Gender detransition in Catholic moral theology

I recently submitted this major essay to my university. Feedback from my assessor are in italics and brackets:

Gender detransition is a real-life moral issue. This essay will initially define gender detransition, and provide associated definitions for context. This essay will then explore related Scriptures, Catholic Tradition and contemporary Magisterium in order to extrapolate the Catholic position on gender detransition, and the reasoning behind it. In doing so, this essay will not only just compare and contrast the extrapolated position with contemporary attitudes towards gender detransition. This essay will also attempt to answer the following questions throughout:

1. How does being a Catholic make a difference to how one would respond to the issue?
2. How does a response to this issue affect the relationship between being a human person and living a moral life?

The essay will also explore the implications for people who have undergone gender transition, especially those who have openly talked about their transition, myself included. The essay will use his/him pronouns for ease, when referring to the human person regardless of gender.

Gender transition refers to the process of shifting towards a gender identity different from that assigned at birth. (Is this concept of gender/sex ‘assigned at birth’ consistent with Christian anthropology?) Such a shift may be social, such as new names, pronouns and clothing, and/or medical, such as hormone therapy or surgery. Gender identity refers to the human person’s inner sense of being male, female or a gender other than male or female, which may or may not align with his sex assigned at birth.[1] Therefore gender transitioners fall under the transgender umbrella (trans), and they may or may not have a history of gender dysphoria (GD), that is, distress arising from incongruence between gender identity and sex assigned at birth.

Gender detransition is the process of reidentifying with, and shifting back to assigned birth sex, post-gender transition. There are two types of detransitioners. The first type are voluntary detransitioners. They voluntarily stop identifying as trans, and usually involves halting or reversing the transition process, such as ceasing hormone therapy and reverting back to pre-transition names and pronouns.

The second type are involuntary detransitioners, who cease the process for themselves due to health concerns, lack of societal or familial support, or dissatisfaction with the transition results thus far etc, but do not cease their trans identification.[2] Therefore, it can be seen from these definitions alone, that gender detransition is a real-life moral issue.

At present, there is no known contemporary and direct Magisterial teaching on gender transition, and by extension, gender detransition.[3] However, it could be extrapolated from Scripture, and Catholic Tradition in general, what the Catholic position on gender detransition would be.

As per the Catechism of the Catholic Church, if the Catholic faith is ultimately an acknowledgement of how great the triune God’s created gifts are to the human person, especially in redemption, then attempts to detransition should be worthy of the gospel of Christ.[4] (The goodness of the body in its created ‘givenness’ (which necessarily includes its sexuality) is reflected in the affirmation of the Creator: “And God saw everything that he had made, and behold, it was very good” (Gen 1:31).)

This probably would prompt the Catholic to recall the moment when Christ said to Thomas, “Put your finger here and see my hands, and bring your hand and put it into my side” (John 20:27). (I’m not sure I fully understand your point here. Is it that the dignity of the body is fully revealed in the resurrection?)

The voluntary detransitioner may perceive the bodily effects of their hormone therapy and/or surgery as scars and wounds. That is, bodily corruption and defect in need of restoration, close to their pre-transition state as much as possible. Deliberate efforts to physically restore may not be necessary on first thought, since the dead shall rise incorrupt anyway (1 Corinthians 15:52). But this prompts the question: why did Christ resurrect with His scarred body?

St Thomas Aquinas thought it was fitting for Christ to resurrect with bodily scars, since St Bede thought that Christ chose to wear His scars as an everlasting trophy of His victory. Further, as referenced by Aquinas, St Augustine thought that in the Kingdom, Martyrs probably retain their bodily scars that arose from their defence of Christ. As such, these scars are not deformity, rather, they dignify and beautify the Martyrs. But most importantly, accordingly to Augustine and acknowledged by Aquinas, Christ kept His bodily scars to remind His enemies of His unconditional sacrifice for them.[5]

Aquinas’ thoughts on John 20:27 give rise to some complex and interrelated questions for transitioners and involuntary detransitioners to unpack, not just voluntary detransitioners. For the transitioner, especially one with GD history, is an imperfect yet satisfactory gender transition a trophy signifying victory over GD, or is it the triumph of the evil, that is GD, that requires a restorative response? For the involuntary detransitioner, is their involuntary detransition a blessing in disguise?

