Interesting Correspondence with Qourom of the Twelve

[Guest Jenn348]

I mentioned these letters in another thread, and found I can attach them here.

An MD with lots of experience wrote a letter to the Quorum of the Twelve explaining the issue of transgender in depth, making recommendations to allow people to transition because it's a medical necessity, not a sin.

Dallin H. Oaks replied, stating "I will share your letter with persons who can benefit from its information, as I did. You have our best wishes as you continue to serve our Heavenly Father's children."

I am copying/pasting the initial letter below, and attaching the scanned reply.

January 23, 2013

James L. Hopkins, MD
[contact info removed]

Elder Dallin H. Oaks

Church Administration Building

47 East South Temple

Salt Lake City, UT 84150

Dear Elder Oaks,

You requested that I write a two-page summary of my previous letter. I have not succeeded in fully complying with your request. I apologize for the length of both this and my previous communication. I hope, however, that you will read this six-page letter. Many that I correspond with have fasted and prayed many days that you and the brethren will clarify some issues for the many devoted transgendered members, potential members, and former members who sincerely and faithfully look to the General Authorities for guidance in all aspects of their lives. Of the nearly 250 transsexuals and heterosexual cross-dressers with whom I correspond, many have experienced the following problems:

1. Many who are asked to make decisions regarding these transgendered persons on the local level--stake presidents and bishops who in good faith are doing the best they can with these tough issues—seem to feel unguided and uninstructed in these matters. The marked variation in decisions from one leader to the next suggests that something needs to be done to clarify how to handle the concerns and needs of a growing number of transgendered members and prospective members.

2. Despite advances in the care of transgendered persons, many trans-gendered LDS members encounter tremendous problems getting rational treatment of their conditions and maintaining membership and full fellowship in the church. Some transsexual investigators are told that they cannot join the church. Some are told that they must de-transition in order to qualify for baptism or remain in good standing in the church despite the essentially irreversible nature of the changes and features that transition treatment creates. Some are told that they cannot use the bathrooms assigned to persons with the gender they appear to be. Some are told that they can not sit next to children despite their outwardly normal appearance. Apparent males are told they cannot attend priesthood meetings, and apparent females are told they cannot attend Relief Society. One female-appearing transsexual who had not yet undergone surgery on her still male genitalia and who wished to marry a straight male member was told that she could be baptized and be married in the church only if she did NOT undergo genital surgery!

3. Many would like to see a website developed that is similar to www.mormonsandgays.org that addresses issues related to trans-gendered LDS or potentially LDS persons. Transgendered persons generally regard themselves as straight and face issues that are entirely different from those with same-sex attraction.

4. It is the hope of many in the transgendered community that medically and legally designated males who are otherwise worthy will be permitted to be baptized, hold the priesthood, and marry in the temple as males and that medically and legally designated females who are otherwise worthy will be permitted to be baptized and enter the temple as females without regard to the anatomical configuration of their genitalia, which many would regard as an absolutely private matter.

5. It seems inappropriate that priesthood leaders be expected to do the work of physicians and judges in determining gender and managing incongruities between mind and body gender. Determining how completely one's genital anatomy corresponds to one's medically and legally determined gender are functions that many feel fall well outside of the responsibilities of priesthood holders and the expertise of laymen.

6. Genital surgery for transsexuals is costly and traumatic. Many must save up for years to pay for the surgery. Furthermore, this surgery is not done now until transsexuals turn 18 years of age. Currently only about 1 in 10 transsexuals undergo genital surgery.

7. Many believe that “God does not make mistakes” and that having, for example, a female spirit in a male body is impossible. Those familiar with the treatment of persons with inter-sex conditions and children with ambiguous genitalia, however, know that genital anatomy, chromosome studies, gonad biopsies, exploratory surgery, and determinations of sex hormone levels can all be misleading in determining the self-perceived gender of a child. Even modern brain scanning techniques capable of picking up subtle differences associated with gender in the brain's anatomy and function are not reliable enough to predict gender self-perception with certainty. A child's self-perception of gender is the only reliable way to guide therapy that does not lead to feelings that one has been changed into or assigned to the wrong sex.

8. Many transsexuals are diagnosed with what is now called gender dysphoria (GD) – broadly defined as discomfort or distress that is caused by a discrepancy between a person’s self-perceived gender and that person’s sex assigned at birth and the associated gender roles and/or primary and secondary sex characteristics they display. A great number prefer castration over maintaining their birth-acquired genitalia and reproductive capability. Commonly they feel that their spirit bodies have the genitalia of the gender that they perceive they are. Their physical genitalia, in contrast, are repugnant to them and seem as foreign as a flipper arm.

