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Transgender arguments hinge on sex versus gender—can you choose?

Published: 1 December 2013 (GMT+10)

In response to landmark article on ‘transsexualism’, Male and female He made them …, correspondent Grant S., from Australia, submitted this comment:

The condition known as xenomelia can tragically lead sufferers to desire that perfectly functional limbs be amputated.

I am a born again Christian and I am taking exception to your recent attacks1 on Transgendered individuals.

This condition MAY be a result of the FALL (one of the MANY things to have gone wrong because of sin), but your assertions that gender is ONLY XX/XY, I fear, may be overlooking OTHER areas of gender dysphoria (such as CHEMICALLY, in the brain).

I refer to the case of “Emma Hayes” (you would, no doubt, know her story). Her case highlights the false assumptions you are making in your campaign against transgenders.

CMI articles posted on Facebook assert that the desire to change gender is rooted in “social/conditioning” influences. HOW do you explain Emma wanting to cut off her penis at age THREE. How can this be attributed to “conditioning”? Her parents had NOTHING to do with her deciding to change from boy to girl. (Yes, I use the feminine pronoun, because, how can you categorically state that those with the body of ONE gender but the MIND of another should make their mind “fit” their physical body?)

The difference between transgenderism and homosexual behavior is that the Bible DOES forbid THAT-and PLEASE don’t give me that verse in Deuteronomy which you like to quote, forbidding men wearing women’s clothing-look at the context, it refers to men dressing as women in order to avoid military service.)

Homosexuality differs because it is a case ot two minds of the SAME gender having a relationship.

If a TG M-F, for instance, dates a male, who LOOK like a male and THINKS like a male, then that is minds of two DIFFERENT genders having a relationship. Yes there are only TWO genders, and I believe that your gender is more about how your brain is wired than how your body looks.

Dr Kathy Wallace responds:

Yes. I agree. Gender can be a complex issue in this fallen world2. Yet there are only two sexes or two natal genders, as you rightly say. Firstly, I would like to clarify that my article “Male and Female He Made Them …” was in no way an attack on transgender or gender dysphoric individuals.

What we think our brains are telling us may not always be correct or real.

I feel that you strongly believe that one can rely on the brain as the final arbitrator on confusing issues. However, what we think our brains are telling us may not always be correct or real. I draw your attention to a strange anomaly where one’s own body parts are not recognised by the brain as part of one’s own body. I am, by the way, not suggesting that this is what young Emma Hayes has struggled with.3 This condition is known as Body Integrity Identity Disorder, or BIID, also called ‘apotemnophelia’( and no, that is not the name of an Egyptian pharaoh!) and also, more recently, called ‘xenomelia’,4,5 ‘xeno’ meaning foreign, ‘melia’ derived from the Greek word for limb, ‘melos’.

The rather sad fact about this condition is that its victims want to amputate perfectly healthy limbs. These folk are not suffering a psychosis, are deemed rational and are aware of the bizarre nature of their desire to amputate their limbs, usually the left lower limb. They explain that the limb, or body part, in question does not feel like it belongs to them, and feels foreign, and they express a strong desire to become an amputee. Indeed, several authors cite the eighteenth century case of a man with xenomelia who enforced the amputation of his leg from a surgeon at gunpoint.6,7 People have also been known to acquire similar delusions after a brain injury, as famously described by Oliver Sacks in his book, “The Man Who Mistook His Wife For A Hat”.8

The brilliant neurologist Oliver Sacks in his book The man who mistook his wife for a hat wrote of the terrible delusions afflicting victims of brain injury.

In a study of sufferers of xenomelia it was determined that:7

  1. The condition is rooted in early childhood
  2. It is associated with marked distress, often leading to self-inflicted amputation attempts
  3. There is a male predominance, and recent studies show that women are more likely to desire bilateral amputations
  4. It is, as a rule, accompanied by a socially non-conforming attitude toward and admiration of “handicapped” individuals’, especially amputees’, bodies.9

In this study conducted in 2005, seventeen per cent of the subjects with xenomelia had obtained amputations, with six of these reporting feeling better than they ever had afterwards, to the point of not desiring an amputation any longer. I would like to stress that sufferers reported they had a strong desire for amputation at a very early age.

