Culture,  News

Why surgery is not the answer for transgender

This should be the last item on transgender for the week, but it is one that readers will want to pay very close attention to. Dr. Paul McHugh is the former psychiatrist in chief at Johns Hopkins Hospital, and he has penned a revealing column for The Wall Street Journal opinion page. In short, he challenges the notion that sex-reassignment surgery is good for transgendered persons. His data are very compelling. He writes:

You won’t hear it from those championing transgender equality, but controlled and follow-up studies reveal fundamental problems with this movement. When children who reported transgender feelings were tracked without medical or surgical treatment at both Vanderbilt University and London’s Portman Clinic, 70%-80% of them spontaneously lost those feelings. Some 25% did have persisting feelings; what differentiates those individuals remains to be discerned.

We at Johns Hopkins University—which in the 1960s was the first American medical center to venture into “sex-reassignment surgery”—launched a study in the 1970s comparing the outcomes of transgendered people who had the surgery with the outcomes of those who did not. Most of the surgically treated patients described themselves as “satisfied” by the results, but their subsequent psycho-social adjustments were no better than those who didn’t have the surgery. And so at Hopkins we stopped doing sex-reassignment surgery, since producing a “satisfied” but still troubled patient seemed an inadequate reason for surgically amputating normal organs.

And then this about the way some parents are allowing doctors to “treat” their transgendered children:

Then there is the subgroup of very young, often prepubescent children who notice distinct sex roles in the culture and, exploring how they fit in, begin imitating the opposite sex. Misguided doctors at medical centers including Boston’s Children’s Hospital have begun trying to treat this behavior by administering puberty-delaying hormones to render later sex-change surgeries less onerous—even though the drugs stunt the children’s growth and risk causing sterility. Given that close to 80% of such children would abandon their confusion and grow naturally into adult life if untreated, these medical interventions come close to child abuse. A better way to help these children: with devoted parenting.

This is an explosive column that challenges the emerging orthodoxy of the sexual revolutionaries. Read the rest here.


  • Ian Shaw

    A very thoughtful response, but it will be only moments before the culture champions hurl flaming arrows and say that this doctor is a cave-dweller, has no touch with reality and will be on the wrong side of history, coupled with a side of bigotry and gender discrimination

    • James Stanton

      Everyone likes to promote a science-based, data-based authority figure when it supports their argument and dismiss the source when it doesn’t.

      I agree with McHugh that children should be allowed to mature before surgical decisions are made.

  • J L Parks

    Ian- I share your thoughts. I am not going to be posting on this thread as I have been on the SBC doctrinal statement thread, but I have been interracting for the last few days with several “transsexual” individuals. Hiaving given them Biblical, Scriptural, medical, physiological, physical, anatomic, and common-sense reasoning, in just 4 days, I have been labelled…

    “Wilfully ignorant, illogical, irrational, adamant, arrogant, an affront to reason, out of my depth on the subject, having a traditional belief I feel good about, having flawed reasoning, using bitter circular reasoning, suffering from the flawed ideas of my generation, and having these beliefs as my security blanket.”

    Ho hum…none of these bother me, of course, as I expected nio less. However…when they then attack God, they demonstrate Romans 1 thinking at its worst. One commenter said…

    “So God obviously messes up once in a while, and is therefore imperfect…”

    The statements of this highly-qualified physician, above, will be flatly rejected…we expect that. But when the Lord is attacked, we really have no further argument or discussion.

    • Esther O'Reilly

      The reasoning that “God must have messed up” in order for there to be sexually confused individuals in the world is no better than drawing the same conclusion from the existence of people with other physical/mental defects. It just boils down to a re-statement of the problem of evil.

      • Ian Shaw

        But if you try to explain that our own flesh (mind, heart and body) is bent towards sin, that’s where you lose some people. Of the world, the flesh and the devil, I truly believe that the flesh is our worst enemy.

