus important to apply, so that a Christian perspective is characterized by compassion and empathy as people explore ways to cope with more intense gender dysphoria when it is present, and as young people find themselves drawn to emerging gender identities about which Christians may voice concern.

Is there anything to be gained from the diversity lens? This is by far the most challenging lens for me as a Christian, since it is often applied by others in such a way that it dismisses male/female sexual difference as merely oppressive and negligible. However, what the diversity lens does is create a sense of identity and community for those who suffer from gender dysphoria and for those who are part of the “trans trending” group. While I disagree with the answers typically offered within the diversity lens, I have to admit that it is the only lens really attempting to specifically meet the longing for identity and community for those with gender dysphoria or are otherwise under the transgender umbrella.

Jesus says in Him we will have life and life to the full, and that means each person ought to find freedom and a capacity to be celebrated in a community where they have a sense of identity by living out Christian faith. Christianity can and has offered people renewed identity and purpose and meaning in life. Proponents of the diversity lens didn’t come up with that; they cast a different vision for what that can be, and they advertise it boldly.

A Christian ministry that wants to be effective will have to address identity and community from a distinctively Christian and biblical perspective. It will have to do this in a way that is emotionally and spiritually compelling to compete with the siren call available to people with transgender concerns arising from the diversity lens. Ministry could do this by communicating that life in Christ can offer identity, community, and purpose in the midst of complex experiences, including experiences of great distress and unwanted suffering. This requires taking into consideration the whole of Scripture, and the myriad of people who, despite their unique experiences and histories, are pursued by Christ to be made anew in His image.

 

On the Nashville Statement

READ-The-Nashville-Statement-on-LGBTQ-amp-Transgender-AcceptanceSocial media has been on fire in response to the Nashville Statement. As you’ve undoubtedly read by now, folks are lining up to either sign the statement or denounce it. I suspect that the hardening of these lines was the point for some of the authors of the statement. But rather than go that route, let’s take a step back for a moment.

I’ve written about my understanding of a traditional Christian sexual ethic in many places. No need to reiterate. So in terms of what you might call the underlying theology, I (along with many other conservative Christians) may agree with aspects of the Nashville Statement insofar as it attempts to reflect such an ethic.

However, the Nashville Statement does not simply reflect what we might call a traditional sexual ethic. It attempts to address several areas beyond the question of whether same-sex behavior is morally permissible or morally impermissible. Most notably, it takes on the question of language or the use of specific sexual identity labels. The use of various sexual identity labels, such as gay, lesbian, and bisexual, is actually a developmental process that has been fascinating to study, particularly among Christians who are sorting out sexual identity concerns. While the use of specific language (e.g., “gay”) has been a concern to a few outspoken conservatives, it has not been a litmus test for orthodoxy that carried the moral significance of behavior, where there is greater biblical clarity. In that way the Nashville Statement will be experienced by some as unnecessarily antagonistic toward some of the very people whose commitment to a biblical sexual ethic means they are living out costly obedience.

The language piece also fails to appreciate how younger people talk about their sexual orientation and ways in which “homosexuality” and “a homosexual orientation” has fallen out of the vernacular. Put differently, the word “gay” to the average 14-year-old is not synonymous with promiscuity the way it may have been for some of the authors of the Nashville Statement; rather, it is the way a teenager might reference his or her sexual orientation, which is important for youth ministers, for instance, to understand. Now I am not suggesting that there is never a pastoral concern about language; there may be, and I’ve discussed that topic at some length. But there isn’t always a pastoral concern about language, and there is a need to nuance this discussion for effective ministry and pastoral care.

Along these lines, I believe it was Andy Crouch who discussed the difference between postures and gestures. Postures are more fixed ways of positioning yourself in relation to a topic. Gestures are the many ways you express yourself in a specific ministry setting. He recommends Christians avoid rigid postures that limit their gestures. On the question of language, the Nashville Statement reflects a fairly rigid posture that, in places, is unnecessarily antagonistic toward other conservatives, particularly those who identity as celibate gay Christians.

Then there is “transgenderism.” It should be noted that “transgender” is an umbrella term for the many ways people experience, express, or live out a gender identity that is different than that of a person whose gender identity aligns with his or her biological sex. This is a complicated topic. There isn’t even consensus on who fits under the transgender umbrella, which is part of the problem when the word is used in such declarations. It can include people who report great distress, such as those who meet criteria for gender dysphoria, but to some the word transgender also captures those who cross-dress, drag queens and kings, transsexuals, those with intersex conditions, various non-binary gender identities, and so on. The diversity here is remarkable.

