Understanding Gender Dysphoria Page 2
To enter into an informed discussion of transgender issues is to switch gears a little away from a discussion about sexual orientation. We can return to it, but it is not the focal point in the way it is when discussing homosexuality, heterosexuality and bisexuality.
To discuss being transgender is to discuss one’s experience of gender identity, one’s sense of oneself as male or female, and how that psychological and emotional experience is not aligning with one’s birth sex.
Background
To begin to understand gender dysphoria, it can be helpful to back up and discuss a broader context based on our understanding of sex and gender. When we refer to a person’s sex, we are commonly making reference to the physical, biological and anatomic dimensions of being male or female.5
These facets include chromosomes, gonads, sexual anatomy and secondary sex characteristics.
Key Terms
Biological sex: As male or female (typically with reference to chromosomes, gonads, sex hormones, and internal reproductive anatomy and external genitalia).
Primary sex characteristics: Features that are directly part of the reproductive system, such as testes, penis and scrotum in males, and ovaries, uterus and vagina in females.
Secondary sex characteristics: Have no direct reproductive function, for example, facial hair in males and enlarged breasts in females.
Gender: The psychological, social and cultural aspects of being male or female.
Gender identity: How you experience yourself (or think of yourself) as male or female, including how masculine or feminine a person feels.
Gender role: Adoptions of cultural expectations for maleness or femaleness.
Sex is frequently distinguished from gender. Gender refers to the psychological, social and cultural aspects of being male or female. When we refer to someone’s gender identity, we are thinking of how a person experiences him- or herself (or thinks of him- or herself) as male or female, including how masculine or feminine a person feels. Gender identity is often associated with gender role. Gender role, then, refers to ways in which people adopt cultural expectations for maleness or femaleness. This includes but is not limited to academic interests, career pursuits and so on.
For most people, these various facets or dimensions of sex and gender align in ways that are essentially taken-for-granted realities. Most people you have met have a relatively unremarkable experience (or remarkable in the sense of all of these facets coming into alignment) of being born male or female (with the alignment of the various biological/physical/anatomical features noted above), identifying as a man or a woman, and feeling masculine or feminine within the cultural context in which they are raised.
But variations occur in these areas. For example, there is likely greater variability in how masculine or feminine a person feels, and that is often a reflection of whether they are reared in an environment with rigid gender roles and how well that person’s experiences line up with those expectations.
These variations occur in other areas as well and are often discussed as intersexuality or an intersex condition.6 In the area of biological/physical/anatomical sex, we can note several deviations from the norm of being born male or female. For example, a former client of mine had been diagnosed with Klinefelter Syndrome, a genetic disorder of gonadal differentiation in which that person had an extra X chromosome (XXY).7 Another person could be born with either incomplete or mixed ovarian and testicular tissues, a condition that has often been referred to previously as true hermaphroditism.8
Table 1.1. Physical/Biological/Anatomical Facets of Being Male or Female
Facet Male Female
Chromosomes XY XX
Gonads Testes Ovaries
Sexual anatomy Scrotum, penis, vas deferens, etc. Labia, clitoris, vagina, fallopian tubes, etc.
Secondary sex characteristics Greater muscle mass, etc. Wider hips, enlarged breasts, etc.
A friend of mine has yet another physiological condition—androgen insensitivity syndrome—as a result of malfunctioning gonads and other prenatal concerns. Although she does not choose to identify as intersex, many of these individuals would describe themselves that way, referring to any number of variations from the norm that make identifying as male or female problematic.
Table 1.2. Understanding Sex and Gender
Biological sex Male Female
Gender identity Man Woman
Gender role Masculine Feminine
Where do gender identity concerns fit into all of this? I located androgyny in between man and woman as gender identity. Androgyny can refer to not having a clearly defined sense of self as a man/woman, or it can refer to a bringing together of male/female qualities or characteristics.
Table 1.3. Exceptions to Binaries
Biological sex Male
Intersex
Female
Gender identity Man
Androgyny
Woman
Gender role Masculine
Outside cultural norms
Feminine
This book is about an experience that is different from what I have been discussing so far, although there are elements of biological sex, gender role and gender identity that are all important in the discussion. Gender identity concerns—or what we refer to as gender dysphoria—refers to experiences of gender identity in which a person’s psychological and emotional sense of themselves as female, for instance, does not match or align with their birth sex as male. This would be the more common presentation, but the reverse may also be experienced: a person’s psychological and emotional sense of themselves as male does not match or align with their birth sex as female.
Our illustration changes, then, to something that does challenge the binary, but it does so not by residing in between the two experiences of man/woman; rather, the experience locates itself in the other (psychologically/emotionally) in ways that are often quite difficult to fully understand or empathize with.
Figure 1.1.
