Ethical Considerations in General Practice

30 MINUTE READ

from Luke’s Journal 2019 | Hot Topics #2 | Vol. 24 No. 1

The Luke’s Journal editorial team is aware that this article has political implications and that, since publication, legislation may have changed nationally or in your state of residence and practice. Luke’s Journal advises that you contact your State chair if you have any questions or concerns regarding implications for your clinical practice.

At this cultural moment in Australia, many patients are presenting to GPs around Australia expressing a felt sense of gender dysphoria¹ and seeking medical help.

The dominant narratives promoting the concept of gender transition have been remarkable in their social and personal impacts, especially in the past five years. As a result, young people hold increasingly strong beliefs about this diagnosis and expectations about what treatment they should receive. The shifting presuppositions and demands of young patients has made work in this area substantially more difficult. The wider social conversation has also led to a dramatic epidemiological increase in young people attributing distress they experience (from a myriad of causes) to gender dysphoria. Fuelling the demand for medicalised treatment and actively recruiting patients, nine large tertiary hospital gender centres have sprung up around the country. They have been zealously promoting stories of gender transitions through all media, and have been heralding the exponentially rising number of children on hormones as a marker of success.

Managing gender dysphoria with compassion, integrity, openness and wisdom

I work with a lot of young people with Gender Dysphoria. Trying to take good care of these patients in a way that is faithful to God’s design has been the most heart-wrenching challenge of my professional life. They have many different stories, and are at different stages of their journeys when I first meet them. Some have already been started on testosterone injections by an endocrinologist. Others are compressing their developing breasts against their body with chest binding garments. Often these young people will dress in loose, androgynous clothing to hide their bodies. Many have adopted a different name and seek to be identified as the opposite gender. Amongst this group, an extraordinary range of self-descriptors are used for both expressed gender and sexual interest. Many of these young people have never been in a romantic relationship.  

For the past ten years I have been working in adolescent medicine as a GP. My work takes place within a multidisciplinary adolescent mental health clinic that is part of a larger network. I working openly as a Christian in an aggressively pro-LGBTQ organisation. At national conferences, workplace in-services and in a meeting with an activist and my manager, it has been demanded that I give specific advice which clearly encourages young people to pursue cross-sex hormones. It has repeatedly been said that those who refuse to conform should be bullied or coerced until they leave or submit. And yet, I continue in this work. Despite such demands, I continually strive to provide better, more honest and, ultimately, more helpful care. Some GP psychological medicine colleagues have compared my approach as akin to the refuge provided by a small island in the middle of a torrential river. My consult room acts as a place where young people can catch their breath, take time, look around and think carefully about whether or not to jump back into the chaotic waters of gender transition.

“It has been demanded that I give specific advice which clearly encourages young people to pursue cross-sex hormones.”

By God’s grace, my work in this context has proved instrumental and timely in the lives of a number of young patients. I have young people in my care that were on a trajectory which almost certainly would have led to them being placed on exogenous hormones. Instead, we worked together to help them navigate their complex feelings, thoughts and relationships. They have been able to get meaningful support in dealing with past abuses, current hardships and anxieties about the future. With support, they have carefully considered who they want to be and decided they could do this without medical interference. Of my large cohort of patients with gender dysphoria, it is this group (who have not been put on hormones or had surgery) who are really thriving personally and in their relationships. In contrast, my patients who pursued hormonal treatments through other clinicians are irrefutably the most socially withdrawn, functionally impaired and profoundly psychologically unwell.

It is a great tragedy to see unscrupulous treatments being offered with a promise of relief and failing so predictably. There is great personal and social cost due to the medical community getting this wrong.

Recent guidelines and current care

One of the Australian children’s hospitals has sought to have their suggestions established as the national standard for managing gender dysphoria in Australian children and adolescents.2 Much of the document is ideologically driven and incongruent with Scriptural truth. Amidst the document are some significant recommendations and admissions. It is suggested that a decision to begin hormonal treatments:

• Should have consensus agreement that it is in the best interests of the young person.

