Biology Isn’t Bigotry: Responding to the Transgender Moment

Transcript (edited for readability).

Okay, so we'll get started with this next session. As Pastor Fleming had mentioned, there is a book that goes into all of this in much greater detail. You cannot buy it at Amazon, unfortunately, which is something we could talk about some other time. Everything I'm going to say this morning, all the quotes, everything — feel free to take pictures of them. I realize it's going to be hard to read for some of them, for people in the back, but they're also all going to be in the book if you're looking for a citation and you want to get the footnote and everything.

But let me just say that, to a certain extent, this talk would have been unthinkable — what is Harold's last name? Sikorsky? Pastor, I don't think this would have even been on his radar screen a decade ago, right? There wouldn't have been a session devoted to the T in LGBT, because for the longest time that had kind of been like the silent partner. For twenty years we had a debate about gay marriage. And then it seems like overnight, when Bruce Jenner went on 20/20 and announced he was now Caitlyn Jenner, everyone was supposed to fall in line. The federal government redefined the word "sex" as gender identity. They sent out the letter to all of the nation's schools saying that you have to now do all of your bathrooms, locker rooms, sports teams, and curricula according to gender identity. You're seeing this play out in school boards across the country. I live in Loudoun County, Virginia, which, if you've been watching the news recently, has several times had to call the police during their school board meetings because the parents have gotten so upset at what they're doing on both the critical race theory and the gender ideology fronts.

It was — let me get the right year — 2007. So just fourteen years ago, Boston Children's Hospital became, quote, "the first major program in the United States to focus on transgender children and adolescents." So we're thinking that within the course of fourteen years, the very first pediatric gender clinic opened its doors, and now there are well over fifty of these clinics. And these are clinics where parents will be told that puberty-blocking drugs and cross-sex hormones are the only way to prevent their child from committing suicide. They use that suicide threat as a kind of emotional blackmail on parents.

Planned Parenthood has recently gotten into the testosterone business. Just last week, Alexandra DeSanctis had a really nice article at National Review looking through the Planned Parenthood annual report on the steady increase, over the past five years or so, of Planned Parenthood doing hormone therapy.

What we know from some long-running statistics is that for children with a gender identity conflict, eighty to ninety-five percent of the time they would naturally grow out of it, and their gender identity, their self-understanding, and their biological reality would line up if they're just given the time and space to continue maturing. We also know that for adults who identify as transgender, they are forty-one percent more likely to attempt suicide at some point in their lives, and that adults who have had surgical transition procedures are nineteen times more likely than average to die by suicide. Those latter two statistics are simply heartbreaking to think about — that there's a segment of the population that is, and let me correct myself: it's not forty-one times, it's forty-one percent of adults who identify as transgender who will attempt suicide at some point in their lives, and they're nineteen times more likely to die by suicide if they've had surgical reassignment procedures.

To think that those are statistically likely outcomes, and then simultaneously be encouraging children into this trajectory — when the alternative is that if you leave children alone, eighty to ninety-five percent of the time they will reconcile any gender identity conflict with reality — should very much stop us in our tracks. It should very much urge caution. Slow down. Think about what's going on.

What I argue in the book is that a doctor named Paul McHugh got this right back in the 1970s. Paul McHugh was a Harvard undergraduate. He then went to Harvard Medical School. He was then hired by Johns Hopkins Hospital and Johns Hopkins Medical School. He was then promoted to psychiatrist-in-chief, and he shut down the sex reassignment clinic that Hopkins had opened in the sixties. Hopkins was the pioneer in sex reassignment procedures. McHugh said, well, now that we've been doing this for almost two decades, we should commission a study to see what the outcomes have been. Once he got the results of that study, he was able to take it to the people who run the hospital and say, "We're committing medical malpractice. We're partnering with a psychosocial disorder and treating it with surgery. There's no other psychosocial struggle where we think the appropriate therapy is surgery. So why are we doing it here?"

The sex reassignment clinic remained shut down until about three years ago. Hopkins reopened it — not the psychiatrists pushing for it, the surgeons. And McHugh, who just turned ninety, is still full-time faculty at Hopkins, still a full-time doctor, still seeing patients, and still saying that he thinks they've made a mistake. He thinks history will vindicate him, because nature hasn't changed. Creation hasn't changed. The underlying truth of our embodiment as male or female hasn't changed. And trying to live not in accordance with nature and creation, trying to live not in accordance with reality, isn't going to bring human happiness, human flourishing, human well-being.

