Dr. Beverly Yahnke — Caring for the Transgender Child

Transcript (edited for readability).

I'd like to introduce our next speaker. Hello. Hello. And, to be consistent, I went and asked my professor last night — having just totally grilled Brian German yesterday, I thought, what does it say about me, I'd been warned away from it, don't look at it — the other, uh, pact, and he said it was kind of fun. So apparently I'm adequate and reasonable for audiences, so you're at no risk. That's the good news.

This morning I simply need to begin by saying: last evening, for those of you who were with us, was astonishing. It is likely to be something I remember for the rest of my life, or at least through the weekend. Oh my heavens, it was exquisite. Thank you again to all of you who made such a special, wonderful evening. I am grateful to each and every one of you.

Let's transition, because I know how to have a good time: depression, dysfunction, despair. Oh my — we're going to talk about transgender children today. It's kind of an opportunity to look at politics, religion, and sex wrapped up into one hour of fascinating conversation.

I became aware of how important this topic is. I'm privileged to get phone calls from pastors who are stuck in a bit of a mess, one way or another. One pastor called me and said, "It's confirmation weekend." I said, "That's wonderful." He said, "Well, it's supposed to be wonderful — let me tell you more about that." He said he'd gotten a call from a father of one of his confirmands, and the father said to him, "Pastor, I've got a problem." The pastor said, "What is that?" And the father said, "Well, I'm really giving kind of an announcement, a heads-up for you, so you won't be caught by surprise. On confirmation Sunday — you know, my son's being confirmed" — and the pastor said, "Yes, we're so proud of him, he's a fine young man" — and the father said, "Well, our son told us that on confirmation Sunday he would like to be confirmed not as Carl, but as Carol. And, as his parents, we want to honor his judgment, we don't want to contradict him in this search for his identity, and so he will be wearing a dress. We hope you can smooth things over."

They decided that the only possible way to address this without moving into a division of the congregation, creating an event which trumps confirmation in all the wrong ways, was this: the pastor said, "What would happen if I simply said, all of the children in this parish are confirmed using their baptismal names, and they may have acquired nicknames of one sort or another, and that's all well and good, but in this holy place, before God, on this special Sunday, we will be confirming children with their baptismal names. And as for what it is that Carl is wearing, I'll ask you to honor the service with decorum — the children will be wearing white robes, and my question for you is, would you be willing to simply have him wear the white robe and be dressed as he always has been for this weekend?" And the father ultimately did agree.

And it occurred to me: this man is in a parish in the absolute middle of nowhere, USA, and he's got children in his congregation who are transgender kids. And I thought, we'd better look at that a bit more.

So our goal for this conversation is to really be confident that we're informed about the genuine realities that exist out there, so that we can offer some passionate and well-informed and godly responses to transgenderism — all important — and to explore what it means to be compassionate in difficult circumstances, and what it means to gather, care, teach, feed, love, and speak the truth in love.

We'll start with the unassailable truth: we are baptized Christians, after all, and I would suspect most of you spent some lovely time with Luther's Small Catechism, where you read, "I believe that God has made me and all creatures" — remember memorizing that? We had to recite it, right? "I believe that he has given me my body and soul, eyes, ears, and all my limbs, my reason, and all my senses, and still preserves them." I read the fine print again, and it doesn't say, "Feel free to exchange any of these as you might choose."

I want to be clear at the outset: I don't pretend to have all the answers, and I don't know anyone who does. Happily, I'm acquainted with all the questions, and I can share some of those with you as we speak this morning. So I'm going to invite you to think with me about the topic, and what we need to do is move a bit away from responding with our reflexes to the topic, and genuinely think about the facts. People have been asking — "I've heard about hormones, I've heard about chromosomes, and I just don't know the story, I don't know the facts." I'd like you to feel confident about what's really going on, so you can speak to other people with confidence, and that's where we're headed.

Kids are confused. Parents are feeling overwhelmed, frightened, confused, angry, in turmoil, guilty. Teachers are begging for resources, in the context of our Christian day schools, and clinicians — my heavens — are afraid to help children for fear of being sued. You heard Ryan Anderson yesterday talk about malpractice claims that are mounting. We'll talk a bit more about that.