• Should be in the context of parental support and family work done over time.

• Should only ever be considered when there has been a thorough consideration of each of the following domains: 
– Assessment and treatment of co-existing mental health difficulties, including appropriate referrals for optimal management
– Assessment of family support, dynamics and functioning
– Assessment of developmental and family history
– Assessment of cognitive, emotional, educational and social functioning
– Comprehensive exploration of early developmental history, emotional functioning, intellectual functioning, peer and other social relationships, family function as well as immediate and extended family support.

Young people with gender dysphoria would be very well served by such an assessment! From my work with many dozens of young people, I have never experienced anything resembling a quality assessment of teens who have all been hastily commenced on hormonal treatments. Genuine assessments, designed to inform wise clinical decisions, are intentionally replaced by meaningless questions which function as a perfunctory, medicolegal bare minimum. Thorough assessments are being disregarded in favour of streamlined questionnaires designed to arrive at one certain, predetermined outcome: exogenous hormonal treatment.

“Thorough assessments are being disregarded in favour of streamlined questionnaires designed to arrive at one certain, predetermined outcome: exogenous hormonal treatment.”

Is such malpractice occurring in other parts of the country? From what I have heard directly from the doctors overseeing the nation’s gender clinics I would say such negligence is widespread. For distress, or even vague questioning, about gender, hormones are promoted as the great panacea. The doctor overseeing Australia’s most prominent gender clinic bragged at a public lecture that “95-98% of children and teenagers presenting to Australian gender clinics are commenced on hormonal treatment.”³

Language is increasingly used to bully or harangue dissenting doctors, parents and teachers. Helping an adolescent with the normal tasks of adjustment and becoming at ease and comfortable with themselves (socially, biologically, mentally, emotionally and spiritually) is reframed and labelled as an unethical attempt at change⁴ which may cause lasting damage.

The group collating the Australian ‘guidelines’ envisions an ideal candidate for hormonal treatment as: a person with insistent, persistent and consistent expressions of gender dysphoria, a supportive family, an affirming educational environment and the absence of co-existing mental health difficulties. In contrast, they cite “a study of the mental health of trans young people living in Australia found very high rates of ever being diagnosed with depression (74.6%), anxiety (72.2%), post-traumatic stress disorder (25.1%), a personality disorder (20.1%), psychosis (16.2%) or an eating disorder (22.7%). Furthermore, 79.7% reported ever self-harming and 48.1% ever attempting suicide.”⁵ Based on mental health comorbidity alone, considering their guidelines alongside the statistics they cite, the vast majority of these patients are far from ideal candidates for hormonal treatment.

It is widely recognised that Autism Spectrum Disorder (ASD) is highly overrepresented in those associating distress with gender. This seems to have increased sharply with the national conversation promoting gender transitioning as a simple solution to distress. Intense fascination with a particular topic is very common in those with ASD and a marked preoccupation with transition can result for a season. My patients with ASD have often expressed deep suicidality when they felt the narrative of transition was obstructed for any number of reasons. Of note, those who continued without hormonal intervention have with time found other areas of interests while concerns about gender have faded. Those who have started on hormones, on the other hand, have been greatly distressed when it failed to bring the promised solution to their difficulties with interpersonal interactions and comorbid mental health issues. It is heartbreaking to hear the deeply personal accounts⁶ of young people who feel devastated by the failure of treatment and a sense of utter betrayal by doctors who misguided them with false promises of relief.

Sadly, a very high portion of young people expressing gender dysphoria have had abuse perpetrated against them. Victimisation through acts of physical or sexual violence in childhood dramatically distorts a person’s view of adult manhood and womanhood. In the wake of wicked cruelty, many of these young people desperately seek to avoid being part of any further cycles of abuse. I commonly witness young men who despise the man who abused them, and feel far more connected with their abused mum and other women. In these situations, gender dysphoria can arise from a strong subconscious impulse to emulate what is good in womanhood, and abjure the abusive patterns they have witnessed from men.

