¹ Yarhouse, Mark A., Understanding Gender Dysphoria (Downer's Grove, IL: InterVarsity Press, 2015)Google Scholar. Yarhouse highlights different degrees of possible identification with feelings of dysphoria (“I am someone who experiences dysphoria”, “I am a transgender person”, “I am transgender”) and draws a distinction between seeing transgender experiences as “who” I am versus “how” I am. He also explores situations in which feelings of dysphoria are able to be minimised by the person, using the example of an icon on a computer which can take up the entire screen or can be reduced to a corner of the screen.

² Or neither male nor female (this article does not address other identifications falling under the generic term transgender).

³ Sometimes a distinction is made between ‘sex dysphoria’ very much focussed on body parts and ‘gender dysphoria’ where the person may be content simply to transition socially, while continuing to have all the body parts associated with their biological sex.

⁴ David Jones, ‘Truth in transition? Gender identity and Catholic anthropology’, New Blackfriars, May 29, 2018, DOI:10.1111/nbfr.12380. See also Sophie Grace Chappell, ‘Transwomen and adoptive parents: an analogy’, Conscience and Consciousness, July 2018, https://conscienceandconsciousness.com/2018/07/ (and comment box below).

⁵ It is often clear to what sex the person with a DSD biologically belongs: real ambiguity is very rare. Moreover, in the words of John Di Camillo, “Biologically, sex is determined by reproductive role, which is understood most essentially in terms of the two gametes: sperm and ova. No intersex condition introduces a new type of gamete; in fact, most people with serious intersex conditions are infertile. There is no third biological sex.” Di Camillo, John A., ‘Gender Transitioning and Catholic Health Care’, National Catholic Bioethics Quarterly 17.2 (2017), p. 215CrossRefGoogle Scholar.

⁶ Lawrence, Anne A., ‘Becoming What We Love: autogynephilic transsexualism conceptualized as an expression of romantic love’, Perspectives in Biology and Medicine 50.4 (2007), pp. 506-520CrossRefGoogle ScholarPubMed.

⁷ If a woman considering adoption was experiencing an overwhelming desire to present herself as a pregnant/labouring woman, then this is something those close to her would even perhaps have a right to know (and they should respond sympathetically if she does confide in them).

⁸ Note that this is a different form of social ‘mis-signalling’ from gestational surrogacy, where a genuine pregnancy gives a false signal as to the genetic parentage and future parenting of the child (in that case, a false signal so serious as to contribute to the absolute moral wrong of beginning such a pregnancy). See Watt, Helen, The Ethics of Pregnancy, Abortion and Childbirth: Exploring Moral Choices in Childbearing (New York: Routledge, 2016)CrossRefGoogle Scholar.

⁹ One former crossdresser, ‘Kerry’, uses strong words to describe what he sees as his own form of appropriation, going so far as to describe it as delusional:

¹⁰ Conversely, a female-to-male transsexual person may of course identify as a father throughout pregnancy – see the accounts in Mullin, Amy, Reconceiving Pregnancy and Childcare: Ethics, Experience, and Reproductive Labour (New York: Cambridge University Press, 2005), pp. 41-2CrossRefGoogle Scholar.

¹¹ Watt, The Ethics of Pregnancy, Abortion and Childbirth.

¹² See Austriaco, Nicanor, ‘The Specification of Sex/Gender in the Human Species: A Thomistic Analysis’, New Blackfriars 94.1054 (November, 2013), pp. 701-715CrossRefGoogle Scholar. Sexual organs have the function of uniting a man and woman both physically and emotionally in a way that is procreative in tendency if not always in effect. For that reason, gonads (that is, naturally-produced gonads) would seem to be better evidence than genitals of one's biological sex: gonads do not merely mature sex characteristics generally but also produce the gametes that provide the most basic raison-d'etre for sexual complementarity.

¹³ Lisa Selin Davis, “My daughter is not transgender. She's a tomboy.”, New York Times, April 18, 2017, https://www.nytimes.com/2017/04/18/opinion/my-daughter-is-not-transgender-shes-a-tomboy.html.

¹⁴ Of course, there will be other things it is helpful to know in this context: both things that should normally be public (whether the person is already married or has taken a vow of celibacy) and things a casual acquaintance would not necessarily have a right to know (whether the person is impotent, for example, or same-sex attracted).