As an interesting aside, the opposite experience is sometimes described by people born without arms or legs, but who are keenly aware from a very young age of ‘phantom’ limbs. The phenomenon of a phantom limb involves awareness of, and sensation, including pain, in a limb that is physically absent, and people who experience phantom limbs report using their non-existent limbs on hand-rails to climb stairs and even to reach out to pick up objects.10

It is touted in the literature that people with xenomelia have an unrecognised right parietal lobe syndrome, therefore a ‘brain related’ issue.11 Xenomelia’s striking similarity to gender identity disorder or gender dysphoria has not gone unnoticed.12 The management of xenomelia is controversial, but should we amputate healthy limbs in individuals expressing a strong desire to have this done? Clearly, the answer is a resounding ‘no’!

Then, why would anyone advocate the amputation of healthy genitals and breasts in order to satisfy a gender dysphoria?13 Similarly, if amputation is deemed appropriate, due to the unwavering demands of a gender dysphoric individual, then so must liposuction be advocated on someone struggling with anorexia.14 Clearly, the brain and emotions can’t be trusted as the defining authority on the human experience of sex. We must pay heed to our Creator in whose Word we are told … male and female He made them.

Sex versus Gender: Are they separate? Can gender be chosen?

Former psychiatrist-in-chief at Johns Hopkins Hospital in Baltimore, Paul McHugh,15 previously involved in preparing gender reassignment patients for surgery for babies born with deformed, ambiguous or damaged external genitalia, said this: “I have witnessed a great deal of damage from sex-reassignment.”16

Wrote McHugh in ‘First Things’ in 2004:

‘We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness’—Johns Hopkins Hospital surgeon Paul McHugh
“The children transformed from their male constitution into female roles suffered prolonged distress and misery as they sensed their natural attitudes. Their parents usually lived with guilt over their decisions—second-guessing themselves and somewhat ashamed of the fabrication, both surgical and social, they had imposed on their sons. As for the adults who came to us claiming to have discovered their ‘true’ sexual identity and to have heard about sex-change operations, we psychiatrists have been distracted from studying the causes and natures of their mental misdirections by preparing them for surgery and for a life in the other sex. We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it.”16

He describes a study in which, according to McHugh:

“I wanted to see whether male infants with ambiguous genitalia who were being surgically transformed into females and raised as girls, did, as the theory (again from Hopkins) claimed, settle easily into the sexual identity that was chosen for them. These claims had generated the opinion in psychiatric circles that one’s “sex” and one’s “gender” were distinct matters, sex being genetically and hormonally determined from conception, while gender was culturally shaped by the actions of family and others during childhood.”

He described:

“… the practice of surgically assigning femaleness to male newborns who at birth had malformed, sexually ambiguous genitalia and severe phallic defects. This practice, more the province of the pediatric department than of my own, was nonetheless of concern to psychiatrists because the opinions generated around these cases helped to form the view that sexual identity was a matter of cultural conditioning rather than something fundamental to the human constitution.
Several conditions, fortunately rare, can lead to the misconstruction of the genito-urinary tract during embryonic life. When such a condition occurs in a male, the easiest form of plastic surgery by far, with a view to correcting the abnormality and gaining a cosmetically satisfactory appearance, is to remove all the male parts, including the testes, and to construct from the tissues available a labial and vaginal configuration. This action provides these malformed babies with female-looking genital anatomy regardless of their genetic sex. Given the claim that the sexual identity of the child would easily follow the genital appearance if backed up by familial and cultural support, the pediatric surgeons took to constructing female-like genitalia for both females with an XX chromosome constitution and males with an XY so as to make them all look like little girls, and they were to be raised as girls by their parents.
Reiner discovered that the male children behaved like boys and were obviously different from their sisters and other girls despite being brought up like female children.
All this was done of course with consent of the parents who, distressed by these grievous malformations in their newborns, were persuaded by the pediatric endocrinologists and consulting psychologists to accept transformational surgery for their sons. They were told that their child’s sexual identity (again his “gender”) would simply conform to environmental conditioning. If the parents consistently responded to the child as a girl now that his genital structure resembled a girl’s, he would accept that role without much travail.”

