Orthodox Reflections

What would you do if your child had a preoccupation with elephants, or flat out told you that he or she wanted to be an elephant? Would you feel that you had to accommodate that expressed desire literally? I cannot think of any parent, or health care provider, who would treat “mommy, I want to be an elephant,” by resorting to surgery to ease any psychological distress they may perceive in this child because he or she was not born an elephant. Reasonable and loving parents might get an elephant mask or costume for this child, watch movies or read books about elephants, or plan a visit to the zoo.  Most parents and health care workers would support this child by helping guide him or her through these feelings, resorting to mental health services, if necessary, because they understand this child is very likely to eventually lose the desire for elephant-hood.

This example might seem extreme, but that is done on purpose to drive home some very important, evidence-based points which shall be discussed in turn. First, most children eventually lose interest in their childish things. Second, one should not overlook the possibility of underlying mental illness, or childhood trauma, in a child whose childhood preoccupation becomes an obsession; and third, maturation is directly linked to brain development, and this takes time to complete – at least 25 years if not more in certain populations.

Because I was born a girl, my father would bring home many dolls from the plastics factory where he worked. I had dolls in all shapes and sizes. I never played with them, except to decapitate and dismember each one to see what was inside. I suppose I hoped to find flesh and blood or at least something more than their hollowness, to explain what made real people “tick.” I was repeatedly disappointed. Each broken doll was replaced with a new one that met the same fate.

My favourite colour was never pink – only blue. My favourite play was in the dirt, with little boys, their cars, trucks and pistols. A plastic sword in a plastic sheath was another favourite as I got to brandish and impale it into everyone I met. After I turned four, we moved and my aunt and uncle bought me a very pretty doll, but what I really wanted was the toy machine gun another little boy was carrying out of the store. So, I improvised: I played “cops and robbers” with the new neighborhood boys. In the end, I did not become a violent killer. I became a doctor, wife and mother. For the record, I still dislike dolls. Thank God my parents laughed at everything I did and let me be. No one tried to change or transgender me. My parents instinctively knew I would eventually outgrow my childish ways.

This instinctive understanding is borne out by several studies such as those from Vanderbilt University and London’s Portman Clinic. In these studies, 70 to 80 percent of children who had expressed transgender feelings, spontaneously lost those feelings over time. This was also confirmed by the World Professional Association for Transgender Health (WPATH), a pro-trans organization. In their own standards of care, they acknowledge that 77-94% of boys and 73-88% of girls outgrow their gender dysphoria when they reach adulthood. Imagine the physical and psychological trauma that would have been inflicted upon these children had they been sexually transitioned.

Even in LGBTQ terms, the definition of “gender” is “ … so fluid and identity labels mean different things to different people.” This means that the same person’s gender “identity” can change over time. For example, “genderqueer…may be characterized by the desire to challenge norms of gender roles and expression, to ‘play’ with gender and/or to express a fluid (changeable) gender identity.”

In a 2015 article published on CNSNews.com, Dr. Paul R. McHugh, the author of six books, at least 125 peer reviewed medical articles, the former psychiatrist-in-chief for Johns Hopkins Hospital and its current Distinguished Service Professor of Psychiatry, said that “transgenderism is a ‘mental disorder’ that merits treatment, that sex change is ‘biologically impossible,’ and that people who promote sexual reassignment surgery are collaborating with and promoting a mental disorder…The transgendered person’s disorder is in the person’s ‘assumption’ that they are different than the physical reality of their body, their maleness or femaleness, as assigned by nature. It is a disorder similar to a ‘dangerously thin’ person suffering anorexia who looks in the mirror and thinks they are ‘overweight.’”¹

 A person’s sex at birth is genetically determined. Sex changes are biologically impossible because the genome (one’s DNA) cannot re-express itself through the intra-uterine re-development of the organism whose sex has already been genetically determined from conception and is evident at birth. Since it is impossible to change one’s genotype (one’s actual DNA) one can only change one’s phenotype (one’s appearance) by performing ‘transgender’ surgery, but the sex or biological gender (a term whose definition began to change in 1945) cannot and does not change. According to Dr. McHugh, “people who undergo sex-reassignment surgery do not change from men to women or vice versa. Rather, they become feminized men or masculinized women.”¹

Furthermore, according to Dr. McHugh, “the suicide rate among transgendered people who had reassignment surgery is 20 times higher than the suicide rate among non-transgender people…while the Obama administration, Hollywood, and major media such as TIME magazine promote transgenderism as normal, these policy makers and the media are doing no favours either to the public or the transgendered by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention.”¹