Slide. Only about 64% of Americans still call themselves Christian — that's from a CNN poll done this year. Fifty years ago that number was 90%. Things have changed, which suggests there are divisions, as we heard this morning in the homily, and the divisions are going to continue to increase in number, in ways that aren't particularly healthy.

Slide. I'm confident that most of you have discovered the Norman Rockwell bubble has burst — the time when we embraced a wholesome, traditional, American Christian worldview. Instead, the forecast is that Christians can expect to face increasing persecution, and I suspect, and we're right to suspect, that the culture is going to continue to grow in its capacity to punish those of us who dissent from the majority view — agree with the culture, or risk being canceled. The culture is wildly indifferent to God, wildly indifferent, certainly, to his vision for Christian sexuality. Ultimately we need to take a look at what the research says, what the literature says, how our kids are doing, and how transgender children can be helped or harmed. And finally, I'll point to some merciful and compassionate responses.

Slide. Our culture has largely rejected the truth of God's will and his word regarding Christian sexuality, and we live in a world where moral and sexual atrocities are multiplying faster than bunnies in a box, and Christian morality is regarded by so many people as so last-century — such an embarrassment, or so they imagine. Chief sins these days in the public square include things like homophobia, transphobia, advocating for the preborn — that's a terrible sin in our culture. We've lost our way in all the worst ways. And the sexual revolution is now at the cutting edge, and it has certainly caught the eyes and ears of the public, with constant media attention. Many of us may have assumed that transgender issues will never touch our lives, or the lives of the children at our church, or anyone we know. An awful lot of people have come to the opinion, "As long as I just keep out of this, let a few people make whatever mistakes they need to, I'm just going to keep out of the thick of it, and I'm not going to put myself at risk by concerning myself." Some of us have almost become numb to this war, this revolution, overexposed to the world's riot of sexual freedom these days.

Slide, please. This is a name I'd like you to be familiar with — I'm going to refer to her a number of times during our conversation. Dr. Michelle Cretella is the executive director of the American College of Pediatricians, which means she's one bright cookie, and she's also extremely gifted clinically, and knows the literature inside and out about these matters. What she wrote took me completely by surprise: she says America is engaged in large-scale child abuse. And she goes on to name the accomplices, for everyone to be aware of them: she names the field of pediatrics, the field of psychiatry, our education system, mass media, social media. Each of them is a co-conspirator against children, and combined they're abusing them, and I think she's right. I think the overwhelming response to transgender kids is becoming a community-shared delusion — which is why I loved the hymn this morning, as we were singing, I was just captured by it, where we had the clear desire — some dark delusion haunts and blinds people, and it is to Christ, our only light and life, that we need to turn with confidence. So there are community-shared delusions which aren't particularly healthy for any of us.

Slide. What's the size of the phenomenon? It depends what data you look at — the data range in some unexpected ways, higher to lower. This seems to be pretty commonly cited: among thirteen-to-seventeen-year-olds, 0.73% of that population — according to Pew Research, 2022 — are regarded as transgender. Among college students, 8% of individuals are regarded as transgender. So you can see there's this explosion that appears to be happening.

For purposes of comparison: 14% of school-aged kids are binge drinking. Let me ask you this — when's the last time you heard any ad, any public service message, or saw any mailing about Mothers Against Drunk Driving? I haven't heard anything in years. So apparently that's no longer a problem, or not — what's happened is the media has chosen to take the focus of the entire nation away from that, which is apparently not important enough, and focus it on the far more sizzling, sexy transgender-children issue. And that's a pity.

Perhaps we get a better perspective on some of the differences that exist when we look a bit at the time lapse involved with transgender children. One pediatrician with fifty years of experience — pretty bright — surveyed twenty-eight of his pediatrician colleagues, and together they had over 931 years of experience treating children. Among them, they could recall only twelve cases of transgenderism. Ten of those cases had serious psychological issues; in two cases there had been serious sexual abuse. So in fifty years, dear people, we've gone from almost nothing to a spike right into the stratosphere. And we, as the United States, come to the table a little later than other countries — they're ahead of us in moving through this dreadful wave. The Dutch, for example, have been using puberty-suppressing hormones for twenty-five years, with some regularity.

