Celebrating Transition: Compassion or Cop Out?

Jan 23, 2019 by

By Felicity Wilson[1].

Summary: 

Gender transition is offered out of compassion—one does not like to see a person suffer. Perhaps it will help. But, we must think. Physicians limit the amount of pain killer prescribed because the risk to benefit ratio of excess usage is, ultimately, not in the patient’s best interest—even if the patient thinks it is. Should we also not carefully consider the risk to benefit ratio of exposing people to treatment with hormones, where we know that the risks are considerable—and include lethal conditions? Moreover, should we not consider carefully whether giving them those hormones over the course of a lifetime, where no medical assessment of the benefit or the risk has even been performed, amounts to malpractice? 

For pastors and bishops, please consider. Is encouraging or condoning a life-threatening practice pastoral? Is this love? Is the use of this liturgy compassion or a cop out?

A new liturgy

The recent release of a document[2] allegedly giving pastoral guidance and suggesting the use of the baptism liturgy to mark gender transition has highlighted a complex contemporary issue: transgenderism. Listening to those on both sides is enlightening and encouraging—most operate from what they perceive as the best of motives—love and compassion for their fellow person.

Those who advocate the church adopting this liturgy say that we must be compassionate towards those who find themselves with gender dysphoria. Being transgender is not the unforgiveable sin and we should not add to the already considerable burden of those who are gender dysphoric. Agreed.

Those who oppose the new liturgy point to the fact that the temptation to think that breaking out of our God-imposed biological limits, such as our sex, was first seen in Genesis and never brings fulfillment. Out of love, we need to encourage people to obey the Maker’s handbook, simply because disobedience always leads to pain. Agreed.

And then, there are those who point out that the theology for such a change in the Church of England’s doctrine has anthropological implications and that more theological study is warranted.[3] Absolutely agreed.

Why do I want to weigh in on this discussion? I am not a theologian. I am not a psychologist. I am not a social worker. I am not a clergy person or a bishop.

I am also not a hater. I am someone who is well-aware of the power one person has to influence another by being negative, positive or simply silent. I feel for all who struggle in this painful world—I am one of them. I am also aware that bishops passing this guidance subtly tells gender-dysphoric people that it is acceptable and even good to undergo gender transition. But, is it? In particular, is it safe? Does it make a bad situation better? To be precise, is it compassionate to celebrate, and thereby encourage others to participate in, dangerous and elective medical procedures that may include both surgery and use of dangerous medications to force a body of one biological sex to appear as if it were another?

A scientist’s assessment

I am a scientist. To be precise, I am a biologist and have both a master’s degree and a doctorate. I have studied immunology, pharmacology, cell biology, signal transduction, and the operation of steroids in these environments. I’ve tutored medical students. I’ve trained allergy specialists. To translate for all those theologians, psychologists, social workers, clergy, etc. out there, who lack the relevant scientific terminology, “the human immune system” is how we fight infection; “pharmacology and steroids” is drugs and their effect on the cells and systems of the body; and “signal transduction” is how cells talk to each other using chemicals like steroids, hormones, and even gases. These topics are fascinating to me. Therefore, I believe I bring a different, important, point of view to the table.

Let’s look at gender transition from the point of view of a cell biologist/pharmacologist. In the first instance, assume that the person who finds themselves feeling like the gender that is not reflected in their sex organs or their genetic make-up is pre-pubescent. After visits to physicians and psychologists, it may be decided to give them time to consider their options.[4] Since puberty is imminent, the young person may be given powerful drugs that oppose the natural processes of growing up—puberty blockers—to buy time, as it were.

Puberty blockers

Puberty is a complex process that requires many cells to, as it were, “talk to each other.” Putting it simply, cells in various glands do this through the release of chemicals or hormones, which then travel throughout the body, “telling” other cells to produce other hormones, which “tell” other cells to produce body hair, grow breasts, develop increased musculature, grow taller, mature the brain, etc. A puberty blocker is a drug that prevents the action or manufacture of these various chemicals.