When studies show that the majority of children outgrow their gender dysphoria and that suicide rates are so much higher in the transgendered, why are children and youth still undergoing trans-sexual medical and surgical treatments? According to Dr. McHugh, “some states…have passed laws barring psychiatrists, ‘even with parental permission,’ from striving to restore natural gender feelings to a transgender minor’…[because the] assumption that one’s gender is only in the mind, regardless of anatomical reality, has led some transgendered people to push for social acceptance and affirmation of their own subjective personal truth.”¹

“Affirming one’s own subjective personal truth” is a concept that accepts a definition of truth as something relative rather than something absolute. If I support that truth can be subjective or relative, I can also argue that if I hear or see things others cannot see or hear, I cannot be deemed psychotic (mentally ill) because the experience is my own personal truth. Furthermore, if these voices tell me to harm myself or someone else, I should obey them, and no one should prevent me, on the basis that these voices are my own “subjective personal truth”.

This type of faulty reasoning makes no sense. No apt physician or court of law can justify it or “affirm” it without invalidating the laws of science and the entire legal system. Such faulty thinking not only does NOT follow the science, it also fulfills the Lord’s prophecy that “just as they did not think it worthwhile to retain the knowledge of God, so God gave them over to a depraved mind, so that they do what ought not to be done.” (Romans 1:28; New International Version)

I am not suggesting that this biblical verse applies to children, for only an adult can argue a complex concept such as “the affirmation of one’s own subjective personal truth” as opposed to God’s (or even nature’s) unchangeable Absolute Truth. Misguided adults may seek to affirm a “subjective personal truth,” by trans gendering themselves, and/or encouraging children and youth to do the same – a movement which has gathered momentum, as have the counter-protests to this movement and to the sexualization of children. A classic contemporary example is the case of Younger vs Georgulas over the trans gendering of their young son, James, which began for him at the age of 2 years.

If the suicide rate among the transgendered who had reassignment surgery is 20 times higher than the suicide rate among the non-transgendered, it follows that the former group would also have higher rates of mental illness. Surgery and hormones do not solve underlying mental illness which can often be masked or undiagnosed; nor do they help everyone feel better about themselves, a fact that plastic surgeons know first-hand because many of them can name off those cosmetic surgery patients who are never satisfied with their body (themselves) because of an underlying depressive illness, for instance, and repeatedly seek out cosmetic changes in their quest for happiness.

Still, there are those transgender advocates who, in support of “affirming a subjective personal truth,” claim that sexual, medical, even surgical reassignment of children and youth must be hastened to reduce the risk of suicide. When suicide is still attempted or worse, after the trans gendering process, these same advocates then blame the tragedy on external factors such as social unacceptance and mistreatment of the transgendered individual.

Considering that more than 50% of the population will be diagnosed with a mental illness or disorder at some point in their lifetime and that the highest prevalence of mental illness (30%) is in young adults aged 18-25 years, it is unrealistic to presume that people with gender issues, including children, would be exempt from mental illness, or that a gender issue could never have anything to do with mental health.

Any person who struggles with any type of unhappiness or emotional distress, first and foremost deserves a complete mental health assessment. Every basic health assessment should include validated questionnaires, such as the GAD-7 and the PHQ-9 which measure and quantify anxiety and depression respectively. If a mental illness is deemed present, the first line treatment includes psychotherapeutic medication and/or counseling, not hormones or surgery because the mentally ill person also has (admits to), or seems to have (a boy who likes dolls), a gender issue.

Many mental health illnesses, including dysphoria and depression, are strongly associated with cognitive problems³ – impairments in attention, memory,  processing speed and executive functions. Executive functions⁴ encompass a variety of higher order capacities, such as judgment, planning, decision-making, response monitoring, insight, and self-regulation (self-control).

The area of the brain responsible for higher level executive functions is the prefrontal cortex, located in the frontal lobes. In humans, this is the last part of the brain to achieve full development or maturation. In the normal human brain, complete development of the prefrontal cortex takes place at roughly 25 years of age.⁵ This is why it is inappropriate to teach calculus, reproductive physiology, sexuality or the modern concept of gender to 7-year-olds, for example, because at that stage, the human brain is not yet at the proper stage of development to grasp these concepts.

Dysfunction of the prefrontal cortex is a central feature of many psychiatric disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Post-traumatic Stress Disorder (PTSD), Schizophrenia and Bipolar Disorder.⁶ In ADHD, for instance, the brain’s frontal lobes will continue to mature until the mid-to-late thirties.