Our culture's most recent descent into this kind of moral rot has been chronicled in all kinds of places, but at the heart of it, as you might reasonably suspect, is the impulse and pulse of wokeism that's been tearing through our cultural memory, shredding all kinds of spiritual truths, and certainly doesn't appreciate respectable reasoning from anybody. Our once-shared moral conventions, our familiar, comforting, biblical promises and narratives, are just about silenced in the public square these days, and that is tragic — and that's why courageous conversations matter. We need to go out into the public square, by the grace of God, and share what he has allowed us to come to know and to believe.

The first known subject of sexual reassignment in the United States goes all the way back to 1930, and at that time there was not a great deal of fanfare about the subject whatsoever — there were no celebrity interviews, no magazine covers.

Slide. But then we became spectators to the media blitz, and things really began to sizzle and pop. In 2011, Chastity Bono became a man and was photographed, and the photo spread wildly, of a man who was chest-feeding his baby — and I still don't know what that means.

Slide. Or in 2015 we had Bruce Jenner, who believed he was a woman, and won the ESPN Arthur Ashe Courage Award. Media has amplified the message — 11.9% of all the characters on television this year represent characters who have assumed an LGBT identity for purposes of the series.

Slide. And in the background you have the crescendo of the sexual revolution, exploding along all kinds of pathways. National Geographic was traditionally seen as a pretty classic, pretty sane, pretty well-written periodical, and then we see their magazine cover, which is unexpected — look at the use of language: "Revolution," incendiary, inviting people to have an emotional response instead of a logical, well-reasoned one, which is sad. And this was at a time when the phenomenon was just beginning to emerge on the public radar.

Slide. So why a Christian response? Well, the biblical concept of God's gift to us, intended for the joy of marriage and the procreation of children, has been ridiculed. Very often, as we talk to people who don't share a biblical worldview, we may hear phrases like, "Your God, your problem — not my God, not my problem, conversation over."

Slide. In fact, one of the slogans I've seen emerging in some Christian groups is "the way, the truth, and the life" as a Christian perspective, competing with the LGBT perspective — which some have called "letting go of biblical truth." Which is fascinating.

We do know that we are fearfully and wonderfully made. Slide. We know, for example, that things start with chromosomes. But before that, we know there's been increasing pressure to separate gender from sex. How did that begin? Well, let's separate sex from marriage, as you heard Ryan Anderson speaking of yesterday. Separate sex from marriage, separate marriage from conception, separate birth from conception, from a mommy and a daddy, and sever birth from a forever home with a mommy and a daddy. And that's serious trouble.

So, as long as we're talking about chromosomes, let's take a look — let's get our facts straight, because the language didn't used to be so difficult. And yet, I would guess a good number of you here this morning recall seeing a video of the confirmation hearing for the Supreme Court of Judge Ketanji Brown Jackson, a nominee for the Supreme Court. In the hearing she was asked this question: "Judge, what is a woman?" There were six seconds of silence, the cameras focused in, and her response was, "I don't know — I'm not a biologist." Really? So we recognize that this concept of the progressive agenda has absolutely saturated and penetrated to all levels, where now even people on the Supreme Court don't know what a woman is. But we want to know.

The word "female" — remember, we mentioned Michelle Cretella, the president of the American College of Pediatricians — she said sex is not assigned at birth. I thought, uh-oh. She says it's determined at conception, and she's right, absolutely right, and she makes the observation that it is in the chromosomes, at the moment of conception, that biological sex is imprinted on our DNA — it's in every single cell in our bodies. She goes on to say human sexuality is binary, and there are at least 6,500 genetic differences between men and women that hormone treatments and injections will never change.

So what's gender? The American Psychological Association says gender includes the attitudes, feelings, and behaviors that a given culture associates with a person's biological sex. Girls love crafts, and baking, and cooking, and dressing up as fairy princesses, and boys love blowing things up, stomping in mud, chasing dogs, kissing reptiles, and dressing as superheroes, or something like that. XX — you're a girl and you become a woman. XY — you're a boy and you become a man. So what if you have a gender identity that doesn't match your biological sex? Then what? What if I look like a girl on the outside, but on the inside I really feel like a boy — what is that?

Slide. It's gender dysphoria. What is that? When a person experiences a mismatch between their biological sex and their gender identity.