The problem is that the chemicals or hormones that are released by cells have many functions. To make signal transduction understandable for the lay person, one could think of hormones as words that cells use to talk to each other. Cells can release a multitude of chemical “words.” The cells that “hear” the words (which can also release words) have over 50 “ears” or receptors, each specific for one word. They “hear” the “words” in combination with other “words.” Just like in our spoken language a word can be used in a number of very different sentences that may give very different instructions, a hormone can affect many cells and its meaning can be altered both by the type of cell it affects and by the other hormones affecting that cell.

Specifically, a commonly-used puberty blocker stimulates the release of Gondadotropin releasing hormone (GnRH) by the hypothalamus. The GnRH inhibits the pituitary gland from releasing follicle stimulating hormone (FSH) and luteinizing hormone (LH). Since one of the actions of FSH and LH is to cause the release of estrogen (a female hormone) and testosterone (male hormone) from the gonads, the effect is that puberty is blocked.

Just this glimpse of the complex interactions of hormones and tissues at puberty illustrates how a limited number of hormones can cause diverse changes in the body—and why blocking them may be so dangerous.[5] The use of puberty blockers is still defined as “experimental treatment” and is considered “off-label.” That is, there have not been any clinical trials showing that the treatment is safe or effective. There also have not been trials showing that the effects are fully reversible, even though many erroneously and misleadingly claim that they are.[6]

Moreover, scientists are still only scratching the surface of understanding signal transduction—we have little idea of how blocking one “word” will affect every type of receptor-expressing cell in every type of tissue in the body. We do know that the administration of puberty-blocking medications can result, not only in the delay of puberty, but also in altered bone mineralization and growth, infertility, and changes in brain development.[7] This makes sense, given that at puberty children grow, become fertile, their brains develop, and in males their circulatory and respiratory systems change to increase endurance.3

Now, say that a child or adult has reached the age of decision (often considered to be 16) and still thinks that her or his mind is trapped in the wrong body. Scientifically, this is of course nonsense since, in most individuals, every cell of their body either has XX (female) or XY (male) chromosomes. There are, of course, a very small number of individuals who have genetic anomalies, or who are born with ambiguous internal organs or genitals, but they are not the topic of this article.

This person will be administered cross-hormones, as well as continuing the GnRH agonist, where genetic females also receive testosterone and genetic males also receive estrogen. They may eventually elect to undergo gender reassignment surgery, where they are operated on, resulting in external genitalia that are more in accord with their gender identity. Removing the sex organs means that GnRH is no longer needed, but also that the person is rendered infertile. This may be perceived by some as mutilation and is certainly drastic, but the results of the surgery are foreknown and the risks presumably understood. One could argue, therefore, that the surgical procedure is ethical from the point of view of foreknowledge of the risks.

Treatment for life and its results

But that is not all the intervention needed. To continue in effective transition, the genetic female must continue to receive testosterone and the genetic male must be given estrogen. They must continue to take these hormones for life.[8] The transition process is, as it were, never complete.

Back to pharmacology. The steroid hormones include cortisol, testosterone, progesterone, prednisone, and more. These hormones are fat-soluble, which simply means they can pass into cells without difficulty. In fact, they interact directly with the cell’s DNA, changing which genes are expressed and drastically altering cellular behavior. Because they work in concert with other hormones, and their effect is different on different types of cells, they are extremely potent and the effects on the body are diverse. Interestingly, it is not only the sex-related tissues that have receptors for sex hormones. Even the immune system cells do.

Therefore, besides causing the person to develop or maintain their desired (and some undesired) secondary sexual characteristics, hormones have many side effects.[9] In genetic females taking testosterone, baldness, increased libido, increased anger and less ability to cry, considered typical of males, may develop. But, those taking testosterone also may develop high blood pressure, high blood sugar, high cholesterol, acne, changes in liver enzymes, increased red blood cells (leading to clotting), and reduced fertility.[10] Unfortunately, lack of data on long-term use of testosterone means that the science there is still uncertain.