¹⁵ Without downplaying potential biological influences and vulnerabilities involved in experiences of dysphoria, to say that social influences have no bearing at all on dysphoria and its intensity would be seriously misleading. Detransitioned adults will often stress precisely the social influences, as well as their own internal reactions to these, which led them to take the step of transitioning (for some examples, see Callahan, Carey Maria Catt, ‘Unheard Voices of Detransitioners’, in Brunskell-Evans, Heather and Moore, Michele, eds., Transgender Children and Young People: Born in Your Own Body (Newcastle upon Tyne: Cambridge Scholars, 2018), pp. 166-180Google Scholar, and the accounts on the website Detransition Info. Such influences are certainly noted by some parents of children with ‘rapid onset gender dysphoria’ – see Littman, Lisa, ‘Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports’, PLoS ONE 13(8) (2018)CrossRefGoogle Scholar, https://doi.org/10.1371/journal.pone.0202330

¹⁶ Even when one does know, one may be inhibited in frankness in front of someone who is not the biological sex he or she appears, nor should one necessarily have to resolve one's own feelings of discomfort in favour of the feelings of the transitioned person, real as these feelings also are. The latter also applies to single sex spaces such as bathrooms where, besides psychological comfort more generally, the traditional rationale for such spaces partly relates to a wish to avoid ‘peeping Toms’ and more aggressive sexual predators. The vast majority of biological males are not sexual predators, but that does leave a small minority who are indeed a threat, including a small minority of biological males who identify as transgender, whether sincerely or to gain access to a target group. See Saunders, Kate, Bass, Christopher, ‘Gender reassignment: 5 years of referrals in Oxfordshire’, The Psychiatrist 35 (2011), pp. 325-327CrossRefGoogle Scholar, https://doi.org/10.1192/pb.bp.110.032664; Amanda Prestigiacomo, ‘Trans-Age: Pedophile Charged With Abusing 3 Girls Says He's A 9-Year-Old Trapped in Man's Body’, Daily Wire (January 26, 2018), https://www.dailywire.com/news/26380/trans-age-pedophile-charged-abusing-3-girls-says-amanda-prestigiacomo#; Jonathan van Maren ‘Male pedophile identifies as trans woman and victimizes children’, The Bridgehead, October 8, 2018, https://thebridgehead.ca/2018/10/08/male-pedophile-identifies-as-trans-woman-and-victimizes-children/.

¹⁷ By analogy, a person's attraction to his or her own sex need not of course be announced to every stranger or acquaintance – despite the fact that, if known, this might affect the willingness of interlocutors to make confidences in what they wrongly assume to be a reliably non-sexual same-sex environment.

¹⁸ “Hiding the fact that you're transgender is hard, in lots of ways. I hid it from absolutely everybody (often including myself) for 50 years, and from nearly everybody for 33 years. This gave me more or less permanent imposter syndrome; I was just waiting to be found out and disgraced. And, I felt, when it happened, it would serve me right.

This waiting-to-be-exposed mindset still comes naturally today. Almost always I felt that I was being dishonest, two-faced and deceptive with everybody around me. (Sometimes I was. But not as often as my brain was telling me.) I had to work full time to keep such a big thing hidden. Such work was both exhausting and profoundly dispiriting.” Sophie Grace Chappell, ‘Being Transgender and Transgender Being’, Therapy Today, April 2016, https://counsellingfoundation.org/wp-content/uploads/2017/11/Sophie-Grace-Chappell-Being-Transgengder-and-Transgender-Being.-Therapy-Today-p10.-April-2016-Vol.27-Issue-3..pdf, p. 12.

¹⁹ Violet Irene, combox comment at 7: 27 am, March 12, 2013, https://gendertrender.wordpress.com/2012/04/25/ftm-detransitioning-experience-quitting-t-and-getting-back-to-life-as-a-woman/

The same author comments at 12:10 am:

Another detransitioned person, who has suffered from dysphoria both before and after transitioning and detransitioning, comments starkly:

TheLumious01, combox comment at https://www.youtube.com/watch?v=9L2jyEDwpEw&t=5shttps://www.youtube.com/watch?v=9L2jyEDwpEw&t=5shttps://www.youtube.com/watch?v=9L2jyEDwpEw&t=5s accessed January 17, 2018.

²⁰ Admittedly, some visibly male features such as beard growth are quite standardly adapted by shaving – but in most cases, this has neither the motive nor the effect of enabling the man to ‘pass’ as a biological female.

²¹ Puberty blockers themselves when initially used ‘merely’ produce appearances, whatever the medical risks, of a kind compatible with a natural slight delay of puberty (as opposed to an opposite-sex appearance which, however, crossdressing may convincingly create). Nonetheless, puberty blockers if continued close off an important opportunity of learning from one's changing body to identify with same-sex peers. Unsurprisingly, children who have been put on puberty blockers rarely transition back to their birth gender.