(These are interesting questions, but an adequate answer must take into account the cause of the scars. Are they to the glory of the person (as fulfilling of their nature) or are they deformities? Are the scars of someone who self-mutilates a trophy or a sign of a deep hurt? A related question is of the nature of the resurrected body. It is glorified, perfected, a thing of praise to God. In light of such perfection, what will be the gender of the transfigured body of one who has transitioned here on earth (for we believe that we continued as gendered bodies in the resurrection). Will it be the gender of preferred identity, or will it be the given gender of God’s creation?)

For the voluntary detransitioner, should they not attempt to actively restore their given body, by means of restorative hormone therapy and reconstructive surgery, because their scars dignify and beautify in a way that is worthy of the gospel of Christ? Should transitioners and involuntary detransitioners also deliberately choose a detransition path worthy of the gospel of Christ?

According to Cardinal Ratzinger, at the start of hominisation (Genesis 2:7), humanity the creature finally related to God the Creator, however dimly the human person’s knowledge of this was at the time.[6] His divine act was not by chance, but by God’s freedom and love that humbles all God-believers and non-believers to be grateful for the gift that is His creation of everything (Genesis 1:26–27).[7] It is for these reasons the human person who has undergone a gender transition which ruptures the gift, should ask moral questions about whether the detransition pathway is worthy of the gospel of Christ, and how so, if how not.

In the case of my gender transition, I am still undergoing feminising hormone therapy (FHT), which maintains the female secondary sex characteristics (SSC) of my chosen body in a manner that satisfactorily aligns with my gender identity.[8] Whilst all medical treatments have benefits and risks, the rupture of the gift here is that such therapy affects fertility and sexual function, and this rupture was cemented by my genital reconfiguration surgery (GRS).

The primary implication of imago dei is that the human person betrays himself if he closes in on himself, that is, denies himself the dignity of a trinity-inspired interdependence. Since all that is created move towards their fulfilment of God’s plan, gender transition disrupts one’s capacity to move towards becoming “one flesh” with the other (Genesis 2:24), in both perfect unity and perfect distinction.[9]

Therefore, gender transition deviates from the fundamental anthropological pattern articulated in Genesis 1–2 — this autonomy is part of a distorted contemporary attitude towards human freedom because it is not divine truth, rather, it is dehominisation.[10] To clarify, the divine truth is the free will to obey in a participated theonomy, which is not to be confused with heteronomy.

It seems that for the transitioner, their gender transition is a triumph of evil, but a restorative response to this can be complicated by a history of GD. Regardless of the person’s circumstances, including those of voluntary detransitioners, in the psychotherapeutic context, recalled exposure and forms of conversion therapy are associated with increased risk of lifetime suicide attempts and heightened psychological distress.[11] This is not a Catholic restorative response.

Revelation is sufficient to extrapolate that gender transition is a sin, in breach of the Sixth Commandment,[12] not just merely a developmental or psychological weakness. Catholics should publicly acknowledge it as such, since it is an abuse of divinely-given free will.[13] However, it appears that at least some transitions are venial sins.

(We must be precise in language. A sin is not a disconnected category but is applied to someone. Therefore, we should better say that gender transition is contrary to God’s will, to the natural order, to the flourishing and perfection of the human person. One who undergoes gender transition sins relative to their knowledge, will, and freedom to choose otherwise.)

In my experience, whilst trans people today tend to surrender to medical temptation, they nevertheless do not desire to experience GD, that is, our GD prevents us from fully appreciating, or having full knowledge of, the theology of our bodies.[14] At time of writing, I am nearing the completion of my postgraduate philosophy and theology studies, yet the phenomenology of my gender identity remains unaffected — this is not deliberately intended on my part, it just is, and I do not know any better.[15]

To clarify, there would be no moral concern for social detransition, whether in the form of re-embracing pronouns or dress, and the like, that align with the Catholic understanding of sexual identity.[16] Moral questions however, would arise over medical detransition. Had I not had GRS, then I would only be on FHT that includes testosterone blockers. Based on medical advice that I have received, if I ceased both FHT and blockers in order to medically detransition, some female SSC, like breast development would remain, and some male SSC may return.