When I wrote Understanding Gender Dysphoria, which was published in 2015, I noted that transgender presentations were a wave that was going to crest on evangelicals and that the church was not prepared for it. I noted that we needed to think deeply and well about gender identity and to engage with some humility what we know and do not know from the best of science, as well as learn from mistakes made in how evangelicals engaged the topic of sexual identity and especially how evangelicals treated the actual people who were navigating sexual identity and faith. I was suggesting we could learn from that experience and make some adjustments as we encounter the topic of gender identity.

I’m afraid the Nashville Statement, perhaps out of a desire to establish the parameters for orthodoxy on gender identity concerns, gets ahead of evangelicals because it doesn’t reflect the careful, nuanced reflection needed to guide Christians toward critical engagement of gender theory, while also aiding in the development of more flexible postures needed in pastoral care.

The statement evangelicals need today is one that guides the church toward a flexible posture, grounded in Scripture, that allows for a range of gestures based on the needs associated with ministry and cultural engagement.

What is Gender Dysphoria?

Here is a talk I gave at Q Denver titled, What is Gender Dysphoria?  It is being featured on Q Ideas. I try to explain the phenomenon, as well as provide a little background information on theories of etiology, prevalence, and management strategies. Also, check out the talk by Melinda Selmys, who shares about her own experiences with gender dyshporia.

After we both spoke, Gabe Lyons invited us to join him for a time to Q & A from the audience. This was a helpful opportunity to reflect further on gender dysphoria:

To give you a little background on Q Ideas, here is a description from their website:

Q was birthed out of Gabe Lyons’ vision to see Christians, especially leaders, recover a vision for their historic responsibility to renew and restore cultures. Inspired by Chuck Colson’s statement, “Christians are called to redeem entire cultures, not just individuals,” Gabe set out to reintroduce Christians to what had seemed missing in recent decades from an American expression of Christian faithfulness; valuing both personal and cultural renewal, not one over the other. Re-educating Christians to this orthodox and unifying concept has become central to the vision of Q.

Together, we explore topics that fall into four broad themes: culture, future, church, and gospel. Q facilitates the investigation of deeper engagement and responsibility in each of these areas. As we continue to work through these ideas on a deeper level, so grows our commitment to equipping innovators, social entrepreneurs, entertainers, artists, church-shapers, futurists, scientists, educators, historians, environmentalists, and everyday people to do extraordinary things. At Q Ideas, you’ll see a broad spectrum of content represented in our small group curriculum, essays, videos, blog articles, and podcasts. These are all contributed and commissioned to shed light on unique areas of culture and the church.

Gender Dysphoria

Here is a chapel address I gave at Covenant College on the topic if Gender Dysphoria. I am usually asked to speak on sexual and religious identity (the intersection of gay, lesbian, bisexual identity and Christian faith); or I am asked to speak on sexuality more broadly (how to be a good steward of one’s sexuality or sexual impulses). So this is different.

We discussed having the chapel on the topic of Gender Dysphoria, which in recent months I’ve been asked to speak on a lot. Christian audiences have been really interested in the topic, but they often have little experience with it apart from media and entertainment. In any case, I hadn’t given a chapel address on the topic, so I thought this could be helpful.

The feedback from students was encouraging. Several came up to me throughout the day, and I received a few emails from students who experience Gender Dysphoria. It is a topic that students are discussing on Christian college campuses, but they often have little opportunity to explore different approaches to it. I don’t know that a chapel address changes that dramatically, but it does provide a venue for awareness of the experience and further discussion.

The Cultural Salience of Gender Dysphoria

thAs we come to the close of 2015, let me take a moment to reflect on what has been a rather remarkable year with respect to gender dyshporia. For about 16 years now, I have seen individuals, couples, and families where a person was navigating gender dysphoria. It is not my primary area of research and clinical practice; that would be sexual identity. Gender dysphoria is thought to be a rare phenomenon, but conservative estimates have frequently come from the number of people seeking out specialty clinics in Europe. More recent approaches have been through national studies and the inclusion of “transgender” as a category option. Neither of these is a particularly accurate measure of prevalence. “Transgender” is itself an umbrella term for any number of experiences of gender identity that do not match those that align with one’s biological or birth sex. Those who experience gender dysphoria would be a subset of people who identify as transgender.

Earlier this year I was asked by the editor of Christianity Today (CT) to write a featured article on gender dysphoria for their magazine. The editor had watched a talk I gave at Calvin College in February and was looking for an article that would help the CT readership come to a better understanding of the topic. I had also just completed a book that was scheduled for publication by InterVarsity Press Academic in June/July, so that timing was actually pretty good. I agreed to write the article.

