[Note: In this piece, “female sex” and “male sex” are used to refer to the clusters “people who have ovaries, uteruses, vaginas, breasts, no beard, estrogen-dominant hormone systems, XX chromosomes, etc.” and “people who have testicles, prostates, penises, flat chests, beards, testosterone-dominant hormone systems, XY chromosomes, etc.” While I agree that these terms are cissexist, I am unaware of any equally clear terms.]

[Content warning: transphobic violence]

As we all know, I love answering questions, so I thought I would answer some questions asked by the Gospel Coalition about transgender people.

Do transgender theories undercut or contradict the idea that sexual orientation is unchangeable?

I don’t think so.

First, while there are many cases of people staying in relationships with their partner even after their partner came out as trans, there are also many cases of such relationships ending in divorce. Even many relationships that stay together become sexless, platonic, yet deeply committed friendships. Among cisgender people, mixed-orientation marriages exist and, even though it’s difficult, some are quite happy. If that doesn’t disprove the fixity of sexual orientation, then the existence of monosexual people who stay with their trans partners should not either.

Second, many heterosexual women– in my experience– are not literally solely attracted to people who identify as men, present as men, and have male primary and secondary sexual characteristics. It is quite common for heterosexual women to be attracted to people with testosterone-dominant hormone systems, regardless of identity, or to people who identify as men, regardless of body type, or people who present as men, regardless of self-identification or sex. If a woman is attracted to people with strong jawlines and penises, she may very well continue to be attracted to her trans female partner. But that doesn’t mean her orientation has changed. She is still orientationally attracted to people with strong jawlines and penises.

Third, many people are Kinsey 1s and Kinsey 5s– that is, they have incidental attraction to people of one gender, but very strong attraction to people of another gender. Kinsey 1s and Kinsey 5s often round themselves to straight or gay (respectively). But if a Kinsey 1 woman dates another woman (whether cisgender or transgender), this doesn’t mean her orientation has changed. Her orientation is as it has always been– “attracted to few women and a lot of men.” If she happens to date one of the few women she’s attracted to, that doesn’t change anything.

Fourth, love is weird. There are many, many women who are not attracted to or even vaguely repulsed by old, fat, and bald men in general, but who find the one specific old, fat, and bald man they love to be the sexiest man alive. Is it that strange to suggest that some people might be not attracted to men in general, but who continue to think the person they love, who came out as a trans man, is the sexiest person alive? That doesn’t mean that sexual orientations typically change in general– although I am now envisioning a trans-positive ex-gay program that revolves around getting gay men to fall in love with self-closeted trans women.

Fifth, yes, some people experience orientation change (although they usually don’t have much volitional control over whether they do– trying to change your orientation yourself is very hard and doesn’t really work). No doubt some people experience orientation change after their partner comes out as trans. That does not change the fundamentals of the pro-LGBT argument, which is that there is nothing wrong with being gay, whether or not you chose to be it.

2. If gender identity is fixed and unchangeable, why do many children who experience gender dysphoria lose these feelings after puberty?

It is very unclear to me how common desistance is. Estimates range from 66% to 88% of gender dysphoric children. However, some trans advocates argue that essentially no truly gender dysphoric children desist; high desistance rates are because, before the DSM-V, the diagnosis of gender identity disorder was given to, say, boys who identified as boys but who liked wearing dresses and playing with dolls, because of sexist ideas about what boys should do. Of course, there’s nothing surprising about a boy with a male gender identity continuing to have that identity as he grows up. I am not sure that given the current state of the evidence one can come up with any firm opinion on how many gender dysphoric children will desist.

But let us assume for the sake of argument that desistance is quite common. Even under the most extreme estimates– if 88% of gender dysphoric children desist– then gender dysphoric children are forty times more likely than the general population to be gender dysphoric adults. In this case, gender dysphoria in children and gender dysphoria in adults are best understood as distinct yet closely related conditions.

It is not surprising that puberty might cause a change in gender dysphoria. Hormone replacement therapy often causes relief of dysphoria even before the hormones have had any physical effect; this suggests that gender dysphoria is linked to sex hormones on some important level. Puberty, of course, is one of the largest changes in sex hormones that a person experiences; it seems quite plausible such a change would ease dysphoria in some people and cause it in others. Some anecdotes suggest that other hormonal changes can ease dysphoria: for instance, Catholic blogger Melinda Selmys finds that her dysphoria lightens when she is pregnant or breastfeeding.