Okay, so that's all just by way of laying the groundwork in terms of where we are. I want to go through three steps: transgender ontology, transgender medicine, and transgender public policy, just to bring everyone up to speed on what's going on in the culture. That's the first half of the talk. The second half of the talk is going to be how do we evaluate this — how to think about the scientific claims, how to think about the medical claims, philosophically and then medically. And then we'll have some time for questions and answers.

So the first thing to say is about transgender ontology. People will claim, "Oh, we live in a postmodern world that's given up on metaphysics." I don't think that's true. We just live in a postmodern world that is promoting an alternative metaphysic. You can't get away from ontology or metaphysics — these are the philosophers' big words for the study of being. Everyone has some worldview, and the only question is whether it's a sound worldview or not — a true, accurate metaphysic or not.

The heart of the transgender moment we're living in is a metaphysical claim that someone is who they identify as. It used to be that a transgender individual was a man who identifies as a woman. That's no longer the claim. The claim now is that Caitlyn Jenner is a woman. And you can see why they shifted their own metaphysics, because a claim about who someone is is much more powerful than a claim about how someone identifies. So the argument here is that the high school trans girl is a girl, and therefore — and I'm using their language — she should be allowed in the girls' locker room, play on the girls' sports teams, et cetera. In reality, that's a high school boy who identifies as a girl, and it's unfair to allow that boy into private places reserved for girls, and it's unfair and unsafe to allow that high school boy to compete, especially in physical competition, against girls. But the language follows the metaphysic. If you believe that individual is a girl — "trans girls are girls" is the phrase you'll hear — what it's doing is intentionally confusing people about what the underlying reality is. Is a trans girl a girl who identifies as a boy — is that a boy? I think they're getting rid of all that historic talk.

This is also happening in courtrooms. This first quote — I'll read all the quotes, because this might be the only downside of not being a mega church: you don't have the giant projection screens and all that, instead you have a nice liturgy, so I think it's — don't tell my Southern Baptist friends I said that, but I think it's an okay trade-off. So the only reason I have the slides is to help people read along with me. Feel free to take pictures of them. Also, everything is in the book if you want to get a copy.

This is Dr. Deanna Adkins. Dr. Adkins is a professor at Duke University School of Medicine. She's the director of the Child and Adolescent Gender Care Center, which opened in 2015 — right around the same time that Bruce Jenner was going on 20/20, Duke opens a child and adolescent gender care clinic, and this is the director. The federal government, under the Obama administration, sued the state of North Carolina because North Carolina passed a law saying that when it comes to single-sex facilities, we're doing them based on biology, not based on self-declared identity. The federal government said that violates civil rights law. And this was the expert witness. Dr. Adkins says, quote: "From a medical perspective, the appropriate determinant of sex is gender identity. It is counter to medical science to use chromosomes, hormones, internal reproductive organs, external genitalia, or secondary sex characteristics to override gender identity for purposes of classifying someone as male or female."

Now, that is a breathtaking quote for a variety of reasons. One, it highlights who the high priests in our society are. The high priests in our society are not the priests — it's not the theologians or the philosophers. The high priests in our society are the doctors and the scientists. A white lab coat, not a clerical collar, gains you public credibility and authority. But this is fundamentally a metaphysical claim. She says, from a scientific perspective, the appropriate determinant of sex is gender identity. That's not a scientific claim — it's purely a philosophical claim. But the philosophers and theologians don't actually have authority in our culture; the doctors and scientists do. So they dress up bad philosophy as science, because it then gets public authority. So you want to see what's going on here.

The second thing to say is that this directly conflicts with all of second-wave feminism. Second-wave feminism said sex is merely biological, and gender is the social construct — sex and gender are two different things. Now we're being told, two generations later, that your gender identity determines your sex.

Third thing to say: any one of us in this church who took high school biology knows the bread and butter of biology — things like chromosomes, hormones, internal reproductive organs, external genitalia, secondary sex characteristics. Now we're being told that if any of those aspects of objective reality conflict with your subjective identity, your subjective identity is given authority, according to "medical science." Medical science is now based on subjective identity rather than objective reality. And that's not actually medical science — that's just bad philosophy dressed up that way because of who's going to have authority. Here's my guess: there were no Lutheran pastors called as expert witnesses in this case. No Catholic priests, for that matter, because again, the theologians and philosophers don't have authority the way the doctors and scientists do.

Now this gets worse, though, if you're a parent — if you're an unsuspecting parent and you have a child with a gender identity conflict, and you go to the best hospital you could find, this is the advice you'll be given. It gets worse, and I realize this is a lot for a morning; you're going to be getting depressed.