The executive functions are highly interrelated, as each type of executive function skill draws on elements of the others. Children are not born with these skills – they are born with the potential to develop them. Some children may need more support than others. If children do not get what they need from their relationships with adults and the conditions in their environments (doctors, teachers, school curricula, social media) — or worse, if those influences are sources of toxic stress – their skill development can be seriously delayed or impaired. Adversity from neglect, abuse, and/or violence may expose children to toxic stress, which can disrupt brain architecture and impair the development of executive functioning.⁷

Toxic stress during childhood became known as Adverse Childhood Experiences or ACEs for short, due to the ACE Study, a major epidemiological study in 1998, San Diego, California, which studied the effect of childhood trauma during the first 18 years of life in over 17,000 individuals over a span of decades.⁸  This study developed the scientifically validated ACE Questionnaire, which can be self-administered to assess the degree of childhood trauma in one’s early life. The higher the score (out of 10), the higher the risk of having chronic disease and/or psychosocial problems, even in adulthood. Most people in North America have at least one ACE. People with 4 or more ACEs have a much higher risk of adult-onset chronic health problems, including but not limited to:

• Heart disease, cancer, diabetes, severe obesity, COPD, stroke, bone fractures etc.
• Violence or being a victim of violence
• Impaired work performance
• Financial and social problems
• Physical inactivity
• Depression, smoking, drug & alcohol abuse/dependence, suicide attempts
• 50+ sexual partners, history of sexually transmitted diseases
• Poor self-rated health

These problems can all result from disrupted brain architecture and impaired executive functioning of brain development, due to toxic stress in childhood. By extension, trans gendering a minor or young adult can amplify trauma and contribute to worse health outcomes in adulthood.

Although the original ACE Study did not examine LGBTQ+ outcomes, more recent work has shown that lesbian, gay, and bisexual (LGB) individuals, on average, have higher ACE scores compared to heterosexual individuals. Newer research findings also show that neglect is a common experience among LGB and Transgender individuals and needs to be assessed along with other ACE domains.⁹

The good news is that “there are people with high ACE scores who do remarkably well. Resilience builds throughout life, and close relationships are key. Research also suggests that for adults, ‘trauma informed’ therapy can help.” ¹⁰ Furthermore, ACE scores do not tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in, may mitigate the long-term effects of early trauma.

The maturation of the prefrontal cortex has been understood by the auto insurance industry for a very long time, which explains why their rates are always the highest for men, followed by women under the age of 25. These companies correctly recognized from their data collection that younger adults have less mature executive functioning and therefore lower impulse control, associated with a higher incidence of high-risk behaviour…and costly accidents.

The founding fathers of America also understood human brain development. In Article 1, Section 2 of the United States Constitution,¹¹

No Person shall be a Representative who shall not have attained to the Age of twenty-five years, and been seven Years a Citizen of the United States, and who shall not, when elected, be an Inhabitant of that State in which he shall be chosen.

The amazing thing is that Article 1, Section 2 was ratified on February 7, 1795! This is long before anyone could have scientifically explained human brain development. Although most people were already married and raising families well before age 25 in those days, the Founding Fathers of America had acquired, not knowledge through scientific study, but wisdom through experience and astute observation (much like the collection of statistics by the later auto insurance companies) to know that a person could not be fully mature so as to govern until at least the age of twenty-five years.

According to the Holy Rudder, the Canons of the Orthodox Church also stipulate, as far back as the first Ecumenical Council in the 4^th century, that Deacons are not to be tonsured until they have reached at least the age of 25, and Presbyters (Priests) the age of 30.¹²

CANON XIV

Let the Canon of our holy and God-bearing Fathers be observed also in respect to this, that a Presbyter may not be ordained before he is thirty years old, though the man be thoroughly worthy; but, instead, let him be obliged to wait. For our Lord Jesus Christ was baptized when He was thirty years old, and then He began teaching. Likewise, let no Deacon be ordained before he is twenty-five years old, nor a Deaconess before she is forty years old.       (c. XIX of the 1^st; c. XV of the 4^th; c. XI of Neocaes.; c. XXI of Car.)

The Holy Fathers were no less wise than the Founding Fathers. Even Christ, Himself, the Creator of our human brains, waited until He was 30 years of age, before embarking on his Public Ministry. Thirty years is the Biblical and Jewish traditional age of maturity to be priest, prophet, teacher, or anyone ministering unto the Lord. This tradition was based on centuries of Wisdom.

The bad news is that less and less is our society following sound science or the wisdom of the past. For instance, we know that cannabis can irreversibly impair brain development,¹³ especially if smoked prior to age 25, and yet Canada has legalized its purchase and use in people 19+ years of age. One can make similar arguments against legalized tobacco, alcohol, consensual sex (does ‘yes’ really mean ‘yes’ when you’re only 16?), voting and even driving under 25 years of age.