To what extent male SSC would return will depend on how early in life I started FHT and blockers, and the duration of me being on FHT and blockers. At time of writing, I have been on FHT for more than a decade starting at around age 20, and that may be too long to hope for my body to be able to produce a decent level of testosterone post-detransition, had I also not had GRS. Testosterone level is relevant for fertility in natal males.

But if cessation of FHT and blockers does not assist with attaining a decent level of testosterone, I would likely need to undergone masculinising hormone therapy (MHT) anyway, for detransition purposes, in order to prevent other medical conditions from arising in future, such as osteoporosis. This would apply even more so in my case of having had GRS, meaning that my body permanently produces very little testosterone, if any. The medical detransition process will differ from person to person — in general, the detransition process for someone assigned female at birth will be opposite of that of someone assigned male.

However, as demonstrated in my case, three moral questions about detransition arise for anyone who has undergone a medical gender transition:

1. Would medical detransition only just be a cessation of hormone therapy and/or hormone blockers, and cancellation of future transition-related surgical plans? If not;
2. Would medical detransition include commencing restorative hormone therapy and/or plans for reconstructive surgery? Such surgery would not just be restorative GRS (metoidioplasty or phalloplasty), it would also include other types of surgery — in my case for example, mastectomy.[17] If so;
3. Would restorative action in this case be for the purposes of realigning with sexual identity? Or is there another motivation or reason?

These complex questions are relevant and moral because life is given to the human person not only just at his conception, but given to him at every moment of his life. Given by others exterior to himself, but are nevertheless relational to him, driven to communion by love. That is, the human person is only able to possess himself by way of relationship.[18] It appears that his true nature is that of paying the gift forward, a masculine invitation, for others to receive the gift, that is, feminine reception. If original sin is the rejection of the initiation of the gift, is medical gender detransition furthering this rejection?

The three moral questions and others could be answered by natural law written in the souls of those who have undergone gender transition, governed by human reason that would move them towards what is good, and especially governed by a higher reason which spirit and freedom is subordinate to.[19] To this end, Aquinas thought that there are several types of goods the human person is naturally inclined towards.[20]

Firstly, human life is a good to be preserved and protected. It is my understanding that medical transition, like many medical treatments usually does not, at least not directly, put human life at risk. What is more relevant in this context is that support from family, friends, schools and the workplace is associated with reduced suicidal risk, and that lack of such support is associated with increased risk of suicidal ideation and suicide attempts.[21] This is important to both transitioners and detransitioners who are relational, in need of communion as they understand it.

Secondly, marriage between a man and a woman, leading them to raising children, are goods to be pursued. Noting that hormone therapy that diminishes the naturally-produced hormones of the body, and GRS, affect fertility and sexual function, medical transition prevents man and woman from becoming “one flesh”, as demonstrated thus far in this essay. But depending on the circumstances, medical detransition could in fact allow once again, for man and woman to become “one flesh” — but the efficacy of this is unclear.

It appears that when the good of life and the good of marriage seemingly clash, this leaves the transitioner or detransitioner to turn to pursuing the good of knowing the truth about relational persons. At the human level, this refers to the truth about fellowship, friendship and society, revealed throughout history. But the ultimate truth in this regard is truth about God, and His eternal law.[22] How befitting of me to be studying at the University of Notre Dame Australia. (This is the good of religion — of communion with God, which in the hierarchy of goods must find its place before the goods of marriage and of life itself.)

This still does not change the situation that the clash is seemingly and absurdly unresolvable for all involved, because the first precept of natural law is that good is to be done and pursued, and evil to be avoided.[23] If human life is to be preserved and protected, then the trans person, especially if they have unbearable GD, should not be denied medical transition treatment if it is discerned to be appropriate given their circumstances. That is, support, which is not necessarily synonymous with moral endorsement, reduces the risk that the trans person will attempt to complete suicide.