Similarly, young women who experienced tragic sexual violence will often experience great anxiety in the time leading into to puberty. The normal self-consciousness of early adolescence is further magnified by a profound fear of being further targeted and abused. In this scenario, I care for a very large cohort of young women who have (often subconsciously) sought to masculinise themselves to avoid being the object of sexual attention. At the simplest level this can be wearing clothes that conceal the figure. For young women with conspicuous chests, binders are sought, not because of distress about breast tissue itself, but in a desperate attempt to dissuade lecherous men from leering at their chests.

A further level of gender dysphoria seeks to actively masculinise – a deeper voice and facial hair seek to act as an attempt to reduce further victimisation. Sadly, this cohort are placed on inappropriate hormonal treatments long before they reach a maturity where sexual assault counselling can generally be manageable and helpful. For these young women, as they get quality counselling and come to terms with the horrendous mistreatment they suffered, they also must wrestle with a permanently changed appearance, voice and the irreversible loss of future fertility. While abusers have stolen parts of their childhood, clinicians have later stolen parts of their future, including the capacity for parenthood.

“While abusers have stolen parts of their childhood, clinicians have later stolen parts of their future, including the capacity for parenthood.”

Young Australians struggling with their gender should never be thoughtlessly started on hormonal treatments. Adequate assessments should seek to clarify why a person has gender dysphoria. A proper understanding of the person should lead to appropriate clinical care and counselling, address underlying causation and promote psychosomatic cohesion and social wellbeing.

Subverting medical science’s understanding of human bodies

The proposals for the changing concepts of gender identity are thoroughly ideological. Dr Deanna Adkins (Professor of Paediatrics at Duke University’s School of Medicine and Director of Duke Child and Adolescent Gender Care) has offered a number of extraordinary pronouncements: “Gender identity is the only medically-supported determinant of sex”. She also says, “It is counter to medical science to use chromosomes, hormones, internal reproductive organs, external genitalia, or secondary sexual characteristics to override gender identity for the purposes of classifying someone as male or female.” For a person in such prominent roles to hold these positions is extraordinary. We live in strange times! What Adkin’s summarises as “a person’s inner sense of gender” is suggested as the guiding determinant of medical science!⁷

Presuppositions of transgender ideology:

• Your physical identity and psychological identity are different and untethered.
• Your body may be lying to you about who you really are.
• Society is to blame for oppressive gender roles.
• There are no fixed genders or gender roles – everything is fluid and shifting.
• There is no design or intent for your body – you are to make your own reality.
• All you need for happiness is physical change.

Concerning features of transgender ideology:

• Explanations and demands constantly change and morph, including the demands upon medicine.
• Differing positions or concerns raised by loving parents, caring doctors or thoughtful researchers will not be tolerated, and must be censored.
• Insists on coercion and is highly defensive. It nervously seeks to evade all scrutiny.

Statistical outcomes:

Without puberty blocking by use of Gonadotropin Releasing Hormone:
• Desistance: 80-95% of children with gender dysphoria resolve without treatment; they come to fully accept their biological sex and are emotionally well by late adolescence.⁸

With puberty blockers:
• 0% resolution, 100% persistence of gender dysphoria in children commenced on GnRH. Every child ended up on cross-sex hormones.⁹

At Australian hospital gender clinics:
• 95-98% of children and teenagers presenting to Australia’s gender clinics are commenced on cross-sex hormonal treatment.¹⁰

Longer term outcomes:

A survey of more than a hundred studies was conducted by the ARIF research arm of Birmingham University. Despite most studies being skewed to promote transitioning, the review found “no conclusive evidence that gender reassignment is beneficial for patients.”¹¹ Instead, even in the rare clinics with very careful and conservative patient selection, the meta-analysis showed that “large majorities of patients remain deeply troubled after treatment, many to the point of suicide.” A fifteen-year follow-up of Swiss patients showed lower satisfaction with general health, person, physical and social impacts from their treatment.¹² 