The CT article on gender dysphoria was recently listed as one of the most-read CT articles of 2015. The article has not been without its critics, however. One theologian wrote a critical response to it in First Things. The editors allowed me to write a reply, which you can read here. (The most insightful review I’ve read is here.)

As I have been thinking through the nature of the critiques, one acquaintance approached me with a typology that he thought might be helpful. He said it was not original to him, but he was sharing that there may be different callings and audiences in the mix. He offered a taxonomy of purposes and corresponding audiences:

  1. to instruct morally and to strengthen ethical resolve;
  2. to instruct for the purposes of pastoral response and engagement;
  3. to engage pastorally with individuals, that person in need, and families who are affected;
  4. to respond to the gay/gender activists, sometimes within the liberal church, and often those outside the church.

The thought that was being shared is that perhaps my article and primary area of work has been in #2 and #3, whereas conservative Christians who have raised concerns have as their primary role #1 and/or #4.

Gender Dysphoria coverIt’s an interesting thought, and one I will leave to the reader to discern. Part of where I think Christians who have raised concerns and I are potentially speaking past one another is that I am focusing on gender dysphoria and the management of the distress experienced by the person navigating gender identity conflicts. Some of my critics are tackling the entire transgender umbrella with many or all of its presentations. We are at times simply not discussing the same thing.

In any case, I do provide clinical services in this area and continue to work closely with individuals, couples, and families navigating gender identity concerns. I typically recommend people go to more comprehensive clinics with larger, multidisciplinary teams, but in many cases people prefer to see a Christian, and so I am willing to meet with those individuals/families. So #3 is certainly a part of my professional work. Also, the CT article itself was geared toward helping Christians have a more compassionate response to a complex phenomenon, so in that sense #2 seems quite relevant.

About two years ago I thought that gender dysphoria would represent a wave that would crest on evangelical Christians and that the church was not prepared for it. This dawned on my through a series of talks to youth ministers who increasingly faced complex ministry challenges associated with gender identity questions. These encounters were why I approached IVP Academic about the book. However, it would have been difficult to predict just how culturally salient gender dyshporia and the transgender experience would become (with multiple reality TV shows, prominent award-recipients, and so on).

As we head into 2016 it will be interesting to track just how salient these topics will become, what they will symbolize in our culture, and how the Christian community will respond. There are no easy answers. What I recommend is a thoughtful, prayerful approach, one characterized by humility about what we know and do not know, and a response that embodies conviction, civility, and compassion in all our exchanges within the Body of Christ and beyond.

 

 

Understanding Gender Dysphoria – Part 4

Gender Dysphoria cover“What can we do?” asked the mother of a 7-year-old boy. She looked up and caught my eye. “What should we do… just last week a woman at the park said something. I couldn’t believe she had the nerve, but she did. I’m worried about him; I’m afraid that kids at school might do worse. There have been a few things said, at least he has hinted at a couple of things. But that could get worse. How they might tease him… I don’t know…” The mother went on to describe her son’s effeminate behavior and mannerisms, as well as how his voice inflection seemed more like that of a girls. She spoke of his tendency to pretend he had long hair and declare, “Mom, I have long hair like you have long hair!” She shared that just this past weekend, he grabbed a towel and put it around his waist and said, “Look, Mom, I’m wearing a dress just like you!” And he would often put on her heeled shoes and walk around in them.

This is obviously a challenging situation for parents, who are often unsure how best to respond to their child. Parents often wonder if this is a phase their child is going through. They may wonder if their child is going to be gay. Most do not know what gender incongruence or gender dysphoria is, so that is often not even on their radar.

Discussions about prevention and/or intervention can be remarkably complicated. Not only are the parents and the child obvious stakeholders, but there are entire emerging communities that have a stake in what happens next. Before we discuss four general approaches that have been in the literature, it is important to know that most cases of Gender Dysphoria (in which the diagnosis applies) actually resolve before a child reaches late adolescence or adulthood. Researchers sometimes refer to “desisters” and “persisters.” A desister is someone for whom the gender dysphoria resolves by late adolescence or adulthood, whereas a persister refers to someone who continues to experience gender dysphoria into later adolescence and adulthood. I discussed developmental trajectories among gender dysphoric children in a previous post, and that might be helpful to review.

So the question of whether and how to intervene is often held up to scrutiny in light of what appears to be a natural resolution of Gender Dysphoria among desisters. But we do not know enough today about how to distinguish children whose gender dysphoria desists from those whose gender dysphoria persists. You can begin to appreciate how not knowing makes every other decision that much more difficult.