In practice, effective discernment of medical transition occurs when comprehensive exploration of the trans patient takes places. This covers early and gender developmental history, trauma or abuse history, state of emotional functioning, state of intellectual and educational functioning, and state of relationships with other human persons including family.[24]

Indeed, at least some voluntary detransitioners regret not having received comprehensive exploratory assessment of their psychological and emotional history prior to transition, a type of history that may had led them to a false sense of GD.[25] It is an absurd moral complexity that in the case of appropriate discernment for medical transition (to alleviate GD), marriage as a good is avoided, and therefore under natural law tradition, medical transition is to be avoided.

Seemingly, certain medical transition acts are only good if it is for the purpose of medical detransition, and allows the detransitioner to move towards both the good of life and marriage, not just one or the other. In my case, if I was to detransition, choosing metoidioplasty, phalloplasty and/or mastectomy would not be in the spirit and intent of natural law, even if the original decision to medically transition has induced a reverse GD that manifests as regret. Further cessation of FHT would only be appropriate if it does not increase my future risk of being diagnosed for other medical conditions such as osteoporosis. If such risk is increased by FHT cessation, only then may MHT be appropriate.

As demonstrated thus far, whilst under natural law the human person can self-control through reason, Cardinal Ratzinger has unsurprisingly referred to natural law as a blunt instrument.[26] (Not in itself, but only in the context of a dominant culture that has abandoned the idea of nature as given and normative.)

Commandments, like the Sixth Commandment mentioned earlier, may well defend relevant specific goods, and is otherwise known as second-level negative precepts, to help contain the adverse effects of sin.[27] But it does not make the moral issue less complex, because even if thorough and comprehensive exploratory assessments are conducted on medical transition candidates as effectively as possible, this will not guarantee that detransition will not occur in future.[28]

It is therefore unsurprising that supportive, and at worse, mixed, contemporary attitudes towards both gender transition and detransition have taken hold. Indeed, gender detransition is an emerging phenomenon that is poorly understood, even compared to gender transition.[29] What is probably clearer is that gender (de)transition as a sin is likely to be venial in nature, especially if it is driven by GD.

In light of this moral and likely unresolvable challenge, and in the spirit and intent of pursuing the good of knowing the truth about God, the Beatitudes remain open as always for transitioners and detransitioners alike, to turn towards in spite of their circumstances. This is because the Beatitudes are a response to the human person’s God-driven desire for happiness, a desire ordered to seek God who alone can fulfil it.[30]

Whilst there may be Thomistic goods which conflict with each other on the moral issue of gender (de)transition, it is the Beatitudes which reveal the ultimate telos of the human person. That is, God calls the human person to His own Beatitude.[31] Such Beatitude confronts the human person with decisive moral choices, and therefore serve as an antidote to the moral challenges of gender (de)transition. It could help GD sufferers to shift their focus to God, because true happiness is not found in well-being or medical technology, but rather, in the source of all good and all love.[32]

It appears that the following from Matthew 5 would most especially apply to those who have undergone gender transition, whatever their circumstances:
Blessed are the poor in spirit, for theirs is the kingdom of heaven — especially transitioners and involuntary detransitioners.
Blessed are those who mourn, for they shall be comforted — especially voluntary detransitioners.

The clarity, if any, of gender (de)transition in Catholic moral theology lies in the Beatitudes for contemplation, for now.

(You are well versed in the subject matter, with considerable depth of discussion and personal insight. As noted in my comments, there are some areas that demand greater thought/consideration (e.g., the anthropological significance of the created sex; its relation to the resurrected body) as they relate to the prospect of (de)transition.

There is a lot of ‘back and forward’ in your argumentation, without a clearly defined thesis; a lot of probing questions without a definable resolution. Morality, by nature, is ordered towards action. It therefore needs some definable conclusion.