9. Detesting anatomical features and even the hair length and dress associated with the gender assigned to transsexuals at birth is common. Female-to-male (FTM) transsexuals who self-identify as males and wish to have normal male bodies commonly feel extremely uncomfortable in dresses. They detest long hair and hate their breasts. Requiring such a person to wear a dress in Sacrament Meeting would be for them as uncomfortable and, in their mind inappropriate, as forcing a bishop to dress like a Relief Society president to conduct a Priesthood meeting. Male-to-female (MTF) transsexuals who self-identify as females, detest wearing suits and ties, cutting their hair short, wearing beards, and are disgusted by their male genitalia. Some even attempt to remove their male genitalia as children or young adults. Forcing them to wear a suit to church in their minds is as uncomfortable and inappropriate as a Relief Society president coming dressed like a bishop to conduct Relief Society.

10. Not identifying mind-body gender incongruity in early childhood, many believe, constitutes a serious medical error that can lead to serious mental and physical illness that can and has led to significant and entirely preventable disability and death. Transsexualism is treatable and ideally should be dealt with as early as possible. Unfortunately, the condition is often not disclosed or fully recognized until adulthood when the social, emotional, and physical price of correcting that incongruity is very high.

11. One should view current hormone and surgical treatment to facilitate male-to-female and female-to-male transition not as sex reassignment techniques but as mind-body gender alignment techniques that ameliorate birth defects resulting in GD.

12. Correcting errors in gender designation on legal papers and on the records of the church when doctors and judges have determined that such errors have been made seems reasonable and kind to those affected by these errors.

13. Misunderstanding and persecution of transgendered children and adults are common among those who are born into or belong to families that frequently attend any church including our own.

14. Despite good results in transition and a deep sense of wellness and peace in their transitioned state and despite the familial stability and joy that some transgendered persons achieve when they are properly understood, supported, and accepted, many LDS transgendered persons feel deeply saddened and embittered that coming out and transitioning commonly leads to loss of spouse and family, loss of church membership, and loss of temple blessings often in spite of having strong testimonies, having served faithfully in the church for years, and having been active youths, good parents, and faithful spouses.

15. Treatment of GD with hormones at appropriate ages that correspond to the self-perceived gender of the individuals getting them commonly relieves the symptoms of GD and decreases the severity of many stress-related medical conditions or causes them to disappear altogether. These positive results of self-perceived gender-guided hormone therapy have been observed often enough that the Supreme Court has recently ruled that the withholding of transition-related hormone therapy from transgendered prisoners is now considered cruel and unusual punishment!

16. What was formerly called the Harry Benjamin Society is now called the World Professional Association of Transgender Health, or WPATH. It has an excellent set of Standards of Care that can help parents, professionals, and religious leaders optimize the treatment of children, adolescents, and adults with GD. Current standards of care for applying MTF and FTM transition treatments do a remarkably good job in treating GD, reducing suicides, and alleviating depression, anxiety, attention and mood disorders, and a host of stress-related medical problems in truly trans-gendered persons. When the current protocols are followed, outcomes are usually good and are improving.

17. Support groups for heterosexual cross-dressers like Tri-Ess have an excellent record in helping prevent suicides and consolidating family relationships among their members. Many would like to see greater support for and recognition of the work done by such groups.

18. The Proclamation on the Family clearly states that gender is an eternal characteristic of all of God's children and that many of God's greatest blessings are linked to gender. Given that this is the case, the sooner an individual, his or her family and friends, and the church correctly determines what gender an individual is, the better off he or she and everyone who surrounds and should support that individual will be. The sooner gender is determined correctly, the better gender nurturing can be and the sooner the blessing of being one gender or another can be realized.

19. Heterosexual cross-dressers overwhelmingly self-identify as males, have normal male genitalia, and have a normal sexual orientation toward females. Although some seek to transition from male to female, it is generally believed to be inappropriate to do so. Tri-Ess, a nationally respected support group for heterosexual cross-dressers, does not allow persons seeking hormonal or surgical transition treatment to be members of their organization.

20. Although most transsexuals clearly self-identify as either male or female, a few with whom I correspond with do indeed suffer from gender identity confusion and have a gender self-perception that includes both male and female components in nearly equal proportions. Determining which gender feelings predominate and correspond most fully to one's sexual orientation seems a wise thing to do as early in life as possible.

21. The presentation of GD among those with whom I correspond is remarkably similar from case to case. MTF transsexuals commonly report telling their parents at around age four that they are females and wish to wear dresses, play with girls, and get dolls for Christmas and birthdays. FTM transsexuals with this condition commonly report telling their parents around the same age that they are males and wish to have trucks and trains and guns for presents, wear male clothing, and play with other males.