There are four basic approaches under consideration:

Decrease cross-gender identification;

Watchful waiting;

Facilitate cross-gender identity in anticipation of an adult identification; and

Delay puberty until a child can decide about gender identity in later adolescence.

Proponents who discuss the first option generally argue that they are facilitating a resolution that is likely to occur anyway. They tend to emphasize the concern that a child will face a difficult social atmosphere in which peer group disapproval takes its toll. One proponent of this model has written about a protocol to facilitate the resolution of Gender Dysphoria among biological males. It includes interventions such as fostering/facilitating (1) positive relationship with the child’s father or male caregiver or role model; (2) positive relationships with the child’s male peers; (3) gender-typical habits/skills; and (4) male peer group interactions. Interventions are really with the parents who then foster/facilitate these interests with the child.

There was an interesting National Public Radio report a few years ago on whether and how to intervene with gender dysphoric children. The NPR report cited The Portman Clinic’s treatment of 124 children since 1989 using a comparable approach, and it was reported that 80% of the children chose later as adults to maintain a gender identity consistent with their birth sex.

Those who are critical of this kind of intervention express concern about the prevention of gender variant expressions and/or homosexuality (as most desisters do later identify as gay, lesbian, or bisexual), and some wonder whether those who live consistent with their birth sex are natural desisters whose gender dysphoria would have resolved anyway.

Those who argue for watchful waiting anticipate that as a child’s gender identify unfolds, it will be clear whether the child will desist or persist, and that what occurs naturally, if you will, is likely to be the preferred outcome in these that any other resolution will likely go against the grain of what is unfolding. Cross-gender interests are permitted here, and the parents try to be as neutral as possible in response to the child’s expressed interests. In addition to providing a neutral environment with respect to cross-gender behavior and identity, watchful waiting as an approach emphasizes helping the family attend to their anxiety about the outcome and to facilitate a positive view of self for the child.

Concerns here tend to be around the practical issues involved in being truly neutral about gender identity. Also, there is a philosophical concern about whether what is being referred to as a natural unfolding is the best or most reliable guide to gender identity resolutions.

The third approaches supports and facilitates exploration and adoption of the preferred gender identity. I am distinguishing it from a fourth option in which puberty is actually delayed to provide more time for an older child to enter into adolescence and make decisions closer to age 15 or 16 about gender identity. In other words, parents may elect to facilitate cross-gender identification (rather than be neutral) (option three) but may not wish to delay puberty through the administration of hormone blockers (option four).

If we return to the NPR report we see research cited in support of puberty suppression as well. Researchers in the Netherlands have  been following children who underwent hormone-blocking treatment, and in their report on 100 patients, all had made the decision as adults to live as their preferred gender identity (rather than their birth sex). Criticisms of this approach range from the effects on bone-mass development to brain development to questions as to whether co-occurring mental health issues are resolved. Sterility is also a concern. Proponents of puberty suppression say that each of these concerns must also be weighed against risks associated with delaying intervention.

Of course, there are additional criticisms and concerns with each of these four options as well. I just wanted to map out the different paths that are under consideration. Many factors go into making a decision as a parent, and no one decision may be the best decision for every child or family. Decisions should be made in the context of a good assessment, accurate diagnosis, and with an experienced team.

Once a child enters later adolescence or adulthood, we are having a different discussion about ways to manage gender dysphoria. I will either do another post on that or encourage the interested reader to see that part of the forthcoming book, Understanding Gender Dysphoria.

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Note: This blog post is Part 4 of a series. If you found this interesting, you may want to read Part 1, Part 2, and Part 3.  Also of interest may be a recent talk I gave at Calvin College titled Understanding Gender Dysphoria. The book I mentioned can be pre-ordered through IVP or Amazon.

Understanding Gender Dysphoria – Part 3

Gender Dysphoria cover“I don’t think you chose to experience gender dysphoria,” I offered slowly, looking at Jeremy who had been looking away ever since he explained how long he had felt different from other boys he knew. He hadn’t held eye contact once since he began talking about the time his mother caught him dressing in his sister’s clothing one day after school. He wouldn’t look at me when he shared how his father confronted him that same night when he came home from work. After I spoke, he turned toward me to catch my eye, as if he wanted to confirm I wasn’t just saying this to make him feel better. You see, he had been told by Christian leaders just the opposite—that he had indeed chosen to feel like a girl; that his experience of gender dysphoria was an act of willful disobedience to be confronted by his parents if they hoped to help him, if they hoped to save him.

It is a remarkable claim to declare that an adolescent is choosing gender dysphoria to make life difficult for his parents or to essentially thumb his nose at God as Creator and at his own body as a part of the creation.