²² Note that even far more controversial identifications with a group to which one does not belong biologically eg identifications as a young child or a member of a different ethnic group still express something real, ie the reality of one's wish to belong to the relevant group or even belief that one is in some sense a member of that group. Feelings really do exist, but so does the world ‘outside’ those feelings, including our own bodies and some aspects of our mental lives of which we ourselves may not be entirely aware.

²³ Like the person with gender dysphoria, the same-sex attracted person has an atypical perception of some aspects of the world that may be very deep-seated (even if more fluid for many than is often assumed – see Diamond, LM and Rosky, CJ, ‘Scrutinizing Immutability: Research on Sexual Orientation and U.S. Legal Advocacy for Sexual Minorities’, Journal of Sex Research 53 (May-Jun, 2016), pp. 363-91CrossRefGoogle ScholarPubMed; on sexual attraction changes following gender transition which are still more common, see Auer, Matthias K. et al., “Transgender Transitioning and Change of Self-Reported Sexual Orientation”, PLOS One (October 9, 2014)CrossRefGoogle ScholarPubMed https://doi.org/10.1371/journal.pone.0110016). Sexual perceptions of the same-sex attracted person may resemble in some ways, if not reproduce, sexual perceptions of a heterosexually-attracted person of the opposite biological sex, just as more general perceptions of the dysphoric person may resemble in some ways, if not reproduce, perceptions of someone of the opposite biological sex. Like dysphoria, same-sex attraction may have biological as well as potential social contributing causes – a possibility which in neither case resolves the moral debate about the best way forward for the person.

²⁴ Even facial feminisation surgery may be undertaken partly, at least, as a means to entering into relationships which may be non-heterosexual in the context of the person's biological sex. Interestingly, one study found that quality of life was improved for those who simply had facial feminisation surgery, and that there was no statistical difference between this group and those who had gender reassignment surgery. Ainsvvorth, Tiffiny A. and Spiegel, Jeffrey H., ‘Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery’, Quality of Life Research 19 (September, 2010), pp. 1019-1024CrossRefGoogle Scholar.

²⁵ Pruss, Alexander, One Body: An Essay on Christian Sexual Ethics (Notre Dame, IL: Notre Dame Studies in Ethics and Culture, 2012)CrossRefGoogle Scholar; see also McCarthy, Anthony, Ethical Sex: Sexual Choices and their Nature and Meaning (Notre Dame, IN: Fidelity Press, 2016)Google Scholar.

²⁶ Permanent cessation of reproductive functioning may be, not merely foreseen but actually intended: a girl or woman with severe dysphoria may have a pregnancy phobia and actively desire sterility for that reason, whether such sterility is caused by a hysterectomy or by prolonged use of hormones.

²⁷ I owe this point to Andrew Sodergren whose comment I have reproduced here near-verbatim.

²⁸ Note that, in particular, a father who has transitioned surgically has rejected – in a far more radical way than a man who has had a vasectomy – the very powers which resulted in his children's existence: something that may be both hurtful and harmful for those children to contemplate.

²⁹ Anonymous, ‘Cross-dressing and Christianity’, in Shick, Understanding Gender Confusion.

³⁰ Having claimed that most gender-dysphoric adults “cannot, or will not, completely accept their given gender through psychological treatment” (emphasis added), the author of one study (himself very willing to support transition) notes that:

The author goes on to discuss two cases (‘Angela’ and ‘Charles’) which seem very similar but are resolved very differently by the married autogynephilic client in question (he explains that these cases are composites of several cases to highlight common patterns and protect the confidentiality of clients). He comments frankly:

The following claim is also worth noting: “Autogynephilic transsexuals are significantly more likely to regret reassignment surgery or experience poor outcomes than are androphilic transsexuals. The reasons for the differences between these two groups remain unknown.” Ibid, p. 496. On therapeutic issues, see also footnote 40 below.

³¹ Covert crossdressing may be less likely to cause social contagion or to distress family members, but can still affect the person profoundly – not least because crossdressing can have an addictive, obsessive quality about it of which some crossdressers have spoken – both those who have ceased crossdressing (see ‘Anonymous’ and ‘Kerry’ in Shick, Understanding Gender Confusion, and Robert Wenman, interviewed in Sophia Lee, ‘Transgenders Warn Others about Their Crazy Decisions to Live a Lie’, April 11, 2017, https://crtxnews.com/transgenders-warn-others-crazy-decisions-live-lie/), and also those who have transitioned and remain transitioned (see again Chappell, ‘Being Transgender and Transgender Being’). The trans-identifying therapist Anne Lawrence (‘Becoming what we love’) talks of a ‘love’ and not just a ‘sex’ element of autogynephilic crossdressing which – like other romantic love – can lead the person to sacrifice huge parts of their life in the pursuit of this love.

