Monday, November 21, 2022
It's Monday, November 21st, 2022.
I'm Albert Mohler, and this is The Briefing, a daily analysis of news and events from a Christian worldview.
‘You Cannot Defy Creation Without Tremendous Cost to the Creature’: Medical Authorities Question Use of Puberty Blockers for ‘Transgender’ Youth
Let's put it this way, the medical establishment has given us very great gifts, but some of those gifts have come with a very great cost, and we also need to recognize that modern medicine is a part of modern culture. It is inseparable from the larger culture and from the larger moral questions. One of the things we need to recognize is that sometimes medical authorities get things wrong, badly wrong, horribly wrong.
The complicity of the medical establishment, even the mainstream medical establishment with the transgender ideology is not only wrong, it is something that will come with tremendous and horrifying human costs. We're now beginning to see this show up. This is one of the points that many of us have been making over the course of the last several years.
You cannot defy creation without cost to the creature. That's a fundamental principle of the Christian worldview. You cannot defy creation without a tremendous cost to the creature. When you look at the transgender ideology, you understand this is coming with an incredible cost indeed, and these costs are not evenly distributed. Some of these costs are particularly costly when it comes to the youngest among us. Now, this is why a front page article that is run in recent days in the New York Times is so important because I really think it's functioning as a signal that there is at least a tinge of conscience in the medical community and that medical mainstream that is causing it to rethink some of its excitement of, and support for, and affirmation of, the transgender ideology and its medical manifestations. In particular, drugs being given to children and teenagers, known as hormone suppressants or puberty blockers.
This front-page article in the New York Times comes with these words, "Pressing pause on puberty." But then the subhead, "Drugs can buy time for trans youth." Then the question, "Is there a cost?" Now, when you understand the liberal perspective of the New York Times, it's a paper that is not just supportive of the entirety of the LGBTQ revolution, but enthusiastically so. For this newspaper to run an article, even raising a question about that ideology, and for that article to appear as an investigative report on the front page of the paper, well, that tells us that something is happening and it is likely to be important and we had better pay some attention to it.
The article's by a pair of reporters, Megan Twohey and Christina Jewett. They begin by saying the medical guidance was direct speaking of an 11-year-old. They speak about blocking puberty in order to relieve depression or distress experienced by a young person believing themselves to be transgender or non-binary.
The child's mother said, "Puberty blockers really help kids like this. It was presented as a tourniquet that would stop the hemorrhaging." In this case, the hemorrhaging is a metaphor for emotional distress. But then the reporters tell us, "As the number of adolescents who identify as transgender grows, drugs known as puberty blockers have become the first line of intervention for the youngest ones seeking medical treatment." The article continues, "Their use is typically framed as a safe and reversible way to buy time to weigh a medical transition." That means surgery by the way, "And avoid the anguish of growing into a body that feels wrong." The article continues, "Transgender adolescents suffer from disproportionately high rates of depression and other mental health issues. Studies show that the drugs have eased some patients' gender dysphoria, a distress over the mismatch of their birth, sex, and gender identity." Now, if you look at this just in terms of ideology analysis, and by that, we don't mean analysis driven by ideology, but rather analysis directed to understanding the ideology, if you look at this, you still have a big problem.
That big problem is this, when you talk about, for instance, the psychological or psychiatric distress of young people identifying as transgender or non-binary, you simply have to ask the question, which is the cause of which? Because the clear implication driven by ideology is that the distress is caused by society's rejection of this transgender identity or social pressure or internal angst. It's virtually never asked whether the non-binary or transgender impression is actually the result of that kind of psychological or personal distress.
But nonetheless, the very fact that the New York Times has run an article raising questions about the efficacy and the safety of these so-called puberty blockers, well, tells us a whole lot. Now, just keep in mind something else that developed in recent years, particularly even in the last several months, and this was something of a U-turn taken by the British Medical Establishment when it comes to treatment for transgender or non-binary adolescents there in the UK.
It led to the closing down of what was known as Tavistock, the most influential and well-known clinic having to do with this kind of gender issue in the United Kingdom for teenagers and adolescents. That U-turn basically has shifted the British Medical Establishment from something that's very pro-transgender or non-binary, pro-intervention when it comes to medicine, to an approach that is far less positive about intervention, and that includes puberty blockers. The fact that now all of a sudden you have issues raised about the puberty blockers in the New York Times, again, this is extremely significant in cultural terms, this doesn't happen by accident.