Slide. So what does that actually mean? We turn to the DSM-5 — the nine-hundred-page doorstop that psychologists and psychiatrists use to understand mental health diagnoses; all the science and symptoms of every mental illness are faithfully recorded there. As we look back a little through recent history: if you disagree, on the inside, with what you look like on the outside — in 1980 we called it transsexualism. In 1994 we called it gender identity disorder. In 2013 the word "disorder" was seen as a little too pejorative and critical, so it was changed to "gender dysphoria," which is descriptive but doesn't make a judgment. I was shocked, actually, about twenty-five years ago, when I discovered how the categories for the DSM-5 were actually created. One of the men who served on the committee said, "Well, actually, there's a small group of us, and we sit and talk about what makes sense to us, and we vote on diagnoses." You won't find clinical research behind it — we're "reasonably well-informed," "all in favor of thinking this is real, raise your hands" — and that's formally recorded in the DSM-5 and used by every professional in the field.

Slide. Current criteria for gender dysphoria in children — not an insignificant problem: incompatibility between sex assigned at birth and identifying gender, lasting at least six months. But our definitions are in place — sex is binary, it is assigned by our Lord at conception, and it is unchanging. "So God created man in his own image, in the image of God created he him." And yet, a while ago, Facebook had forty-seven possible gender identities for one to check off.

I'm beginning to regard gender dysphoria as an epidemic, largely because incidence continues to grow by leaps and bounds — it appears to be contagious, we'll talk about that in a moment — and it has consequences that can genuinely cause harm and even death. That sounds like an epidemic to me.

Until about ten years ago, gender dysphoria only occurred in little children. Then, ten years ago, suddenly adolescent girls started reporting that they were gender dysphoric — that hadn't happened before, no one quite knew what to do with it, it was virtually unheard of. Now, adolescent girls becoming gender dysphoric is widespread — it's commonplace. In 2007, Boston Children's Hospital was the only facility in the United States devoted to treating children with transgender issues. By 2017, there were forty-five hospitals devoted to treating transgender children. The first such clinic in the nation sadly relied on flawed research and saw the procedure as useful and important, and they were wrong. London, home to one of the largest transgender clinics, the Tavistock, has recently said, "You know what, we're going to stop doing this." They're ahead of us. Why are they stopping? You heard Ryan Anderson preview it for us yesterday — because the lawsuits are crushing them, lawsuits brought by families and children who have transitioned and are now beginning to understand the devastating impact that action is having on their lives, and holding accountable the professionals who should have — who could have — made better decisions with them and for them.

Slide. According to a recent study of parents surveyed, 87% of children came out as transgender when their daughters began spending excessive amounts of time online, when their daughters' group of friends became interested in the subject and talked about it a great deal, and after there had been cluster outbreaks of gender dysphoria in their school. That sounds like COVID to me — let's everyone wear masks, and maybe we can deal with this problem too. I'm thinking not.

Social contagion is powerful. Some of you know the name Jordan Peterson, a wonderful Canadian psychologist who has made an international career for himself saying things most people don't want to hear — things that are true. He says this about how gender dysphoria spreads: the disease spreads, transmitted through the general population, by people who are ill-informed. It spreads as politics and ideology and political insistence on false claims grow. And third, it's transmitted as a disease among medical professionals, when poorly trained clinicians try to serve children with genuine problems. Dead center and right.

Some groundbreaking research done recently by Dr. Lisa Littman, a Brown University researcher, found that an awful lot of adolescents appear to be embracing gender identity problems after struggling with some other significant mental health issues — such as depression, such as anxiety, such as OCD, such as autism, or other socially awkward behaviors that made it difficult for them to fit in. And something magical happened when a child would identify himself or herself as gender dysphoric or transgender: children who may have simply been a shadow in their school, in their classroom, are now celebrities, and they have a whole new group of people applauding them, taking an interest in knowing what they think, and how they feel, and what they're doing. And it's really rather heady for the children. But we don't want to miss the fact — Littman says, "I've come to believe that these children are turning to gender dysphoria as a way of dealing with depression, and anxiety, and OCD, and autism, because it's something that might help and make them feel different." I understand there's a YouTube video that's had 4.1 million views with the title, "If You're Wondering If You Might Be Trans, You Probably Are." You can check it out tonight, or not.

So for these teenage girls, we're talking about rapid-onset gender dysphoria — nothing wrong in childhood — and almost two-thirds of the transgender children in some studies had one or more mental health diagnoses, a psychiatric disorder, preceding any talk whatsoever of gender dysphoria. Other research tells us that among children who identify as trans, over 50% struggle to handle negative emotions confidently and effectively. So there's a compromise at the outset — in some ways these children are trying desperately to feel well, to be well, and they're choosing some things that are not very healthy for them at all.