The most rigorous study, conducted by Gothenburg University, found that, despite the full gamut of treatments – including ongoing hormonal treatments – outcomes were far worse in post-operative transgender patients.¹³ Even after adjusting for past psychiatric treatment, they had three times the rates of psychiatric hospitalisation when compared to the control group. They had lower general life satisfaction scores, lower quality of life, increased social isolation, a lack of improvement in social relationships, and increased dependence on welfare. Suicide attempts were five times higher. Death by suicide was nineteen times higher. Those who did not have surgery showed a statistically significant improvement in wellbeing over time.

Clearly these procedures don’t always alleviate the mental health issues they promise to resolve. Despite countless injections and operations, the investment of many years and thousands of dollars, patients’ lives are worse than ever. This is a terrible, terrible solution.

A philosophical divide

This opens up an important philosophical divide:

Uninterrupted natural puberty in those with gender dysphoria allows almost all adolescents to become comfortable with an identity in harmony with their biological sex. In contrast, puberty can be vilified as undesirable or unhealthy for a person with gender dysphoria. In these patients, interrupting puberty always interferes with normal neurological, hormonal, physical and psychosocial development. By doing so, it increases the alienation of adolescents who are left behind by their peers as they remain children. It consolidates and reinforces gender dysphoria in 100% of young people who are hormonally manipulated in this way. It therefore makes them far more likely to end up seeking lifelong hormonal treatments and surgical sex reassignment. This means a lifetime of medically-induced social marginalisation.

“The meta-analysis showed that ‘large majorities of patients remain deeply troubled after treatment, many to the point of suicide.’”

There is no way for any doctor to know if a nine-year-old experiencing gender dysphoria is one of the 5-20% who will continue to experience this dysphoria in adulthood. But a doctor can be sure that promoting medical treatments will result in a self-fulfilling protocol with a single, inevitable, irreversible outcome. Lifelong hormonal treatments, monthly visits to the endocrinologist, and a permanent inability to have children cannot be ethically or morally justified based on the self-diagnosis of a child or adolescent. It is highly dangerous to make such a decision in the context of the confounding mental health comorbidities that are ubiquitous in this population. Such drastic and experimental treatments on unwell children, and the doctors who promote this, warrant harsh scrutiny. Such treatment is certainly not something that I can recommend as a Christian who cares for my patients. I would like to think that our major hospitals make sure that only really exceptional cases are treated with hormones, but I can tell you that Australian data indicates that between 95 and 98% of all children and teenagers who attend Australian hospital-based gender clinics are started on hormonal treatments which then are continued for life.¹⁴

My great concern is that an exponentially growing cohort of children and adolescents who may never have struggled, or struggled only for a season, with their gender identity are now presenting to clinics around the country insisting that pubertyblocking, potent hormones, and radical surgery on their healthy bodies is their only means to happiness and that medicine is the essential solution. At this cultural moment, a campaign is currently convincing young people to accept a lifetime of medicalisation. The outcome will be social marginalisation, ongoing disability, and terrible longterm psychological health.

Surely, quality medical practice will aim to promote human flourishing based on healthy development of one’s own body, and also promote relating to others in a healthy way with an integrated union of body, mind and soul. It is imperative for physicians to have the ultimate, long-term benefit of our patients in mind.

We appreciate that even the most intense sense of gender dysphoria involves misinterpretations, incorrect social assumptions and a whole gamut of complex psychosocial issues. However, medicine must be based upon the goal of physical and mental health being restored. This requires us to be sympathetic and compassionate toward various types of suffering. For psychosomatic misinterpretations, this means helping suffering patients to manage the distress about concerns they have about their healthy, functioning bodies. It cannot, and should not, be simply a matter of acquiescing to patients’ harmful desires or bowing to social pressure. As Christian doctors, we cannot allow ourselves to capitulate to wicked cultural demands which ask us to betray what we know to be right, true and in the best interests of our suffering patients.