A resident psychiatrist, William Reiner17 undertook a systematic follow-up of these children. He had been a paediatric urologist prior to training as a psychiatrist, thus was aware of the difficulties with such cases. He focussed his attention on the male children that were surgically assigned female genitals in infancy. He set out to determine just how sexually integrated they would become as adults. Dr Reiner picked the condition ‘cloacal exstrophy’18 for his intensive study, “because it would best test the idea that cultural influence plays the foremost role in producing sexual identity”.16

Astonishingly, Reiner discovered that the male children behaved like boys and were obviously different from their sisters and other girls despite being brought up like female children.

The results were published in the New England Journal of Medicine in 200419, and were as follows:

Reiner assessed all 16 genetic males in the cloacal-exstrophy clinic at the ages of 5 to 16 years. Fourteen underwent neonatal assignment to the female sex socially, legally, and surgically; the parents of the remaining two refused the advice of the paediatricians to do so, preferring to raise their sons as boys.



What role does family environment and upbringing play in gender affirmation or denial? In the light of undeniable evidence, leading psychiatrist Dr William Reiner now believes that children are born either male or female, and, irrespective of subsequent surgery or rearing, they retain their birth gender.

Eight of the 14 subjects assigned to the female sex declared themselves male, and the two raised as males remained male. Five subjects were living as females; three were living with unclear sexual identity, although two of the three had declared themselves male; and eight were living as males, six of whom had reassigned themselves to male sex. All 16 subjects had moderate-to-marked interests and attitudes that were considered typical of males. All sixteen of these people had interests that were typical of males, such as hunting, ice hockey, karate, and bobsledding. Reiner concluded from this work that the sexual identity followed the genetic constitution. Male-type tendencies (vigorous play, sexual arousal by females, and physical aggressiveness) followed the testosterone-rich intrauterine fetal development of the people he studied, regardless of efforts to socialize them as females after birth.16

Dr Reiner is quoted in the New York Times saying: “The larger point is that it’s been a monstrous failure, this idea that you can convert a child’s sex by making over the child’s genitals in the sex you’ve chosen. This began in the 1950’s, when surgeons who felt helpless when they encountered intersex children thought they were helping them with sexual reassignment. The psychologists were saying, ‘You can make a boy or a girl or anything you want.’ It wasn’t true. The children often knew it.”20

Reiner now believes children are born either boys or girls, and that no matter what happens to them, be it surgery or rearing, they remain that way.21

Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will.—Romans 12:2

References and notes

  1. This comment was submitted in response to the article by Dr Kathy Wallace, Male and female He made them …, but the correspondent, Grant S., might also be referring to Dr Wallace’s subsequent response to another comment submitted to the article by French correspondent Tony B., which can be accessed here: George Jamieson /‘April Ashley’: A ‘model life’ for the ‘gender reassignment’ brigade? Return to text.
  2. www.mercatornet.com/articles/view/gender_bending_let_me_count_the_ways#idc-cover, 2011. Return to text.
  3. http://sixtyminutes.ninemsn.com.au/article.aspx?id=8674056. Return to text.
  4. Van Dijk MT, van Wingen GA, van Lammeren A, Blom RM, de Kwaasteniet BP, Scholte HS, Denys D. Neural basis of limb ownership in individuals with body integrity identity disorder. PLoS One. 2013 Aug 21;8(8):e72212. doi:10.1371/journal.pone.0072212. PubMed PMID: 23991064; PubMed Central PMCID:PMC3749113. Return to text.
  5. http://brain.oxfordjournals.org/content/early/2012/12/20/brain.aws316. Return to text.
  6. Johnston J, Elliott C. Healthy limb amputation: ethical and legal aspects. Clin Med. 2002 Sep-Oct;2(5):431-5. PubMed PMID: 12448590. Return to text.
  7. Hilti LM, Brugger P. Incarnation and animation: physical versus representational deficits of body integrity. Exp Brain Res. 2010 Jul;204(3):315-26. doi: 10.1007/s00221-009-2043-7. Epub 2009 Oct 25. Review. PubMed PMID: 19856177. Return to text.
  8. Sacks, O., The Man Who Mistook His Wife for a Hat (1985) Paperback, Touchstone Books, ISBN 0-684-85394-9. Return to text.
  9. First MB. Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder. Psychol Med. 2005 Jun;35(6):919-28. PubMed PMID:15997612. Return to text.
  10. Ramachandran, V K and Blakeslee, S, Phantoms in the Brain: Probing the Mysteries of the Human Mind, Sandra Blakeslee, 1998, ISBN 0-688-17217-2. Return to text.
  11. http://www.fortbildung.usz.ch/pdf/FS2013/2013_03_14-15_xenomelie.pdf. Return to text.
  12. Lawrence A. A., “Parallels between gender identity disorder and body integrity identity disorder: a review and update,” in Body Integrity Identity Disorder: Psychological, Neurobiological, Ethical and Legal Aspects, eds Stirn A., Thiel A., Oddo S., editors. (Lengerich: Pabst;), 154–172. 2009. Return to text.
  13. http://www.wnd.com/2013/10/amputating-healthy-organs-the-new-normal/. Return to text.
  14. http://www.dailymail.co.uk/news/article-2432956/Laura-Ferguson-Tragedy-showjumper-complained-headaches-dies-sleep-battle-anorexia.html. Return to text.
  15. http://en.wikipedia.org/wiki/Paul_R._McHugh. Return to text.
  16. http://www.firstthings.com/article/2009/02/surgical-sex--35. Return to text.
  17. http://www.oumedicine.com/urology/general-program-info/faculty/pediatric-urology/william-g-reiner. Return to text.
  18. ‘Cloacal exstrophy’ is an embryonic misdirection that produces a gross abnormality of pelvic anatomy such that the bladder and the genitalia are badly deformed at birth. The male penis fails to form and the bladder and urinary tract are not separated distinctly from the gastrointestinal tract. But crucial to Reiner’s study is the fact that the embryonic development of these unfortunate males is not hormonally different from that of normal males. They develop within a male-typical prenatal hormonal milieu provided by their Y chromosome and by their normal testicular function. This exposes these growing embryos/fetuses to the male hormone testosterone—just like all males in their mother’s womb. Return to text.
  19. Reiner WG, Gearhart JP. Discordant sexual identity in some genetic males with cloacal exstrophy assigned to female sex at birth. N Engl J Med. 2004 Jan 22;350(4):333-41. PubMed PMID: 14736925; PubMed Central PMCID: PMC1421517. Return to text.
  20. http://www.nytimes.com/2005/05/31/science/31conv.html?pagewanted=all. Return to text.
  21. http://www.jhu.edu/jhumag/0900web/babes.html. Return to text.

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Readers’ comments

Fe H.
From the experiments referred to in this article I am understanding that the best way to know the actual gender of a person is to know which is the major sex hormone of the person, testosterone or estrogen. So, if a person has the external genitalia of a female from birth, but has the major testosterone hormone, then he is a male. And the other way around. Am I understanding it right? So physiology, mentally, emotionally a person may be male/female but in a female/male body. In the end, its the hormones that can tell us, is that correct?
Dr Kathy Wallace

The short answer is 'no'. Both males and females produce both testosterone and oestrogens, but in different amounts. Hormones may not always help to clarify natal sex eg in cases of congenital adrenal hyperplasia, a genetic condition that affects the adrenal glands, both boys and girls will have high oestrogen levels. Very low oestrogen levels in pre-pubescent children may indicate hypopituitarism, a condition in which the pituitary gland in the brain, that controls the amounts of oestrogen and testosterone produced by the ovaries and testes, does not produce enough of its hormones.

Additionally, post-menopausal females have no or little oestrogen, but they are still 'female'. Similarly, males from an older population may not produce testosterone, or low levels, but they are not thought to be anything other than male.

Pre-pubescent females and males have equally low levels of oestrogens. Boys, after infancy, may have barely detectable levels of testosterone until puberty, up to only 20 ng per dL of blood. At puberty, oestrogen levels in both sexes increase, but at different rates. In boys, aged 10 to 13 years, testosterone levels can be as high as 1000 ng per dL of blood. Overly high levels of testosterone, causing rapid development of secondary sexual characteristics, may be caused by congenital adrenal hyperplasia.

A phenotypic female, with ovaries and a uterus, will not produce testosterone in the amounts needed for the male sex. In the absence of the sex determining portion, or region, of the Y chromosome, SRY, a baby will be female, developing ovaries and female organs. However, when the SRY is present, then pre-birth development progresses along the male pattern, and the baby will be male, with testes and male sexual organs.