You have consulted a range of solid resources from medical, psychological and theological perspectives. Your referencing is well done. Your paper is punctuated by relevant questions which gives structure to your paper and flow of ideas. However, the conclusion is quite vague. The paper is clearly written in accessible language.)

Bibliography

American Psychological Association. “A glossary: Defining transgender terms.” Monitor on Psychology, September 2018. https://www.apa.org/monitor/2018/09/ce-corner-glossary.

Aquinas, Thomas. Summa theologica. trans. Fathers of the English Dominican Province. New York: Benziger Brothers, 1911–25.

AusPATH Board. “AusPATH: Public Statement on Gender Affirming Healthcare, including for Trans Youth.” Effective June 26, 2021. https://auspath.org.au/2021/06/26/auspath-public-statement-on-gender-affirming-healthcare-including-for-trans-youth/.

Catechism of the Catholic Church. 2nd ed. Vatican City: Vatican Press, 1997.

Expósito-Campos, Pablo. “A Typology of Gender Detransition and Its Implications for Healthcare Providers.” Journal of Sex & Marital Therapy 47, no 3 (2021): 270–280.

Healthdirect Australia. “Gender affirming surgery.” Accessed August 15, 2022. https://www.healthdirect.gov.au/gender-affirming-surgery.

Horn, Stephan Otto and Siegfried Wiedenhofer, eds. Creation and Evolution: A Conference with Pope Benedict XVI in Castel Gandalfo. San Francisco: Ignatius Press, 2008).

Jones, David Albert. “Truth in transition? Gender identity and Catholic anthropology.” New Blackfriars: A Review 99, no 1084 (2018): 756–774.

Ratzinger, Joseph. ‘In the Beginning…’: A Catholic Understanding of the Story of Creation and the Fall. Translated by Out Sunday Visitor, Inc. Grand Rapids, MI: Wm B Eerdmans Publishing, 1995.

Ratzinger, Joseph. “Truth and Freedom.” Communio: International Catholic Review 23, no 1 (1996): 16–35.

Ratzinger, Joseph. Values in a Time of Upheaval: Meeting the Challenges of the Future trans Brian McNeil. San Francisco: Ignatius Press, 2006.

[1] American Psychological Association, “A glossary: Defining transgender terms,” Monitor on Psychology, September 2018, https://www.apa.org/monitor/2018/09/ce-corner-glossary.

[2] Pablo Expósito-Campos, “A Typology of Gender Detransition and Its Implications for Healthcare Providers,” Journal of Sex & Marital Therapy 47, no 3 (2021): 271.

[3] David Albert Jones, “Truth in transition? Gender identity and Catholic anthropology,” New Blackfriars: A Review 99, no 1084 (2018): 756.

[4] Catechism of the Catholic Church, 2nd ed. (Vatican City: Vatican Press, 1997), 1692.

[5] Thomas Aquinas, Summa theologica, trans. Fathers of the English Dominican Province (New York: Benziger Brothers, 1911–1925), IIIa, q 54 art 4.

[6] Stephan Otto Horn and Siegfried Wiedenhofer, eds, Creation and Evolution: A Conference with Pope Benedict XVI in Castel Gandalfo (San Francisco: Ignatius Press, 2008), 15.

[7] Joseph Ratzinger, ‘In the Beginning…’: A Catholic Understanding of the Story of Creation and the Fall, trans. Out Sunday Visitor, Inc (Grand Rapids, MI: Wm B Eerdmans Publishing, 1995), 53–54.

[8] “Feminizing hormone therapy,” Mayo Foundation for Medical Education and Research, accessed June 10, 2022, https://www.mayoclinic.org/tests-procedures/feminizing-hormone-therapy/about/pac-20385096.

[9] Ratzinger, ‘In the Beginning…’, 47.

[10] Joseph Ratzinger, “Truth and Freedom”, Communio: International Catholic Review 23, no 1 (1996): 28.

[11] “AusPATH: Public Statement on Gender Affirming Healthcare, including for Trans Youth,” AusPATH Board, effective June 26, 2021, https://auspath.org.au/2021/06/26/auspath-public-statement-on-gender-affirming-healthcare-including-for-trans-youth/.

