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Separating Fact from Fiction with Gender Identity

With gender identity and transgender questions at the forefront of public discourse in recent years, the need for discerning the truth is as critical as our care for those navigating these questions.

With so much information circulating about gender identity these days, it can be difficult to distinguish truth from error. Why are so many people identifying as transgender, particularly young people? Why does society seem to suddenly be taking for granted such different understandings of both gender and sex? It can seem confusing and overwhelming at times—especially when some of these new ideas are presented as an “obvious” reality that everyone should be eager to embrace. 

This can also be a challenging topic to discuss when notions of gender and gender identity cut so close to who we are and how we understand ourselves in the world. As much as we can and must be sensitive to the experiences and needs of those struggling to navigate incongruences or dysphoria around gender, we must be willing to have hard conversations about what the research does and doesn’t say—because some of the most popular notions about gender identity conflict with available data in striking ways. In what follows, we summarize some of the most substantial discrepancies between popular narratives and scientific realities. As Elder D. Todd Christofferson recently noted, attempts at love that are not grounded in truth “risk harming the person or persons we are trying to help.”

Defining some terms. The terms sex and gender have often historically been used interchangeably. (The Church clarified in 2019 that the term gender used in the family proclamation is intended to include “biological sex at birth.”) By comparison, in the 1950s, the psychologist John Money promoted the idea that gender and sex were distinct things and coined the terms gender identity and gender role

A person’s sex is determined by the reproductive role that a body is organized to perform, regardless of whether the body can do so successfully. There are only two reproductive roles: the production of small reproductive cells, or sperm, and the production of large reproductive cells, or eggs. Therefore, there are only two sexes, male and female. Sex is not assigned at birth; it is observed, often before birth. Cases do exist in which a person’s sex is ambiguous or mislabeled at birth; however, these conditions are rare.

Gender, as discussed and taught today, encompasses characteristics, behaviors, stereotypes, and roles. Some gender differences appear to be linked to biology, such as the tendency for girls to like playing with dolls and the tendency for boys to prefer playing with trucks—traits that can also be observed in primates (see also here and here). Other gender differences, such as color and clothing preferences, are shaped by culture and environment. Most people have understood sex and gender to be aligned; however, gender theory asserts that they are related but independent of each other. Some use gender as a synonym for feelings or personality; hence the ever-expanding list of genders. 

Gender identity is often described as one’s inner sense of being a man, a woman, or something else, such as nonbinary (neither entirely a man nor a woman). As the term indicates, it is self-defined. 

Gender dysphoria refers to “marked incongruence” between one’s sex and one’s gender, accompanied by significant distress. Identifying as transgender no longer requires the experience of gender dysphoria. 

The terms gender affirmative care, gender affirmative hormones, and gender confirmation surgery are new terms referring to therapies, treatments, drugs, and surgeries that encourage the transition to a different gender presentation. This document will usually use older terms that are more accurate and less politically loaded, such as cross-sex hormones.

Now let’s examine some popular notions that turn out to be myths:

People can change their sex. People can alter their appearance and hormones and even have sex organs removed, but a person’s sex is written in every cell of the body—regardless of the procedures one undergoes. In essence, there are masculinizing and feminizing medical procedures, but there is no such thing as a “sex change.”

People who identify as transgender are simply being their authentic selves. The belief that one’s gender identity is part of one’s core self, and that being “authentic” is a primary goal of life, comes from the contemporary worldview known as expressive individualism. The concept of the “authentic self” raises a host of questions—starting with what exactly constitutes an “authentic” identity. Must gender identity, a modern concept unknown to past generations, always be considered more important than other aspects of one’s identity that might conflict? Should being one’s authentic self require the lifelong administration of synthetic hormones, with all the side effects and risks that this entails, as well as invasive surgery? Why must the feelings of the mind trump the realities of the physical body? How much of the self is informed by one’s particular social and cultural narratives through which we interpret life experiences?

Reinforcing transgender identities by using preferred names and pronouns, and by including them in spaces traditionally reserved for the opposite sex, does have a cost and is not a neutral act.

Some claim that one’s authentic self is indicated by the happiness and relief one feels when engaging in behaviors or expressions that align with a particular identity. Many transgender individuals say their transition helped them feel happier than they had ever felt before. But not all have this experience, nor does this feeling, which is sometimes called “gender euphoria,” endure for everyone. Those who end up regretting their transition may not do so for a number of years. Furthermore, cross-sex hormones are known to affect mood, both positively and negatively.