In this blog post I want to introduce the topic of etiology or causation. The question is: What causes someone to experience gender dysphoria? Recall that gender dysphoria refers to the incongruence between one’s biological/birth sex and one’s psychological and emotional experience of gender identity. One possible benefit to discussing causation is to improve the exchanges between Christian leaders and someone like Jeremy.

Let me first acknowledge limitations to research in this area. These limitations should help us take a posture of humility toward the topic of gender dysphoria, toward what we know and what we do not know.

When we discuss who is transgender, we quickly realize that while this is an umbrella term, there is not consensus as to who is transgender. Put differently, there is great heterogeneity among these different phenomena. A range of people  may identify as transgender. In a chapter he wrote on the topic, Richard Carroll recognizes “transsexuals, transvestites, she-males, queers, third sex, two-spirit, drag queens, drag kings, and cross-dressers.” Not all of these folks will experience gender dysphoria, and many would not feel comfortable including everyone else under the umbrella of “transgender.”

How this is related to research on causation? The heterogeneity represented under the transgender umbrella makes it difficult to conduct research on causation. We have to begin by identifying the key variables and then finding ways to operationalize and measure those variables. If we are trying to explain cross-dressing behavior, for example, we have to acknowledge that not everyone who cross-dresses experiences gender dysphoria. Not everyone who identifies as transgender either cross dresses or experiences gender dysphoria.

Most of the research on causation is limited to transsexuals. In some ways this can be helpful, as most transsexual persons presumably experience sufficient gender dysphoria such that they form a cross-gender identity and may pursue hormonal treatment and/or sex reassignment surgery. However, the experience of diagnosable gender dysphoria is rather rare, and finding a sufficient number of transsexual persons for research purposes can be problematic. Most of these studies are conducted with small samples, which is just one of many potential limitations to research in this area.

In any case, the most popular theory of causation today is called the brain-sex theory. The brain-sex theory holds that transsexuality is essentially biological in origin. It might be thought of as (in the words of Milton Diamond) an “intersex condition of the brain.” The theory is based on the understanding that sex differentiation of the genitalia and sex differentiation of the brain occurs at different stages of fetal development. The idea is that perhaps in rare instances the genitals develop in one direction while the brain develops in the other direction.

In support of this theory, the most widely-cited studies have been on neuroanatomical structures of the brain. Proponents believe that differences in size and volume of cells in specific regions of the brain suggest a biological basis for etiology. Other studies in support of the brain-sex theory have been conducted as well, and I discuss these in greater detail in the book that will be out in June.

There are other theories of causation that do not receive as much attention. They tend to be multifactorial models with more consideration given to psychosocial factors. Proponents of these models suggest there are–in addition to prenatal/biological considerations–differences in areas such as temperament, level of anxiety, sensory reactivity, same-gender parental identification and modeling, and early childhood trauma that may also be part of the picture.

I also want to acknowledge that research is not conducted in a vacuum. It is conducted in a sociocultural context. Today that context is one in which identity has emerged as particularly salient. It has figured prominently in what Cressida Heyes refers to as the “gay liberation movement,” which focused historically on equality for gay and lesbian persons: “Visible early lesbian and gay activists emphasized the immutable and essential natures of their sexual identities. For some, they were a distinctively different natural kind of person, with the same rights as heterosexuals (another natural kind) to find fulfillment in marriage, property ownership, and so on.” This kind of focus on identity can also be part of the motivation to conduct research with a focus on biological bases for gender dysphoria. That is, there would then be a more identity-focused discussion of transgender kinds of persons that can be distinguished from cisgender kinds of persons. My sense is that in the minds of many proponents of transgender interests, research on biology lends itself to the kind of argument in favor of an “essential nature” related to gender identity.

I think the most accurate answer to the question of causation is this: We don’t know what causes gender dysphoria. While the research in this area has been going on for many years now, there just is not that much data to point to for a final word on causation.

When I think of Jeremy, the person I was talking to who had been told by Christian leaders that he chose his experience of gender incongruence, I have to urge those who minister to people like him to resist the pressure to have the answer at that moment. It is okay to not know what causes a person’s experience of gender dysphoria. I say this to people all the time. I have found it much more helpful to take a posture of humility about causation and to focus on care. To do this, you could always ask the person, What would it mean for you to know what caused your experiences of gender dysphoria? This question may open up a more helpful discussion of meaning and purpose that may guide efforts to provide support as the person navigates questions of gender identity.

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Note: This blog post is Part 3 of a series. If you found this interesting, you may want to read Part 1 and Part 2. Also of interest may be a recent talk I gave at Calvin College titled Understanding Gender Dysphoria. The book I mentioned can be pre-ordered through IVP or Amazon.