Does Scripture address gender dysphoria?

The Bible does not speak explicitly about our modern concept of gender dysphoria, nor the current medical phenomenon of hormonal treatments for the alleviation of distress. It does, however, speak vividly about human personhood, about how we conceive of ourselves, about suffering and distress, and about our longings for change and relief. I will briefly offer four thematic points of Biblical reference.

1st: Gender and gender roles are addressed richly throughout Scripture. Great detail is contained in the chapters of Genesis and reiterated by Jesus. We can turn to countless other texts such as Ephesians 5 and 1 Peter 3. In Scripture we find explicit boundaries of gender roles within marriage and church life. But outside of these there is a distinct lack of prescribed, rigid stereotypes. Instead, there is a beautiful vision of healthy personhood and flourishing throughout Scripture. There is great freedom to find a full personal expression of who we are, as we are, as God made us – body, mind, heart and soul. God graciously, purposefully and lovingly shapes the bodies he intended specifically for us. It is within these bodies that we live our lives within the family, community and society that God places us in. It is a vision which offers great freedom of expression.

2nd: Everything is not how it should be – sin distorts us and society. Scripture’s narrative about sin originates as Satan questions the goodness of God and the benefits of keeping the one boundary God had given. Adam fails to lead Eve and humankind sets itself on a course of craving self-rule and autonomy: we want to set our own rules, we want to decide, we want to act like God. As a result – brokenness corrupts God’s good creation and we experience guilt and shame, sin and hiding. Our flawed bodies are definitely not a secure basis for personal identity. The Fall impacts our minds – with mental illness, confusion and rebellion against God following. Sin also devastates families and wider society by poisoning all of our relationships.

Many of my young patients see a landscape of calamity in their broken families. They experience a hurting society, marred by hyper-sexuality, distorted gender roles and wicked pressures. They are overwhelmed with fearfulness about having to live out the disfigured cultural caricatures of manhood or womanhood, and begin to think, “I can’t do this!!!” In this tragic context, the promise of gender transition seems to offer a lifeline. Prompted by a society that rejects God, they begin to question the goodness of how God has created them. They begin to doubt the basic foundations of life, relationships and even their own bodies. A great paradox exists when our society encourages young people to doubt their bodies, when their body may be one of the few clear pointers in their life to God’s intentionality and purposeful design.

3rd: The Gospel is all about producing radical personal and societal transformation. A deep yearning for radical change is the driving force of transgenderism. As Christians, we recognise that only the Gospel can bring about such profound personal and societal redemption. Ultimately, we Christians share a similar desire to that of gender activists – to see people deeply transformed – but we have radically different ideas about what true change looks like and how real change can happen. Without Christ, self-identity-making projects are doomed to fail. Without Christ, no amount of surgery, hormones or social transitioning can bring the sweet relief we all long for. Can we not cry with these folks? Because alongside them, we also recognise how broken we are, and how much we need the transforming work of God. Because we are Christians, we know Christ, and we are granted the task to share his life-giving message to the marginalised and outcast of our society. Who is more marginalised and longing for radical transformation than the transgender community?

4th: Identity – do we make our own? Or do we find our identity in Christ? Our truest identity is defined by God. Because He made us and has called us His own – He gets to say who we are. No longer suppressing our knowledge of God as Romans 1 describes, our newly revealed knowledge of God and our relationship with Him help us to more truly know ourselves. Other, self-made, sources of identity are no longer primary. Our truest identity is now relational – as Ephesians emphasises, we are with Christ, we are in Christ. Christ is our stable reference point. In Christ, we experience the work of God’s sanctification – we get to experience living transformation and true freedom. And this gradual transformation through sanctification will one day be complete. 1 Corinthians 15:52 promises: “We shall all be changed, in a moment, in the twinkling of an eye.” Whilst it is good to desire change, true change is ultimately only possible through Christ.

