Dan,

The fact of the matter is this: there is no scientific evidence that “reparitive therapy” is either helpful or harmful, worse with resistant or refractory patients, or just plain foolish or folly. Those that practice “reparitive therapy” do so without any of the standard protections of human subjects or internal review boards specifically mandated by ethical protocol to protect patients; and while they frequently report extraordinary “success” (even to the level of repairing sexual fantasies), they adamantly refuse to release their research protocol and raw data to the scientific community for scrutiny. Those that oppose “reparitive therapy” equally lack any credible science and rely solely on an accumulation of anecdote – generally highly emotional, related to youth and suicide, which constitutes an especially limited cohort. The defies the axiom that anecdote is an indication of the need for research, not policy. I would note that when GLAAD made it a point to emphasize that the AMA and both APAs (psychiatry/psychology) declared “reparitive therapy” as medically unsound and unethical, I responded on their website that if they were able to provide credible research citations from legitimate journals, they could publish my picture formally apologizing to GLAAD, the AMA, and the APAs for my error. It never happened.

My point is that the LGBT community has used pure social influence – intimidation, threats to research funding, threats against endowment funding, threats against professional licensing, and in two states criminal charges – to prevent the controlled, empirical investigation of “reparitive therapy” for homosexuality, even with voluntary adult subjects. And to have convinced nearly every national medical and social service organization to declare “reparitive therapy” unethical without any scientific evidence whatsoever is in a class with Houdini and P.T. Barnum. Are they really wizards?

M. Stankovich,

Thank you for your reply.

I looked at the entire study and still do not see where there is any comparison to non-SRS trans people, or any conclusion that supports that SRS is doing harm. Additionally, note the suicide attempt drop between 1973-1988 and 1989-2003. This strongly suggests that the majority of suicides are due to a lack of societal acceptance rather than internal mental illness.

While I understand your frustration with purely dismissive language from critics, Kay Brown did offer a little more than that in support of her stance against McHugh:

“Autogynephilia, while NOT related to anorexia nervosa and body dysmorphic disorder (BDD), is related to Body Integrity Identity Disorder, a member of the family of Erotic Target Identity Disorders. This family is about sexuality and sexual orientations, which like heterosexuality and homosexuality have been shown to be very resistant to change, thus the move to outlaw “reparitive therapy”.”

Dan,

I merely provided a quote from the Swedish study for the sake of expediency. Please note the link to download the entire study as a PDF, including the methodology in its entirety.

As to the commentary of Kay Brown, I personally tire of the dismissal of critics as “phobic,” homo or now tran, as a cheap convention: it is impossible to have a legitimate disagreement and/or dispute that is not somehow based in some underlying subconscious, unnatural “terror” (“phobia”) of homosexuality – and the unstated “trick” is that your terror is that you might be homosexual yourself. The scam here is that the term “internalized homophobia” was originally intended to apply to homosexual self-loathing – or what the Holy Fathers would term the “conscience” – and not misapplied to anyone critical of a lifestyle contrary to the created order. I was taught in medical school to continue to question & gather information until a crystal clear impression of the problem emerges, then, state the obvious. Apparently, Mr./Ms. Brown resolves this suspension of reality by declaring it the “homophobic bigotry” of a “devout Roman Catholic,” while completely disavowing both his credentials, his position, and his reputation & respect in the psychiatric community.

Dr. McHugh has done nothing more than state the obvious: a femanized male is not a woman, and a masculinized woman is not a man. Duh. Gender Dysphoria, pursuant to the DSM-V and the ICD-10, is a profound mental illness that predictably & characteristically distorts an individuals perception of reality, and colluding in this process is insanity. And finally, his conclusion is evidence-based and customary: we do not treat mental illness with surgery, but with psychotherapy and medication. And McHugh wasn’t kidding when he concluded: “But gird your loins if you would confront this matter. Hell hath no fury like a vested interest masquerading as a moral principle.”

Well said, M. Stankovich! I rarely manage to understand your writings, but this one was crystal clear and effectively elucidated.