22. Parents commonly and understandably dispute their children's self-perceptions of their gender and to varying degrees try to suppress or modify these feelings in their children. Many transsexual children are spanked and otherwise punished for saying that their gender is opposite to what it appears to be, and some are violently abused and severely mocked or ostracized.

23. Feelings of suicide are common among trans-gendered persons and heterosexual cross-dressers. Generally speaking, these persons feel that live members of their groups are better off and better able to contribute to society than dead ones. Many, including some church members and leaders, seem to disagree with this notion and frequently say so to persons with these conditions.

24. Many MTF transsexuals report that as children they wondered when their male genitalia would disappear and when they would start looking like the girl they felt they were. Many FTM transsexuals report that as children they wondered when their male genitalia would appear so that everyone would know that they were really males. Nearly all learned very quickly, however, that sharing their desires to look like or be treated as members of the sex opposite to that suggested by their genitalia or displaying behaviors congruent with their perceived genders is dangerous.

25. The greatest and the most common problems among transsexuals, however, involve men who said they were females at around age four, were punished for making that assertion, but like many good children, did attempt to obey their parents and assume the roles their genitalia suggested that they should assume, obtained the priesthood, served missions, and eventually married in the temple, and had families with female companions that they came to love deeply even though they never stopped perceiving themselves as females. Incongruity between their perceived gender and the gender they were assigned at birth at some point, however, commonly becomes unbearable. Many hide their self-perceived gender for years to protect themselves physically and emotionally until they can no longer tolerate the incongruity of their mind and body genders.

26. Coming out with one's transsexual feelings or the feeling that one has a female “second self” that needs expression as an adult is almost always an excruciating experience that often leaves a long trail of broken hearts and broken dreams especially in persons whose family, friends, neighbors, and fellow church members view any deviations from norms of sexuality as inherently evil. In many cases, disclosure results in nasty and painful divorces, many with full support from bishops, high councils, and stake presidents despite years of fidelity and responsibility as parents and spouses.

27. The number of transsexuals and heterosexual cross-dressers seems to be increasing not only because of increased reporting or disclosure of trans-gendered feelings but also due to an increasing prevalence of these conditions that many are coming to believe is related to increased intrauterine exposure to substances called hormone disruptors that can affect genital and brain gender-related structures and functions. Well studied substances that have been shown to have these effects include DES or diethyl stilbesterol, an estrogen-like hormone used to prevent premature labor that was available over the counter along with prenatal vitamins from the late 1940s to the mid 1970s, DDT, an insecticide widely used for mosquito control in the US until the mid-1970s, lead, a heavy metal to which our population was widely exposed in the form of leaded gasoline, leaded paint, and lead-laden ceramics, estrogen compounds used for birth control and to fatten cattle and chickens and, PCBs and dioxins produced in the manufacture of plastics and other materials and chemicals.

28. Studies of males who were sons of women who took DES during pregnancy, for example, found that 25% were either gay, transsexual, or transvestite. Some forms of ambiguous genitalia have also been associated with the use of DES. Some of its adverse effects have even been observed in the children of those exposed as fetuses to DES. These environmental hormone disruptors have also been associated with a variety of medical conditions including endometriosis, the autistic spectrum of disorders including Asperger's Syndrome, as well as transsexualism, transvestism, and gay/lesbian behavior and are currently being studied intensively.

29. Exposure to these substances can result in ambiguous genitalia if exposure is early in pregnancy or normal genitalia with self-perceptions of gender and gender-associated behaviors that are at odds or incongruous with one's anatomy and chromosomes if exposure occurs later in pregnancy. Even wild life, especially fish and ducks, exposed to such substances have been observed to exhibit trans-gendered behavior. Abnormally feathered male ducks have been observed courting, in a manner typical of females, normally feathered and normally behaving male ducks in the Potomac River, for example.

30. Promiscuity is not common among LDS transgendered persons. Hypogonadism and asexuality are more problematic. Marital fidelity and good parenting are the norm among most transsexual persons and heterosexual cross-dressers, who both perceive themselves as straight.

31. The prevalence of promiscuity and pornography production among gays, lesbians, bisexuals, many of whom cross-dress, gay female impersonators, drag queens, and so called she-males or Transgender prostitutes are disturbing enough to many transsexuals and heterosexual cross-dressers that many wish that the T in GLBT be removed.

