Love-in-Truth: Accompanying Those Suffering Gender Dysphoria
By Archbishop Paul S. Coakley
Every generation faces its own misunderstandings about the human person, which inevitably distort her relationship with God and neighbor. In our cultural moment, confusion is being fueled by the transgender movement, which supports body-centered changes for those who feel a disconnect between their biological sex and gender. As the issue continues to rise in prominence among the youth and divide society, we must be ready to speak about it in a pastoral and informed way.
Loving Persons in Pain
Any discussion of this topic must acknowledge the immense pain found within this small segment of the population.1 According to the largest study of transgender people in the United States, 40% have attempted suicide at least once—a rate almost nine times higher than the general population.2 Nearly half (47%) have been sexually assaulted3 and more than half (54%) have experienced verbal harassment.4 Furthermore, they are more likely than the general population to suffer from additional issues such as eating disorders, dissociative disorders, and substance abuse.5 This picture is alarming and as Catholics we must be concerned for the welfare of transgender persons and categorically condemn all forms of violence and discrimination against them.
In addition to eschewing all injustices, Jesus commands us to love as we have been loved (see John 13:34). Transgender people are either our brothers and sisters in Christ or, if unbaptized, our brothers and sisters in the human family. Each is loved by God—a person Jesus died to redeem. To love like Christ means to desire the good of the individuals in our lives and to walk with them, regardless of their degree of openness to the good. Since what is good for humanity is derived from the truth about our nature and purpose, we must begin with anthropology. But this is also where fault lines emerge. The culturally dominant transgender movement has an understanding of nature and purpose radically at odds with the Catholic understanding of the human person.
The transgender movement is rooted in a modern form of dualism where body and soul/mind/spirit are separate realities. In this view, the human person is the immaterial inhabitant of a physical body, which can and should be manipulated at will. Where the transgender movement sees a disconnect between the material and immaterial, Catholics see a beautiful unity (albeit one wounded by the Fall).
The Beauty and Truth of Creation
As Catholics we recognize through reason and revelation that God created everything good. This is particularly true of the human person, who is “very good” (Genesis 1:31) and exists as a unity of body and soul. The two so integrally comprise the person that any attempt to separate body and soul inevitably diminishes our very humanity. We don’t have bodies; we are bodies enlivened by souls.
Furthermore, as Christians, we learn from the Bible that the human person has a far greater dignity than we can know by reason alone: “God created man in his own image, in the image of God he created him; male and female he created them” (Genesis 1:27). Here we find the stunning truth that we image God in body and soul.6
But what does it mean to image God? “This likeness reveals that man, who is the only creature on earth which God willed for itself, cannot fully find himself except through a sincere gift of himself.”7 This is why the very next verse, Genesis 1:28, is to be fruitful and multiply—man and woman most fully image God by their own self-giving love, a truth reflected in bodies that were designed for fruitful union. There are two sexes,8 made for each other for the sake of life-giving love. In other words, the givens of body and soul are gifted to us so we may give ourselves in love.
God’s definitive statement on the goodness of the human person generally and the body in particular, however, is found in the Incarnation of Jesus. That God became fully man, even assuming a human body, is the ultimate affirmation of the entire human person. Incredibly, after the Resurrection Jesus didn’t shed His human body,9 but is and will be embodied for all of eternity, providing the final word on the dignity of the body.
Furthermore, in the Gospel, Jesus reaffirms that there are two sexes that God designed for each other.10 While only the body is sexed, each soul is adapted to a particular body, so there is a sense in which the body feminizes or masculinizes the soul.11 Because the sexed body causes this effect in a sexless soul, the two always align.
The two God-given sexes give rise to the two genders, whose lived expression varies across and within cultures, creating the beautiful diversity among men that is masculinity and among women that is femininity. Since gender should reflect the entirety of the person, Pope Francis emphasized that the “biological sex and the socio-cultural role of sex (gender) can be distinguished but not separated.”12 If gender is to serve the individual, it must neither be confined to rigid stereotypes nor untethered from the sex that grounds its meaning.
Gender Confusion
It is especially in regard to gender that humanity’s complexity and freedom come to bear. Upbringing, societal norms, religious beliefs, and individual choice are a handful of the many factors that affect how we think and feel about ourselves. All can promote or negate a healthy understanding of gender and its relationship to the body.
The situation is further complicated by sin. Sins against us can create wounds that make it difficult to recognize the body as gift. Our own fallenness also exacerbates the internal and external disharmony we experience in varying ways. These factors add to the challenge of recognizing the goodness of our bodies and foster discord within the unity of body and soul. Both are often keenly experienced by those who struggle with gender dysphoria, which is defined as “strong, persistent feelings of identification with another gender and discomfort with one’s own assigned gender and sex.”13 What tremendous suffering to feel a lack of congruity between one’s sex and gender! We must tread lightly and with great compassion as we seek truth related to situations filled with so much pain.
