Transgender 103: Sex Stamped on the Body (continuing the dialogue with M. Yarhouse)

In my last two posts, I’ve been addressing some common concerns which conservative Christians raise when they encounter and/or consider transgender.

In the first, I noted that Trans is not the result of American secularism, feminism, individualism, etc. but a phenomenon which has been around for millennia in many contexts and cultures. I raised questions about therapeutic success, vulnerability, and honesty and provided resources for beginning to listen with compassion.

In the second post I began a dialogue with an article written by Mark Yarhouse, one of the most trusted voices among evangelicals on matters of sexual and gender identity. I commended Yarhouse’s recommendations for welcoming transgender persons into our churches and lives at the same time that I questioned the theology—borrowed from Robert Gagnon—which undergirds his perspective.

In this post, I want to begin to address the theological concerns he raises. The the first is summarized in these excerpts:

Cross-gender identification is a concern because it threatens to dishonor the creational order of male and female—“the sacred integrity of maleness or femaleness stamped on one’s body.” It is a “denial of the integrity of one’s own sex and an overt attempt at marring the sacred image of maleness or femaleness formed by God.”

Yarhouse and Gagnon argue that maleness and femaleness are stamped on the body and that biological sex (the physical body) trumps gender identity (the mind or the sense of being a man/woman/girl or boy). Even while Yarhouse acknowledges that the most common explanations for transgender come from the emerging science of brain sex — the ways in which brains are influenced by prenatal and postnatal hormones and shaped through lived experiences — he appears to downplay the fact that the brain is part of the body.

The challenge with this phrase “maleness and femaleness stamped on the body” is that one must ask: Which stamps?

Certainly at birth, we look to the genitals to determine the sex of the infant. But we have also come to know that for some individuals genitals can be ambiguous. In these cases doctors look to chromosomes – most often XX (typical female) or XY (typical male) but also other variations (XXY, XXYY, XO, etc., or a combination called “mosaic”). Doctors also examine circulating levels of hormones which vary not only between typical males and typical females but also among males and among females.

The fact of the matter is sex is stamped on the body in many different ways.Chromosomes, gonads, hormones, genitals, secondary sex characteristics, brain sex, and so on. And for a number of people—these do not all fall into line.

Consider one of the most common forms of intersex to illustrate this point.

Androgen Insensitivity Syndrome (AIS) leads to an infant born with XY chromosomes and testes (typical male) which secrete typical amounts of androgenic hormones (typical male levels). So far, it looks like the sex “stamped” on this body is male. However, hormones require receptors in the cells in order for the body to be able to make use of the circulating chemicals. AIS individuals have receptors that do not “read” the androgens circulating in the body. In persons with androgen insensitivity, the genitals do not masculinize—they appear feminine at birth. Secondary sex characteristics also follow the female pathway. And at puberty, when one would expect nothing to happen (given that male hormones are increased but the receptors still cannot “read” these hormones), the body converts the testosterone in such a way that it sets into motion breast growth, widening of the hips, etc. The only secondary sex characteristic which does not appear is pubic and underarm hair—these require the processing of testosterone both in typical men and typical women.

So we have two sexes “stamped” on these bodies—internal reproductive structures of the male and external genitals and secondary sex characteristics of the female. Which sex did God intend? Which is the “real sex”? How do we choose?

Today, doctors allow patients to choose. Based on what? Based on their sense of gender identity — their feeling of being male or female.

So, it seems like in some cases – for medical professionals and psychologists – the gender identity of the individual is taken seriously as a marker of personal identity. Androgen insensitive women are not surgically reconstructed as men, even if their bodies produce sperm that could be implanted to fertilize an egg. In other words, these women could “father” children – with the help of a Petrie dish, an ovum, and fertility specialists.

So, when the body is unclear, doctors look to the patient to say how they feel. Do they feel like a man? Or do they feel like a woman? It just so happens that over 98% of Androgen Insensitive persons identify as female. Some do not like to be associated with the idea of “intersex” because for them, their sense of self is so clearly female. Others, after learning of their bodily differences combine terms and call themselves “intersex women.” Individuals choose how they want to identify, how they want to interact in the world.

As we are beginning to see, sex is stamped on our bodies in many different ways.

True, for most people, these various stamps line up so that most people do not question the sex assigned to them at birth. And yet, the beautiful diversity we see between persons of the same sex testify to different hormones levels, different ways that the brain is coded, as well as different experiences and feelings about how to live as men or as women.

As Dr. Hines, Dir. of the Neuroendocrinology Research Lab in London, explains,

“few, if any, individuals correspond to the modal [statistically most common] male pattern or the modal female pattern. Variation within each sex is great, with males and females near the top and bottom of the distributions for every characteristic. … In fact, although most of us appear to be either clearly male or clearly female, we are each complex mosaics of male and female characteristics” (M. Hines, Brain Gender, 18-19).

What does this mean for our current conversation? It means that we must acknowledge that sex is stamped on the body in many ways – ways which are subject to more than two combinations. Some of these variations may lead to gender identities that fit certain “stamps” but not others. And sometimes, following the lead of the individual as they express their own gender identity, is the most compassionate and reasonable response.


Of course, some of you are already thinking…

Is this the way God meant for it to be? Or is this an accident? A result of “the fall”?

Stay tuned. We’ll get to those questions in future posts.

In the meantime, take some time to learn more about how sex development works – the various forks in the road, the different places and ways that sex is stamped on the body.

Here is an animated educational tool created by physicians to help parents and children with intersex (often called DSD—disorder of sex development by doctors) understand how variations occur.

To learn more about Androgen Insensitivity in particular, consider visiting the support group website.

The Intersex Society of North America (ISNA) has an informational website which answers many questions.

Unfortunately, what the ISNA soon learned was that doctors were put off by the association between the name “intersex” and sexual identity politics. At the same time, intersex persons who wanted medical help aligning their body with their gender identity (those same interventions which transgender people sometimes choose) were having trouble getting insurance companies to pay for these surgeries. By allowing a name change – from intersex to Disorder of Sex Development (DSD) – they were able to make better progress in changing standard medical care for intersex and getting insurance to cover their procedures. Some of their leaders also changed their name from the Intersex Society of North America to Accord Alliance in order to focus on working with the medical community for better care. Accord Alliance is also a good place to continue learning.

(originally published 6/12/2015)