My approach

For young people, I consider it essential to explore the feelings and thoughts that create a link between their biological sex and concerns about future social roles, relationships and expectations. It is important to me that children are supported in healthy psychosocial and sexual development, including addressing misapprehensions about stereotypes and the actual meaning of their biological sex. There are likely to be predisposing, precipitating and perpetuating factors involved in feelings of gender dysphoria.

I seek to explore personality, family dynamics, family mental health history and its impact. Exploring peer relationships with both sexes is essential. Relationships with parents, instability in the family home and the quality of attachment all have a profound impact on whom children identify with and the way gender roles are perceived. Personal temperament also plays a large role – overactive girls and underactive boys are far more likely to identify with the other sex as a result of differing playtime interests, such as an aversion to rough play, interpersonal interactions and sensitivities. In such cases it is a great relief for children to know that it is okay to be a sensitive boy, or a girl who likes to participate in full contact sports. In all of their personal preferences, young people can come to understand that they can be comfortable with who they are.

In the common presenting request to transition, I seek to slow things down. I explore with my adolescent patients what they expect and hope that gender transition would change in their life and the benefits they anticipate. I also explore aspects of transition that may cause them to be hesitant or uncertain.

It is really important to help the large portion of adolescents with autism spectrum disorders and gender dysphoria to understand what contributes to a sense of not fitting in, of not belonging, or of interpersonal interactions being exhausting. It is also important to recognise the intense, obsessional and very rigid thinking that promotes these patients to see gender in very black and white terms. To challenge these obsessions hastily, without sensitivity and love, can produce severe anxiety. We can’t afford, as Christian doctors, to apply simplistic treatments to these young people. It is not sufficient to have a five-minute consult, give a jab of testosterone and say “see you next month”. As a parallel situation, if a child was stressed out about their ethnicity, we would always seek to help them appreciate the various dynamics involved. For example, we would never encourage someone to bleach their skin in order that they might feel more comfortable amongst lighter-skinned peers. In a similar way, good medicine requires us to care more. To care about the “Why?” underlying a sense of gender dysphoria. We want to help promote healthy attitudes and feelings towards our God-given bodies. We want to establish an understanding of healthy differences between the sexes and the ability to challenge restrictive stereotypes. We seek to promote a richer understanding of the diverse scope of healthy manhood and womanhood.

“I continue to support these young people, and care for them with compassion. The same cannot be said for the clinicians who take their money, treat them with hormones and are extraordinarily uninvolved.”

Ultimately, I want young people to be able to flourish and become comfortable with who they are in a complex and broken world. Caring for this population is a tremendous challenge and a great privilege. I have many dozens of young people who have come to see me, deeply convinced of a trans identity. A few have started transitioning through other doctors and they are in terrible shape. Almost universally in this group, chronic suicidality is relentless. The social impact is terrible. I care for numerous patients who feel substantial regret for starting hormones, but feel that they cannot turn back. Some say, “I have already put my parents through too much for me to change my mind.” Or, “The T (testosterone) makes me feel so awful, I’m angry and explode all the time. I hate it, but I can’t stop or I’ll be stuck; I won’t be a man or a woman.” Others struggle with the prospect of ridicule and shame, feeling that they were wrong, but not wanting people to torture them about their mistake.

For those that continue, they live with this solitary goal… “I hope that I pass.” “I hope that I pass for being a woman.” “I hope that someone doesn’t question my patchy facial hair.” “I hope I don’t get attacked.” I continue to support these young people, and care for them with compassion. The same cannot be said for the clinicians who take their money, treat them with hormones and are extraordinarily uninvolved. Amongst all of my patients, these young people are overwhelmingly the most psychologically unwell.