This next graphic is the "genderbread person." You could pull it up on your phone if you do a Google search for "genderbread person," you could see it up close. But the basic idea here is that it has all of these arrows on the right-hand side — five different sets of arrows: gender identity, gender expression, biological sex, sexual attraction, and romantic attraction — and all of these things exist along spectrums. This is used in kindergartens, grade schools, to indoctrinate children into how they should understand themselves. Where do you fall along the spectrum of gender identity, which is, quote, "how you, in your head, define your gender, based on how much you align or don't align with what you understand to be the options for gender"? Then there are those four blue boxes in the upper right-hand corner — it says "four of infinite possibilities." Womanness, manness, two-spirit, and genderqueer are four of the infinite, because gender identity and gender expression both exist along a spectrum and are fluid. One day you could be on the womanness side of the spectrum, one day on the manness side, one day the two-spirit side, one day genderqueer. It can be fluid, and it's a spectrum, not a binary. Even biological sex, you'll notice, has arrows — it's a spectrum, a fluid spectrum, apparently, even for biological sex.

Okay, the genderbread person — and this was, as you'll notice, version 3.3, right in the upper right-hand corner, like your iPhone, like what iOS system are you using. This was, at the time, the most up-to-date genderbread person. It got in trouble. And so the new graphic — if we could, yeah, just advance. It looks like there's a pop-up window, so something went wrong there. Sorry. Okay, so now we're good.

The new graphic is the "gender unicorn." The reason I want to highlight this is that some of you will have children or grandchildren who will have this image used as part of their grade school curriculum. This is not meant to persuade you — you see this thing and it looks like Barney, it's ridiculous. But it is meant to persuade your child or grandchild, because it looks like Barney and it's attractive. It's meant to capture their moral imagination.

What are the two differences? One is that the genderbread person looked too much like a man — it looked like a gingerbread man, and so it was accused of being part of the patriarchy. So it's oddly appropriate that they use a mythical creature, a unicorn, to embody their worldview. I'm not entirely sure they thought that through all the way. The second thing you'll notice is it says "sex assigned at birth." The new politically correct language: sex assigned at birth. Here's the reason why. If sex is merely assigned at birth, that means it can be reassigned later in life. So if you were a child, this is meant to catechize a child — not with the Baltimore Catechism, if you're Catholic, or the Westminster Catechism, if you're Reformed — this is meant to catechize a child into how to think about their own body and their own identity. They have a gender identity, gender expression, romantic attraction, and a sex assigned at birth that may or may not line up with any of those other things, and they need to figure it out for themselves. There are no givens, there are no truths built into reality, creation, nature. It's all kind of plastic — liquid modernity, if you're familiar with — I'm blanking on his name. Thank you, yes, say again — Zygmunt Bauman wrote a great book, Liquid Modernity, the concept that everything in modernity is liquid, fluid — there are no stable givens. That's the worldview the gender unicorn is embodying, and it's indoctrinating young people about this.

Now imagine two young people, both experiencing a gender struggle. They don't quite feel comfortable as a boy. One has been taught that he is made by an all-knowing, all-loving God, created in God's very image and likeness as a boy, and that if he's not feeling comfortable, the problem's probably with the culture, with the school — the problem's not with his body, it's with his understanding of what it is to be a boy. The other child has been taught with the gender unicorn — catechized with the gender unicorn — that your sex is merely assigned at birth, that you have a real gender identity that's up here, that sex can be reassigned later in life. Two different people experiencing all the same discomforts are going to interpret them in radically different ways, because we are all narrative creatures. Constantly, whatever age you are, you're still trying to make sense of your thoughts, your feelings, your experiences according to certain basic commitments. We all make sense of our lives according to fundamental beliefs that we hold. And if your fundamental belief is the creation narrative of Genesis, or your fundamental belief is the gender unicorn, you're going to interpret your thoughts, feelings, and experiences in radically different ways — even more so if your parent or your therapist's underlying worldview is the gender unicorn or the creation narrative. They're going to interpret these things in radically different ways.

I'm going to skip the next slide — I'll leave this up and then go to the next one after that, for the sake of time.

All right, so from this worldview, this kind of liquid-modernity understanding of the body and of the person and of gender identity, et cetera, that explains the medicine we're seeing. There's a certain logic to it, but it's a bad train of logic. It's a four-part standard of care for children.

The first step is what's known as social transition. A child as young as three years old can know their true gender identity, and a child as young as three should be affirmed in their real gender identity. Which means — I have a three-year-old son — if he were to tell me, "I'm actually a girl," or "I'm gender fluid," or whatever, I am supposed to give him a new name, refer to him by new pronouns, give him a new wardrobe, et cetera. The first step here is to affirm the true gender identity, and that children even as young as three can know their real gender identity.