However, this model does not suggest that gender dysphoria is not de facto permanent for post-puberty gender dysphoric people. Male-sexed people will not experience a change in sex hormones as large as that of puberty. Female-sexed people may experience pregnancy, breastfeeding and menopause. However, many female-sexed gender dysphoric people do not want to be pregnant or breastfeeding for the rest of their lives. Even if menopause may get rid of dysphoria for some female-sexed people, that still means a female-sexed gender dysphoric person will be gender dysphoric for half their life with only the faintest hope that menopause will ease their suffering. Therefore, this argument does not imply that transition treatment is a poor choice for most people.

The Gospel Coalition’s article includes a highly speculative comment by Alice Dreger that perhaps affirming a child in their transgender identity decreases the chance that they will desist. Of course, there is no evidence to suggest that this is the case; we can’t even figure out how common desistance is! The potential risk that affirming a child’s transgender identity will cause them to be a happy trans person instead of a happy cis person must be weighed against the certainty of the harm that gender dysphoria causes to gender dysphoric children. I think there should be further research into gender dysphoric children, and in the meantime the most sensible stance is affirming the child’s transgender identity while explicitly embracing the possibility that they may grow up to be a cisgender adult.

3. When a person feels a disjunction between one’s sex at birth and one’s gender identity, why is the only course of action to bring the body into closer conformity with the person’s psychological state, rather than vice versa?

No treatment has yet been developed to change a person’s gender identity. It is somewhat difficult to prescribe a treatment that doesn’t exist.

That said, some people do choose to manage their dysphoria without transition. Melinda Selmys, whom I mentioned above, is one. Angus Grieve-Smith handles his dysphoria through crossdressing. Some detransitioned women are still gender dysphoric, and handle it through exercise, meditation, creative work, and self-acceptance.

Of course, it’s quite common for people to make mistakes about what the best way to handle their own dysphoria is. Many transitioning transgender people spent years or decades trying to manage their dysphoria without transition, and discovered the experience was hellish; they tend to shudder reading about experiences like Melinda’s or Angus’s or 23XX’s, assuming that they are in as much pain as we were in their shoes. Gender dysphoric people who detransitioned often have equal regrets about their transitions and warn transitioning trans people that they’ll experience the same pain the detransitioners did.

There have been no randomized controlled trials of transition for relief of dysphoria. No, the Swedish study— cited in the article– is not a randomized controlled trial of transition. The gender dysphoric people in that study were compared to controls who were not and had never been gender dysphoric. Gender dysphoric people obviously do not have the option to become a person with no history of gender dysphoria.

Of course, there have also been no randomized controlled trials of alternatives to transition for relief of dysphoria.

In the absence of such studies, I think there is no responsible option except carefully and thoughtfully considering your choices, talking with trusted friends, trying out options which are easy to reverse if you don’t like them, being cautious about hard-to-reverse choices, and then making the decision that seems to you like it will be best.

At this point many people may suggest that gender dysphorics who are uncertain about whether to transition should talk to a therapist. While that would be nice, few therapists have any sort of expertise in transgender issues at all. In my personal experience as a transgender person, my therapists have never consistently passed such low bars as “knows what a nonbinary person is” and “understands the effects of HRT on the human body.” If I have to pay my therapist to spend fifty minutes being her Transgender Continuing Education class, I very much doubt they will be able to have any sort of useful opinion on the merits of crossdressing versus social transition. Therapists who do have expertise in transgender issues sometimes hold to unscientific and unjustified beliefs, such as the idea that if you didn’t like trucks as a four-year-old testosterone can’t possibly be the best choice for you as an adult. Some therapists push people to transition, whether or not it’s the right choice for them. Other therapists view any admission of doubt about transition as a sign that you are not a true transgender person, and will refuse you hormones or surgery.

But I think this question gets at some deeper issues which are highlighted by the article’s objection to people with bodily integrity identity disorder who want surgery to blind them or remove a limb, as well as their description of medicine as a field in which “the purpose of treatment is to restore bodily functions and facilities that are ordered towards certain ends.”

