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Luke’s Journal July 2026  |  Vol.31  No.2  |  Sexuality

Part 2: Causes for Transgender Self-Identification

As discussed in our first article, the term transgender describes people whose gender identity does not match their biological sex. Transgender ideology states that trans self-identification flows from possessing an internal, immutable gender identity that is not only different to a person’s physical body but also more central and essential to the person than their body. This gender identity is an invisible self-concept which only the trans-self-identifying person can access and declare, but which everyone else – including health professionals – must obey.

In the USA, the number of college students (average age of 20) self-reporting a transgender identity has risen steadily over the last few years, reaching 4.7% in 2025.¹ Another 2025 study reported that 3.3% of US youth aged 13 to 17 identified as transgender.² The Australian Bureau of Statistics reported that in 2024, 4.5% of Australians 16 years and over identified as LGBTI+.³

Self-identifying as transgender does not always lead to gender dysphoria. Some seem to cope well with the incongruence between their biology and feelings. However, there may be substantial distress as evidenced in the graph below, which shows the sudden significant increase in referrals to specialist paediatric gender services over time in several Western countries including Australia.⁴

As a health professional, we may encounter:

• A gender non-conforming child uncomfortable with their body;⁵
• A teenager who suddenly identifies as the other sex or any of the other gender labels (a condition named rapid onset gender dysphoria – ROGD);⁶
• A teen or adult effeminate homosexual male who identifies as female or (more rarely) a butch lesbian who identifies as a male;⁷
• The adult (usually a male) who having lived as a male, sometimes married and with children, suddenly identifies as a female—a condition sometimes called autogynephilia;⁸
• A teenager or young adult who having started down the path of gender affirmation therapy develops transition regret (called detransitioners);⁹
• A person who has transitioned and has complications due to medicalisation or surgery;¹⁰
• The parent of a child who identifies as the other sex or takes on a gender label;¹¹
• The spouse¹² or children¹³ of a person who identifies as the other sex.

Our previous article explained how trans ideology seeks to redefine reality by defining ultimate reality as being within the self. This article will use an analogy of a tree to explain the different, interconnected aspects of sex and gender development, and how trans ideology misinterprets them. It aims to provide basic knowledge to help in responding to the different trans-identifying people we may encounter.

The sex and gender tree

A tree’s beauty is in one sense unique. No one tree is exactly like any other. But a tree’s beauty also expresses its species. Californian Redwoods are very different to rugged Arizonan Desert Ironwoods, and they’re both different to Australian Gumtrees. That’s why a tree is a useful image of human sexuality. Just as there are different parts of a tree, so there are different elements to our sexuality. And while we’re all unique individuals, the beauties of our individual sexuality follow the basic patterns of our sex as male or female.¹⁴

Biological sex forms the roots and trunk. The biological sex of an individual as male or female is determined in the womb at fertilisation. In the presence of the Y chromosome, the SRY gene on that chromosome directs the formation of testes and male sexual organs. Otherwise, the zygote goes down the female developmental path.¹⁵ No one can be born in the wrong body or have a male brain in a female body. The body you are born with and live in till you die was determined at conception.

After birth, the next significant time for biological sexual development is puberty. This is the first branch of our tree. Puberty is triggered by the secretion of the hormone Gonadotropin Releasing Hormone (GnRH) from the hypothalamus. This causes the release of gonadotropins—luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary. These activate the gonads to produce gametes (eggs in women and sperm in men) and sex hormones. These sex hormones are responsible for the body and brain changes of puberty. GnRH is more than just a puberty trigger. It is involved in the development and maintenance of other important functions in the brain, including sense of smell and cognitive capacity.¹⁶

Approximately 0.018% of babies are born with disorders of sex development (DSDs).¹⁷ DSDs are commonly called intersex conditions—the I in the LGBTQQIA acronym. Unfortunately, the term intersex is often thought to imply that there is a third sex which is in-between male and female or that sex is a spectrum. That is not true. While some babies with DSD are born with ambiguous genitalia or other abnormalities in the gonads and internal genitalia, the majority, if not all, of these children can be classified relatively easily as either a boy or a girl.¹⁸

The other two branches of the sex and gender tree represent gendered behaviour and sexual orientation.

