Understanding Transgender Identities

If you are interested in the topic of transgender experiences, you might want to pre-order a forthcoming book. The resource is titled, Understanding Transgender Identities: Four Views. Here is the description from the publisher: Cover Understanding TG Identities

This book offers a full-scale dialogue on transgender identities from across the Christian theological spectrum. It brings together contributors with expertise and platforms in the study of transgender identities to articulate and defend differing perspectives on this contested topic. After an introductory chapter surveys key historical moments and current issues, four views are presented by Owen Strachan, Mark A. Yarhouse and Julia Sadusky, Megan K. DeFranza, and Justin Sabia-Tanis. The authors respond to one another’s views in a respectful manner, modeling thoughtful dialogue around a controversial theological issue. The book helps readers understand the spectrum of views among Christians and enables Christian communities to establish a context where conversations can safely be held.

The book is scheduled for release November 5. You can pre-order today.

Minister to What Lies Beneath the Surface

Iceberg-1024x767Icebergs are formed from the ice that breaks off of a larger body of ice, typically a glacier. The analogy of the iceberg is a familiar one. The idea is that there is so much under the surface that goes unnoticed. Our focus tends to be on what we see, on what is above the surface. But what is above the surface doesn’t tell the whole story. What is particularly noteworthy is what lies beneath.

I recently used this analogy to talk with youth ministers about how Christians often respond to identity labels and gender atypical expression. Identity labels or sexual identity refers to terms like gay, lesbian, bisexual, bi-curious, queer, and so on. Gender atypical expression might be in hairstyle or clothing or mannerisms associated with the other gender.

Many people in ministry react to the label or expression rather than to what needs or questions may reside under the surface. What might those needs and questions be?

In a recent workshop with youth ministers, Julie Rodgers and I discussed what we see as the most frequently asked question teens wonder about. That question is: “Do you want me here?” There are many ways in which those in ministry and fellow youth may essentially answer that question with a “No,” primarily because they react to identity labels and gender atypical expression rather than to the question or the needs. The answer “Yes” may raise more questions than answers for those in ministry, and we discussed those at length with those in attendance. I would say by far most of the people we worked with wanted to answer “Yes” to that foundational question.

If one of the most frequently asked questions that is under the surface is, “Do you want me here?,” what are some of the common needs and other questions that may arise? I think the needs include a need for intimacy – to be known and to know others. A need for community. A place to land and belong. A place to explore questions about faith and God. “Does God love me?” and the more emotionally loaded question, “Does God like me?” Of course, these are questions many youth are asking. The questions become more complicated for those navigating sexual and gender identity questions, particularly if they have reason to believe they will be rejected by Christians.

Those providing ministry will not have an opportunity to minister to these questions and needs that are under the surface if their primary point of reaction is to what is going on above the surface. That doesn’t mean that identity labels and gender expression are unimportant. But a hypervigilance these things can create a set of conditions that may not reflect your heart and vision for ministry.

Even well-intended, seasoned ministry folks face the additional challenge of creating a ministry climate that reflects their heart and vision to minister to what is beneath the surface.

A youth minister once shared with me how he was trying to reach LGBT+ youth in his community. He was trying to be missional in his approach. A missional approach looks  like this: Belong – Believe – Become. This is in contrast to models that focus on Behave – Believe – Belong, in which behavioral compliance is communicated on the front end and is ultimately a condition for belonging. (This is not original with me; I discuss it and the source in Understanding Gender Dysphoria.)

So this youth minister was working on a missional approach in which all young people would be welcomed (belong), and in which all would have an opportunity to learn about Christ (believe). Only later would ministry focus on discipleship with a focus on Christlikeness (become). He then has to think deeply and well about what it means to become more Christlike and navigate sexual identity and gender identity questions.

One evening as they were getting going in youth group, a visitor to the group came dressed in androgynous attire and it was unclear whether the person was male or female or transgender. The youth minister struck up a conversation and was making an initial connection. But this is a large youth group, and he was pulled away to attend to an admin issue that arose for programming that night. He was gone for literally 3-4 minutes. In that time, a group of guys from the youth group went up to the visiting teen and made derogatory comments about the person’s attire and joked in a way that set the message (apparently), “You aren’t really in the right place.” The teen was gone when the youth minister returned.

