Catholic Medical Quarterly Volume 70(1) February 2020

Transgender Issues: The Personal Side [1]

Helen Watt

Helen WattTransgender issues are hard to think and talk about, not just for those with no personal experience but also, in a different way, for those personally affected. This short essay is offered as a ‘lightning tour’ which I hope may be of interest both to the general reader and to those identifying as transgender themselves, their friends and their families. Briefly, I will look at moral dilemmas for adult individuals and parents of young and older children. Before that, however, I will flag some misunderstandings concerning how trans-identified people view themselves. These, however innocent, can contribute to an over-heated climate where too often the needs, not least the spiritual needs, of individuals and families go unmet. In public as in private, any comments of a more critical nature must be accurate as well as respectful, avoiding unwarranted assumptions.

To begin with, it should not be assumed that all who identify with the opposite gender necessarily deny their biological sex. Indeed, transmedicalists, a subgroup of trans-identified people, say frankly that they have an illness causing their unhappiness with their sex and identification with the opposite social gender. Crossdressing, surgery and/or hormones palliate their symptoms, they may say, and help them function better day to day, [2] but their biological sex remains what it is.

Staying with personal, as opposed to public policy issues (though the latter are certainly no less crucial), how should we think about these morally? This is an area where every aspect needs a separate focus. Even the physically less invasive step of social transition via crossdressing and changing names and pronouns raises challenging questions concerning the ethics of trying to ‘pass’ as a member of the opposite sex and social gender. Is there a moral absolute this violates, or a moral onus (how strong?) against it? Such questions can arise both for individuals themselves and for those to whom they may confide feelings of dysphoria – unease at the mismatch between biological sex and ‘felt’ gender – of a more or less intense and painful kind.

Does biological sex in every case require a corresponding male or female presentation? In thinking through this question, it is helpful to remember the case of intersex conditions, where reproductive biology is ambiguous. An intersex person raised in the opposite gender may find it very difficult to live instead in the gender associated with their true, fertility-oriented [3] sex – something only their recent puberty may perhaps have made apparent. While intersex people, too, may have genuine moral dilemmas concerning, for example, presentation to potential romantic partners, to say that they are obliged to transition the moment they realise their true sex would be a claim too far. Presenting socially as the sex one is – which one should accept, [4] however privately, as an unchangeable fact – is not a moral absolute itself for all conceivable situations.

That said, there is a great value in presenting socially, even if only subtly, as the sex one is, for a range of reasons [5] including transparency in social relations, and acting as a male or female role model, including for one’s own children. With transition to a gender discordant from one's biological sex, vulnerable young people who see one as a role model may be adversely affected or even influenced to identify [6] as transgender themselves. These and other, more basic factors should not be dismissed by those drawn to transition – perhaps of a radically invasive kind that ends their reproductive functioning, albeit seen perhaps as the only[7] way to save their mental health.

In regard to dating and marriage, appreciation of biological sex and its implications is fundamental. Those who accept traditional sexual ethics will understand the need to avoid attracting partners not available from that perspective, and to avoid absolutely crossdressing with any self-directed [8] sexual/romantic motivation. The latter applies in particular to heterosexual males, and older, married men crossdressing or considering transition will have wives and children to consider: something which will or should weigh very heavily in the choices they make.

Increasingly, we are hearing from young [9] and older [10] people who have ‘detransitioned’, as well as those [11] who have ‘desisted’ from pursuing transition and found other ways of dealing with any dysphoria that may remain. Reconciliation with one’s birth sex is particularly likely for young people following puberty (for those who did not take puberty-blockers), with some then experiencing homosexual or bisexual attractions and others heterosexual attractions. Despite the likelihood of such reconciliation, health professionals are increasingly, albeit controversially, [12] inviting children to live ‘as’ members of the opposite sex, followed by puberty blockers, followed by hormones and perhaps some form of surgery.