These are not biologically innate but refer to people’s behaviours and the objects to which they tend to be sexually attracted. However, both can be studied empirically. Gendered behaviour can be examined through the social sciences. A person’s sexual orientation can be studied in the laboratory by observing sexual-arousal patterns and observed and recorded in relational behaviour.

Gendered behaviour or gender expression is how we tend to behave as males or females. Every culture has certain stereotypes for how people of each biological sex should express themselves in the ways they dress and behave.

Some boys’ and girls’ behavioural preferences differ from the prevailing culture. Many cultures expect men to express strength and women to show gentle compassion. However, some girls prefer rough-and-tumble play. Some boys enjoy music, dance, and dressing up in soft materials and bright colours. We must not mock or punish such children for departing from behavioural stereotypes. Their behavioural preferences represent part of the God-intended diversity of humanity.

Importantly for the purposes of this article, these behavioural preferences do not contradict their essential biological sex. They remain biologically male or female, who engage in non-stereotypical behaviour. They are still the same species of tree. They are unusual in this one aspect of their tree-ness. That unusualness makes them more interesting and beautiful, not less. But it doesn’t stop them being that species of tree.

The third branch is sexual orientation or sexual attraction – what type of person (male or female) a person is romantically/sexually drawn to. While most people are sexually attracted to people of the other sex, sexual science has documented how all cultures across the world have some males and females who are homosexual or bisexual. These people are sexually attracted towards people who are of the same biological sex as themselves, and who therefore possess the same kind of body as they do. Transgender contradicts this, as we’ll see below.

For most people, the three branches of pubertal development, gendered behaviour, and sexual attraction are congruent with the root system of biological sex. Most biological males behave in ways broadly congruent with cultural norms and are sexually attracted to females, and vice versa for most biological females.

Transgender identity deforms healthily integrated sex and gender through the gender identity parasite

Transgender ideology’s prioritisation of a person’s internal self-identity allows gender identity to redefine all aspects of the healthy sex and gender tree. In the process, gender identity becomes like a parasite which cuts the tree off from its roots, kills the real tree, and tries to mimic the real tree in a false, unhealthy, unsustainable way.

As noted above, transgender ideology’s relocation of authority allows it to simply ignore contemporary scientific knowledge about intrauterine and pubertal biological development. This is because (according to trans ideology), a person’s internal emotional disposition is more central, and therefore more authoritative, than their physical body.

Trans ideology asserts that a child’s sex cannot be recognised through inspection of their sex organs at birth. Instead, children are said to be ‘assigned’ male or female at birth – AMAB or AFAB.

That language of ‘assignment’ is not neutral. It makes normal, healthy intrauterine development sound like something alien and unnatural. And it makes the people who recognise that child’s biological sex – the medical professionals and their parents – sound like wicked people who are seeking to impose their will upon a helpless, vulnerable child.

This misrepresents and insults parents and the entire medical profession. Parents love their children and make enormous sacrifices for them. Medical professionals spend years, sometimes decades, learning enough about the detailed operations of the human body to be accredited to diagnose and treat illnesses. That knowledge and hard work are used to care for people’s health.

Medical professionals (and all parents) are permitted to counter-accuse the transgender lobby as being the potential child abusers who seek to alienate vulnerable, impressionable children from those who care about them in order to deceive those children into harming themselves – there’s more about that below.

The concept of gender identity also redefines teenage pubertal development from being an exciting, if turbulent, time of maturation. Instead, it adds to the multiple stressors that teenagers already experience by making teenagers believe that they might be going through the ‘wrong’ puberty.