Second step: as that child approaches puberty, you're supposed to prevent the child from going through puberty in the, quote, "wrong body." So what the doctors are doing is prescribing puberty-blocking drugs to indefinitely block a child from going through normal, biologically appropriate puberty. Let's say it's that boy — as he approaches eight, nine, ten years old, he's placed on this drug to prevent him from hitting his growth spurt, to prevent his voice from deepening, his muscles from developing, et cetera. If it was a girl, same thing — you're placing her on puberty-blocking drugs to prevent her from having her first period, to prevent her from developing breasts, et cetera. The idea here being, well, since their real gender identity is the opposite, it would be like physical torture to force a boy to menstruate and develop breasts, or to force a girl to have her voice deepen and her shoulders broaden, et cetera. That's the logic here — that gender identity is what determines biological sex, that Dr. Deanna Adkins quote. And therefore we have to prevent the merely physical body from developing in ways that are discordant with the real gender identity.

All right, so that sets up social transition and then puberty blockade. The third step is hormonal transition, because now you have a problem — you now have a young teenager trapped in a child's body. Fourteen, fifteen, sixteen — everyone else has hit their growth spurt, everyone else has matured into an early adult, and I haven't. So the official guidelines are at age sixteen — increasingly this is being done around age fourteen, at the start of high school — high doses of testosterone being administered to girls who identify as boys to masculinize their bodies, high doses of estrogen being given to boys who identify as girls to feminize their bodies. Hormonal transition.

And then the fourth step is surgical transition. The official recommendations are age eighteen, increasingly being done at age sixteen. But we do know, through your tax dollars — you funded an NIH-funded study out in California — where two thirteen-year-old girls had double mastectomies performed as part of their treatment for gender dysphoria. The idea with surgical transition is that you would remove body parts that don't align with the real gender identity — that could be removing secondary sex characteristics like breast tissue, removing external genitalia, removing internal reproductive organs, and then using plastic surgery to create body parts that resemble the opposite sex. The surgical transformations can go even further — there are techniques to reduce the Adam's apple for males who want to identify as women, to change the size and shape of hands and knuckles for people who have large hands, large knuckles. It can get rather intricate, but early on it's focused on secondary sex characteristics, external genitalia, and internal reproductive organs.

Why are they doing this? This next quote — this is also from that case in North Carolina, expert witness Dr. Scott Leibowitz, says: "Peer-reviewed research demonstrates that pre-pubertal children asserting a different gender identity from the one they were assigned at birth are cognitively capable enough to be aware of the gender identity they are asserting. The meaning of a child's gender identity assertion at a younger age is no less valid than the meaning of a gender identity assertion of an older child." So peer-reviewed research shows that pre-pubertal children are cognitively capable of knowing what their real gender identity is, rather than their, quote, "sex assigned at birth." You see the politically correct language, the ideological language in there, and then the appeal to a peer-reviewed process that, you know, your five- or six-year-old is cognitively capable enough to know that they're a boy trapped in a girl's body and vice versa, or that they're gender fluid, et cetera.

Okay, I'm going to skip two slides for the sake of time. We'll go to this one. This is from Dr. Diane Ehrensaft. She's the director of mental health at the Child and Adolescent Gender Clinic at the University of California, San Francisco. Speaking of gender-diverse children, she says: "They refuse to pin themselves down as either male or female — maybe they're a boygirl, or a gender hybrid, or gender ambidextrous, moving freely between genders and living somewhere in between, or creating their own mosaic of gender identity and expression. As they grow older, they might identify themselves as agender, or gender-neutral, or genderqueer. Each of these children is exercising their gender creativity, and we can think of them as our gender-creative children."

Just realize that this is the director of mental health at a children's hospital in San Francisco. Unsuspecting parents who are simply looking for the best healthcare they can get might be told, "Oh, you have a boygirl. You have a gender hybrid. Oh, you thought you had a son — actually you have a gender-ambidextrous child." And in the very same breath that she says, as they grow older their gender identity might change, she's also — her clinic is one of the biggest ones prescribing puberty-blocking drugs and cross-sex hormones. So she acknowledges that as children develop, their gender identities might change, and yet she's radically transforming their bodies right now in accordance with what they happen to believe about themselves, rather than helping them believe the truth about who they are — radical and frequently permanent, irreversible transformations of the body. Abigail Shrier has written a great book titled Irreversible Damage, because it's not just transformation — they're damaging these young people's bodies.

Okay, third thing I wanted to say — we did the worldview: transgender ontology, transgender medicine, transgender public policy. All these things flow, and it's important that we understand what we're up against, what the logic of the other side is. I wanted to mention four areas to be watching, to be concerned about.

