The Desire For A Sex Change
says sex-change surgery is a collaboration with a mental disorder, not a treatment.
By Richard P. Fitzgibbons, M.D.
should the Catholic community respond to men and women who think that a person's sex change operation would solve their
problem? Catholic teaching in this area is clear. It is impossible to "change" a person's sex. Hormone treatments,
cosmetic surgery and surgery to mutilate the sex organs do not change a person' sex. Confusion in this area has
come about because people tend to defer to scientists, particularly in areas where their personal experience is limited. Therefore,
when doctors, including those from the prestigious Johns Hopkins, have promoted "sex change" operations for physically
normal men who believed they were really women trapped in men's bodies or women who believed they were men trapped in
women's bodies, many have accepted the idea that it was indeed possible to change a person's sex. In an article
in First Things titled "Surgical Sex," Dr. Paul McHugh, of Johns Hopkins, laid out some of the history of the "sex
change" phenomenon.1 From the beginning, McHugh had doubts. He interviewed the men for whom the surgeons had created
bodies that appeared female, and found the claim that they were now women unconvincing. He states: None of these encounters
were persuasive...The post-surgical subjects struck me as caricatures of women. They wore high heels, copious makeup, and
flamboyant clothing; they spoke about how they found themselves able to give vent to their natural inclinations for peace,
domesticity, and gentleness--but their large hands, prominent Adam's apples, and thick facial features were incongruous
(and would become more so as they aged). Women psychiatrists whom I sent to talk with them would intuitively see through the
disguise and the exaggerated postures. "Gals know gals," one said to me, "and that's a guy."2
he became psychiatrist-in-chief at Johns Hopkins, McHugh decided to challenge what he considered to be a misdirection of psychiatry.
He encouraged a study already begun on the outcomes of such surgeries. The study found that while most of the clients said
they were happy with the outcome, the various psychological problems, which accompanied their feeling they were the other
sex, remained unchanged. They still had the same difficulties with relationships, work and emotions. McHugh concluded
that "to provide a surgical alteration to the body of these unfortunate people was to collaborate with a mental disorder
rather than to treat it."3 He ordered the practice halted at Johns Hopkins and tried to convince others that such interventions
were a misuse of psychiatry and surgery. However, in spite of the evidence, the support for the idea of "sex change"
operations has continued to grow. In fact, there have been several articles discussing whether it is advisable to begin the
"sex change" process in adolescence or even before.4 McHugh was frustrated to find that those promoting the
practice were not persuaded by empirical evidence:
One might expect that those who claim that sexual identity has
no biological or physical basis would bring forth more evidence to persuade others. But as I've learned, there is a deep
prejudice in favor of the idea that nature is totally malleable. Without any fixed position on what is given in human
nature, any manipulation of it can be defended as legitimate. A practice that appears to give people what they want--and what
some of them are prepared to clamor for--turns out to be difficult to combat with ordinary professional experience and wisdom.
Even controlled trials or careful follow-up studies to ensure that the practice itself is not damaging are often resisted
and the results rejected.5 Each cell of a person's body contains chromosomes which identify that individual
as either male or female. It is not simply a question of different genitals. Before birth prenatal hormones shape the brains
of boys to be different than those of girls.6 Mutilating surgery and hormone treatments can create the appearance of
a male or female body, but it cannot change the underlying reality. It is not possible to change a person's sex.
