While shadowing Dr. Norm Spack in his work with the GeMS clinic at Children’s hospital Boston, I couldn’t help but wonder what my Mormon pioneer ancestors would think if they could see me now. Dr. Spack is one of the rockstars of LGBTQ health (with more of Kanye’s swagger than Taylor Swift’s mass appeal) and his work with transgender children has placed him at the forefront of the controversy over what role medicine has to play in helping gender-nonconforming kids grow up to be healthy and happy adults in bodies that match their gender.
The treatments offered by Dr. Spack at the GeMS clinic might alarm the average LDS reader–but they shouldn’t. Children who present to the clinic with severe adolescent gender dysphoria are supported with counselling and therapy until their bodies begin to go through natural puberty–a process fraught with terror for a transgender child. If you are a man, imagine suddenly waking up with growing breast tissue or a menstrual period. Women can picture their voices suddenly dropping and an unfamiliar growth between their legs. Now imagine going through this at age 13. These traumatic developments lead many transgender kids to self-mutilate, fighting back against their bodies that have so suddenly turned against them.
Not Dr. Spack’s patients.
This is because Dr. Spack’s patients are given GnRH analogues (so called “puberty blockers”), a reversible treatment that halts the onset of puberty (think Peter Pan) to give children, their parents, and their treatment team more time to evaluate the stability of the child’s gender identity before irreversible changes come–whether by the child’s own hormones or hormones supplied by the doctor.
The Family: A Proclamation to the World, a document akin to scripture in Modern Mormonism, states, “Gender is an essential characteristic of individual premortal, mortal, and eternal identity and purpose.” What it doesn’t say is how God intends us to know what the gender of the spirit residing in each body around us actually is.
Indulge me for a second as I engage in a little LGBTQ teminology 101. Sex and Gender are two separate things. The words male and female have to do with an individual’s sex. Man and woman with an individual’s gender. Remember, it is our gender that was declared eternal in the Family Proclamation, not our sex.
Science summary that can be skipped by all people who will agree that gender and sex are distinct terms:
During embryonic development, human beings start with a blank slate (actually, our default setting is to develop as female, but hey, this is 101). Their growing bodies are then acted upon by hormones derived from the action of their own chromosomes and those of their biological mother to differentiate along the spectrums of both gender and sex (again NOT synonyms. See Genderbread Person).
These hormones work centrally to change the development of one’s brain and help it differentiate along the man/woman spectrum. This brain development will then interact with societal and cultural norms to create the individual’s gender, one’s personal identity along the spectrum between man and woman.
The hormones also work peripherally on an individual’s genitals and other body tissues to create one’s sex, an individual’s place on the spectrum of maleness/femaleness, a place determined largely by the shape of the person’s genitals and chromosomes. At birth, the process is only partially completed. Once puberty comes, the hormones are once again ramped up by the body and differentiation continues.
End of Boring Science Summary
Did you catch all that? Well it’s important! At least it likely is to someone you love.
In over 99% of the population, the central “gender” identity of the person coincides with the peripheral “sex” of the person’s body. These are the people for whom the words of the Family Proclamation make sense. For everyone else, how are they to know what the gender of the spirit inhabiting their body is?
Is it in the genitals? These people will have a tough time figuring that out.
What about the chromosomes? Still not the answer for these people…
Well then how about in the individual’s personal firm and consistent identity, found through either prayer or just being alive, that lets the person claim the gender they’ve always had.
That is an answer my pioneer ancestors would resonate with. Personal revelation. God showing the answer in the face of much uncertainty, tailored to the individual to meet an individual need.
That is how things seemed to work in Kristy, a 15 year-old girl with severe developmental delay who happened to come into Dr. Spack’s office the same day I was shadowing. Kristy would not have been a candidate for baptism into the LDS church for two reasons. First of all, her mental capacities did not meet the standard of accountability set by the church for baptism. She is one of the spirits LDS leaders have said “retain the status of innocence” held by children incapable of sin.
The second reason is that Kristy was born a male and was initiating the process that will eventually lead to fully transitioning her body to match her gender as a girl. How did Kristy’s parents know this was the right choice for their child? Kristy showed them. She wore her sister’s dresses and refused to let her hair be cut. By age 8, she referred to herself as a girl and became increasingly uncomfortable with the sight of her penis.
I was lucky enough to be present at the appointment in which it was finally decided Kristy could receive her hormones, the ones that would make her body look like those of her girl friends at school. I will never forget how Kristy’s face lit up when the doctor asked if she would like to start her hormones. “YES!” she exclaimed without hesitation, beaming up at her parent’s on each side of her with excitement and a hint of gratitude. It was the kind of glee only a child can feel. I felt it my first time seeing Mickey Mouse at Disneyland. She felt it when she learned that she was finally going to look on the outside how she was on the inside.
By embracing their daughter’s gender early, Kristy’s parents have protected their daughter from the costs and risks of medical procedures used to help people transition after the body has gone through the irreversible changes of natural puberty. They have also ensured that Kristy’s ability to pass as a woman will be drastically improved, protecting her from the crippling burden of society’s transphobia that leads to a rising tide of violence and discrimination. I mean, the central holiday of the transgender community is a day of remembrance in which they commemorate all of their members who have been attacked or killed in the last year. Kristy (and society for that matter) can use all of the help she can get.
There is no reason for the LDS church to feel threatened by children like Kristy. After all, what could possibly affirm the premise that the gender of a human being is eternal and unchangeable than a person who is born in an unfamiliar body and yet knows his or her gender regardless. While Kristy’s embracing of the gender binary is not common to all gender minority people, it plants her firmly on a path consistent with LDS doctrine. Kristy is a woman spirit who was born in a male body. She is taking the appropriate medical measures to correct this problem. While her gender is eternal, the discrepancy with her sex is simply a result of being born to a fallen world where problems have been known to arise. It really can be that simple.
While I personally believe that every non-affirming message sent to a member of the LGBTQ community by the LDS church–or any group for that matter–is a mistake and a tragedy, I also believe that some of these rejecting messages are entrenched in the current doctrine. For example, Mormonism’s enshrinement of heterosexual union requires complex mental gymnastics (or maybe just a grad degree from the Harvard Divinity School) to reconcile with full acceptance of homosexuality.
It does not take a genius, however, to see that even current LDS doctrine holds a place for full acceptance of transgender people who embrace the gender binary right in the middle of mainstream Mormonism–a place that comes with great benefits (and I’m not just talking about having regular home teachers). We, as Mormons, should be looking for reasons to embrace rather than exclude others. Transgender children seem like an easy and important place to start.