One: what's going to be taught in schools? I don't care if these are government-run schools, church schools, private schools, classical schools — we should care, particularly if they're government-run schools. But frequently when I talk to religious audiences, they don't realize that many religious schools have drunk the Kool-Aid on this. So you shouldn't assume that if you're sending your kids to a private Christian school, the Christian school is solid on these things. You should look at the curriculum. What's going to be taught to a generation of young people about the truth when it comes to these issues? Is the gender unicorn going to indoctrinate a generation of young people? And even if you're fortunate to be able to homeschool or send your kids to a private school, you should not therefore not care what's going on in the local school district — because we should care about our neighbors, we should care about the options for people who aren't financially able, or intellectually able, or career-able to homeschool or send their kids to private school. For those whose only choice is public schools, those kids should not be subjected to this indoctrination. So one question is what's going to be taught.

Second question: how will access to sex-specific facilities and programs be governed? If your school has different bathrooms, locker rooms, sports teams, dorm rooms, hotel rooms for overnight field trips, will it be conducted on the basis of biology or the basis of identity? You should look into this for your local school. When you have these separate programs and facilities for boys and girls, are you defining boy and girl based on biology, or, as Dr. Adkins says, based on self-identity?

Third: will you be forced to speak someone else's beliefs? Already we have seen teachers fired because they won't use preferred pronouns. What they've tried to do is say, "Look, I'm not going to speak in a way that makes my student uncomfortable, but I'm also not going to speak in a way that suggests to all of the other students that I believe a boy is a girl or vice versa." These have not been teachers who were intentionally trying to demean a student with gender dysphoria — they said it isn't actually loving and compassionate for me to affirm their mistaken gender identity. It's not compassionate to the student with gender dysphoria, and it's also not compassionate to all the other students who would therefore think that I believe in gender ideology. Teachers are losing jobs over this, including in my school district back in Loudoun. And in the office setting, in New York City, you can be fined a quarter of a million dollars if you intentionally misgender someone. Again, what they mean by "intentionally misgender" is refuse to use preferred pronouns.

Last issue of public policy: provision of medical services. This comes in two parts. Will good medicine be prohibited? Paul McHugh would lose his medical license in nineteen states if he practiced medicine with a minor the way he believes it ought to be practiced. Nineteen states have laws that ban what they call conversion therapy, and they consider it conversion if you try to help a boy feel comfortable identifying as a boy — because that boy currently identifies as a girl, and that's his true gender identity, and you're trying to change it, you're trying to engage in a conversion. That's the logic here — there is a certain logic to it, it's just faulty logic.

So one, will good medicine be prohibited; two, will bad medicine be mandated? Just last week there was a lawsuit — a group of pediatricians, through the Alliance Defending Freedom, filed against what was originally an Obamacare mandate. Trump got rid of it, the Biden administration has brought it back — expect this ping-pong to happen for the next several administrations: when it's left-leaning we get these sorts of mandates, when it's right-leaning the mandates go away, but then they come back. I think, unfortunately, that's the short-term future on this.

What the mandate says is that you're discriminating on the basis of, quote, "gender identity," if you don't treat someone in accordance with their gender identity. So if you are a doctor who does testosterone therapy for men with low testosterone, you need to do it for women who want to identify as men. If you are a surgeon who performs a hysterectomy or a mastectomy in the case of uterine or breast cancer, you need to perform the hysterectomy and the mastectomy in the case of a woman who wants to identify as a man. There are Catholic hospitals — my childhood hospital in Baltimore, Maryland, is currently being sued by the ACLU for not performing a hysterectomy on a woman who wants to identify as a man. So will bad medicine be mandated, will good medicine be prohibited?

I want to read one more slide here. This quote comes from the ACLU, the Human Rights Campaign, Gender Spectrum, and the National Education Association. The NEA is the largest teachers union in America. So the teachers union has partnered with four left-wing LGBT activist groups to create a handbook, and this is what it says: "Privacy and confidentiality are critically important for transgender students who do not have supportive families. In those situations, even inadvertent disclosures could put the student in a potentially dangerous situation at home. So it's important to have a plan in place to avoid any mistakes or slip-ups."

That quote is from a checklist that the teachers union, the ACLU, and the three LGBT groups have put together. The title of the booklet is Schools in Transition, and it's a K-through-12 guide on how to allow a student to transition at school without the parents knowing. Because if you have "unsupportive" parents — meaning they actually want to support the child living in accordance with the truth — that could be a "potentially dangerous situation at home," so you can't disclose this. The idea here is that the privacy and confidentiality of the student trumps any form of parental authority, parental notification, and informed consent, et cetera. And that's another thing that, as parents and grandparents, you should be particularly concerned about.