Slide. Is gender dysphoria pathologic? Yes, thank you for asking. However, a good number of my clinical friends do not agree with me, and would take me to task, and tell me I'm not very compassionate and I'm being offensive — but it is pathology, I'm sorry. And ultimately, psychiatrists will tell you gender dysphoria belongs in the family of disordered assumptions about the body. Another one of those disordered assumptions about the body is anorexia nervosa — I think most of you are probably pretty well acquainted with that. The child tells us, "I'm fat," and she weighs eighty-seven pounds, is five feet tall, and is being fed with a drip, because she refuses to eat. We tell them, "Your body image is wrong, you're mistaken about all of this." We don't put anorexics on a high-weight-loss regimen. We don't put them on a high-calorie-burning regimen. We don't put them on an exercise program, or send them to liposuction to get every molecule of fat out of their bodies, because that's just wrong in every possible way. We don't let them make changes to their body that will hurt them. We become responsible for their care, we become responsible for their well-being, and sometimes that means telling them they are wrong — they have delusions. What's a delusion? A delusion is a fixed, false belief about something. And the fixed, false belief for transgender kids is that they are in the wrong body. We don't treat delusions by changing the body — you work to change the mind and help people accept what's happening with the body. That's important, or we hurt kids plenty.

Slide. This comes from a video — I had thought about sharing the video, but it's really disturbing, so I settled for just a screenshot. The individual you see before you is an example of a person who, in my deeply humble opinion, is mentally ill — an individual who has the very vivid delusion that he is a fish. You'll notice, by the deep tattooing he's had on his body, he's trying to replicate the scales. And if you look very carefully at him, what's missing? He has no ears. Some surgeon, on a whim, or out of a desire to please or placate this man, removed his ears so he could feed his delusion of being a fish. In my deeply humble opinion, that is radical malpractice — just radical irresponsibility. Let it not be so among us. We have to call out and speak the truth when we're aware of it, or you end up with people who end up mutilating themselves — this man, as a fish; children, in ways we'll discuss in a moment.

The evidence that teens with gender dysphoria are suffering from mental illness is overwhelming, according to every kind of data you can look at these days. But instead of psychiatric help, we're moving immediately to affirming care — the notion that a child will be hurt if we said, "Well, little girl, you are not a boy" — "You're offending me, you're not a boy, I hate you, you're not a boy, I feel—" "You're not a boy." Out of the risk of hurting a child's feelings, we say, "We can help you with that." And that is irresponsible, in every possible way. Affirming care has been accepted by parents, by schools, by doctors, by universities, by government agencies, by insurance companies. And now we're being asked to respect the judgment of children about what they want to do with their bodies, at the tender age of nine, and ten, and eleven — an age where some boys are jumping off the garage roof, driving their bicycles downstairs, showing how clearly they think about things. Their judgment is not well developed. They cannot give informed consent, because they haven't a clue what the implications of this will be for their life, their relationships, their body, and the children — and grandchildren — that their parents will never have. "Yes" is not always a good answer to give a child. So affirming care is not what we ever want to embrace.

Slide. Treatment approaches. Step one, first steps: affirmation — new name, new clothes, new pronouns, new diagnosis, new bathroom if your school is really wacky enough. And as a child begins on stage one, the progression to each of the next stages becomes easier and easier — you hop onto this conveyor belt, and once you hop on it, you rarely hop off, and you move through to complete transitioning.

Stage one — let's see the slide — is puberty blockers: injections or surgical implants that block the child's natural hormones, which would ordinarily lead to maturation and development of secondary sexual characteristics. Oddly enough, no laws regulate the age, nor prohibit the use of puberty blockers, even though they're not FDA-approved. Great news. They're suspected to contribute to higher blood pressure, to acne, weight gain, breast cancer risk for boys, and dropping bone density that can be frightening — as low as 1% of required density. So this is not a particularly good thing at all.