Genetic males taking estrogen and anti-androgens will develop breasts, experience lowered libido and they may be more emotional. The hormones cannot reduce facial hair, reverse baldness, or change a male voice to a female. But, they can cause blood clots, high blood pressure, migraines, and liver enzyme changes. All of these risks have been documented over years of administration of contraceptive pills and HRT to women. Possibly more seriously, it is known that some cancers may be estrogen-dependent.[11] Taking both estrogen and progesterone for only five years doubles your risk of breast cancer.[12] In short, hormone therapy may make a person look more like their chosen gender, but it might also kill them by a heart attack, stroke, diabetic incident, liver disease or cancer!

Do no harm

Best practice in medicine is to do no harm and always to aim for an acceptable risk to benefit ratio. Those who have been on the contraceptive pill know that the responsible physician always prescribes the lowest effective dose—because the hormones are powerful and dangerous and they have an effect on many areas of the body. Those who have been on prednisone know of the unpleasant side effects such as bloating, thin skin, hump back, and more. They also know that the physician will always try to reduce the dose as soon as possible—because the hormones are powerful and dangerous and they affect many areas of the body. Many is the woman who has discovered too late that hormone therapy utilized during her quest for fertility has resulted in a mastectomy, chemotherapy and radiotherapy later in life.

Normal function of the body requires an elegant ballet of extremely precise levels of specific hormones released at different times. The administration of what the body perceives as huge and continuous quantities of hormones suitable for the gender which is not in accord with the genetic constitution of the person could be compared to killing a fly on a person’s forehead with a shotgun. Effective, but not healthy!

Conclusion: Is this compassion love?

Of course, gender transition is offered out of compassion—one does not like to see a person suffer. Perhaps it will help. But, we must think. Physicians limit the amount of pain killer prescribed because the risk to benefit ratio of excess usage is, ultimately, not in the patient’s best interest—even if the patient thinks it is. Should we also not carefully consider the risk to benefit ratio of exposing people to treatment with hormones, where we know that the risks are considerable—and include lethal conditions? Moreover, should we not consider carefully whether giving them those hormones over the course of a lifetime, where no medical assessment of the benefit or the risk has even been performed, amounts to malpractice?

For pastors and bishops, please consider. Is encouraging or condoning a life-threatening practice pastoral? Is this love? Is the use of this liturgy compassion or a cop out?

[1] Felicity Wilson (a pseudonym) has a PhD in Pharmacology. Her identity is protected because of previous experience of intimidation from trans activists.

[2] https://www.churchofengland.org/sites/default/files/2018-12/Pastoral%20Guidance-Affirmation-Baptismal-Faith.pdf

[3] https://mbarrattdavie.wordpress.com

[4] Keep in mind that, according to the Diagnostic and Statistical Manual of Mental Disorders, only 2.2-30% of gender dysphoric males continue to feel like females and only 12-50% of genetic females continue to self-identify as males.

[5] According to Dr. Paul Hruz, Professor of pediatrics, endocrinology, cell biology ad physiology at Washington University School of Medicine, “gender-confused children are being used as human guinea pigs” and suffer many “dangers and long-term consequences.” (https://onenewsnow.com/science-tech/2017/10/15/doctors-transgender-puberty-blockers-are-dangerous)

[6] For a detailed and scientific discussion of puberty and the effects of puberty-blockers, see this article, based on a review of the peer-reviewed literature, written by three leading physicians. https://www.thenewatlantis.com/publications/growing-pains#blocking_puberty

[7] Data on this is limited since large scale administration of experimental medications to children would be prohibited by most university Institutional Review Boards. https://www.sciencedirect.com/science/article/pii/S2444866417301101

[8] https://www.quora.com/Do-transgender-people-on-HRT-need-to-keep-taking-hormones-for-the-rest-of-their-lives

[9] For a description of the side effects of prednisone, a medication that mimics cortisol. https://www.mayoclinic.org/steroids/art-20045692

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583373/

[11] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62458-2/fulltext

[12] http://med.stanford.edu/news/all-news/2009/02/new-evidence-of-hormone-therapy-causing-breast-cancer-stanford-professor-says.html

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