Therefore, reliance on sex steroid hormones to determine sex may not work.

Birth sex or natal sex can be determined by chromosomal analysis in cases of ambiguous genitals.
Michael I.
Fantastic article Dr Wallace. It was very informative and a good response to the comment. Keep up the great work.
Debbie D.
"Reiner now believes children are born either boys or girls, and that no matter what happens to them, be it surgery or rearing, they remain that way." Makes sense since God knit us in our mother's womb.

And thanks for shedding light on a subject that the world could use to try to 'prove' the no-God theory. CMI is always such a blessing to me for helping in defending my faith....with gentleness and respect.
I have read the articles on transgender with interest and have a small contribution to make.

There are clearly no hard and fast rules in this area as some people are transgenders due to their physical conditions, some due to the processes of the mind and some a mixture of the two.

As christians however the instruction from the Lord is to deny ourselves. So we find that all sorts of things which we want to do or be we are called to shun or limit or struggle against or abstain from.

As in anything individual circumstances determine individual actions but as a general rule we could say that for those in such a situation they are called to deny themselves. So for example a young man who feels like and wants to be a woman and identifies as female is called as a christian to deny themselves. That's not going to be easy but it is their calling.

For someone who becomes a christian who has undergone surgery and lived as the opposite to their birth gender the question of what to do - if anything - will be more difficult and can only be worked out by them with the Lord.

For those assigned a gender due to surgery or those with development issues, such as the children above, again the particular situation can only be worked out by them.

Regarding those who aren't christians it is simply not our place to make determinations for them. Their lives are their own to live. The percentage of transgendered people is very low and surgery etc even lower. The current approach of the medical and psychological professions seems to take a balanced attitude.

The whole issue raises discussions on the balance of biology and the brain and upbringing in our lives, and hence evolutionary theory, but this is another question altogether which is not limited to transexualism.

Regards etc
E. M.
Thanks for these two articles. I have a relative who has lived as a transgender person for years, and it has become clear to me that this is both a psychological and spiritual problem, in this case involving being in a spiritual vacuum and becoming involved in the occult, and in false reading of the Old Testament (the 'ancient astronaut' reading of Ezekiel 1 promoted by people like Erich Von Daniken, in flat opposition to the Bible).

The other thing is that male-to-female transsexualism/transgenderism is very often really a cover for a sexual perversion called autogynephilia. Michael Bailey from Chicago Northwestern University and Ray Blanchard among others are psychiatrists and psychologists who have revealed this truth. Transgender activists can't stand such revelations.

I believe the time will come when biblical creationist Christians will be the only ones who will stand for healing of people with GID and their traumatised relatives, and against the transgender lobby, because once you deny a historical Adam and Eve, and the difference and equality of men and women, there is practically nothing to prevent such a 'strong delusion' from taking hold of legal and social institutions, as has already happened in every western country.
S. F.
An excellent response: respectful, complete, professional.

It is so sad to know there's so much confusion and ignorance in the body of Christ. We cannot be born-again without accepting Jesus as our Lord and Savior. How can we call Him 'Lord' without obeying Him?

I notice too, that the fact that homosexuality can have a spiritual origin -as all sin, it came into this world right after Adam's fall- is ignored in the articles I have read. It can well be the origin of that chemical imbalance in the brain.

Thanks for this article. The truth sets us free.
Bob S.
Whoever you yield yourself as slave to obey, that's whose slave you are, whether God or Satan. Original sin, inherited from Adam and Eve, accounts for all human desires that off of the Way that leads to genuine and absolute fullness of Life. This includes all covetousness, murder, stealing, and all sexual sin. Everyone is born a slave in this way, but Christ came to set us free from this slavery. The word, forgive means more than just pardon. It also means to send the sin away. Redemption is the setting free of a slave. While many experience a great emancipation from sin when they are born again, there is a progressive experience, from glory to glory and from faith to faith, of being redeemed, set free. We are not called to be natural. The natural mind is enmity against God. We are called to be joined to the King of kings in total submission and obedience to Him. May we never give up that walk and settle for a fleshly, fallen existence that no longer grows in His Righteousness and Holiness.

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