The crucial turning point in this investigative report comes with this paragraph, "But as an increasing number of adolescents identify as transgender, in the United States, an estimated 300,000, ages 13 to 17, and an untold number who are younger, concerns are growing among some medical professionals about the consequences of the drugs, a New York Times examination found. The questions are fueling government reviews in Europe, prompting a push for more research and leading some prominent specialists to reconsider at what age to prescribe them and for how long. A small number of doctors won't recommend them at all."
Now, you won't be surprised perhaps to understand that the first doctors to offer puberty blockers to adolescents were in the Netherlands. They were Dutch. But here's where we need to understand that Dutch culture has been one of the most liberal or progressive, and for that matter, one of the deadliest in terms of medical ethics for a matter of generations now. It is the Dutch who have pioneered in physician-assisted suicide and then passive and then even active euthanasia. It's the Dutch who have been pro-LGBTQ and aggressively so, long before the initials had ever been put together.
And thus, you're also looking at the fact that the Dutch medical establishment, which again, is so pro-euthanasia, it is also pro-puberty blockers, or at least that is where the use of these drugs in young people first emerged. But the questions are now emerging just about everywhere, and it's about time.
Now, what about the harm? What would be the harm defined here? We're going to come back to the morality of harm as a major theological question in just a moment. But the harm is demonstrated when the report turns like this, "There is emerging evidence of potential harm from using blockers according to reviews of scientific papers and interviews with more than 50 doctors and academic experts around the world. The drugs suppress estrogen and testosterone, hormones that help develop the reproductive system, but also affect the bones, the brain, and other parts of the body."
Then listen to this specific language, "During puberty, bone mass typically surges, determining a lifetime of bone health. When adolescents are using blockers, bone density growth flatlines, on average, according to an analysis commissioned by the Times of observational studies examining the effects." That's just massive. Now, let's go back to a Christian worldview consideration here. Is puberty something natural or unnatural? And this is where the Christian Biblical worldview tells us it is profoundly natural. It is based in creation, not just in the creation of all human beings as male and female, but in the special creation of every single human being as male or female. Puberty is a massive confirmation of what is already clearly present in identity. And by the way, we're not talking about cases in which there is some kind of genetic question. We're talking about the transgender revolution, which clearly is claiming that someone who is anatomically male can be female and someone who is anatomically female can be male.
And here's where we understand that the Christian worldview would tell us that if you interfere with the pattern of creation and with the pattern of human development that is God's intention, it is going to come with deleterious damaging effects. Now, those effects might come up when it comes to a matter such as bone density, but those effects can also be far more significant than anything that can be measured by a percentage of calcium. Speaking of the realization of this fact, one doctor quoted in the article said, "There's going to be a price, and the price is probably going to be some deficit in skeletal mass." Now, how many parents have been told about this trade-off? How many adolescents are told about this trade-off?
And furthermore, if you don't trust adolescents to give, say, medical permission for just routine surgery, such as a tonsillectomy, on what rational basis does a society say when it comes to something like puberty blockers, this is something that they all of a sudden have the capacity rightly to consent to. It is moral insanity, but it's also medical confusion. At the very least, it is medical insanity. It's a radical rejection of the order of how God made human beings to develop.
Puberty is not an interruption. Puberty is not a contradiction. Puberty is indeed a confirmation of God's purpose for the individual. Interrupting puberty is going to come with costs. Psychological costs, moral costs, reproductive costs, and now we know even bone density cost. That is a lifelong cost. Another factor, by the way, that comes up in this article, well, it really has two dimensions. Number one, why is all this research emerging just now? Actually, as you look at it, some of it has existed for some time. Why has it not gotten much attention? This has to be due to ideology.
Perhaps it is due, to some degree, to what might be described as groupthink. Even as you're looking at professions, and this would be pretty much across the board, professions do often, at least at times, think as a group. Now, sometimes this can be profoundly helpful. It's important that the entire group of architects understand the principle of gravity. But beyond that, sometimes it can be driven by ideology, by fashion, by cultural pressure, by some kind of peer impression. At any event, it can sometimes be absolutely deadly. And, by the way, medicine is not immune from that. Just think about the sterilizations that took place in the late 19th and early 20th centuries based upon eugenic concerns.
Just think about the commitment of the medical establishment, and in many cases, the elite medical establishment to that kind of racialist eugenic studies and medical responses as well. You're looking at the fact that every single human endeavor corrupted by sin shows the effects of sin and what can sometimes be mass delusion driven by ideology.