In promoting the truth about the human person, the Church is on the side of science when it proclaims that it is
not possible to change a person's sex. Therefore, persons who claim to have had their sex changed may not marry or be
ordained.7 A man who is surgically altered to resemble a woman may not marry a man and a woman with a male appearance may
not be ordained a priest. Unfortunately, the promotion of "sex change" operations has decreased investigation
into prevention and therapy for those suffering from gender dysphoria. However, a number of mental health professionals work
with and do help such individuals. For example, in one case a Catholic, married man who had several children wanted
to become female. He had completed electrolysis to remove facial hair and was on hormone treatment. As child he had been unable
to model after his angry father, aggressive older brothers, or hostile boys in the neighborhood. He viewed men as angry, violent,
dark people with whom he could not identify. Instead, he had escaped from what he perceived as the unsafe world of men, into
a fantasy female world where he felt safe. As he matured, these fantasies diminished and he married and had children. However,
at a certain point in his career he found himself in an extremely stressful situation both at work and at home, and his original
fantasy about being more safe as a female reemerged. In his therapeutic treatment, he came to understand the origins
of his inability identify with his masculinity. Then he worked on forgiving the men and boys who had hurt him in his childhood
and in his adolescence, especially his father and his brothers. In working with a spiritual director, he slowly came to experience
God as loving father who could protect him, and to develop a relationship with St. Joseph as a role model of male love. A
major goal of treatment was to help him see his own masculinity as a positive gift from God. In another case, a thirty-year-old
man with excellent athletic abilities was seeking "sex change" surgery. The therapist he consulted was able to help
him uncover serious emotional conflicts with his mother. She was a self-centered person and a substance abuser who had essentially
abandoned him as a child. Unconsciously, he thought that if he were a woman, he finally might receive his mother's love
and acceptance. Because he had not experienced a comforting, loving mother/son relationship, his ability to trust and feel
safe in the world was badly damaged. He thought that if he were a female he might feel protected in the world. As a result
of his regular participation in a "transgender support group" (which was biased toward encouraging "sex change"
procedures), he came to believe that there was a biological basis for his belief that he was female. It was extremely difficult
for the young man to admit his problems with his mother, or to acknowledge his feelings of disappointment, sadness, and resentment.
Eventually, through therapy, he was able to recognize the effects of his mother's dysfunction on his self-image.
Dealing with clients who have a desire to become the other sex, it is important not to take the desire at face value, but
to uncover the emotional conflicts which has led them to think they would be happier, safer and more confident as the other
sex. The recognition of emotional pain with peers or with a parent leads to the awareness of significant anger which can be
resolved through a process of forgiveness.8 At the same time it is necessary to treat low self-esteem, poor body image, sadness
and fears. Many of those who seek surgical "sex change" suffered from untreated and undiagnosed gender identity
disorder (GID) as children. For example, a therapist was consulted by a member of the family of a young woman who had told
her parents that she wanted "sex change" surgery after graduating from college. Since childhood, the young woman
had shown all the classic symptoms of GID.9 She had never had female friends, never wore a dress, never used make up, never
wore jewelry or dated a boy. She also insisted that her Catholic parents address with a boy's name which they agreed to
do. GID in children is a treatable condition; however, according to Zucker and Bradley, who are experts in the treatment
of this disorder in children, parental ambivalence is, in most cases part of the problem with parents ignoring or excusing
obvious problems.10 Zucker and Bradley encourage early intervention, not simply to avoid a later desire for a "sex change"
but to prevent the suffering, unhappiness, and isolation that children with GID experience. In the case of this young woman,
the therapist recommended treatment of GID to the family member who asked for consultation, but this recommendation was never
communicated to the parents. The young woman recently had her breasts removed. The other conflicts in those who seek
"sex change" surgery experience are a failure to embrace the goodness and beauty of their masculinity or femininity,
hatred of their bodies, deep resentment with a parent or peer, childhood loneliness and sadness, rejection by peers of the
same gender, intense fears of being betrayed and hurt, and a deep desire to be protected in the world. A less common conflict
is seen in some boys and men who have powerful artistic and creative gifts, which lead them to experience a strong attraction
to the beauty in the female world and to an identification with femininity. This artistic response can begin early in childhood
and can lead to a desire to be female. In rare cases, a parent wants a child to be of the opposite sex, dresses and treats
the child as being of the opposite sex and may even take the child to a "transgender support group." Self-knowledge,
forgiveness, skilled psychotherapy and good spiritual direction can all play a part in the healing process. Much more work
needs to be done in this field. Parents, pediatricians and educators need to be able to recognize GID in children. Mental
health professionals and priests should understand the origins of the condition, and know that successful treatment can occur
in persons who come to them with the desire for a "sex change." Finally, professionals with positive experience
in treating this problem need to share their expertise with others.