Okay, that's all I want to say for right now about what's going on. Let me pivot to evaluating some of this — how should we think about it.

One: there are deep philosophical contradictions here. This worldview is literally incoherent, meaning it does not cohere. It's a combination of the ancient heresy of Gnosticism, where the real self is something other than the body, but simultaneously these people are embracing materialism — they're materialists. So where's the real self that's trapped in the body? They don't believe in the soul. And even on the Christian understanding of the soul, it's not a disembodied soul — the soul is the form of the body. So there's a contradiction going on there. It simultaneously embraces rigid sex stereotypes — boys play with trucks, girls play with dolls — while also insisting that gender is merely a social construct. And yet it also wants to say that your gender identity determines your biological sex. These are contradictory positions. And then it wants to embrace radical individualism for me, and radical conformism for you — I get to live in accordance with my belief about who I am, and you have to affirm it and conform with it.

All right, let me ask you a couple of questions. What does gender feel like? They say that your gender identity is your inner sense of gender. What does it feel like to feel like a woman? For, roughly, half of the people in this church who look like women — I don't know how you identify, let's just assume I haven't asked you your preferred pronouns, but just based on body type and that sort of thing, it looks like half — do you all feel the same way? Have you all talked to each other to see if you have the same inner sense of womanness? Remember that graphic that had the spectrums — is that you all lying? Is that what it is to be? Or do you all have the same type of body — a body that is organized with respect to reproduction in a certain way? Think back to the previous lecture where we talked about how the two can become one flesh — two different ways of being organized, a male way and a female way. What is it that makes you a woman? Is it that you have a certain identity?

Now, here's a question for the men in the room: how would you know if you were feeling like a woman? How can I know what it is? Even if there is such a thing as feeling like a woman, how would I know if I was feeling that way? So there's an ontological question — what is it to feel like a woman — and there's also an epistemological question — how would I know if I was feeling like a woman? Now the last thing to say about this: why should feeling like a woman, whatever that is, make you a woman? Our feelings don't determine reality on other questions of importance. Think about Rachel Dolezal, the white woman who felt like she was Black, who was running the local NAACP chapter. No one said, "Oh, she's transracial, she's a Black girl trapped in a white girl's body." Everyone said she's an impostor, she's a phony. Now, race is actually more of a cultural, social construct than sex — sex is a bodily, biological reality. So why are we now treating sex as a social construct, whereas race is treated as an immutable characteristic?

To a certain extent, gender identity sounds a lot like religious identity. Here's what I mean: identities that are determined by our beliefs. Someone who identifies as a Christian believes that Jesus is the Christ. Someone who identifies as a Muslim believes Muhammad is the prophet. But there's also a similarity between gender identity and religious identity: Jesus either is or is not the Christ, regardless of what any of us believe. And someone either is or is not a man, regardless of what anyone, including that individual, believes. In the religious life, the entire purpose of the religious life is to conform our beliefs with reality, to conform our beliefs with the reality about God. Our beliefs don't determine the reality of God, but we try to line up our beliefs about God with the reality of God. This is why people engage in discernment, why people have conversion experiences — the whole point is figuring out what's the truth about God, and then lining up my thoughts, my feelings, my actions, my identity with the truth about God. The same thing should be true with respect to gender: what's the truth about my incarnation as male or female, and then I want to try to live out that truth — conform my thoughts and feelings with the truth of the matter.

Okay, and this is going to be important — this philosophical point — when we get to the medicine. The short version is: rather than trying to do what is impossible, transform a body to line up with mistaken thoughts and feelings, good medicine would at least attempt to do what is possible — help people line up their thoughts and feelings with reality, including the reality of the body. And in fact that's what good psychology, psychiatry, counseling, and therapy does on every other issue. You don't try to change the external world, even your bodily world, in accordance with your mistaken thoughts and feelings — you try to have thoughts and feelings that accurately correspond with reality.

All right, so what are the bodily outcomes? I mentioned the philosophical problems — now the bodily problems. Contrary to what the activists say, sex isn't assigned at birth, and that's why it can't be reassigned later in life. Sex is the bodily reality based on how an organism is organized with respect to sexual reproduction. There are two ways of being organized. There are two sets of chromosomes, there are two reproductive organs — chromosomes, hormones, internal reproductive organs, external genitalia, secondary sex characteristics — these are binaries. It's not a spectrum, it's not fluid. There are some individuals who have disorders of sexual development, but that's not a third sex. There's not a third gamete, there's not a third genital, there's not a third reproductive organ or reproductive system, nor are these things a spectrum. What you do have are people who have disorders where they don't fully develop. We have disorders of cardiac development — we call it heart disease. Disorders of respiratory development — they call it lung disease. There are also disorders of sexual development, and they've been well known, diagnosed, and treated for years, centuries even, and that has nothing to do with gender dysphoria. People with gender dysphoria, people who identify as the opposite sex, ninety-some percent of the time have fully developed sexual capacities — they simply don't identify with their underlying bodily reality.