There are two recommendations here. First, my encouragement to those in ministry is to think of the analogy of the iceberg. To react not to what is presented above the surface but to take time to explore what may be beneath the surface. A second recommendation is to develop a ministry climate that reflects your vision. This includes training adult volunteers and key students in what you are trying to do and how, so that they understand their role in key moments of hospitality. This is especially important insofar as you may wish to take a more missional approach to people who may be curious about faith and have normal, fundamental needs regarding intimacy and community.

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.


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.

Legislation Regarding Gender Dysphoria

Boy Girl signpostFinished up an interview today for a Christian magazine that is working on a story on gender dysphoria. The story was prompted by recent legislation that is being voted on in California. The legislation would “ensure students could participate in school activities and use facilities like bathrooms based on their gender identity, not their physical sex,” according to the LA Times. Here is the key text from the legislation:

Existing law prohibits public schools from discriminating on the basis of specified characteristics, including gender, gender identity, and gender expression, and specifies various statements of legislative intent and the policies of the state in that regard. Existing law requires that participation in a particular physical education activity or sport, if required of pupils of one sex, be available to pupils of each sex.

This bill would require that a pupil be permitted to participate in sex-segregated school programs, activities, including athletic teams and competitions, and use facilities consistent with his or her gender identity, irrespective of the gender listed on the pupil’s records.

Another story coming out of Oregon raises similar questions about access to facilities. In that story, six bathrooms were converted to unisex restrooms. This resolution seemed to meet the concerns of multiple stakeholders, as many families might not be comfortable with where the CA legislation is heading, while at the same time there is a desire among many families to respond compassionately to the needs of the person who experiences gender dysphoria. In any case, the conversion of six bathrooms to unisex restrooms was viewed by the transgender teen featured in the article.

In the interview I participated in, I didn’t really get into a discussion about legislation. I think that is an area where we need wisdom in thinking through how best to respond so that Christians are not reducing the complexities to just how to defend one’s beliefs/values in a culture war. While there is a need to defend religious liberties, there is also a need to respond to a range of issues that arise in these discussions. Unfortunately, when these complex issues are handled through legislation, my experience is that frequently no one comes out ahead. So we need to be wise about political issues while at the same time consider the experience of people who are gender dysphoric and the challenges they may face in a range of situations.

Back to the interview: I discussed what we know and do not know about gender dysphoria in terms of prevalence, etiology, and treatment, including controversial treatment options and current trends. We also discussed how Christians ought to respond from more of a clinical and pastoral standpoint, and I discussed humility and empathy for the family that is navigating gender identity concerns. We certainly do not want to drive them away from the church or contribute to shame (which is essentially self-condemnation that isolates itself from others for fear that if their experiences were know by others, they too would reject/condemn them).

In my role as a psychologist who provides consultation to individuals, couples and families navigating these difficult issues, I make sure that they are familiar with the current state of the research, including what we know and do not know in the areas mentioned above (e.g., etiology). I also want them to know what options are available to them at the present time and in the years to come. I also talked about working with the gender dysphoric person and his or her local church in terms of providing education and encouraging a supportive and sustained presence in the life of that person (and his or her family), as well as providing mature spiritual guidance.

MtF Transgender Persons in Corrections

Here is part 1/7 of a documentary titled “Cruel and Unusual” on male to female transgender (MtF) persons in corrections:

The rest of the documentary is available via YouTube.

It is an interesting documentary that opens with the argument that the mistreatment of transgender individuals amounts to “cruel and unusual punishment” – hence the title of the documentary.

I am reviewing it as part of a consultation I’ve been doing for a couple of months now dealing with sexual minorities in corrections. You can see from watching the documentary that significant challenges arise in the juvenile justice system (which are not covered here) and in prisons in terms of responding to those who experience gender dysphoria.

The responses to these challenges can become polarizing, with one side charging the other with making demands for accommodations that smack of “political correctness” to them; the other side can run the risk of marginalizing the very staff that they are meant to train and educate.

In my work so far, I have found it helpful to note that those who are incarcerated are serving their sentence by virtue of being in corrections. They are not to be further punished through violence, sexual assault, or other forms of mistreatment. These forms of mistreatment – particularly sexual assault – are of significant concern especially to sexual minorities (those who experience their sexual identity or gender identity in ways that are different from those in the majority).

This has been an thought-provoking topic for me as a Christian who studies sexual identity and gender identity issues. If you are particularly interested in this topic, you might read this post in which I discuss T.J. Parsell’s experience as he shared in his book Fish.