Dysphoria means being uneasy about or generally dissatisfied with something. Thus, gender dysphoria refers to the experience of having a psychological and emotional identity as either male or female, and that your psychological and emotional identity does not correspond to your biological sex—this perceived incongruity can be the source of deep and ongoing discomfort. Specifically, gender dysphoria, is on the one hand the experience of being born male (biological sex) but feeling a psychological and emotional identity as female. Similarly, gender dysphoria is the experience of being born female (biological sex) but feeling a psychological or emotional identity as male. When a person experiences gender incongruence and it is causing them significant distress or impairment, they may meet criteria for the diagnosis of Gender Dysphoria.9
However, as we broaden the discussion to transgender issues, we begin to extend the discussion beyond merely the experience of gender dysphoria, an experience that might be characterized by gender incongruence in which the person does not experience an aligning of birth sex and psychological sense of gender. Transgender is an umbrella term for the many ways in which people might experience and/or present and express (or live out) their gender identities differently from people whose sense of gender identity is congruent with their biological sex.
Key Terms
Gender dysphoria: The experience of distress associated with the incongruence wherein one’s psychological and emotional gender identity does not match one’s biological sex.
Transgender: An umbrella term for the many ways in which people might experience and/or present and express (or live out) their gender identities differently from people whose sense of gender identity is congruent with their biological sex.
Cisgender: A word to contrast with transgender and to signify that one’s psychological and emotional experience of gender identity is congruent with one’s biological sex.10
Gender bending: Intentionally crossing or “bending” gender roles.
Cross-dressing: Dressing in the clothing or adopting the p
resentation of the other sex. Motivations for cross-dressing vary significantly.
Third sex or third gender: A term used to describe persons who are neither man nor woman, which could reference an intermediate state or another sex or gender or having qualities of both man/woman in oneself.
Transsexual: A person who believes he or she was born in the “wrong” body (of the other sex) and wishes to transition (or has transitioned) through hormonal treatment and sex-reassignment surgery.
Male-to-Female (MtF): A person who is identified as male at birth but experiences a female gender identity and has or is in the process of adopting a female presentation.
Female-to-Male (FtM): A person who is identified as female at birth but experiences a male gender identity and has or is in the process of adopting a male presentation.
Genderfluid: A term used when a person wants to convey that their experience of gender is not fixed as either male/female but may either fluctuate along a continuum or encompass qualities of both gender identities.
Genderqueer: An umbrella term for ways in which people experience their gender identity outside of or in between a male-female binary (e.g., no gender, genderfluid). Some people prefer a gender-neutral pronoun (e.g., “one”).
Drag queen: A biological male who dresses as a female (typically flamboyant dress and appearance) for the purposes of entertaining others. Such a person may not experience gender dysphoria and does not tend to identify as transgender.
Drag king: A biological female who dresses as a male (stereotypic dress and appearance) for the purposes of entertaining others. As with drag queens, such a person may not experience gender dysphoria and does not tend to identify as transgender.
Transvestism: Dressing or adopting the presentation of the other sex, typically for the purpose of sexual arousal (and may reflect a fetish quality). Such a person may not experience gender dysphoria and may not identify as transgender. Most transgender persons do not cross-dress for arousal and see transvestism as a different phenomenon than what they experience.
Intersex: A term to describe conditions (e.g., congenital adrenal hyperplasia) in which a person is born with sex characteristics or anatomy that does not allow clear identification as male or female. The causes of an intersex condition can be chromosomal, gonadal or genital.
A person could be under the transgender umbrella and be gender dysphoric (experiencing significant incongruence that is distressing). Another person could cross-dress and find the act of cross-dressing sexually arousing (but they might not experience the gender dysphoria the other person reports). Still another person could cross-dress with a strong desire to start hormonal treatment with an eye for sex-reassignment surgery. Yet another person could do drag shows and be quite flamboyant in presentation (e.g., drag queen or drag king), which may have little if anything to do with a subjective experience of dysphoria or a desire for sexual arousal. That person would unlikely identify as transgender, although some might, and that person’s decision could be tied to motivations to cross-dress in this manner.
It should be noted that not every expression of gender variance defined in the sidebar would report gender dysphoria. Most people who have an intersex condition, for instance, do not experience gender dysphoria, although they have a higher incidence rate than those who do not have an intersex condition, and many would report going through a time of navigating gender identity questions.11 Likewise, most people who perform in drag would not report gender dysphoria as such and may not identify themselves as transgender—nor would those who do identify as transgender necessarily consider those who perform drag to be transgender.
If you are beginning to get the sense that this could get complicated, you are not alone. This is an area that requires time and patience to unpack and truly understand—and even then, we do so with humility given how much we do not know at this time. But the church is going to need to spend some time on this topic. I urge church leaders to spend time in careful reflection as we think about the best way to engage the broader culture from more of a missional approach while simultaneously considering how to come alongside people within our own Christian communities who are navigating this terrain.