All that modern medicine can do is feminize a male body or masculinize a female body. We can't actually reassign someone's sex — you don't reassign the chromosomes, you don't reassign any of the bodily capacities. What you do is lose functionality — you destroy functionality when you remove breasts, when you remove genitalia — and then you try to create something that cosmetically appears as the opposite sex. So that's the bodily and psychological outcome, and it doesn't actually resolve the underlying condition.

For the sake of time, I'm not going to go through tons of slides, but there are quotes from several people in the Obama administration admitting this. The bottom line is that the best science we have shows that even when sex reassignment goes well as a cosmetic matter, five to ten years down the road there's no difference in underlying psychometrics — things like anxiety, alcohol abuse, depression, suicidal ideation, suicide attempts, et cetera. All the underlying reasons that got you to go to the doctor in the first place, five or ten years later, are still there. And in some cases they get worse. That's why the Swedish study I mentioned earlier — the nineteen-times-greater likelihood of death by suicide — those suicides only start occurring ten years after surgery. Because at first people are excited: "I'm finally getting to live my truth as a woman, I've had this surgery, I'm now living my life." And then five, ten years later, when they still feel a sense of alienation, still feel anxiety, still feel depression, they realize, "Oh, this didn't work." Now imagine feeling so alienated from your body that you would go to a surgeon to remove these body parts — these people are not faking it, they're not making it up. They are victims. They are being disserved by a medical establishment that has been hijacked by ideology. Now imagine how frustrating, how depressed, how sad you would feel if, after doing that, things didn't get better — all the underlying forms of distress that took you to the doctor's office are still there. You still don't feel comfortable in your own body, you still have trouble fitting in, you still have anxiety, depression, substance abuse, et cetera. That's the sad reality.

The largest study conducted, about two years ago — published a little over a year ago — came out with great media fanfare saying that sex reassignment surgery brings benefits to patients. I think it was eight different teams of researchers who wrote letters to the editor of the journal saying, "Actually, your data doesn't show that — your data shows no improvement, and on two factors, things actually got worse." They actually forced the journal to issue a correction, and the media didn't cover the correction. But the reason the media touted this study originally was that it was a population-based study, the largest data set ever, and what we now know from that data set — this is now about a year and a half old — is no benefit, and on two of these issues, negative consequences.

Last thing I want to say, and then we'll get to questions — actually, if I have two minutes, I'll say two last things. The first is: what's the alternative? What Paul McHugh says is: analogize this to anorexia. If you had a high school girl struggling with anorexia, would any of you say, "Oh, we've got to get her on liposuction"? The answer is no, because there's nothing wrong with her body. If you have a high school girl struggling with a body identity conflict like anorexia, you would try to figure out what's the underlying cause — and it's going to be different, no two high school girls are the same. You want to figure out, in this particular student's case, why does she feel uncomfortable in her body? Could it be sexual abuse? Could it be a bad boyfriend? Could it be keeping up with the Joneses, trying to keep up with other girls in the school? Could it be low self-esteem? Could it actually be more of an eating disorder than a body image problem? Disorders and body image problems aren't always the same thing. A good therapist wants to get to the root cause and then direct the intervention there. McHugh says: do the same thing for gender dysphoria. Figure out what the underlying cause is, and it can be a variety of things, especially in a culture like ours that is so messed up when it comes to male and female. I don't think it's surprising at all that we're seeing an explosion — 4,400 percent — in high-school- and college-age girls rejecting their feminine identity, because we've never had a culture like this. Think about why the Me Too moment and the rise of gender dysphoria in young girls are happening at the same time — it's a very inhospitable, toxic culture for them.

And then the very last thing to say is that the most heart-wrenching stories you will hear are the stories of people who transitioned in high school and then, five years later, detransitioned. And with that, I'll stop — they actually make me tear up, so it's better that I don't have to read any of them, but they're just incredibly tragic.

So this is Q&A time.

I did remember — I forget the name of this disorder, there's that disorder where people think they don't have a leg — yes, body dysmorphia, I forget — yes. No, it's considered malpractice to remove the legs of someone who doesn't think they have them. Right? Why do we recognize that's a mental disorder that we need to get into the mind for?