Unlike the author, I am a disability rights advocate and transhumanist. I do not believe the purpose of medicine is to restore bodily functions and facilities that are ordered to certain ends. I believe the purpose of medicine is to allow people to exercise their bodily autonomy. Of course, many people will choose to exercise their bodily autonomy to cure pneumonia, get prosthetic limbs, and get flu shots so they don’t spend a week puking. But if a Deaf person chooses to remain Deaf, an intersex person rejects normalizing surgery, or an autistic person chooses to continue to practice autistic ways of relating, I don’t think medicine has somehow failed; those are all individuals exercising their autonomy. I find nothing strange about a woman seeking birth control when she’s twenty and infertility treatment when she’s thirty; both allow her to choose how her reproductive system will work. I support breast implants and reductions, nose jobs and laser hair removal, as ways of letting people decide what they will look like. And I see nothing wrong with either a trans person seeking bottom surgery or a person with bodily identity integrity disorder seeking to remove a limb.

In addition, I am a utilitarian. As such, I tend to have qualms about treatments intended to change people’s terminal values; I worry this would naturally lead to a sort of wireheading, in which we change people’s terminal values to ones that are easy to fulfill. Of course, sometimes value change is necessary, as when a terminal value causes a great deal of distress to oneself or others. But I think it is something to be approached with care and caution, and I would feel uneasy if value change were the first line of treatment for gender dysphoria. The author no doubt disagrees with me here, as he believes in God and thus an objective grounding for human flourishing outside of human values.

4. Is the higher rate of suicide among transgender persons due primarily to the inner tensions of experiencing gender dysphoria as a disorder, or are these acts motivated primarily by societal rejection?

According to one of the largest surveys of transgender people ever conducted, experiences of discrimination are correlated with suicide attempts. Participants who experienced discrimination at school, at work, in housing, in health care, or by law enforcement were more likely to have attempted suicide. 69% of transgender people who experienced homelessness due to being transgender have attempted suicide. Those who were sexually assaulted at school due to being transgender are at particularly high risk: 73% of those assaulted in elementary school, 73% of those assaulted in middle school, 69% of those assaulted in high school, and 78% of those assaulted in college. 68% of those physically assaulted in high school, 68% of those physically assaulted in college, and 65% of those physically assaulted at work due to anti-transgender bias have attempted suicide. 65% of those who experienced domestic violence from a family member due to being trans have attempted suicide. 70% of those sexually assaulted by police officers have attempted suicide.

Perhaps we would be less likely to attempt suicide if people stopped assaulting us.

And, sure, maybe we’d still have an elevated rate of suicide, even in a world without transphobia. But I feel like not being assaulted anymore would be a good start.

Of course, “wondering out loud about the significance or meaning of gender” (to quote the article) is not assaulting people. But transphobic beliefs do provide the societal context that eventually results in anti-transgender discrimination and assault. Talking about how transition is harmful is part of what leads a family to decide that screaming at and rejecting their child is the only way to keep them from making a horrible mistake. Talking about how men are just naturally one way and it’s shameful for them to behave differently is part of what leads elementary schoolers to throw rocks at the little boy who wants to watch My Little Pony. Talking about how having sex with a trans woman is basically like having sex with a man, and having sex with a man is the most disgusting thing possible, is part of what leads cis men to resolve their confusion about being attracted to trans women by murdering them after sex.

And social support matters! Trans people who have strong relationships with their families have a below-average rate of suicide attempts (33%). So do transgender people who are neutral to comfortable with reporting assaults to police. Acceptance of transgender people– at least if you’re the family member of a trans person or a police officer– is a clear, practical step towards reducing the transgender suicide rate. Yes, it’s effortful to make sure you use the right pronouns, but the benefit to transgender people’s mental health is clear.

5. Why are the strongest critics of “gender binaries” the most likely to support gender stereotypes on display in transgender celebrities?

For transgender people, particularly transgender women, there’s often an unfair double bind. If a transgender woman goes about in jeans and a T-shirt with no makeup, she’s told that she’s not putting any effort into her transition. If a transgender woman goes about in a dress, heels, and a full face of makeup, she’s told that she’s conforming to gender stereotypes and real women don’t wear dresses all the time.

People have unfair and unrealistic standards for transgender celebrities. Caitlyn Jenner is a Republican reality TV show star. Neither group is particularly known for their deconstruction of patriarchy. When Kylie Jenner dresses like this, no one says shit:

When Ann Coulter dresses like this, no one says shit:

But when Caitlyn Jenner dresses like this:

Suddenly everyone is up in arms about how sexist she’s being. Somebody should go tell Ann Coulter that it’s very wrong to imply that you have to wear dresses to be a woman. She probably just has the long blonde hair because she’s internalized that women are all bimbos! And don’t get me started on Kylie Jenner. Clearly the only possible reason that she could be wearing that top is because she thinks that women are only women if they’re performing for the male gaze. And what’s with that makeup? Lots of women don’t wear makeup, Kylie! You don’t have to prove you’re a woman by drawing on your eyebrows!