        The idea that everyone sins and not everyone sins in the same way I know doesn’t really give it justice, but some people battle certain sins more so than others. For some it’s sexual sin, for other’s it’s lying, stealing, murder, etc. I know I am my own worst enemy. I love and do the things I hate and what I want to do, I fail to do (to paraphrase Paul). We may be called closed-minded, however it’s not arrogance to understand from scripture how messed up we are from the start, regardless that that’s not how we were intended to be from the beginning. So that leaves you with two choices:

        Either God doesn’t make mistakes and whatever your self-determination/thoughts/feelings, emotions say you are must be what God meant you to be (which is an attitude of self)


        God doesn’t make mistakes, but being born into sin, our entire being is fighting against the will of God. But if we remove self and start with God, with the authority of the Word, where God reveals to us who He is, we will find who we truly are.

    • Tammy Rainey

      “Wilfully ignorant, illogical, irrational, adamant, arrogant, an affront to reason, out of my depth on the subject, having a traditional belief I feel good about, having flawed reasoning, using bitter circular reasoning, suffering from the flawed ideas of my generation, and having these beliefs as my security blanket.”

      and some of those are not insults but observations. For example, and I may have noted this before, my grandfather was born in 1910 and was an ardent southern Baptist his entire life and as godly a man as I could imagine, But he was also stridently opposed to interracial marriage. He was controlled by the outdated ideas of his generation, and was not prepared to risk considering the possibility that he had been wrong. That is not an insult toward a man that I loved as much as any human who ever lived, it’s simply an objective observation of fact.

      Now, of course, this may or may not be true of you. But I will acknowledge that, being 50 years old, I know that my own generation is much more resistant to admitting error on this point sin younger generations. Indeed, I myself was very resistant to changing my position on this issue. So, true of you are not, there’s no reason to list that (or a couple of the other items there) as if they were meant to be insults.

  • Brian Darby

    Dr. Burk, I hope you and yours are having a nice weekend. I will ask a plain question, when modern science contradicts the biblical narrative, which it does, often, is it your position one should hold to what Scripture says? Thanks.

    • Ryan Davidson


      I’m not sure that modern science contradicts the biblical narrative itself, even though it may contradict our interpretations of the biblical narrative. For example, it wasn’t that long ago that evangelicals overwhelmingly believed that the Bible forbade interracial marriage. Over the course of the past two decades, evangelicals have largely jettisoned that interpretation, although nearly 20% of evangelicals still hold to it. All the while, modern science indicated that there were no adverse biological outcomes that result from interracial marriage (although there may be adverse social outcomes).

      On issues such as gender dysphoria, it’s a lot harder to determine what modern science is even saying. After all, the condition is heavily dependent on social context. Gender is largely a social construct. Although there may be some common features that persist across different cultures, gender constructions vary markedly from one culture to another. In a way, we’re all bound to experience some degree of a mismatch between our own role preferences and the expectations of our social context. For those who experience gender dysphoria, the mismatch is substantial, leading them to conclude that their own role preferences are closer to the social expectations of the opposite sex. So, while sex reassignment surgery may reduce the degree of mismatch, it’s unlikely to eliminate it.

      The same principles may apply to those who consider themselves to be gay. In our social context, a guy who has a gay orientation is a guy who has a generalized attractional preference for members of the same sex, i.e., generically prefers the male form over the female form. In that sense, the term “gay” describes the person’s experience of a mismatch between his preferences and those that society expects him to have. But this would play itself out very differently in cultures where the expectations are different. For example, in many parts of Portugal, Spain, and southern Italy, men view it as “natural” to have an attractional affinity for the male form over the female form, although it is viewed as “unnatural” for that attractional affinity to crystallize into a desire to engage in sexual acts with other men. So, it’s quite possible for an American guy to be viewed as “gay” in our social context, and to be viewed as “normal” in Naples or Lisbon.

      I spend about 25% of my time traveling in Europe and East Asia. Notions of masculinity vary widely from the US to Japan, to Korea, to Italy, to Hungary, to German-speaking Switzerland, to French-speaking Switzerland, to Denmark, etc. So, unless we travel extensively and spend significant time in other cultures, we can be prone to read our own cultural and subcultural experiences into our interpretations of Scripture. That’s especially true when we talk about things like homosexuality and gender dysphoria, where the diagnosis of the condition is fairly dependent on social context.