Gender Identity Issues

Here is an interesting video we are viewing in preparation for a training on Gender Identity issues at the Institute for the Study of Sexual Identity:

If you are curious about how we approach training, let me begin by saying we follow many of the leading mainstream LGBT researchers and theorists; they are the one’s doing the majority (by far) of the research. There are few Christians doing serious scholarship in this area, and to limit our understanding of gender identity, for instance, to just what is produced by Christian psychologists (or Christians from other disciplines), would put us at a severe disadvantage.

Some of the strengths of this video include exposing the viewer to the ways in which the word “transgender” functions as an umbrella term. We may say this all the time, but it can be helpful to “meet” various people who prefer different ways of describing themselves and their experiences, such as transman or female-to-male transsexual. There is also some interesting perspective offered on key terms, such as biological sex, gender role, gender identity, and sexual orientation. Just the discussion of the common ways people think of differences and the ways in which the folks in the video think of differences is informative. There are also some helpful suggestions on how to approach a person – how to talk with them in a way that would be respectful given how they experience themselves.

It would have been helpful to have additional information on developmental perspectives on gender identity, as well as information on some of the issues that lead people to seek counseling/therapy services. But that was not the purpose of the video; the video was meant to be introductory and essentially a primer.

You can imagine that there are many issues that arise for those interested in integration of a Christian worldview with the study of gender identity. I won’t be able to do them justice here, but there are important questions about the relationship between biological sex and gender identity, the nature of the Fall, and how best to respond to such concerns from either a mental health or pastoral care perspective.

Transgender Christians’ Experiences

This Thursday I’ll be co-presenting an interesting study I conducted with Trista Carr, a student in the Doctoral Program in Clinical Psychology at Regent. The study is interesting to me in part because it is the first one we’ve undertaken that has addressed the relationship between gender identity and religious identity. Specifically, it is a study of 32 self-identified Christians who also self-identified as biologically male but transgender. They provided information on their experiences with local churches, their relationship with God, their spouses, employers, and so on. They also shared ways in which religion was a coping resource. Some even shared how their struggle with gender identity concerns led to a strengthening of their personal faith as Christians.

Here is the abstract from the paper we’ll be presenting:

Though the experiences of transgender persons have been explored to some extent, very few scholars have delved into the relationship between gender identity as a trangender person and religious identity as a Christian. Therefore, the qualitative data described herein reflects the narratives of 32 transgender individuals who are biological males and identify as Christians. The study sought to bring some understanding of the events and processes that occur for this specific population. Although some participants indicated that their gender identity conflict led to a strengthening of their personal faith, others reported a past struggle – often with specific persons or church leadership – and some indicated that they moved away from organized religion in light of their conflict. Many participants in this study still identified religious coping activities tied to their faith tradition as sources of support during present difficulties. Participants also shared experiences with conflicts in their marriages and places of employment.

The study came about through a number of developments over the past several years. Some of those developments included providing consultations to families who were worried that their child might be gay. The children were often presenting with symptoms of Gender Identity Disorder, and some met criteria, while others had symptoms but were sub-threshold for the diagnosis. I’ve also worked with older adolescents and adults who identified as transgender and Christian and were asking for assistance with possible ways to manage their dysphoria and/or conflict with their religious beliefs and values. If you know someone who is transgender or if you’ve worked with this population, you may have a sense for how challenging it can be to fully understand the issues that are involved.

A few years ago I was also introduced by someone who identified as transgender and Christian to an online group of people with similar experiences. This led to the idea of possibly furthering my own understanding of their experiences (and the experiences of adults I’d worked with) by conducting an initial study of some of what they had been dealing with. I brought this idea to the Institute for the Study of Sexual Identity (ISSI), the research institute I work with at Regent, and Trista expressed interest in working on it, as did some of our other team members. So we got to work on developing a questionnaire, and we ran it by various members of the community for help with wording, etc. We announced the study through various avenues, and people were able to access it online and provide us with some of their experience with gender and religious identity issues. So the study is a first step, and I hope we are able to follow it up with additional studies that delve into other related areas, but it is a start.

The paper we’ll be presenting is titled, “Transgender Christians’ Experiences: A Qualitative Study.” It will be presented at the Virginia Psychological Association’s (VPA’s) spring convention this Thursday, April 22, from 4-5pm at the Norfolk Waterside Marriott.