The hormones block that normal transition which ordinarily — say, for example — confirms that a boy is becoming a man: the hormones make some marvelously delightful changes in little boys, who suddenly have voices breaking in choir practice, their voices moving to a deeper, masculine voice, their shoulders broadening, they're starting to grow whiskers, and they're so thrilled — every bit of evidence that they're becoming a man encourages them, as the proper hormones that God has given the body allow that to happen. The child on puberty blockers sees that his peers are becoming different — they're becoming bigger than he is, more muscular than he is, deeper-voiced than he is, they're starting to tease him and kick him around a little bit, and he feels less and less like them, which is tragic.

More tragic is that 95% of kids who start with hormone blockers — even though they may have had second thoughts about it — ordinarily go directly to the very next step, even though parents have been told, "Hormone blockers are reversible, don't worry about it." Virtually no study exists to support that claim, and it's shared with parents on a routine basis. The rationale is, it's going to give the child a little more time — let the child evaluate their gender, consider their desire to move ahead, delay those troubling secondary sexual characteristics, and their peers are growing while the little boy remains a little boy. I was surprised to come across an article recently that said the same chemical cocktail, the same hormone blockers used for children, is identical to the drug used for treatment of prostate cancer, and is licensed to chemically castrate men. But it's just a hormone blocker — don't worry about it, you'll be fine.

Cross-sex hormones — now it's time to move ahead with the program. I've heard as early as ten, although it's usually recommended not to begin until age sixteen — different states have different rules, and some doctors seem to have no rules at all. It will almost always result in the child becoming sterile, and that's not a decision you can reverse. The hormones mimic the process of puberty that would occur in a person of the opposite sex, and these children will need to stay on those hormones for the rest of their lives, which is no small deal. It's not regulated by anyone — the FDA is missing in action. And yet the National Conference of State Legislatures tells us thirty-eight states have firm laws that prohibit both body piercing and tattooing on minors. Hormones are fine, but we don't want to make any dents in your skin, right? So we're getting things wrong — priorities are wrong, facts are wrong. And parents, in some states, who will not assist their children to move forward with this plan can be charged with child abuse, and in some very rare circumstances, guardianship of their children has been taken over by the state when the child insists on transitioning and the parents will not consent. A girl can begin hormone treatments, plan for a double mastectomy and plastic surgery, and oppose her parents' will, and move through the process. So if a child is determined, a child will be able to succeed somewhere, in one of the states.

Stage three: surgery, ordinarily not before age eighteen — I say "ordinarily," because it happens earlier for some children — upper and lower surgery that makes the target pretty clear. It is irreversible surgery, simply to create the physical appearance of the opposite sex's genitalia. The research says centers are refusing to track the adverse outcomes — refusing to track the detransitioners, and refusing to track the suicides. And if you don't have the data, it can't be used against you.

A new type of surgery I only came across about eight or nine months ago is "nullification surgery" — I don't know if you've heard of that, I hadn't — a procedure where a smooth swath of skin covers the area where genitalia would ordinarily be. It reminded me of a Barbie or a Ken doll. So now you can pick from a menu of what you'd like to look like when you're done.

Slide. Please read this aloud with me: "It is impossible to recommend gender transitioning to minors as evidence-based, or even safe." Was that some dopey person on a bad date? No — the Journal of the American Medical Association, clinical guidelines, as early as 2017. And yet the juggernaut goes on. Only in 2016 did the National Institutes of Health begin research protocols asking, "What happens to these kids? Five years, ten years, fifteen years, twenty years down the line?" We don't know. But we're guessing it isn't all that good.

In some ways this procedure reminds me of lobotomies in the 1950s — chiefly 1949 to the mid-'50s, there were over fifty thousand lobotomies performed, with no medical evidence whatsoever. What's a lobotomy? You haven't had one — good. There were many different styles and strategies by which lobotomies could be administered. The gentleman who seemed to really take the practice most seriously was Dr. Walter Freeman, who personally performed 3,500 lobotomies. He had the ice-pick method, where he would essentially take an instrument shaped just like an ice pick, slide it along the inside of the nose, up through the orbital bone into the frontal lobes of the brain, and then — and disconnect all kinds of connections vital for normal processing, severing countless connections in the frontal lobe. Other lobotomies actually removed portions of the frontal lobe.