Okay, so, questions. Yeah.

Pastor Phillips Linsky, from the Cleveland, Ohio area. Thank you for your presentation. With marriage being an extension of natural law, and that we see it developing in places other than Judeo-Christian realms, but also in secular cultures and Jewish cultures and things — in what way, or do we see, Jewish communities, either secular communities, and maybe in particular Muslim communities, as perhaps allies in the preservation of traditional marriage? At the same time, that really hasn't been the case. What are your observations on maybe the Muslim silence on same-sex marriage?

Yep, great question. Two thoughts: one is that you have seen, in the United States context, a lot of Muslims feel alienated from politically conservative politics because they feel like the Republican Party is anti-Muslim, et cetera, and so they don't want to make common cause in other areas. I think there has also been some intentional effort at co-opting Muslims for the left — various activist groups on the left have tried to get Muslims onto their side of different political debates. So it's both, I would say, a problem of conservatives not being very hospitable to Muslims, where Muslims don't feel comfortable joining coalitions, and the left being very intentional about trying to hijack Muslims for their causes. And I think, true for some Muslims, as a coping mechanism of being in the U.S., there's a strong bifurcation between religious law and civil law. Which is interesting, given that Islamic theology and the legal system wants to be totalizing — I think the idea would be that while we're such a small minority we don't really have a voice in the public square, but in an ideal world we would run the public square.

Earlier in your presentation you mentioned the biological components, and you said if anyone's taken high school biology they would understand this stuff. I've seen a fair amount of stuff within the last year or so talking about, well, genetically you can have not just XX or XY, but all of these various changes, et cetera, and therefore that legitimizes the gender spectrum. Could you respond to that?

Okay, yeah, great. So those, all those chromosomal or hormonal disorders, those are the DSDs, the disorders of sexual development. To give an example: you could lack a second sex chromosome, and you would develop as an infertile woman — it's known as Turner syndrome. Likewise, you could have a Y chromosome that lacks the SRY gene — SRY, sex-determining region on Y, that's how they named it, it wasn't a very creative naming process. If you have a Y chromosome but you lack that specific gene, you would also develop as if you had Turner syndrome, as an infertile woman, because even though you have a Y chromosome, you lack the gene that actually makes the Y chromosome impactful. That specific gene, around day five in utero, initiates male development, and if you don't have that gene, you don't initiate that development, but because you lack the second X chromosome, you don't fully develop — I don't remember which internal organ doesn't fully develop, and that's why you're infertile. So those are chromosomal disorders. Another example would be androgen insensitivity syndrome — in this case you're insensitive to androgens, androgen being the genus under which testosterone is a species. Your body produces testosterone but you're completely insensitive to it, and again you would develop largely as an infertile female, because the testosterone in utero would do nothing to masculinize your developmental capacities, but you would have testicles — when they produce testosterone, it's ineffectual. For the vast majority of these people, they grow up readily identifying with their biological sex.

This also suggests that biological sex is a little bit more complicated than just XX or XY — that the chromosomal component is in conversation with other components, and the way biological sex is determined is by looking at the totality of how the organism is organized. The organism might be organized along a female trajectory even though there's a Y chromosome there, if the Y chromosome lacks the SRY gene, or if the organism is insensitive to testosterone. But the vast majority of those people — something like ninety-some percent — would identify as female.

So I actually think that when people point to disorders of sexual development to try to justify some of the transgender stuff, it's kind of like throwing spaghetti against the wall and seeing what sticks — they're two very different underlying issues. With the transgender stuff, it's not people who have a bodily disability or a bodily disorder — these are people with fully developed bodies. As far as we know, Bruce Jenner fathered several children — he's fully developed as a man, but identifies as a woman. So for that reason I don't think we should say that therefore sex is a spectrum, or sex is a social convention. Sex is a binary — there are two ways of being organized, a male way and a female way. Some people have disorders where they're not fully developed, but there's not a spectrum where you're half, in between, nor is it not a binary — there is not a third way of being organized, not a third gamete or a third set of chromosomes, a third genital, et cetera.

And, last thing I'll say: in good medicine, if you have a child with this — because some of these conditions can be life-threatening if the body doesn't develop in response to certain developmental cues — what doctors try to do is figure out what's the underlying sex of the patient, and then help them develop according to that proper trajectory. They're not just assigning a sex to those people — they're trying to discover what the reality is, and then doing whatever medical interventions they need to do to correct the disorder of sexual development.

Thank you very much.

Well, we'll take a break now, okay? We're at time. So, fifteen minutes — we'll be back at 11:30, okay? There are some goodies and drinks back there at 11:30.