More people are identifying as transgender today due to declining stigma. The number of young people seeking treatment for gender dysphoria has exploded over the past 10-15 years. In the UK, the rate has increased by 4,400%; in the United States, the number of transgender-related surgeries has quadrupled. If reduced stigma were the primary reason for the increase, however, we should see a comparable rise among females and males and among various age groups. But the increases have been disproportionate. While all groups have seen an increase, the majority of those seeking treatment for gender dysphoria are adolescent females—unlike previous years, when most people identifying as transgender were males. Females, particularly teenage girls, are most likely to be influenced by their social environment. This has been observed with other conditions and behaviors involving social contagions such as eating disorders, self-harm, and new phenomena such as tic disorders that appear to be triggered or exacerbated by social media

People identify as transgender simply because their brain or spirit does not match their body. The pathways into a transgender identity are much more complex and varied than this simple explanation suggests. The reasons a three-year-old boy insists he is a girl are vastly different from the reasons a 13-year-old girl suddenly identifies as trans. And her experience is vastly different from that of a married father who transitions during middle age. 

Researchers have observed several different presentations of gender dysphoria. For instance, physician and researcher Lisa Littman identified the phenomenon she called rapid-onset gender dysphoria in a 2018 preliminary study of parent reports. More than 80% of the adolescent and young adult children described by parents in her sample were female. Around the time they identified as transgender, many spent increasing amounts of time on social media; they also had friends in their peer group who started identifying as trans. Most experienced an increase in social acceptance after announcing their identity. 

The majority of these young people had previously been diagnosed with at least one mental disorder, such as anxiety, depression, bipolar disorder, or borderline personality disorder; and/or a neurodevelopmental disability, such as autism spectrum disorder, which can involve an obsessive focus on one or two interests and difficulty fitting in with peers. Many had histories of trauma, including sexual trauma and family disruption. These issues are ripe for exploring and addressing therapeutically.

While most of those experiencing rapid-onset gender dysphoria are females, growing numbers of young males with similar histories are also presenting as transgender. 

In the 1980s, the sexologist Ray Blanchard identified two types of gender dysphoria that males experience. (Again, most people reporting experiences with gender dysphoria at that time were males.) One type is childhood-onset gender dysphoria, which is typically experienced by same-sex-attracted males who might naturally appear very feminine or are more attracted to female-stereotyped roles and behaviors. This type also occurs in gender-nonconforming females. Another type is present only in males who are attracted to women or are bisexual or asexual (not attracted to either sex). The onset of this second type occurs most often during adolescence or adulthood. These males are not necessarily gender nonconforming and are sexually aroused by the thought of themselves as women, though the intensity of this feeling may wax and wane. This type has also been observed by other researchers (see also here). To be clear, however: sexual arousal does not always accompany gender dysphoria for males and rarely for females.

Both Littman’s and Blanchard’s studies have been criticized by activists who prefer the “born in the wrong body” narrative, but their work has not been debunked, despite claims to the contrary. 

Other observers have noted the relevant influence of pornography and other sexualized messaging in the media. Both females and males may be repelled by how members of their sex are portrayed in these materials, and they may want to escape from their biological sex. In other cases, males may be affected by the growing influence of pornography genres that include “sissy porn” or “forced feminization” (which depict submissive males being forced to take on feminized roles).

Some mental health professionals have suggested that many young people are identifying as transgender due to social isolation from the COVID-19 pandemic and increased time spent online. Additionally, as more young children are presented with information about gender identity at school and in the media, we will likely see growing numbers of young children identifying as transgender—particularly if they are gender nonconforming.

Regardless of why and how a transgender identity develops, people with gender dysphoria deserve compassion and options that don’t solely involve transition and the compelled participation of others.

Using a minor’s preferred name and pronouns supports their mental health. One Latter-day Saint social media influencer frequently says, “It costs me nothing” to use a transgender individual’s chosen name and pronouns. There are different views regarding how to refer to transgender adults: some believe using a chosen name and pronouns is appropriate and respectful for older adults who are consistent in their gender presentation, and that doing so can benefit their relationship. Others believe that using such language, particularly pronouns, blurs the distinction between males and females and requires them to participate in what might be called “collective collusion.” People of faith may feel that they are being forced to go along with a lie, in reference to convictions that “gender is an essential characteristic of premortal, mortal, and eternal identity.”