In Canada, one can legally vote at age 18 and then legally buy cannabis at age 19, just before heading off to College or University, where learning and memory brain function are needed to succeed. One can legally drive at 16 and then legally consume alcohol at age 19, thereby contributing to the highest rates of DUIs, which happen to occur in young adults aged 21-24.¹⁴ Prior to age 21, car accidents are the leading cause of death among US teens aged 13-19.¹⁵ When our sober driving teens do survive to age 19, they are then legally introduced to alcohol and expected to somehow overcome the impulses of their still underdeveloped prefrontal cortexes by not mixing alcohol with cars when both are legal (just not together). We couldn’t be doing a better job of stunting, maiming or killing our youth if we tried. Clearly, succumbing to the prevailing social pressure, which drives the “political correctness” of the time, and changing something from legal to illegal or vice versa, does not necessarily change it from good to bad, from wrong to right or from scientific to unscientific.

Similarly, with so much scientific evidence that supports the wisdom of the ages, the new and personal truth affirmation-based LGBTQ+ movement would still have us believe that the first line solution for any person exhibiting or admitting to any type of gender incongruence, should be a change in their sexual expression, their sex hormones and/or their sexual body type regardless of their age or developmental stage. Even more astounding is how far this lobby group has succeeded in influencing the entertainment industry, the media, politicians, the field of psychiatry¹⁶ and even some US medical regulating bodies who, for the sake of “political correctness,” have forsaken the art and scientific practice of medicine to interfere with the doctor-patient relationship to such an extent, that it has become “inappropriate”, even illegal in some states, to counsel individuals in favour of postponing gender reassignment or treating them with a mood-altering drug that may improve or restore their mental health and executive functioning so they can actually make a properly informed decision regarding trans-gendering – and heaven forbid, decide against it!

All parents, educators, health care professionals, law makers, policy makers, regulators and advocates of the LGBTQ+ movement need to properly, and without bias, inform themselves and take note of these three elephants in the room. For those who still cannot see them, the first elephant is over-reacting to a young child’s preferences, such as a boy who likes to play with dolls or a young girl who enjoys boys’ toys. This is normal behaviour in children and should not be over-interpreted to mean anything more. The second elephant is to not overlook the possibility of underlying mental illness or childhood trauma in someone whose childhood preoccupation becomes an obsession. Exploring, uncovering and treating a possible underlying mental health issue can lead to healing without more scarring from inappropriate or premature surgery of any kind. The third elephant is failing to recognize the undeniable importance of maturation, which is directly linked to human brain development. This takes patience and time – at least 25 years and more in certain populations. It is vital to allow a person the opportunity to grow fully before committing to invasive and life-altering medication or surgery that cannot be undone.

What a full-fledged adult does with their sexuality, or gender, is beyond the scope of this article. Children and youth need and deserve proper guidance that is informed by common sense, good judgment and absolute truths – time-tested wisdom and sound science – not by any individual’s or group’s “politically correct” subjective personal truth which can be prone to error and tragedy.

Irene Polidoulis MD CCFP FCFP

Family Physician and member of the Orthodox Church in Canada

References:

1. John Hopkins Psychiatrist: Transgender is ‘Mental Disorder;’ Sex Change ‘Biologically Impossible’,com, Nov 26, 2020
2. Genesis 1:26-27
3. Pereni et al. Cognitive impairment in depression: recent advances and novel treatments, Neuropsychiatr Dis Treat, 2019; 15: 1249-1258
4. Robinson et al. Neuroanatomical correlates of executive functions: A neuropsychological approach using the E XAMINER battery, J Int Neurpsychol Soc 2014 Jan; 20(1): 52-63
5. M Arian et al. Maturation of the Adolescent Brain, Neuropsychiatr Dis Treat 2013; 9: 449-461
6. J. Gamo et al. Molecular Modulation of Prefrontal Cortex: Rational Development of treatments for Psychiatric Disorders Behav Neurosci 2011 Jun; 125(3): 282-296
7. Centre on the Developing Child, Harvard University
8. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study, Felitti et al Am J Prev Med. 1998
9. W. Schnarrs et al. Differences in adverse childhood experiences (ACEs) and quality of physical and mental health between transgender and cisgender sexual minorities, J of Psych Res 119 (2019) 1-6
10. Jack Shonkoff, Pediatrician and Director of the Center on the Developing child at Harvard University.
11. The United States Constitution, Article 1, Section 2
12. The Holy Rudder, Canon 14
13. Cannabis (Marijuana) Research Report, NIH National Institute on Drug Abuse
14. Drunk Driving Statistics 2022
15. CDC Centers for Disease Control and Prevention – Transportation Safety
16. The “Trojan Couch”: How the Mental Health Associations Misrepresent Science by: Jeffrey B. Satinover, MD, PhD.