Given this anthropological foundation laid by reason and revelation, what is an authentic Catholic response to gender dysphoria? We must avoid the extremes of a) ignoring the pain of the person and dogmatically asserting that biological sex is the end of the conversation, and b) jettisoning the truth of the body in the hopes of relieving pain. A Catholic response must hold the struggle of the person in front of us as well as God-given sex. It requires listening with empathy as well as extending the invitation to receive God’s gift of the sexed body. It also means recognizing that all desires are rooted in something good, including the desire to identify as the opposite sex (which can be fueled by a wide range of good things, such as a desire to feel at home in one’s body, a desire to be seen as a person and not be objectified, a desire to pursue a life that feels authentic, etc.), even though pursuit of those desires can be misdirected. Ultimately, it entails inviting the suffering person to surrender to Truth Himself—Jesus. For it is through entrustment to Christ that all those struggling with gender dysphoria can receive assurance that despite the challenges and pain of bringing gender into alignment with one’s God-given sex, it is ultimately the way to happiness, holiness, and peace.
A Word about the Science
Our culture is stridently promoting what it calls gender-affirming care (which seeks to bring the body into alignment with one’s felt gender rather than working to align one’s felt gender with biological reality). Both our Catholic faith and the limited scientific research14 confirm this is not the answer. About a dozen studies show that for the vast majority of children—a whopping 73–94%—gender dysphoria resolves itself in adolescence.15
While the media likes to tout the short-term benefits of gender transition surgery,16 the most reliable long-term study shows that those who surgically transitioned had vastly higher suicide rates and suicide attempts than their peers.17 Even a report from the Centers for Medicare and Medicaid Services under President Obama was forced to admit “there is not enough evidence to determine whether gender reassignment surgery improves health outcomes.”18
Perhaps less dramatic, more reversible medical interventions are better? Puberty blockers are often promoted as a “pause button,” but this is extremely misleading. More than 95% of children who go on puberty blockers eventually transition to opposite sex hormones,19 so it is more accurately an on-ramp for gender affirming hormones. The findings of short-term hormone studies are typically over-hyped,20 and the one long-term study showed mixed results.21 It is also worth noting that puberty blockers and opposite-sex hormones are experimental, with long-term effects still unknown. Studies on how they impact a child’s brain development, bone mass, and fertility are only just beginning.
Experimental treatments on children are not the solution, and thankfully Europe is starting to back away from these approaches. Recognizing they went far beyond what the science supports, recently Finland, Sweden, Norway, and the U.K., have begun limiting forms of gender-affirming care. This year three lawsuits have been filed in the U.S. by de-transitioners against their doctors, hopefully paving the way for a reform of the reckless and sometimes aggressive way trans care is offered in this country.
Compassionate Engagement
We are called to bear witness to the truth inscribed in every human body and to do so with great love. As Pope Francis famously said, “I see the church as a field hospital after battle…. Heal the wounds, heal the wounds.... And you have to start from the ground up.”22 Confusion about the goodness of the human body, the gift of biological sex, and what it means to be male and female are foundational wounds. Healing requires us to speak about gender and sex in logical and compassionate ways, doing our best to speak into the other’s worldview. Love requires that we offer the truth in a time and manner that is appropriate to the relationship. For as St. John Paul II noted, evangelization should be “joyful, patient, and progressive.”23 So too the work of treating gender and sex confusion in our local field hospital.
Scorning transgenderism as crazy or sex change as fantasy misses the intense pain driving these ideas forward. Compassionate engagement fosters an openness to truth, but it requires that we seek first to understand. Truth-in-love accompaniment is especially crucial for those of us who have or will have the opportunity to walk alongside someone struggling with gender dysphoria. Accompanying someone who is facing her pain can be healing in itself (we typically underestimate the impact of being seen and loved in raw circumstances). However she may view herself, we must always hold in view the fullness of her personhood. None of us is reducible to our sexual identity, and we all have a God-given vocation to love in truth. Ideally, the relationship will also allow for sharing some of our story. We too are wounded, and we should be ready to share how Jesus has worked our own, unfinished healing for good.
Transformation in Christ is often painful, but it’s the path to wholeness and, ultimately, sanctity. What we need now is to seek personal holiness—encouraging others likewise as we come to embody St. Catherine of Siena’s maxim: Be who God meant you to be and you will set the world on fire.24
The Most Reverend Paul S. Coakley is the Archbishop of Oklahoma City. He currently serves as Secretary for the United States Conference of Catholic Bishops. His episcopal motto is “Duc in Altum” (Put Out into the Deep). This essay is revised and adapted from the Archbishop’s pastoral letter “On the Unity of the Body and Soul: Accompanying Those Experiencing Gender Dysphoria.” He has also written on the transgender ideology in “Transgenderism and the Eclipse of Truth.”
According to the William Institute (ibid), an estimated 1.6 million children and adults identify as transgender (Ibid), which equates to less than 1% of the population. This estimate is much lower than Pew Research Center’s estimate that 1.6% of adults are transgender or nonbinary, which doesn’t include children (Anna Brown, “About 5% of young adults in the U.S. say their gender is different from their sex assigned at birth,” Pew Research Center, June 7, 2022). Neither of these estimates captures those who struggle with gender dysphoria but do not identity as transgender or nonbinary.