      • Tammy Rainey

        I think you make a valid point about the social construct of gender, and the gender norms in each various culture, and it is certainly something that can be confusing to the uninitiated observer. I believe that the more vocal “transgender” activist” I made a strategic rhetorical air and putting so much effort into the word “gender” and then defining gender by those social constructs which you mentioned. In point of fact, the experience of “gender dysphoria” is not really dependent on those social constructs at all. Not a few trans-women conduct themselves in a distinctly “book” manner post transition, for one example. There would not be such a overarching effort to initiate physical bodily modifications if the primary source of discomfort was simply a matter of cultural gender expectations. Albeit, I think that there is an element of the “transgender” population that is much more focused on defying the so-called gender binary than an actual transition.

        That is why I almost never use the term “transgender” – I don’t want to be on the hook to defend every variation of, as they say “gender nonconforming” behavior that activists want to cram under that umbrella. That said, there is surely a reason beyond whether or not one hates their nails or whatever why people are willing to spend thousands of dollars in endure hundreds of hours of pain in order to modify the physical aspects of their body. Indeed, they do this even in cultures in which the life and role of a woman is subservient if not degrading.

    • Denny Burk

      Yes, scripture is the authority. But but I would distinguish actual contradictions between apparent contradictions. In other words, when there are apparent conflicts between scientific knowledge and biblical biblical revelation, there is a resolution even if we cannot see it yet. Our apprehension of things is not perfect, and in time the congruity of all things will be clear.

      • Ryan Davidson

        I would argue that there are no actual contradictions between the two. The God of general revelation is also the God of special revelation. As Calvin notes, we should expect these “two books” of God’s revelation to be consistent. When there’s an apparent mismatch, it suggests that there’s some deficiency in our interpretation of one or both of the two books.

      • Tammy Rainey

        indeed, well said. Given the churches documented history of choosing the wrong side of those conflicts (Galileo being perhaps the most notable example) why are you so eager to conclude that the traditional doctrine reflects God’s truth and not the scientific conclusions? Never mind that I can see any place where you’ve actually documented an exegetically sound support for the claim that the Bible contradicts science on this point. The question remains that even if one could make a reasonable theological interpretation of the Scriptures which reflected negatively upon transsexual transition, there still remains the question of whether or not we would be repeating the same mistakes so often made in church history of elevating our understanding – our flawed human understanding – a Scripture over established scientific reality?

      • Christiane Smith

        an honest comment, DENNY, and one that should cause concern about how self-proclaimed Christ-following ideologues ought to be interacting with people who have gender issues

  • Michael Karpf

    I live in Bangkok, and this operation is performed here more than any other place in the world.
    3 years ago, I reconnected with a long lost friend whom we went to the same university. I will not go into details, but over a short course of time, I could tell this man had some very deep emotional problems. He was extremely volative; telling me he loved me like a brother one day then telling me to to go ….. myself the next day. He had blamed me for stealing his girlfriend, whom I hadn’t talked to in 29 years. He said he finally got in contact with her but told her he was “Jenny.” When I asked him about it, he told me he had recently had a sex change operation, at the age of 60. He/she said he/she had an extra X chromosome (XXY). Now I could understand why he/she was so emotiallny volatile. I got my cellfone number changed and I have not answered any of his email for over 2 years, simply because I will not take any more abuse.
    This person has some very deep emotional problems, but I can be sure of one thing; a sex change operation is not the answer. Why anyone wants to go through this is beyond me. God made me a man, and while there are things I don’t like about myself, I will accept the fact that God made me according to His design (Psalm 139)

    • Chris Ryan

      What’s interesting abt the example you raised is that there is clearly a physical ailment afflicting this person. In fact, in TX, gender is based on chromosomes not genitalia. This person is properly called intersex, and so a “sex change” operation would be/should be a purely medical decision. I don’t see how this would be sinful in the slightest. The larger question you raise is what if there’s something neurologically afflicting ppl w/ gender dysphoria. What then? If the brain’s actual neurons have “short circuited” (and medical science still isn’t advanced enuf to detect it) do we still consider sex change surgery sinful?

  • Tammy Rainey

    McHugh is to his profession something akin to what Fred Phelps is to Baptist pastors. That is to say the nutter the same ones I’d rather not talk about. Citing the guy who is almost entirely alone within his profession as the reliable source in the face of thousands of others just as qualified if not more who hold the opposite view hardly supports the credibility of your position.

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