That's exactly what we have detected when it comes to the medical establishment's embrace of the LGBTQ agenda from the start.
The Research on Damage of Hormone Therapy for Minors Is Not New, So Why is the Medical Establishment Just Now Acknowledging It?
Something else Christians need to consider here, the second dimension, is that when you think about human development, this is not merely a medical issue.
It can't be because we are not merely bodies, but our bodies are very much a part of the self. The biblical worldview tells us that the self is not separate from the body, but includes the body to such an extent that even in our glorification, we will have a glorified body, that will be in some sense continuous with the body that we have now. Our personal identity is tied to our body, and our body is not some kind of materialistic accident.
Our body is a revelation of God's purpose for us. And, by the way, from a biblical perspective, the very idea that you could have gender identity and biological sex fundamentally at odds, well, that just turns out to be a huge theological problem. But there's more to this of course, and even as we understand that the issues can be very traumatic and very deep, we are talking about the most intimate issues of personal identity here, it also becomes particularly urgent when we talk about the youngest people affected by this kind of phenomenon.
As you're looking at children and teenagers, well, just ask yourself the question, if a medication is strong enough to block puberty, then what else is it doing? It's also very interesting to see that the issues of individual patient consent also arise here. You have people saying, "Look, our concern is always when is gender identity fixed and not fluid anymore and when do you fully understand the lifelong consequences of such treatment?"
Interestingly, this is quite morally significant. Many of the medical practitioners cited in this article make the point that the puberty blockers were supposed to slow down the process of this identity question or supposed to slow down some kind of further medical or surgical intervention. But you'll notice here the issue is when an individual can morally consent to such treatment. But that of course just assumes that one can consent to something, that in biblical terms, is just absolutely wrong. This just shows you how the idea of the autonomous self is so supreme in our contemporary culture. So supreme that it will deny biological fact.
The article by the way, and this is very instructive and helpful, it cites a young person who had been prescribed puberty blockers at age 13. This is a girl prescribed to these puberty blockers. She had a question concerning her gender identity. She was given the puberty blockers later in life, and this is just a matter of a few short years, she came clearly to embrace her biological sex as her gender identity, but those medical treatments had come with a cost. It's a cost that she now regrets. She said, "I wish there had been more questions." Now a young woman, this patient said, "I wish there had been more questions asked by the doctors. I wish I hadn't been steered into transitioning the way I was, and that I had been told that there were other ways to cope with the discomfort of puberty." Notice how many of those sentences begin with, I wish.
The Times helpfully indicates there's something of an international reconsideration of the use of these puberty blockers. An absence of bone density is something that seems to be rather, particularly of concern to the medical community, but I think Christians understand that the bones in this case are pointing to an even deeper personal and moral reality.
‘I Wish There Had Been More Questions’: The Problem of the Morality of Harm
This gets back to an issue I said we needed to consider, and that is the morality of harm. We've talked about this before, but it's particularly helpful in this consideration because the word harm shows up so many times in this article.
This gets to the fact that in a highly secularized society, the only morality recognized by many, particularly when it comes to public policy, is what is known as a morality of harm. This comes down to the legal and moral assumption that if you can't show that this particular action, this particular practice, harms someone, and if we can't see that harm, then it should be morally legitimate or at least morally allowable. That's a very interesting argument. In other words, if we can't see the harm of this action, then you should not censor it or try to prohibit it, much less sanction it. If you can't prove there's an immediate visible detectable harm, this can't be wrong.
Now, from a Christian biblical perspective, there's a huge issue here. Number one, the scriptural logic concerning sin begins with the fact that sin is the transgression of the law and violence against the character of God. That is prior to any understanding of a harm that will come to the center. Now, the Bible is very clear and honest about those harms, but the Bible never tries, nor takes any responsibility to say, this particular sin is a sin because here is the human harm that is caused. For one thing, a lot of this simply can't be measurable. What is the specific harm of lust? What is the specific harm of greed? What is the specific harm, say, of envy? How exactly does that work? Well, we know it does come with a harm. It comes with a harm to the center. We know that it comes also with a harm to others whereby actions and logic, there is a harm that is brought about. There's also a harm to the larger society and the unraveling of the moral fabric that is necessary for that society to exist and to be healthy.
We live in a society that has for decades tried to have a discussion about so-called victimless crimes. What about prostitution? What about pornography? But of course, we know none of these crimes, none of these sins, are actually victimless. But we live in a society that wants to say, I want you to show me the direct effect of this particular act which leads to a harm that we can document and we can measure, otherwise, this can't be a matter of our public concern, of our moral concern, of our legal concern.