What resulted from that kind of mistaken treatment? People who had OCD, people who had depression, people who had psychosis, people who had schizophrenia, people who had neuroses, people who were aggressive — did the treatment work? The early studies said, "Oh, it works wonderfully well!" Why? Because a person who had been aggressive, or who might have been depressed, was now neither depressed nor aggressive. In large part they were unresponsive, in large part they were calm, and docile, and were sent home to live like a bag of vegetables with their family. And it's tragic — and every clinician in the United States, in those years, heard of, used, or recommended lobotomies for resistant mental health issues. Are we doing the same thing now? Yes — again, in my deeply humble opinion.

Slide. Oh, I love this: as many as 98% of gender-confused boys and 88% of gender-confused girls eventually accept their biological sex after naturally passing through puberty and adolescence. There it is — that's the home-run slide, which says: chill. Tape the kid to the chair with duct tape for three years — no, that's abusive, of course. But you don't affirm the child's inclinations, you don't take the child to a clinic and say, "Do you have some hormones we could use?" You wait. You wait upon the Lord. You wrap the child in prayer. You encourage the child to do whatever might be helpful in addressing the depression, or the anxiety, or the OCD, or the Asperger's issues they may have. But you don't let the child move through this.

So why would parents do this to their children? Why would they reject the truth and cave in to their child? Largely because a good number of professionals say, "Do you want a dead girl or a live boy? If you won't allow this child to transition, be aware that this child is a very high suicide risk." And if you were a parent, and the child you desperately loved appeared to be at grave risk, I think you would be in a place of great decision-making, and you would need to be surrounded by your pastor and your friends, for support, encouragement, strength, and comfort.

41% of people who identify as transgender will attempt suicide at some point in their life. The normal population number for attempted suicide is 4.6%. Perhaps the most radical piece of news is this: they took a group of people who wanted to be transgender and created an experiment. They moved ahead with hormone blockers and the change of new hormones for one group, and then they took an equal number of people who wanted to be transgender and put them on a waiting list — it's called a control group. These kids went through the entire procedure; that group received no treatment whatsoever. They did all kinds of psychological comparisons between the two groups, and the group that received no treatment was far healthier than the group that did — suicidal ideation in the group that received no treatment was lower than the suicidal ideation among the children who did receive treatment. So we've got to begin sharing the facts that we know to be real.

Slide. Our friend Dr. Michelle Cretella: there is no proof that radical therapies will prevent adolescents from attempting suicide. Done deal. It's a myth that perpetuates abuse of our children.

Slide. So let's look at the mental health issue and say, that's where we need to be focused, that's what we need to attend to, that's what we need to be aware of. We can refer children for immediate, life-changing clinical help if they're depressed, or anxious, or struggling with confusion or demoralization. We can provide very sophisticated clinical treatment for them, in concert with well-informed spiritual care by their pastor, both for the child and for the parents — that's home-run time, that's what it looks like when we get it right.

Mental health evaluation and treatment is being skipped. A lot of detransitioning children are saying, "I had a ten-minute conversation with my doctor before I started this course of action" — a ten-minute conversation, which suggests people aren't doing the job of treating mental health issues, not treating illnesses for which we have excellent strategies. For psychologists, we're given aspirational guidelines for our conduct clinically — this from the American Psychological Association: "Psychologists understand that gender is a non-binary construct." You don't get to ask questions — it's the American Psychological Association — it's "a non-binary construct that allows for a range of gender identities that can be fluid and may not align with the sex assigned at birth." So professional organizations are saying you must affirm the child, or you're being irresponsible.

Physicians — you'd think, well, at least physicians, right, they'll be prepared to assist parents, they'll be prepared to make the right recommendations. For individuals who go through any kind of significant plastic surgery or body-changing surgery, it's very commonplace that the plastic surgeon will say to the local psychologist, "I would like a complete psychological evaluation of this person." And those evaluations are conducted very, very carefully — the doctor is trying to determine, is this person making a healthy choice, or does she have really outrageous expectations about what her body could or might be? If a psychologist finds there are other issues that are deeply troubling, and she is probably not in a place to be making decisions that would change her face or her appearance — or it happens to be her forty-second surgery — we recommend against it. Children don't have the benefit of that psychological evaluation. And that's tragic.

Slide. So how are we to respond to this in love? Well, I kind of gave away the answer. A meaningful Christian response starts with being deeply rooted in Scripture and in prayer — I don't think we take on any task that we don't first wrap in prayer, and ask for our Lord's guidance and blessing in the efforts we'll endeavor to use to serve children. We need to, one, be well informed — we need to speak with authority and confidence about the facts, and now you're in a place where you can do that. You have some irrefutable facts that could help a parent make some reasonable decisions. You know some of the dangers.