Medical training gives a basic understanding of how testosterone and other hormones stimulate the body and brain changes associated with puberty – especially the development of secondary sex characteristics. Those bodily changes can be stressful! The young person may not understand or enjoy what is happening to them. Many young people experience peer pressure and bullying. Such stresses are compounded in today’s comparator culture, where young people are tempted to compare themselves to online influencers who apparently possess (probably digitally enhanced, therefore unreal, fictional) ideal bodies and lives.

Young people, facing multiple stressors from multiple directions, deserve attention, compassion, and care. But transgender ideology exploits their vulnerabilities by leading them to fixate on transgender self-identification as a panacea to solve all their problems. Transgender ideology tells already traumatised young people they can

• Solve their discomfort with their developing body by pausing and perhaps reversing the direction of their puberty, and
• Reverse their status of being a social outsider by becoming a transgender celebrity.

In the process, trans ideology deceives young people into fearing, even hating, their pubertal bodily changes instead of recognising them as a stage in their growth into strong, healthy young adults. That is a tragic attitude to one’s body. An ‘inclusive’ society rightly uses technology to try and give people whose bodies operate sub-optimally, ’disabled’ people, equal access to society as people with healthy bodies. Why are we encouraging impressionable young people to despise the normal, healthy operations of their growing bodies? Why are we permitting, even encouraging, them to intentionally contradict that healthy development in ways that potentially damage them for life?

Trans ideology misleads young people into damaging themselves by giving them unrealistic expectations about medicine’s ability to construct a new self. It deceives them into believing that medicine is magic – that pharmaceuticals and surgery can help them easily change, even reverse, the direction of their natural pubertal development without risk or long-term consequences.

It thereby leads them onto a treatment pathway that is not neutral but which, through its demands for universal ‘affirmation,’ medicalisation, and surgery, ends up constantly reinforcing trans self-identification. The steps of ‘gender affirmation’ are:

1. Social transitioning: the young person dresses as and joins in the activities associated with the opposite sex. That means, for example, that a trans girl – a biological boy who self-identifies as a girl– would not only dress in a girls’ school uniform but be given access to girls’ sports, girls’ change rooms, girls’ toilets, girls’ dorms, etc. Everyone around them—family, schoolmates, friends—are expected to unquestioningly affirm and celebrate their transgender self-identification. Anyone who objects, e.g. parents who object to their daughters being forced to share a room with a biological boy, is vilified as a transphobe. The UK’s Cass Report found that childhood social transitioning tended to reinforce transgender self-identification: 94% of children who transitioned socially still identified as transgender after five years, making it more likely that they would proceed with medicalisation. Given what we know about brain development, this is no surprise.¹⁹ Social transitioning therefore encourages children towards the next step, which is:
2. Delaying puberty using GnRH analogues prevents the secretion of the sex hormones that would normally trigger pubertal sexual development. This is not an inconsequential act like pausing a music track. Health professionals like you understand how the body is not a machine that can be disassembled and its parts changed, e.g. changing tyres on a car. The body is an interconnected organism, and altering one element, e.g. sex hormone production, impacts everything else. GnRH analogues not only delay but permanently malform the sex organs. Some early human research has warned they may also impact brain development and cause lower IQ. Despite these risks, research indicates that the majority of children (up to 98%) who pause puberty continue to the next stage²⁰ which is:
3. Using synthetic cross-sex hormones to force the body to undergo the puberty of the opposite sex. They cause the child’s natural sex organs to atrophy and develop some of the characteristics of the opposite sex – e.g. skin and muscle tone, hair and fat distribution around the body – to develop instead. However, hormonal treatment alone cannot force the body to develop the significant sex characteristics of penis and vagina. That requires surgery (see below). But because these hormones are opposed to the body’s natural development, the body treats them like a disease, constantly seeking to reject them! This causes side effects which in turn require more medication. Despite this, the euphoria induced by cross-sex hormones—especially testosterone for girls seeking to transition to boys—causes many of them to proceed to the final stage of:
4. Surgical removal of (perfectly healthy) natural sex organs (women’s breasts and vagina, men’s penis) and cosmetic construction of organs that look like the opposite sex. However, the body seeks homeostasis through constantly rejecting these artificial organs. A male body treats a neovagina as a wound and constantly seeks to close it, requiring it to be regularly dilated to prevent closure, and that dilation is uncomfortable and comes with its own health risks. Furthermore, being artificial, these organs never function like natural ones. Artificial breasts cannot lactate, and an artificial womb cannot grow a child, so a transwoman will never bear children or breastfeed them. Neophalluses cannot achieve erections; they need to be manipulated.