Regardless, reinforcing minors’ transgender identities by using preferred names and pronouns—as well as by supporting their social transition in other ways, such as including them in spaces traditionally reserved for the opposite sex—does have a cost and is not a neutral act. While this practice may produce positive feelings in the moment, it reinforces identities that might otherwise be temporary and perhaps not in the minors’ best interests, particularly when these practices pave the way to medical transition. 

Some have found it helpful to find a compromise regarding minors’ names, such as using a minor’s initials, last name, or a name related to their given name that sounds more gender-neutral. 

Research clearly demonstrates that medical transition decreases suicidality. Evidence for this commonly cited belief is lacking. If it were true, the rate of suicide and mental distress among adolescent girls, those most impacted by gender dysphoria today, would have been higher in the past due to the lack of services and opportunities to transition. One 30-year Swedish study, the longest study on transgender surgery outcomes to date, showed that participants who underwent such surgeries continued to have a significantly higher suicide rate than that of the general population.

The suicide rate for trans-identifying people is indeed higher than for those who are not transgender, and this should be taken seriously. However, reports showing rates of attempted suicide as high as 41% or 56% rely on weak evidence such as online self-report surveys of non-representative convenience samples in which terms are not clearly defined. Many people with gender dysphoria have comorbid conditions that may also contribute to suicidality. Suicide experts caution against oversimplifying the reasons for suicide.

Life-altering decisions should be made only when one is stable, not suicidal. The demand “Give me what I want or I will kill myself” can be used to manipulate, as can the question often posed to parents: “Would you rather have a dead daughter or a living son?” Furthermore, the suicide narrative can be self-fulfilling. It is well known that social contagion can impact suicidality. When the common refrain is “Transgender people must transition (or otherwise be affirmed) or they will kill themselves,” is it a surprise when vulnerable young people come to believe this? In multiple ways, this rhetoric could be inflaming and exacerbating the problem. 

LGBT+ members of the Church are more likely to take their lives than LGBT+ people who are not members. This is a belief that many people “know” to be true, but research has failed to confirm it (see also here and here). A growing body of research even suggests that membership and activity in the Church may be a protective factor (see here and here). 

Puberty blockers are a benign “pause button” on puberty, allowing young people time to decide whether they want to proceed to cross-sex hormones or to align with their biological sex. While this is another popular theory, the reality is that puberty blockers are not neutral—tangibly reinforcing a transgender identity and almost always leading minors to proceed to the next step: cross-sex hormones. Skipping puberty and then directly starting and maintaining a regimen of cross-sex hormones means that the individual will be sterile, will not follow normal sexual development, and will be unable to have a normal sexual relationship throughout their life. While some have claimed that puberty blockers reduce suicidality, research is lacking. Puberty blockers may also negatively affect bone development, which increases the risk of fractures and osteoporosis. Far from benign, these medications are intended for other conditions and have even been used to chemically castrate sex offenders. Lupron, the primary medication used in the United States to block puberty, still has not been approved by the FDA for this use.

Lifelong cross-sex hormone treatment is thoroughly vetted and relatively safe; the benefits outweigh any risks. The growing numbers of young people who take puberty blockers and cross-sex hormones are unwittingly participating in a global experiment. There is little data regarding the long-term use of hormone treatment when commenced at such young ages. It is known that some changes to the body prompted by the treatment are permanent and that long-term use of testosterone by females increases their risk for cardiovascular disease and vaginal atrophy, while long-term estrogen use by males increases the risk of cardiovascular disease and osteoporosis

Several progressive European countries have pulled back on medical treatment for gender dysphoria, citing the poor evidence base for such treatments. These countries include Sweden, Finland, France, and the UK

No children are too young to understand who they are. We as parents and supportive adults need to follow their lead. Children develop their identity throughout their formative years and often try on various roles during that time. They do not reach cognitive maturity until their mid-twenties or so. Young children do not understand modern-day definitions of gender. Usually, their understanding is based on external gender stereotypes: people who wear dresses are women; people with short hair are men. Before gender ideology was reinforced in the culture at large, 60-90 percent of prepubescent children with gender dysphoria whose parents used a “watchful waiting” approach no longer identified with the opposite sex following puberty. There was no way of determining which children would persist in their gender dysphoria after puberty and which would not, even when children met the criteria of being “insistent, consistent, and persistent” over time.