“The Report of the 2015 U.S. Transgender Survey: Executive Summary,” December 2016, p3.
Ibid.
“The Report of the 2015 U.S. Transgender Survey,” December 2016, p201.
Cf. María Paz-Otero et al “A 2020 Review of Mental Health Comorbidity in Gender Dysphoric and Gender Non-Conforming People,” Journal of Psychiatry Treatment and Research, vol. 3, is. 1.
Cf. CCC 363–64.
Gaudium et Spes 24.
The UN estimates .05% to 1.7% of persons are intersex, meaning their sex is not easily determinable from their sex characteristics (“Intersex Fact Sheet”, United Nations). These exceptions do not disprove the sex binary but are instead anomalous expressions of it. There are only two kinds of sex cells (sperm and eggs), and therefore only two sexes. In the rare cases where a person’s sex appears ambiguous, science can be of great help in understanding and aiding the sexed body. The difficulties inherent in these situations in no way detract from the truth that all such persons are made in God’s image and likeness and deeply loved.
See Lk 24:36–43; Acts 10:41; CCC 999ff.
See Mt 19:3–8.
Theologians refer to this as the commensuration of souls to bodies. Cf. Thomas Aquinas, Summa contra Gentiles II, ch. 81, para 8.
Pope Francis, Post-Synodal Apostolic Exhortation, Amoris Laetitia, March 19, 2016, no. 56.
See “Gender Dysphoria,” Psychology Today.
For an excellent literature review, see Paul Dirk’s “Transition as Treatment: The Best Studies Show the Worst Outcomes,” Public Discourse, February 16, 2020.
The World Professional Association for Transgender Health’s found gender dysphoria remitted for 73-94% of adolescents. Cf. “Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People,” in International Journal of Transgenderism. For a summary of additional studies, see Sexual Identity, ed. John Desilva Finley (Steubenville, Ohio: Emmaus Road Publishing, 2022), pp.196–97. More research needs to be done on gender dysphoria that develops suddenly in adolescence, a phenomenon that has become increasingly common in recent years.
For instance, Dan Avery, “Gender-affirming surgery linked to better mental health, study finds,” NBC News, May 1, 2021.
Suicide was 19 times more likely and suicide attempts were 5 times more likely. Cf. Cecilia Dhejne et al “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” PLoS One, February 22, 2011.
Cf. “Gender Dysphoria and Gender Reassignment Surgery,” June 2, 2016.
97% transitioned to hormones in the study by Polly Carmichael et al “Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK,” PLoS One, February 2, 2021, and 98% transitioned in the study by Chantal Wiepjes et al “The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets,” Journal of Sexual Medicine, April 15, 2018.
The latest study being touted is from the prestigious New England Journal of Medicine. It concludes “GAH [Gender Affirming Hormones] improved appearance congruence and psychosocial functioning,” even though the lack of a control group makes it impossible to tie any findings to the hormones themselves. Additionally, only half of the participants showed modest improvements (biological males showed basically no improvement) and, tragically, two participants committed suicide during the study. Yet this is still touted as a promising success. For a thorough critique of the study and its conclusions, see Jesse Singal’s “The New, Highly Touted Study On Hormones For Transgender Teens Doesn’t Really Tell Us Much Of Anything,” Singal-Minded, February 7, 2023.
Cf. Henk Asscheman et al “A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones,” European Journal of Endocrinology, April 2011.
Fr. Antonio Spadaro, S.J. “Interview with Pope Francis,” September 2013.
St. John Paul II, Post-Synodal Apostolic Exhortation, Ecclesia in Asia, November 6, 1999, #2.
This is a paraphrase, and not her original quote. Cf. Oxford Essential Quotations, “St. Catherine of Siena”.
Archbishop Coakley's thoughtful, well written article is an important and welcome contribution to this discussion. Nevertheless, like so many other faithful Catholic commentators on this topic, his focus on pastoral tenderness when dealing with individuals suffering from gender dysphoria misses a huge obstacle in our path: those who do not suffer from gender dysphoria but actively and aggressively promote both gender ideology and "gender affirming" care. In my humble experience, these "advocates" have zero interest in dialogue or truth. They are angry ideologues, hell-bent on imposing the demonic transgender ideology on society and using every tool at their disposal to do so. Moreover, the transgender phenomenon is inextricably linked to the Sexual Revolution. In short, transgender ideology will not be overcome solely by pastoral care for those wounded by it any more than simply treating the wounded in a field hospital will win a war. The apostasy that underlies the Sexual Revolution and the heresy of moral relativism must be confronted and exposed. Together, these ideas are an Anti-Christ: the rejection of all truth and authority and the promotion of the selfish and slavish individual who places his own disordered desires and gratification at the center of the universe. Without an expanded effort against them, we will simply have a steady stream of severely, often mortally, wounded people seeking treatment in a field hospital that is itself under withering attack by the same enemy. I pray that our bishops, priests, and laity will have the courage to more effectively combat the Anti-Christ of the Sexual Revolution.