Now, the way this works out in our consideration of this frontpage article in the New York Times comes down to this. It is very telling that it takes an argument about specific harm, in this case, something as specific as a loss of bone density and puberty to lead to a realization that something's wrong. That's wrong at a far deeper moral level.
The harm, by a biblical worldview, we would see here, is to the individual, to the soul, to the mind, to the emotions, to the heart, to the self-consciousness, to a set of relationships. It's actually an injury that is far larger than anything that can be detected, like bone density, but it is telling that bone density does in this case, show the problem.
That too is a part of God's ordering of creation.
The New York Times Is Raising the Alarm on Puberty Blockers — How Long Until Others Follow?
Now, one final consideration on this issue, I'm just going to make a prediction. This kind of article appearing on the front page in the New York Times is likely to be something of a small trickle that is going to become a raging stream.
I think once you have an establishment source like the New York Times, say, "Hey, maybe we have a medical problem here." Others are going to say, "Well, I've been thinking the same thing. Here's the evidence that I've been seeing." I think at some point in the fairly near future, there's going to be a huge mass embarrassment come to the medical profession because of its complicity in the transgender revolution. I think there is also going to be a tidal wave of litigation that is likely to come with legal liability because if you're talking about documenting harm, it turns out that one of the main ways that is done in our legal system, is by tort law. That is to say, filing lawsuits, perhaps even class action lawsuits.
I also want to make clear that I'm not just throwing the medical establishment under the bus here. The medical establishment in this case is complicit along with other establishments and other professions. The professions have largely given themselves over to the LGBTQ moral and sexual revolution. But an even greater responsibility falls to those who are theologians and ministers, members of the ministry, pastors of liberal churches, who have also been absolutely complicit in this revolution. They have done so as they have embraced liberal theology and have abandoned creation order and the clear teachings of the Scripture. They have simply absorbed modern views contrary to scripture and made them the central doctrinal platforms of so many of their denominations. They have added their churches, their denominations, their seminaries, their colleges, their universities, to the moral revolution. That also comes with devastating costs, particularly the cost of the absence of the gospel.
Christians, churches, denominations, committed to biblical truth have a long way to go in terms of responding with adequacy and with pastoral and ministerial care to those who are struggling with these issues. That too is a challenge for biblical Christianity. But Christians committed to the scripture, to the inerrancy in the authority of scripture, and Christians committed to the gospel, can never move from assumptions that are contrary to scripture, nor take any actions that contradict scripture, nor affirm any therapy or any way forward that is in any sense disobedient to, or contrary to Scripture.
There is a sense, and I think it's a righteous sense, in which we look at this article on the front page of the New York Times and say, we told you so, but that is not said from a position of some kind of complacency when it comes to the Christian church's response to those struggling with these issues.
We must not be complacent, but we must be consistent with Scripture. Our starting place and our response to these issues cannot be what you see right now taking place in the larger culture, in the therapeutic community, and in the medical establishment. Where you see, for example, people in the medical establishment and in the so-called therapeutic professions, where you see them concerned for human brokenness, that's a sign of common grace of the fact that it is good that human beings would be very concerned about the trouble that other human beings are experiencing and would seek to respond to it. That is the church's calling.
It's the church's calling, always in all times everywhere to understand these issues and to respond to those in trouble on the basis of biblical truth. Which, after all, is going to be consistent with the structures of creation, and is going to be consistent with the principles of the Gospel, and is going to root our only hope for wholeness in the atonement accomplished by the Lord Jesus Christ, and our only hope for holiness in the sanctification brought about in the believer by the ministry of the Word, through the power of the Holy Spirit.
There are so many issues in the headlines that have very significant worldview dimensions, but frankly, it's hard to imagine a news story with greater worldview significance than the one we have considered today. The fact that it has appeared, and the fact that it has appeared where it appeared, how it appeared, is just incredibly significant.
But how the Christian church thinks about these issues and responds to these issues, that's even more significant. And that's going to keep us busy for quite a while.
Thanks for listening to The Briefing.
For more information, go to my website at albertmohler.com. You can follow me on Twitter by going to twitter.com/albertmohler. For information on The Southern Baptist Theological Seminary, go to sbts.edu. For information on Boyce College, just go to boycecollege.com.
I'll meet you again tomorrow for The Briefing.