James Bradshaw,

Elective cosmetic surgery (such as botox facial injections or breast augmentation) is sinful or not sinful depending on the circumstances. If a woman has undergone a double mastectomy to better survive and endure breast cancer, I don’t think our Lord is so heartless as to put her receiving reconstructive surgery in the same ethical standing as a woman who, for purely selfish reasons, decides to get a breast augmentation or a man who decides to remove some stomach fat.

Surgery to correct a deformity such as a cleft palate is just that: corrective surgery. It doesn’t break what isn’t broken, which “gender reassignment surgery” does. Gender reassignment surgery — a biological impossibility — breaks, mutilates, and nips a perfectly natural, functioning part of the male or female body and in its place grafts on a fake, plastic “body part”, an unnatural aberration. A “sex change” surgery breaks what isn’t broken, deliberately defacing and defaming God’s natural, beautiful image. It is therefore a grave sin.

Father Deacon Patrick,

You make an excellent point. Cleft palates may be healed through truly restorative, corrective surgery as they are unnatural, conditional aberrations. To heal a cleft palate is to correct something that is incidentally broken/flawed. To butcher perfectly functioning, natural genitalia and graft on fake, pseudo-genitalia is to break something that isn’t broken and to therefore cause the body made in God’s own image to be mutilated and maimed. It is a grave, grave sin to abuse and so tarnish the image of the Creator. Man is not absolutely sovereign over himself, as deists and atheists believe. Man is ultimately accountable before His Creator, in this life and the next.

Well said, Deacon Patrick!

The study you cite, at least from what I can tell about the part you quoted, does not seem to support your claim that surgery “frequently results in worse pathological states than prior to the ‘correction’ “. What this shows is that there is a higher rate of suicide after surgery compared to the general non-transgender population, which is not surprising given issues they face in society. It does not compare SRS patients with transgender individuals who have not undergone SRS, or even transgender individuals after surgery compared to before surgery. The only way to support your conclusion would be to do a long term study of transgender individuals, randomly assign some to receive SRS, and compare how they do in follow-ups. Or, at least show that the suicide rate increases after surgery.

In response to the McHugh article, I would direct you here: https://sillyolme.wordpress.com/2015/06/10/a-wither-spoonful-of-poison/

Mr. Bradshaw,

I believe that this line of discussion is both superfluous & tangential to the ethical issue of surgical intervention for Gender Dysphoria. The fact of the matter is that research indicates that this “correction” does not only fail to achieve its intended goal – the “reintegration” of the person with their “real” gender, thereby alleviating the dysphoria and ending the suffering that characterizes the disorder – but it frequently results in worse pathological states than prior to the “correction”:

Results:
The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8–4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8–62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9–8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0–3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls.

Conclusions:
Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and
somatic care after sex reassignment for this patient group.

Dhejne, D, Lichtenstein, P, Boman, M, Johansson, ALV, Langstrom, N, and Lande, M. “Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in sweden.” PLoS ONE 6(2): e16885. doi:10.1371/journal.pone.0016885 [Available here

Secondly, I would direct the discussion to the reasoning behind the decision of Johns Hopkins University – pioneers in gender reassignment – to no longer perform the procedure. There is an excellent essay written by Paul McHugh, MD, Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School and the former psychiatrist in chief at Johns Hopkins Hospital (and the voice behind the moritorium) published June 10, 2015 here.

Protodeacon Brian,

Again, thank you for your response. You are correct – I am pushing my point too far against St. Paul for “effect”, however this aspect of Paul does seem to be the side emphasized by St. Gregory of Nyssa and others.

Thank you for the reading recommendations – I have printed off your essay’s and hope to get through them today. Kyle Harper’s book looks very relevant and being a native Oklahoman I have two reasons to read him 😉

James, that’s not how Christians, especially Orthodox Christians, understand sin or the effects of sin. Sin is not merely a deliberate transgression of a divine decree; it is behavior contrary to nature separating us from the personal Source of divine grace necessary for sustaining us in our natural state. The effects of sin and the resulting separation include congenital deformities like cleft palates, which are not natural but merely conditional and are therefore to be healed sooner or later through communion with God. Christ Himself healed people of such deformities, but sinful men sometimes inflict deformities on themselves and others.