Several of the points discussed in the explanation of this question are absurd. Of course some people– both cisgender and transgender– identify strongly with a particular gender, and that is not somehow anti-feminist of them. Of course it is wrong to assume that someone else is not really trans just because they don’t look trans enough to you.

But I want to talk about one point which the quoted feminist, Elinor Burkett, brings up more closely. She questions why Caitlyn Jenner, who presented as a man for most of her life, should be allowed to define womanhood. Presumably only cis women (and perhaps trans women who have presented as female for a long time? it’s unclear) should define womanhood. I am not sure how Burkett plans to do this: opinion poll? That would be unfortunate for her; the vast majority of women in the world have a definition of womanhood which– while not necessarily trans-inclusive– is far more regressive and gender essentialist than Caitlyn Jenner’s. Most women worldwide do think that female brains are inherently different from male brains. The solution, I think, is not to fuss about who is “allowed” to define womanhood, but instead to attempt to come up with a useful definition for the particular purposes we are discussing it.

Burkett argues that “being a woman means having accrued certain experiences, endured certain indignities and relished certain courtesies in a culture that reacted to you as one.” She explicitly rejects a definition of womanhood grounded in breasts and vaginas (and, presumably, in uteruses and XX chromosomes) as reducing women to their bodies. However, her definition opens itself up to two criticisms.

First, exactly how many gendered experiences does Burkett have in common with a subsistence farmer in India? Did Burkett’s father have to pay her a dowry for her to get married? Did she have a sister who was aborted because she was a girl? Was she fed less than her brothers? Did her parents not send her to school because they wanted to protect her virginity? If the answer is “actually, Burkett doesn’t share many gendered experiences other than the purely biological with female subsistence farmers in India”– which I think is probably true– then by her own argument either she or female Indians subsistence farmers are not really women. This seems somewhat silly.

Even in our own culture, experience of womanhood is very diverse, as an intersectional perspective shows. A developmentally disabled woman may find that she is desexualized and degendered, as part of being treated as a child due to her disability; does her desexualization and degendering mean that she is, in reality, not a woman? A butch lesbian may never have experienced the courtesies associated with being read by straight men as an appropriate object of desire; does that mean she is not a woman?

Second, many transgender women do, in fact, accrue the experiences, endure the indignities, and relish the courtesies of being a woman in a culture that reacts to them as one. Any trans woman who passes does, as do non-passing trans women in trans-positive environments in which they are considered to be women. Even non-passing trans women in trans-negative environments are not read as men and given the privileges of men; they are read as weirdo freaks. Why is one’s past experience of gender– often an experience years or decades in the past– prioritized over one’s current lived experience?

Similarly, gender dysphoria impacts many trans people’s experience of gendered socialization. Society says “you are a woman, so you are like this and you should do these things.” Many cisgender girls feel dissonance when they don’t want to do what they are supposed to do or when they aren’t like what society says they are like. But many transgender men feel dissonance about the statement “you are a woman”– even long before they articulate their gender identity to themselves! They want to do the things men do, have the traits men have, cultivate the virtues men cultivate. Many young transgender men feel a sense of pride in how many sexual partners they have, or in their ability to lift heavy things, or other accouterments of masculinity which are stigmatized for women. Trans bros exist! Of course, that isn’t the same as growing up a cisgender man. But it is an experience which is in some ways more similar to growing up a cisgender man than growing up a cisgender woman.

6. Why must one’s self-declared gender identity be accepted without question, while other forms of self-identification can be exist?

The reason that people dismiss ‘transracial’ identity is that every self-identified transracial person has turned out, upon closer inspection, to be either a troll attempting to discredit transgender people or Rachel Dolezal.

Rachel Dolezal herself has a history of lies and fraud: for instance, she faked hate crimes against herself and falsely claimed to have lived in South Africa. It seems to me much more plausible that she, a person who lies about many other things for self-advancement, pretended to be black for career purposes and came up with a transracial identity after she was found out. I don’t think it’s too much to ask that a prospective identity have one representative who is not a con artist.