My experience of patients under the care of psychiatrists who persuade and induce adolescents to transition, and the endocrinologists and surgeons who facilitate it, is of tragedy. Despite varied backgrounds, (of social anxiety, of feeling different, of broken families or living in the rubble and aftershocks of abuse) the results are remarkably consistent – increasing feelings of alienation, marginalisation from the wider family, distress at hormonal sideeffects, and reinforced desperation about themselves. Transitioning not only fails to bring the promised relief, it seems to worsens the un-dealtwith anxiety, depression, ASD, social brokenness and impacts of trauma which contributed to the initial gender dysphoria.

Another common scenario is of thoroughly disabled adolescents, barely able to engage in self-care or socialise, unable to work, trying to save up Centrelink payments for a bilateral mastectomy. “I feel heaps worse than before treatment, but I’ll start feeling better once I have top surgery.” In the lives of a substantial number of my patients, the well-intended medical interventions are unmitigated failures. Because of my care for them, it is personal to me, and it is heartbreaking.

By God’s grace, the vast majority of my patients who have come to see me in the primary healthcare setting with a sense of gender dysphoria are on the journey of acceptance, of healthy relationships and flourishing. Clinically, we are taking it slow and we are making headway. Most are swimming against the current by not starting hormones. We try to address all of the things that are going wrong. We are treating depression and anxiety. We are organising quality sexual assault counselling. I’m making sure that my patients on the autism spectrum are given good support to help with their interpersonal interactions. I am helping to facilitate better parent-child relationships. I am helping young people to consider what healthy relationships look like.

Rather than accepting the simplistic and superficial treatments of gender transition, we are working towards fuller, more authentic lives. We are hunting for and celebrating the good stuff, God-given character and gifts. We are working through the discomfort and pain and trauma. I’m praying for them, and sometimes with them. They get to witness the love of God in me, through consistent care and in my words. I’ve grounded my care in Scripture and seek the Spirit’s leading. I take the time to cultivate meaningful conversations about what is most important in life, including spiritual wellbeing, and I prayerfully seek God’s help in the way I work and walk alongside them.

A number of these patients are starting to explore the Christian faith and are becoming involved in local churches. In God’s sovereignty, He placed these folks in a pro-LGBTQ clinic, with an openly Christian GP, who seeks to be a faithful witness to them by offering consistent, holistic care.

As you will almost certainly care for some of these young people in your own careers, I’d like to leave you with these encouragements:

• The Gospel is the most wonderful agent of change and transformation.

• Jesus, the great high priest, sympathises with us in our weakness – follow his example.

As Gospel-fuelled doctors please know your patients well, listen closely, care deeply, speak with great honesty, and point them always to their very real and ultimate source of hope in Jesus Christ. Overflow with Christ’s compassion and love. As terrific as our medicine is, our patients need Jesus’ living water far more than they need our medicine. Please be doctors who are brave enough to share the living water of the life-changing Gospel with your patients.

For parents seeking your help:
• Encourage them to not overreact, to ask good questions of their child, support a clear perception of reality and social adjustment without transitioning.
• Reinforce that blocking puberty has a huge negative impact on social wellbeing and outcome.

Suggestions when counselling young people with Gender Dysphoria

• Allow the person to be deeply known by you.
• Don’t get overwhelmed or panic.
• Don’t let anger at society impair your sensitivity and care for individuals
• Don’t let gender dysphoria become the sole focus.
• Be ready to explore the fuller sense of what gender means to them.
• Consider that different approaches are essential for different people. “If you’ve met one person with gender dysphoria… you’ve met one person with gender dysphoria”.
• What are the bases for this person’s identity?
• What shapes this person’s worldview, vision of personhood and questions of faith?
• What other issues that may be contributing: victimisation and traumatising exposures, social expectations, roles and stereotypes, difficulty relating to others and those on the Autism Spectrum. NB: A different approach is needed for those who are expressing gender as experimenters, as activists, and as older men (who often have eroticised reasons for pursuing transition).

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