32. Some transsexual feelings have been found to be associated with trauma to the maternal-child relationship in early childhood, but such trauma appears to be relatively rare among transgendered persons. A significant number of children with transsexual feelings, however, will revert to having a self-perceived gender that is congruent with their anatomy if parents allow these children to have a trial of living in and being accepted as the gender they perceive themselves to be.

33. Adult transsexuals who from their early childhood felt they were members of the sex opposite to their perceived birth sex and male heterosexual transvestites whose cross-dressing urges are persistent and intense seem to defy all attempts to be “cured” or “normalized.” Their self-perceived gender and their need to give expression to a female “second self” frequently seems to become hard-wired into their psyche.

34. If these conditions were understood by larger numbers of people, particularly LDS parents, adults, and leaders, better support would be given to these individuals, less abuse and ostracism would occur, fewer unfortunate marriage choices would be made, fewer spouses would feel betrayed, fewer divorces would take place, fewer children would feel abandoned, and fewer suicides would occur.

35. Helping the spouse of a transgendered person work out some sort of arrangement that accommodates at least to some degree the legitimate needs of both parties seems a better, more enlightened, kinder, and ultimately more celestial solution to the problem.

In Matthew 19:12, Christ seems to describe some whom we now might call trans-gendered: 1) eunuchs which were so born form their mother's womb, much like inter-sex persons with ambiguous genitalia; many now believe that transgendered persons are similar to inter-sexed persons; 2) eunuchs which were made so by men, that is, emasculated men who oversaw harems and were sometimes given positions as trusted officials. Today men suffering gender dysphoria allow doctors to do surgery that aligns their physical body with the gender they perceive themselves to be and in doing so are castrated and become somewhat like eunuchs. In Isaiah 56:4-5, the Lord said unto “the eunuchs that keep my Sabbaths, and choose the things that please me, and take hold of my covenant; Even unto them will I give in mine house and within my walls a place and a name better than of sons and of daughters; I will give them an everlasting name, that shall not be cut off.”

Morally as followers of Christ, we believe in caring for the hungry, the naked, and the sick. Healing conditions created by toxins and mutagens seems like something as worthy of a follower of Christ as seeking the cures of and healing leprosy and blindness rather than attributing these conditions to sin and poor choices and ostracizing and censuring those afflicted. Currently, the way many members and leaders in our church treat transsexuals and heterosexual cross-dressers seems more like the way that the Levite and the priest who passed by the man injured on the road to Jericho without helping him than the Good Samaritan.

Many of those I correspond with were heartened by Elder Nelson's remarks in his talk last February at the world leadership conference that “some [who]. . . struggle with gender issues or other conditions . . . may not be fully understood. We need to help and encourage them and their family members without, of course, condoning sinful behavior.”

Many who read those words with joy and hope, however, wondered just what would be regarded as “sinful behavior.” Are the sins referred to basically the Ten Commandments with some emphasis on the law of chastity? Or is cross dressing by one who has an incurable need to do so a sin and a violation of temple covenants that require divorce and censure? Would transitioning with hormone therapy and SRS be regarded as sinful behavior for those plagued with GD? Does saying that one has GD and wishes to undergo treatment constitute a sin? Is it a sin for a four-year-old to say that he/she is female when his/her genitalia suggest the he/she is a male? Should such children be disciplined and silenced? And should those who have been abused and coerced to suppress their feelings for years be forced to endure the torture of having unresolved mind/spirit-body gender incongruity indefinitely? Currently the AMA supports "public and private health insurance coverage for treatment of gender identity disorder [now called gender dysphoria] as recommended by the patient's physician.” What should our church recommend?

I wonder at the courage that some spirits must have had facing their turn on earth as they found out that they would be coming at a time in history when pollution was so rampant and toxic that many would be joined to bodies that would be defective in many ways including having brains that had gender characteristics that were different from the bodies they would receive!

We are taught that every person who comes to earth was a much cherished veteran on the Lord's side of the War in Heaven and that Christ loved us all so much that he suffered for everyone's sins and maladies and underwent the suffering of Gethsemane, scourging, and crucifixion to save our souls. I doubt that few if any of us would have come to earth were it not for the atonement of Christ and the doctrine of vicarious work for the dead.

The souls who agreed to come and face the calamities and pollutions of our day must have been among the most faithful and courageous of our brothers and sisters. Their faith in the Lord's atonement and in the members who would do missionary work and build temples and eventually perform vicarious ordinances on their behave, if they didn't find the Gospel in this life or mistakenly rejected it, must have been very great. I think, that like the Savior, we are not here to condemn those afflicted with incurable conditions but to help save all we can by assisting as many as we can to face and overcome what seem to be overwhelming challenges and disadvantages.

Sincerely,

James L. Hopkins, MD