Transition regret is extremely rare. Most studies cited in support of this popular belief were performed before the current sharp rise in transgender identification. The reality is that few gender clinics attempt to track long-term all those whose transitions they facilitate. Follow-up time in existing studies is typically short, and many who detransition, or decide to align with their biological sex, are missed in this follow-up effort. This is unsurprising, as few would want to stay in contact with a clinic or provider who they felt had caused them harm. Furthermore, some attempts to study detransition have been discouraged or shut down altogether. While not many studies capture the numbers or experiences of detransitioners, research is slowly emerging, and many are sharing their experiences on social media. The Detrans subreddit, for example, has more than 29,000 members as of this writing.

“If this undeniable fact [of biology] can be denied en masse, then we become hostages to chaos.” – Colin Wright

Psychotherapy that explores and addresses gender dysphoria and gender nonconformity in “non-gender-affirming” ways is a form of conversion therapy.Conversion therapy” is any therapy that aims to convert one’s sexual or gender identity to another, particularly by using coercive means. This is not ethical treatment. Is it not also unethical to inform individuals with gender dysphoria that their only option for treatment requires them to adopt a transgender identity, take medications for the rest of their lives, and permanently change their bodies? Should adults not be able to make choices for their lives?

Ironically, because many trans-identifying young people are same-sex-oriented, some observers have even suggested that medical transition can be a form of conversion therapy, with the goal of making a person trans and straight rather than not trans (“cisgender”) and gay. Some call this “transing the gay away.”

Brain scan studies provide reliable evidence of transgender identities. Some brain scan studies have shown that the brains of transgender individuals resemble the brains of the gender with which they identify. However, brain scan studies are still in their infancy. Some such studies have used small samples with non-standardized measures. Other studies have not been able to indicate whether any similarities are due to sexual orientation or gender identity. Currently, the only way to tell that a person is transgender is by self-identification. 

Intersex conditions prove that sex is a spectrum rather than binary—thus validating transgender identities. In contrast with subjective gender identities, intersex conditions—also called differences in or disorders of sex development (DSDs)—are observable medical conditions involving atypical reproductive organs, genitals, and/or chromosomes. These conditions are not identities, unless, of course, a person with an observable DSD chooses to incorporate it into his or her identity. 

Having an intersex condition does not mean that a person is on a spectrum between male and female, nor does an intersex condition indicate a different sex. There are no additional sexes because there are no reproductive roles other than the production of eggs or sperm. In most cases, a person with a DSD can be identified as either female or male because it is clear which of the two reproductive roles the person’s body is organized to perform, even if they also have some features of the opposite sex. Only .018% of the population has a sex that is truly ambiguous. Still, medical anomalies do not invalidate the rule. 

Two examples might be helpful: Some people are born with one or no legs. These exceptional cases do not indicate that humans are not a bipedal (two-legged) species. Also, some people have fewer than 10 fingers; some people have more. This does not mean that the number of fingers humans have is on a spectrum. It means that there is a rule, and there are exceptions to this rule.

The majority of transgender people do not have DSDs, and the majority of people with DSDs do not identify as transgender. And when a person has fathered, conceived, or given birth to a child, we know without a doubt what his or her sex is, regardless of whether the person has a DSD.

***

Many of the above myths are perpetuated by legacy media, public institutions, therapists, social media influencers, and well-meaning individuals who rely on personal narratives, ideology, or studies that are misreported or fraught with methodological problems (some of which are discussed here, here, here, and here). Even many respected medical organizations have positions that are based more on ideology than on science.

Why is it so important that people have an accurate understanding of biological sex? The evolutionary biologist Colin Wright summed it up succinctly: “I’m frequently asked why I focus so much on the nature of biological sex. It’s because in my view this may be reality’s last stand. If this undeniable fact can be denied en masse, then we become hostages to chaos. We simply cannot afford to lose our collective tether to reality.”

Becoming more discerning in recognizing fact from fiction can help us make sound decisions in how we address the topics of sex, gender, and gender identity and how we minister to our transgender-identifying loved ones. If we are coming from a place of genuine love, we are obligated to be wise consumers of research, to listen with compassion to others’ stories while not simply taking them at face value, and to take the long view when making important decisions that will have consequences not only now but far into the future—for the individual as well as for society. As always, for Christian believers, the Savior Jesus Christ is the perfect example. He can guide us as we navigate these complicated waters and as we strive to show genuine love and care while remaining grounded in both scientific and revealed truth.

About the author

Hypatia

Hypatia is a pseudonym for a group of writers in academic, legal, and professional circles with legitimate fear for threats on employment, reputation, or family well-being for speaking out publicly.
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