Toward a Reasoned Response
This brings us back to the person. I am thinking here of the person who is navigating gender identity questions in his or her life. I am thinking of the person who experiences gender dysphoria. That experience of gender incongruence—the experience of biological sex and psychological experience of gender not aligning—can also be experienced along a continuum. In other words, gender identity concerns are not one thing experienced in exactly the same way by all people everywhere who experience it. Rather, think about the experience of incongruence and distress/discomfort reflecting different degrees of both incongruence and discomfort.
What is the best way to proceed for the person who experiences gender dysphoria? The remainder of this book takes that into consideration, but let me outline a few things for us to consider as we move in the direction of a more thoughtful response.
Let’s consider what we have said so far: the person is navigating gender identity concerns. These concerns are real and often quite confusing and isolating. The person worries about who would believe them, what people would think about them, and so forth. This is tremendously isolating and often associated with other concerns, such as depression and anxiety. One reviewer shared with me that she had a good friend who cross-dressed and abused a significant amount of alcohol to suppress her dysphoria; she shared that the substance abuse abated once her friend was able to come to a place of congruence.
This is also not a particularly common concern. Most people experience a remarkable alignment of the many facets that make up biological sex and their sense of themselves as male or female. But for those who experience gender identity conflicts, the church will need to consider how best to respond.
At the level of the individual, it can be helpful to ask a simple question, such as: How is the gender identity conflict experienced by this person? Invite the person to tell you more about their experiences.
Figure 1.2.
Keep in mind, too, that the person is navigating gender identity questions in a cultural context in which many people will respond to them out of a culture war mentality. No one navigates gender identity concerns in a vacuum. Rather, each person who faces this unique challenge does so in a sociocultural context in which sex and gender are being discussed and debated.
As I mentioned earlier, some people are capitalizing on discussions in this area to deconstruct sex and gender. I will discuss this in greater detail in chapter two. David Kinnaman of the Barna Group, in discussing gay marriage and reflecting on our rapidly changing culture, observed that
Figure 1.3.
the data shows that evangelicals remain countercultural against a rising tide of public opinion. If the sands have shifted under evangelicals’ feet in the last 10 years, we at Barna predict it will seem the ground has completely opened beneath them during the next 10. In part, that’s because the very belief that same-sex relationships are morally wrong is deemed by many to be discriminatory and bigoted.12
This comment by Kinnaman is in reference to same-sex sexuality, but the overarching discussion is about LGBT issues in general. In other words, the cultural opinion surrounding gay marriage represents a broader cultural opinion that extends to transgender issues and gender variant persons. These cultural shifts frequently trigger a response from social conservatives of concern and, in some cases, fear for the erosion of long-held norms. These battles are played out in politics, entertainment, the media and education. The person you are talking to is unlikely involved in these spheres but may simply be looking for support as they navigate this terrain.
As Christians provide care to people in a sociocultural context characterized by ideological and political battles, we need to think about rising above the culture war when providing ministry and meaningful pastoral care and support. We keep it in view (it
is inescapable) while we provide services and compassionate care.
Why is this important? There is good reason to believe that the next generation of Christians tends to value a relational ethic that does not sacrifice relationships even when drawing distinctions in ethics and morality:
The Christian response to these issues [marriage, ethics, human flourishing, and so on] has to be rooted in a deeply relational ethic—that sexuality is a relational and interconnected aspect of our humanity. That relationships matter, including those between people who disagree.13
We will want to keep this in mind, and this book is intended to respect that shift in how discussions are carried out between people where there is disagreement, but it is at least important to recognize this cultural shift among Christians.
Unfortunately, one way people respond to transgender issues is to devalue the person who is gender variant and simultaneously turn to rigid stereotypes of gender. That reaction is not only overly restrictive, but it can create a forced choice for those who do not fit into those rigid categories. It won’t be helpful to stress stereotypes that people are unable to adopt. Also, keep in mind that we have witnessed a cultural shift that may contribute to greater uncertainty around sex and gender.14
Also, I will share later some thoughts and suggestions on what it looks like to live out various expressions of gender identity concerns, but generally speaking, I can see the value in encouraging individuals who experience gender identity conflicts to resolve the conflicts in keeping with their birth sex if possible. Where those strategies have been unsuccessful, I recognize the potential value in managing the gender identity conflict or concern through the least invasive means (recognizing surgery as the most invasive step toward expression of one’s internal sense of identity). I will come back to this, as it warrants more attention. There is a risk, too, with so much media attention focusing almost exclusively on transsexuality while there are many other expressions and experiences of transgenderism and gender variance. I will say this for now: Given the complexities associated with these issues and the potential for many and varied presentations, pastoral sensitivity should be a priority.