As medical professionals, we know the risks and limitations inherent to the medical steps above. Drugs have side effects, interact with each other in complex ways, and can cause long-term dependence. As far as possible, diet, exercise, and other lifestyle adjustments are better than inculcating lifetime drug dependence. All surgery is risky. Surgical alteration of a person’s sexual organs is radical; therefore, it comes with increased risk. But it’s also only cosmetic – it doesn’t change the person’s chromosomes, which were determined at conception.

Health professionals therefore have the responsibility to at least moderate trans ideology’s misconceptions by warning people, especially impressionable children and their parents, of the consequences and limitations of the kind of medical dependence which trans ideology inculcates.

“Medicine is not magic; it is the difficult, complex management of the integrated biological organism which constitutes a human being.”

Medicine is not magic; it is the difficult, complex management of the integrated biological organism that constitutes a human being. We believe medical professionals have the right to refuse to participate because of the belief that the course of treatment would cause harm instead of health.

You may be required by law to refer the patient to a different medical professional who is more sympathetic towards trans ideology. Medical institutions should not try to compel health professionals to participate in medical interventions that contradict their conscience. That is a dangerous breach of basic human dignity and rights. It is also an insult to our status as medical professionals, who have undergone the rigorous training required to know the limits of medicine as well as its abilities.

Those who are caught in this dilemma directly can protest to agencies like the Human Rights Law Alliance (HRLA).²¹ We recommend you also seek legal advice and demand that your employing institution indemnify you against possible future legal cases for medical malpractice. There are increasing cases of detransitioners who are understandably furious with the medical practitioners who permitted them to transition and are suing them.²¹

We can deal with the other two limbs of the sex and gender tree more briefly because they don’t introduce challenges to the medical profession beyond those we’ve mentioned above.

“Transgender ideology reinterprets sexual attraction by requiring that people be attracted not to a person’s body, but to their professed gender identity.”

Transgender ideology reinterprets sexual attraction by requiring that people be attracted not to a person’s body, but to their professed gender identity. Therefore, being gay or lesbian isn’t about being attracted to those who have the same bodily sex as you, but to those who profess to identify as the same sex as you.

This means that a lesbian must be prepared to be sexually intimate with a man who identifies as a lesbian woman, even if he still has male genitalia. To refuse to consider such a form of sexual intimacy is vilified as a ‘genital fetish’, and the lesbian gets demonised as a ‘transphobic bigot’ or trans exclusionary radical feminist (TERF).

Furthermore, children with emerging same-sex attraction, many of whom are non-stereotypical in their behaviour, who are exposed to transgender ideology, get channelled into the transition pathway. Some call this ‘transing the gay away’. This has caused a significant rift in the LGBT community, fracturing the LGB from the T.

“…children with emerging same-sex attraction, … who are exposed to transgender ideology, get channelled into the transition pathway.”

Finally, according to transgender ideology, behaviour expresses your sexed identity more ‘authentically’ than your biology. This is again used to confuse and mislead children and their parents through the new concept of a ‘trans child.’ Trans ideology holds that play preferences and personal tastes reveal a child’s gender identity, i.e. whether they are ‘really’ a boy or a girl. Therefore, a boy who happens to like ‘girly’ things and/or behaves in stereotypically ‘girly’ ways is actually a girl, and a girl who is ‘boyish’ in her interests and/or behaviour is actually a boy.