The article then talks about otherkin and Stefonknee, a trans woman who engages in ageplay in which she is a six-year-old girl, both of whom actually seem to have non-fraudulent reasons for their identities. (Although Stefonknee appears to use ageplay as a coping mechanism for mental illness, rather than actually believing she has a six year old’s soul.)

It is hard for me to get into a state of mind where I’m bothered about opposing otherkin or Stefonknee in the first place. As long as they’re happy, who cares? It neither picks my pocket nor breaks my bone. I would certainly never discriminate against an otherkin or Stefonknee and I am happy to do any little courtesies that would make their lives more comfortable, such as referring to an otherkin as a “being” instead of a “human”. If body modifications help otherkin or Stefonknee feel more comfortable in their bodies, I think they should get them. While I don’t have a great knowledge of health-care economics, I see no problem with insurance or government-funded health care covering such body modifications if it is a cost-effective way to achieve more quality-adjusted life years. (And not if it is not, of course.) Life is too short to spend my time sticking my nose in other people’s business.

Psychology is a really confusing field. I don’t think we actually understand it well enough yet to go “in fact, it is completely physically impossible for people to develop dysphoria about being animals.” Maybe they do! And until the day when we understand psychology that well, I’m not going to be invested in “opposing” any particular identity.

7. Without a settled definition in our legal system for transgender, how can we avoid all sorts of problems, including bathroom access?

If someone is harassing others or invading their privacy in the bathroom, then of course they should be removed. But I think that allowing people to use the bathroom of their choice is obviously the correct perspective, even if you only care about cisgender people. Cisgender women have already been mistaken for transgender and harassed. Many people are mistaken about the wide variety of bodies that cisgender women can have. Do you really want a Sikh woman who has a beard due to polycystic ovary syndrome to be excluded from the bathroom because dumbasses don’t know that some cis women can grow beards?

But to address the main point: trans activists are pushing a very clear and concrete definition for transness. It’s “if a person says they’re trans, then they’re trans.” It is hard to be mistaken about this definition!

The author seems confused about how something can be both a medical condition and something a person has if they say they do. But this is actually very common for mental health disorders! For instance, look at one of the standard screening tools for depression. Here are some of the answers that will get you four points for being depressed:

“I am so sad and unhappy that I can’t stand it.”

“I feel the future is hopeless and that things cannot improve.”

“I am dissatisfied and bored with everything.”

“I hate myself.”

Basically, about half the questions on the Beck Depression Inventory are different ways of phrasing “are you depressed?” and then if you say “yes” the BDI will reveal that you are depressed. Truly a triumph of medical science here.

And it gets worse! In my experience, primary care physicians usually don’t bother with trying to come up with different ways of asking if you’re depressed, they just ask you outright and then write an SSRI prescription.

Of course, depression and transness are treated differently from a medical perspective. Psychiatrists will often say things like “have you considered that the reason you hate yourself and want to die is that you’re depressed?” when the person has not thought of this at all, and they will also say things like “even though you say you’re depressed, based on your history of running off to Reno to take cocaine and gamble away your life savings I think you actually have bipolar disorder”. Conversely, transness is pretty much always self-diagnosed, and it is relatively rare for trans-positive doctors to say that you actually have a different thing unless you are literally a psychotic person with delusions of being male.

The reason that transness and depression work differently is mostly that trans people don’t trust doctors, because doctors went through a long period of trying to figure out who was Really Really Trans based on Science. “Sorry, you wore pants, women don’t wear pants. Denied.” “You admitted being attracted to women and as we all know lesbians don’t exist. Denied.” “You played with trucks as a kid and little girls don’t play with trucks. Denied.” “You’re not hot enough, and as we all know women are all hot. Denied.” “Please tell me all about your sex life. It is very important that we make sure you have a properly feminine sex life after you’ve transitioned. Tell me, what do you think about when you masturbate?”

Probably depressed people would also be suspicious of this whole psychiatry thing if for a couple decades you couldn’t be diagnosed with depression unless you also wore solely black, wrote reams of terrible free-verse poetry, and listened to The Smiths, and also if depression diagnosis regularly involved people asking about your masturbation habits for no reason.

But the main point stands. There is no blood test for the vast majority of mental health conditions. They are diagnosed based on self-report. Either you think all mental health conditions are invalid and unreal, or you accept that gender dysphorics are, in fact, accurately reporting our gender dysphoria. Those are the options.