Pdn Mitchell: If our bodies reveal divine intent as they are, then it is necessarily sinful to modify them for purely cosmetic reasons (as opposed to functional). I don’t believe that, though. As I said, I’m an open Deist, so I don’t subscribe to a theology that says God sovereignly decrees everything that is or that comes to pass.

However, I acknowledge that rejecting one’s perfectly functional and aesthetically sufficient body in favor of one that is disfigured is a reflection of mental illness. I don’t see where there’s sinful intent in it.

Dear Christopher,

First, you’re being very unfair to the Holy Apostle Paul, who also wrote 1 Cor. 11 and Eph. 5, both of which say quite a lot that is grandly good about both marriage and the distinction of male and female.

Second, of course there’s a lot more to marriage than sexual desire, and, no, you don’t need to belabor that point here. I think we all understand, thanks to the Holy Apostle Paul and much else in tradition.

Third, the ancient world was really immersed in sexual immorality and needed to be cleansed, and the Church performed that cleansing by availing itself of the wisdom it had at hand, which is not sufficient now but was sufficient then. (See Kyle Harper’s From Shame to Sin, Harvard, 2014).

Fourth, there are within the tradition principles that can help us correct the insufficiencies of the past in its understanding of sexuality. Here are a couple of offerings of my own, to which I hope to add at length in the future:

“Christian Anarchists? How Politics Corrupts Our Language of Relations”

“The Problem with Hierarchy: Ordered Relations in God and Man”

Finally, your point is important, and you are right to raise it. There are times when we need to tell our fathers in faith that their answers really aren’t nearly as sound and sufficient as they need to be. We now face new questions and will need new answers.

In Christ,
Pdn. Patrick

While I find transgender-ism to be a mental illness along the lines of other body dysmorphic disorders …, I’m not sure I find it a “sin” any more than wanting bigger breasts, a smaller nose or a fixed cleft palate.

Really? Transgenderism is no more a sin than fixing a cleft palate? This pretty much tells us where you’re coming from, James, excusing us to dismiss everything else you say. Unless you want to reconsider.

Thank your for your thoughtful reply Mr. Stankovich. Some thoughts:

While the Patristic Fathers happened to be monastic, they never disparage Christian Marriage as a “lesser” or inadequate, or insufficient path to salvation.

This is what I thought for 20 years. However, I have recently been disabused of this notion. I quoted St. Gregorys of Nyssa’s description of Christian Marriage as “The last sad stopping place” above. As Fr. Lawrence and Fr. Sergei document in their books, one can fill page after page of quotes from the Fathers (almost all of them the “big names”) that indicate that they indeed think of Christian Marriage primarily as a “concession” to our fallen sexual drive. St. Paul certainly thought in these terms, though he himself elewhere thinks in much higher terms and a deeper mystery. As Fr. Lawrence puts it, (I am paraphrasing) ‘Christian marriage is defiantly an ‘economy class’ way of salvation – monasticism trumps it in some writers’.

I highly recommend to you Fr. Georges Florovsky’s essay, “Antinomies of Christian History: Empire and Desert,” found in his Collected Works, Volume II, Christianity and Culture where he warns of the danger of establishing dichotomies in Christian life, monastic vs. “secular.” In the beginning, we were not created to be virginal nor celibate, and obviously, there was no point in imitating the “angelic life.”

Thank you for the recommendation – I saw that you quoted this essay over on monomakhos and I agree, it is a terribly important point. For some reason, I only have Volumes 5-10 (which I received as a gift years ago and have hardly cracked). I will be purchasing this Volume soon…

Finally, I would point you to Paul Evdokimov’s The Sacrament of Love, which is a beautiful, coherent, and unconfused exploration of conjugal love as at the heart of the Sacrament of Marriage

Again, thanks for the recommendation. Your the second person to recommend this book based on my recent ruminations. I will be purchasing this one very soon…