But it should be immediately obvious that all this does is reinforce narrow gender stereotypes in ways that reduce diversity, increase homogeneity, and thereby reverse decades of progress in increasing social inclusion and tolerance. Tragically, gender-nonconforming children, instead of being celebrated for their uniqueness, end up being channelled onto the transitioning pathway with all its attendant harms as detailed above.

Managing the underlying causes

As we discussed in our previous article, a person’s gender identity is a set of emotions and convictions that they hold towards themselves – towards their ‘real,’ ‘authentic’ identity, which is different from their biological constitution. Gender dysphoria occurs when that disjunction is serious enough to cause diagnosable distress. We believe it is possible to:

• Recognise the honesty of people’s beliefs about themselves – their gender identity;
• Recognise their genuine distress at the difference between their view of themselves and the biological reality of their body;
• Without uncritically affirming the priority of that internal gender identity over the body and therefore rushing to artificially alter the body through pharmaceuticals and surgery;
• Instead exploring the underlying psycho-social causes of the person’s internal state;
• Then giving the person the psychological resilience to accept the goodness of their body’s natural development instead of being (to various degrees) uncomfortable with it.

Research has indicated a very high association between autism spectrum and other neurodiversities with trans self-identification. These young people certainly deserve care. However, encouraging them to damage their growing bodies is not caring; it is irresponsible.

Conclusion

A person’s embodied sex is binary. They are either a male or female. Their sex is determined at conception and develops significantly in the womb and during puberty.

As either a man or a woman, people – children, teenagers, and adults – behave in a variety of ways. While most are attracted to the opposite (bodily) sex, some are attracted to those who possess the same bodily sex as them.

Trans ideology exploits young people’s naivety and vulnerabilities to mislead them with an inflated, unrealistic view of medicine’s capacity to construct a new self for them. Health professionals have an excellent opportunity to moderate those misconceptions by telling them the truth about the risks and limitations of seeking to ‘deconstruct’ and ‘reconstruct’ the wonderful, complex, interconnected organism that is the body God gave us.