[12] Catechism of the Catholic Church, 2333.

[13] Ibid, 387.

[14] Ibid, 1862.

[15] Ibid, 1734–35.

[16] Ibid, 2333.

[17] “Gender affirming surgery,” Healthdirect Australia, accessed August 15, 2022, https://www.healthdirect.gov.au/gender-affirming-surgery.

[18] Ratzinger, ‘In the Beginning…’, 72.

[19] Catechism of the Catholic Church, 1954.

[20] Aquinas, Summa theologica, Ia IIae, q 94, a 2.

[21] AusPATH Board, “AusPATH: Public Statement on Gender Affirming Healthcare, including for Trans Youth.”

[22] Catechism of the Catholic Church, 1952.

[23] Aquinas, Summa theologica, Ia IIae, q 94, a 2.

[24] AusPATH Board, “AusPATH: Public Statement on Gender Affirming Healthcare, including for Trans Youth.”

[25] Expósito-Campos, “A Typology of Gender Detransition and Its Implications for Healthcare Providers,” 273.

[26] Joseph Ratzinger, Values in a Time of Upheaval: Meeting the Challenges of the Future, trans Brian McNeil (San Francisco: Ignatius Press, 2006), 38.

[27] Aquinas, Summa theologica, Ia IIae, q 100, a 1.

[28] Expósito-Campos, “A Typology of Gender Detransition and Its Implications for Healthcare Providers,” 276.

[29] Ibid, 277.

[30] Catechism of the Catholic Church, 1718.

[31] Ibid, 1719.

[32] Ibid, 1723.

Pre-Course Assessment: Article Review

Servais Pinckaers OP, “The Return of the New Law to Moral Theology” (1999)

There are four parts to fundamental moral theology. The first part is law, specifically, natural law as willed by God. Such law stipulates moral obligation to restrict human autonomy, but not completely — just legal prohibitions. The second part is conscience, which interprets, applies and promulgates moral law — it is therefore the judge in the interior life. The third part is human acts, which are material in the cases of consciences, leading to casuistry. The fourth part is sins, which is an input of Penance, and a major concern for post-Tridentine morality.

There are ten parts to special moral theology, with each part based on a natural law-based Commandment. They are inclusive of certain canon laws, and rules governing the reception of the sacraments. This God-given moral and juridical framework drives strict ethical obligation for all. And the moral part of the Catechism could be considered the civil code of the Catholic Church. These aspects of moral theology can come across as apophatic.

The cataphatic aspects include asceticism (virtues via ordinary grace) and mysticism (special grace via the Holy Spirit). These enable moral aspirations beyond ordinary obligations, and are presented as good advice for consideration, almost obligatory for those in religious life. This is rooted in the Law of the Gospel which perfects, rather than displaces, the natural-law based Decalogue.

This raised the following issue for Pinckaers: what are the links, proper to Natural Law, with New Law? For starters, there cannot be no links, because “the Son of Man came to fulfill the precepts of the Decalogue”. There may need to be a level of Christocentric morality based on the New Law complementing the Decalogue, but there is the opposing view that Natural Law in itself suffices. Little attention was given to this conflict during Vatican II, and the concerted push to resolve this issue was not until during the period between Humanae Vitae and Veritatis Splendor.

St Thomas Aquinas clarified that New Law is “the presence of the Holy Spirit in the souls of the faithful”, and this is incorporated into the Catechism of the Catholic Church. From the special moral theology perspective, the Catechism poses the question as to whether its division on a Commandment basis is appropriate, or should this structure change Thomistically to that focused on the virtues and gifts of the Holy Spirit. Like Pinckaers, I have no significant issue with the current structure of the Catechism, as it does not drift away from something as fundamental as the Decalogue.

I believe that the Catechism, in this way, contemporarised the understanding of the Commandments, which, alone, is too apophatic for today. This new dynamism deepens its links to the corresponding virtues, and like Pinckaers, I believe it is a step in the right direction.