For parents anxious to avoid a lifetime of medical dependency for their child, one highly fraught question concerns the use of opposite-sex pronouns, to avoid the immediate risk of painful triggering and alienation from those who do not comply with this request. To be weighed against these risks is the real and serious risk that using oppositesex pronouns will give the impression that the young person is seen as male or female from that time forward – not just in presentation, but in all important respects. Even if it is not wrong in literally every situation (as the case of intersex people shows) to use pronouns that do not belong to the biological sex of the one referred to, this will indeed be a mistake in the great majority of situations involving a young person wanting to transition. Where necessary, avoiding – not replacing – birth-sex pronouns will normally be a better response.

The challenge for parents is to listen to their child’s views and feelings, but to be honest [13] about their own position regarding transition and those things (biological sex and its sexual ethics implications) that transition cannot change. Many children will eventually desist, and parents rightly wishing to encourage resilience should not focus on gender issues to a counterproductive extent. Gender-critical parents on sites such as 4th Wave Now recommend broadening a dysphoric child's activities and interests and spending ‘normal’ time with the child, of a kind that has nothing to do with gender.

Detransitioned or desisted young adults repeat such advice, and remind those currently facing these intensely demanding family situations that there is no quick fix and that parents are shepherds, not engineers. [9] The same applies to other guides, responding (say) to a dysphoric adult's call for help. Picking their way, with their intelligent charges, through patches of greater as well as lesser moral certainty, good shepherds can only strive to guide them in this formidable terrain with all the skill and empathy they can.

 References and Notes

  • See also our book review on page 19. Inventing Transgender Children and Young People.
    Reviewed by Pravin Thevathasan. Catholic Medical Quarterly 2020 Volume 70:(1) page 19
  1. A version of this article was published by Catholic World Report on 13 August, 2019,
  2. The extent to which cross-sex hormones and surgery have a longterm positive mental health outcome for transitioned people overall is, of course, disputed. For a recent study of high-quality Swedish data, see Richard Bränström and John E Pachankis, ‘Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Population Study’, American Journal of Psychiatry, 4 October, 2019,
    For a response to this study, see Mark Regnerus, ‘New Data Show “Gender-Affirming” Surgery Doesn’t Really Improve Mental Health. So Why Are the Study’s Authors Saying It Does?’ Public Discourse, 13 November, 2019,
  3. Bryan R. Cross, ‘Gender Ideology and the Catholic Church’ , Public Discourse, 25 June, 2019,
  4. Catechism of the Catholic Church, 2333,
  5. Helen Watt, ‘Gender Transition: The Moral Meaning of Bodily and Social Presentation’, New Blackfriars, online first 18 April, 2019,
  6. Lisa Littman, ‘Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports’, PLoS ONE 13(8) (2018),
  7. The too-ready assumption that this is the only practical solution is challenged both by detransitioned and desisted adults and by gendercritical therapists. See, for example, Sasha Ayad, ‘How I Work with Gender-questioning Teens’, 12 November, 2018,;
    Hacsi Horváth, ‘The Theatre of the Body: A detransitioned epidemiologist examines suicidality, affirmation, and transgender identity’, 19 December, 2018,;
    contributors to Michele Moore and Heather Brunskell-Evans, eds., Inventing Transgender Children and Young People (Newcastle upon Tyne: Cambridge Scholars, 2019), including Robert Withers, ‘Be Careful What You Wish For: Trans-Identification and the Evasion of Psychological Distress’, pp.121-132; and contributors to Heather Brunskell-Evans and Michele Moore, eds., Transgender Children and Young People: Born in Your Own Body (Newcastle upon Tyne: Cambridge Scholars, 2018), including Carey Maria Catt Callahan, ‘Unheard Voices of Detransitioners’, pp.166-180.
  8. Anne Lawrence, ‘Autogynephilia and the Typology of Male-To-Female Transsexualism: Concepts and Controversies’, European Psychologist 22 (2017), revised version at
  10. Horváth, ‘The Theatre of the Body’; Callahan, ‘Unheard Voices of Detransitioners’.
  11. Sam, ‘Baptised in Fire: A relieved desister's story’, 4th Wave Now, 12 March, 2018,
  12. For ongoing discussion by critical health care professionals and researchers, see the Pediatric and Adolescent Gender Dysphoria Working Group at
  13. Inga Berenson, ‘Acts of Love’, 4th Wave Now, 15 February, 2019,