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1. Society for Evidence-Based Gender Medicine (SEGM), ‘Transgender Identification in College Youth is at an All-Time High but May Be Reaching A Plateau,’ 22 Oct 2025, https://segm.org/transgender-identification-college-youth.
2. Jody L. Herman and Andrew R. Flores, ‘How Many Adults and Youth Identify as Transgender in the United States?’ Williams Law Institute Aug 2025, https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/.
3. Australian Bureau Of Statistics (ABS), ‘Estimates and Characteristics of LGBTI+ Populations In Australia,’ 19 Dec 2024, https://www.abs.gov.au/statistics/people/people-and-communities/estimates-and-characteristics-lgbti-populations-australia/latest-release 
4. Jo Taylor, Ruth Hall, Trilby Langton, Lorna Fraser, and Catherine Elizabeth Hewitt, ‘Characteristics of Children and Adolescents Referred to Specialist Gender Services: A Systematic Review,’ Archives of Disease in Childhood, 109 (Suppl 2), 2024, s3-s11.
5. Stella O’Malley, ‘Conceptualizing Gender Dysphoria,’ Chapter 3, pp 68-70 in Stella O’Malley, Carol Bartle, Carrie Clark, and Amanda Miller, eds., The Gender Framework: A Comprehensive Evidence-Based Guide for Professionals and Families, Pitchstone, Durham, North Carolina, 2025.
6. Lisa Littman, ‘Rapid-Onset Gender Dysphoria in Adolescents and Young Adults: A Study of Parental Reports,’ PloS One, 13(8), (2018).
7. J. Michael Bailey and Ray Blanchard, ‘Gender Dysphoria is Not One Thing,’ 4thWaveNow 7 Dec 2017, https://4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/.
8. Ray Blanchard, ‘Early History of the Concept of Autogynephilia,’ Archives of Sexual Behavior 34(4) (2005), 439-446.
9. Lisa Littman, Stella O’Malley, Helena Kerschner and J. Michael Bailey, ‘Detransition and Desistance among Previously Trans-Identified Young Adults,’ Archives of Sexual Behavior 53(1) (2024), 57-76.
10. Christel J. M. de Blok, Chantal M. Wiepjes, Daan M. van Velzen, Annemieke S. Staphorsius, Nienke M. Nota, Louis J. G. Gooren, Baudewijntje P. C. Kreukels and Martin den Heijer, ‘Mortality Trends Over Five Decades in Adult Transgender People Receiving Hormone Treatment: A Report from the Amsterdam Cohort of Gender Dysphoria,’ The Lancet Diabetes & Endocrinology, 9(10) (2021), 663-67.
11. Lyvia Maria Bezerra da Silva, Silvana Neves Dias Freire, Eduarda Moretti and Leila Barbosa, ‘Pelvic Floor Dysfunction in Transgender Men on Gender-Affirming Hormone Therapy: A Descriptive Cross-Sectional Study,’ International Urogynecology Journal 35(5) (2024), 1077-1084.
12. See the web site of ‘Parents with Inconvenient Truths about Trans (PITT)’ https://www.pittparents.com/.
13. Julie Szego, ‘The Secret Pain of ‘Trans Widows’,’ Szego Unplugged Substack, 22 March 2025, https://szegounplugged.substack.com/p/the-secret-pain-of-trans-widows.
14. Ikekhwa Albert Ikhile, ‘Navigating Family Identity: A Systematic Review of Children’s Psychological Resilience During Father-To-Mother Gender Transition,’ EUREKA: Social and Humanities (5) (2025), 70-84.
15. Astute readers will recognise that this tree analogy differs from that which we used in our book The Gender Revolution, Sydney: Matthias 2023. This is because we are now even less positive towards gender identity than we were then. We no longer believe gender identity to be in any way a legitimate understanding of one’s self, but to be a parasitic declension from the other, legitimate branches.
16. Zachary A. Elliott, ‘Male or Female: There’s Nothing In Between,’ Quillette 25 Sept 2023, https://quillette.com/2023/09/25/male-female-end-of-list/.
17. Colin M. Wright, ‘Why There Are Exactly Two Sexes,’ Archives of Sexual Behavior 54 (2025) 3941–3945.
18. Colin Wright, ‘Avoid the ‘Intersex Trap’: How Intersex Conditions Are Used By Activists to Sow Confusion and Manipulate Your Emotions,’ Reality’s Last Stand 12 April 2023, https://www.realityslaststand.com/p/avoid-the-intersex-trap.
19. Sallie Baxendale, ‘The impact of suppressing puberty on neuropsychological function: A review,’ Acta Paediatrica, 113 (2024), 1156–1167, https://doi.org/10.1111/apa.17150; Ruth Hall, Johanna Taylor, Catherine Elizabeth Hewitt, Claire Heathcote, Stuart William Jarvis, Trilby Langton and Lorna K Fraser, ‘Impact of Social Transition in Relation to Gender for Children and Adolescents: A Systematic Review,’ Archives of Disease in Childhood, 109 (Suppl 2) (2024), s12-s18; Kristina R. Olson, Lily Durwood, Rachel Horton, Natalie M. Gallagher and Aaron Devor, ‘Gender identity 5 Years After Social Transition,’ Pediatrics 150(2) (2022), 1-9, e2021056082.
20. Una Masic, Gary Butler, Paul Carruthers and Polly Carmichael, ‘Trajectories of Transgender Adolescents Referred for Endocrine Intervention in England,’ Archives of Disease in Childhood 107(11) (2022), 1012-1017; Maria Anna Theodora Catharina van der Loos, Sabine Elisabeth Hannema, Daniel Tatting Klink, Martin den Heijer and Chantal Maria Wiepjes, ‘Continuation of Gender-Affirming Hormones in Transgender People Starting Puberty Suppression In Adolescence: A Cohort Study In The Netherlands,’ The Lancet Child & Adolescent Health 6(12) (2022), 869-875.
21. HRLA, ‘Contact Us,’ https://www.hrla.org.au/contact-us.