So what do we do? Love, teach, care, pray, befriend. We don't judge — I'll talk more about that later this morning. How do we talk about these things with the greatest likelihood of influencing people in healthy ways? I'll offer a couple of suggestions for your consideration.

One pastor wrote this on Doxology's Facebook page a while back: "Are you aware there's no one in a mental health profession around me who would even consider compassionate treatment of this dysphoria? All the mental health professionals I've contacted are into affirming, and would encourage feeding the delusion. I know that. I am simply not qualified for this work — I'm a pastor. So at best I can get someone to recognize their need for help, and then there's no one to help." Let me be clear — this is not theoretical for me, I am trying to care for one of my members.

Bev, can you provide treatment? No, right? I had a chance to visit LCFS in Milwaukee — I see Carol is with us, and she shared candidly about the fact that LCFS is not taking transgender clients either, simply because the overwhelming threat is devastating, and you can't have vulnerable clinicians — it takes training. But they provide referrals, and they know how to help, and equip and support, if a child chooses to be transgender — they'll equip and support the parent and refer the child, in love. The Christian response — we've got to identify some skilled professionals, some credentialed physicians, some psychiatrists, some psychologists, with a biblical worldview. LCFS in Milwaukee is doing that, and they have some wonderful counselors I met this week, and they're learning about the distinctness of Christian counseling, and receiving advanced training in that area, which is terrific.

Do our districts have a list of counselors you could turn to? In large part, the answer is no, although many districts do have a mental health team of one sort or another — continue encouraging your districts to make those resources available to you. The American Association of Christian Counselors may make available some individuals who could be helpful — you simply drop in your zip code and a number of counselors' names emerge. I'd encourage you to take a look, as well as Focus on the Family. Focus on the Family offers a one-time consultation available at no cost, which may help you slow down in the direction you're moving, or give you some additional ideas, and they may be able to help you find a counselor within the Christian counselor network. No guarantees.

What do we, as the church and universities, need to do? We need to educate, and prepare, and identify professionals we're able to provide. There's a therapeutic approach known as "watchful waiting," as opposed to affirming transition — that is not conversion therapy, it is watchful waiting. And sadly, some of the people stepping forward to care for transgender children are those who will help them accept their need for a new body, which is precisely what we wish would not happen.

Slide. And so places like this, I hope, are going to begin having these conversations in the nursing department, are going to begin having these conversations in the ethics department, are going to begin having some of these conversations in the teacher education department, and in the pre-seminary department. Why? Because the next generation is vital, and the work that the wonderful professors and staff do in this place to prepare these kids to take on the world is huge — we can't overestimate that.

Slide. Teachers, pastors, and principals: be informed. Examine your curriculum — what does your curriculum say about a biblical worldview? We'll talk a bit more about this at the close of the morning. What does your school board think about gender identity and gender dysphoria? Have you had the conversation? Should you have the conversation? Where, in the religion class in your school, or in the social studies class in your school, does an emphasis on diversity begin, and how is it treated and discussed? We recognize themes of Christian sexuality are now beginning in 3K, in some rare and special Christian day schools — and conversations about sexuality in general are beginning everywhere, at 3K, by people who probably shouldn't be working with little children.

New slide. Parents, we've got to talk to our children — those are some of the courageous conversations we'll talk about later this morning.

New slide. We want all of these kids to be confident in their identity as God's own baptized child, and we want, to the extent we're able, to be confident that our good, loving God will equip us to serve these kids in every possible way we can, because they desperately need us.

Slide. If your school has not seen this book — and I think Ryan Anderson referred to it yesterday as well — from the Alliance Defending Freedom: Protecting Your Ministry, against the inevitable challenge by a government inquiring as to why you do or don't teach the things you should or shouldn't be teaching. That's certainly concerning.

Slide. Pastors, you need to gather, care, teach, feed, pray. Bring the gifts of God, bless, and love, and respect the parents and the child, and repeat, and repeat, and repeat, and repeat. We can be confident that we've got a good and loving God who has equipped us thoroughly for the doing of his will — even those things which are challenging, even those things that may take courage — and yet we can be confident he'll provide precisely what's required, one day at a time, for each of the days ahead.

Thanks for letting me share with you.