³² Littman, ‘Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports’.

³³ It may be objected that the transitioning adult could be a good role model for some young people, such as a young person whose dysphoria was so exceptionally severe and so resistant to other approaches that some form of transition really was the only effective palliative option. Even if we accept that a rare individual might be positively affected by the older person's transition, it is far more likely that those affected in practice would be gender-discordant and/or same-sex attracted young people who do not currently experience dysphoria to any/a great degree but are nonetheless highly vulnerable to social contagion.

Similar concerns regarding young people and social contagion may seem to apply to an intersex person transitioning – but there, an explanation in terms of the person's predominant biology is available and could in principle be given where appropriate. Intersex people who have not yet transitioned may not be risking social contagion to the same extent by living as members of the opposite biological sex - but may need to reveal their intersex status to some people, particularly friends who may become romantically interested in them, or more generally, friends who are close enough to need/deserve to know more about their lives.

³⁴ Without deliberate collusion with the overall project of transitioning, with which one may strongly disagree, it may still be possible to avoid pronouns in favour of (say) ‘Fred's’ rather than ‘his’ or ‘hers’; similarly a manager wishing to prevent workplace conflicts might intimate that the issue of pronouns will be left to the good sense of employees and that if they wish to avoid the chosen pronoun this may be done simply by using the chosen name. As the example of intersex people shows us, it is in any event not absolutely wrong in every case to use a pronoun which does not reflect the person's biological sex and the gender associated with that sex. As with terms such as ‘Father’, ‘Mrs’ or ‘Professor’, use of preferred names and pronouns by those who ideally would prefer not to use them is not a lie and may sometimes be necessary to avoid risk of harm – harm of triggering the person and/or harm to oneself, such as legal or employment repercussions.

³⁵ We might think here of legal situations such as ‘show trials’ where everyone present knows that the ‘confessions’ of political prisoners do not reflect reality in any way. Leaving aside cases of perjury and apostasy, would it necessarily be wrong to save oneself by ‘confessing’ where (because no-one would believe the assertions) there was no issue of deliberate deception by statements purporting to be truthful (any more than in theatrical representations)?

³⁶ In the words of one parent, commenting on an article on the gender-critical website 4^th Wave Now:

In an earlier comment in the chain (July 5, 2018 at 1:57 pm), the same commentator advises:

³⁷ Denise Shick, ‘Family Complications’, in Shick, Understanding Transgender Confusion.

³⁸ Lisa Marchiano, ‘The project of a lifetime: A therapist's letter to a trans-identified teen’, 4th Wave Now, May 10, 2018, https://4thwavenow.com/2018/05/10/the-project-of-a-lifetime-a-therapists-letter-to-a-trans-identified-teen//.

³⁹ Anonymous, ‘Making Mountains Out of Molehills’, at http://docs.wixstatic.com/ugd/8960cb_cc81b74cb79b4bca952c087cb059e9b3.pdf.

⁴⁰ See eg Sasha Ayad, ‘How I work with ROGD Teens’, November 12, 2018, http://gdworkinggroup.org/2018/11/. Hacsi Horváth (‘The Theatre of the Body: A detransitioned epidemiologist examines suicidality, affirmation, and transgender identity’, December 19, 2018, https://4thwavenow.com/2018/12/19/the-theatre-of-the-body-a-detransitioned-epidemiologist-examines-suicidality-affirmation-and-transgender-identity/) notes the paucity of literature on ‘non-affirmative’ treatment of people with dysphoria, and particularly, the lack of trials using newer ‘transdiagnostic’ approaches such as cognitive behavioural therapy, dialectical behavioural therapy and mindfulness therapy. He comments that “GD is not sui generis… it is well within the spectrum of conditions efficaciously treated with transdiagnostic approaches.”

⁴¹ Desisting or detransitioning people report the role of stress in exacerbating experiences of dysphoria: see for example Carey Maria Catt Callahan:

Commenting on alternative ways of managing dysphoria, another detransitioned person asks:

For an account by one gay-identifying man of how non-sexual male friendships helped him resolve his gender dysphoria, see Chad Felix Greene, ‘Gender Identity: Embracing My Masculinity’, https://mensmovement.com/gender-identity-embracing-masculinity/

⁴² A humorous cartoon on the website Detransition Info

https://detransinfo.tumblr.com/post/171457500190/redressalert-tehbewilderness-naamahdarling points out that no-one expects us to love our consciousness and that our bodies similarly are ‘us’ – we don't need to form a ‘relationship’ with something that is us. In the comment box, tehbewilderness remarks: