Catholic Medical Quarterly

The Journal of the Catholic Medical Association (UK)

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Catholic Medical Quarterly Volune 70(4) November 2020

Transgender, from a medical and a Christian perspective

Dr Adrian Treloar

This article is a transcript of a talk given by Dr Treloar, in Edinburgh on 29th February 2020 – the introduction to the talk, below, sets the context and intention of the article

Introduction

Good evening. It’s good to be here in such a wonderful city. I agreed to give this talk as I felt that The Church and Her faithful do need to reflect upon transgender issues and to think through how to support and work with LGBT people whom we meet in our day-to-day lives. I hope very much that what I will say is helpful, thoughtful and compassionate. It is intended thus. And if I fail in that intention, I apologise in advance.

 

Let’s just start with some fundamentals

• Christianity firmly attests the humanity, dignity and worth of every individual, from the weakest and most vulnerable to the most marginalised and to the most advantaged.
• Christ seeks to build in each one of us our strengths and our goodness, while also recognis-ing the weaknesses and challenges which we each carry.
• The Church absolutely rejects any discrimination against any people and also rejects all violence against people for any reason, including their sexuality. [1]
• And Christ (with His Church) seeks with all people to understand and support them with and through the challenges that they face while also drawing them to a greater union with Himself.
• Everyone is of worth.

A tiny bit of biology

We almost all have two sex chromosomes. The vast majority of people are XX or XY. Other variations exist but are rare. Rarely men with Klinefelter’s syndrome have XXY and there are other combi-nations such as men with XYY that occur rarely. And a few have only one X chromosome (XO).

They are women with Turner’s Syndrome. As well as that, some people (for example) have sex hormone receptor insensitivity have XY chromosomes but are seen as female receptor insensitivity and have XY chromosomes

Intersex and Hermaphroditism exist but are very rare: in 2002 Sax said that was less than 2 in 10,000. Therefore, over 99.98% humans are clearly either male or female.[2]

Transgender brings with it multiple descriptions of sexuality and is focussed upon how the individ-ual sees themselves and not the chromosomal definition of sex. It has a very high profile politi-cally and publicly with the Scottish Government Consultation: Gender Recognition Reform (Scotland) Bill being but one example of that. And of course, we are discussing it here today.

Some time ago (in 2014) there were 71 gender options on facebook. [3]

How many Transgender people are there?

Estimates vary, but quite a lot. Amnesty Interna-tional suggests that 1.5 million transgender people live in the European Union. [4] The Williams Institute[5] suggests in the US a "rough estimate" that 0.3 percent of adults in the US are transgender, overlapping to an unknown degree with the estimated 3.5 percent of US adults (1-in-30) who identify as LGBT. More recent studies released in 2016 estimate the proportion of Americans who identify as transgender at 0.5 to 0.6%. This would put the total number of transgender Americans at approximately 1.4 million adults (as of 2016).

• We are certainly seeing transgender people declaring their transgender status more frequently than used to be the case.
• We also know that the frequency with which children are being referred to gender assignment clinics, has increased substantially.
• That might be because prevalence of transgender is increasing or it might be because it is publicly expressed more often. Which may make young people (especially perhaps including those with autism, Asperger’s syndrome or learning disabilities) more likely to be troubled by that increased public discussion.
• And it could be a bit of both.

How common is same sex attraction?

• The Office for National Statistics (ONS) found 1.1% identified as gay or lesbian,[6] but only 0.4% of respondents identified themselves as bisexual to ONS (1.2% in Natsal3)
  The National Survey of Sexual Attitudes and Lifestyles 2012[7] found that
  • A lesbian, gay or bisexual (LGB) identity was reported by 2·5% of men and 2·4% of women, whilst 6·5% of men and 11·5% of women reported any same-sex attraction and 5·5% of men and 6·1% of women reported ever having experience of same-sex sex.
  • This equates to approximately 547,000 men and 546,000 women aged 16–74 in Britain self-identifying as LGB and 1,204,000 men and 1,389,000 women ever having experience of same-sex sex.
  • Stonewall, the Gay rights charity reckon that 5-7% “is a reasonable estimate” for people who identify as gay or lesbian. That figure is an estimate and may be an overestimate.

Are sexual attitudes and behaviours changing?

The frequency with which (especially young people) are identifying as gay or lesbian and reporting same sex behaviours is changing.

There are, without doubt, changing attitudes towards sexual relationships and sexual behaviours

The National Survey of Sexual Attitudes and Lifestyles 2012[8] showed how numbers of heterosexual partners have been increasing over time from 3.7 for women in 1991 to 7.7 in 2012.

Comment

Note that the definition of same-sex sex is broad and involved asking women “Have you ever had any kind of sexual experience or sexual contact with a woman? Please say 'yes' here, even if it was a long time ago or did not involve contact with the genital area/vagina, and then if same sex genital contact had occurred as well as “oral (or anal) sex or any other contact involving the genital area”. Which is quite a broad definition.

Alongside that, numbers of partners for homo-sexual people are far higher. For men who have sex with men have a mean number of partners = 41.3 between ages 35-44. The standard deviation (a statistical test) for that number is 106 from which it is clear that some men who have sex with men have hundreds of sexual partners or perhaps even more.

The 2012 survey also noted that[8] the biggest changes in behaviour are seen amongst women

• People have sex at an early age and continue into their 70s
• the average frequency of sex reported by men and women declined in the most recent survey
• People are more accepting of same-sex relationships, but less tolerant of married people having sex outside of marriage
• While the number of men reporting having same-sex partners has changed little from 3.6% in the first study (1990-1) to 4.8% this time around, for women, the figure has increased four-fold, from 1.8% to 7.9%

A bit about children (The Portman Clinic)

For young people, Gender Identity Services have been run by the Portman Clinic in London and have faced significant controversy

• Medical intervention isn't considered until they approach puberty, when hormone blockers might be offered.
• Puberty blockers delay the physical changes associated with puberty, giving the young person longer to decide if they want to live as a man or a woman. 32 children received them in 2017. An attempt to bring legal action against the Portman is currently underway.[9]
• At the age of 16 a patient can then take cross-sex hormones, with full surgery only offered after the age of 18.

However,   Endocrine    Society    Guidelines published in 2009 state that the large majority (75–80%) of prepubertal children with a diagnosis of Gender Identity Disorder in childhood do not turn out to be transsexual in adolescence.[10]

But in the Amsterdam gender identity clinic for adolescents, none of the patients who were diagnosed with a GID and considered eligible for sex reassignment dropped out of the diagnostic or treatment procedures or regretted sex reassignment.[11] Treatment options included the suppression of puberty by drugs in 12-16 year olds. Which for me, does not absolutely seem to match the statement in the Endocrine Society Guildelines, which suggest that if you do nothing, “75-80% do not turn out to be transgender in adolescence”. The Endocrine Society guidelines suggest that treating young people with drugs, and especially puberty   blockers  early   may   be inappropriate.

Can the frequency of expression of being LGBT change with changing societal attitudes and behaviour?

• The LGBT movement frequently state that you are what you are and nothing will change that (put another way, people are made with their sexuality). But there is no doubt really that the frequency of expression of homosexual, lesbian, transgender etc has increased over decades. As has, according to surveys, the frequency of sex outside of marriage, homosexual sex and many other sexual practices.
• Does that then mean an actual increase in homosexual people?
• Or do people feel able to state they are LGBT more often and more easily?
• Does thinking you are gay make you gay?
• Does telling people you are gay make you gay?
• Does having sex with people of the same sex make you gay? (clearly the answer to that question is no, as people who consider themselves heterosexual are reporting same sex behaviours)
• Does being married and having children before you realised you are trans mean that you were always trans? Some might think that you have become trans.
• Or is our sexuality simply defined by what we say we are at the moment we say it?
• An even bigger question perhaps would be “Is it legitimate to ask such questions?”
• And do please forgive me if it is not legitimate to ask such questions.

Is it legitimate to question the perceived wisdom?

James Caspian wanted to research people who have surgically de-transitioned. He had 16 years’ experience of gender transition and works at a pri-vate gender clinic. His proposal was to research people who had undergone surgery to “retransi-tion”. Refusing permission, the University Ethics Sub-Committee said “This is a complex project and the risks are too great to the university and the researcher.” “Working on a less ethically complex piece of research to complete the Masters would be more appropriate.”[12]

The sub-committee added: “Engaging in a potentially ‘politically incorrect’ piece of research carries a risk to the University”.

Mr Caspian commented that “That would mean that students and academics are no longer free to discuss, dissent with, question, or examine critically material that may be challenging to someone, somewhere.”

So what does all that mean?

• Organisations, including schools must recognise that some people will identify as LGBTIQ… (plus)
• Some will “come out”.
• Others will not.
• And some may (so we hear from young people) “go back in” or revert to identifying as heterosexual
• And there is clear evidence for that also happening in transgender young people
• But we must make reasonable adjustments to accommodate all those whom we serve.
• We are all equal and we are all God’s children

What are the problems and difficulties associated with being Homosexual Lesbian or Transgender etc?

Well there are rather a lot of them. There is a lot of documentation about these issues and I have therefore, in a few moments, tried to summarise data from Stonewall and the US Transgender Survey. In preparing this talk I did not want to be partial about whose data I used. While the finer points might be argued, I hope I have captured a reasonable set of estimates. Using “mainstream“ data I think. The problems include:

• Suicide
• Self harm
• Depression
• Anxiety
• Complex, fragile and multiple relationships
• Alcohol and substance abuse
• Life events
• Chem sex and drug abuse
• HIV, gonorrhoea, chlamydia etc etc
• Violence, harassment, discrimination
• Suicide and self-harm

In the US, suicide attempts among trans men (46%) and trans women (42%) are roughly ten times the rate found in the overall population.[13] In Stonewall 2018 survey below, the UK rate is similar “Almost half of trans people (46 per cent) have thought about taking their own life in the last year, 31 per cent of LGB people who aren’t trans said the same.” [14]

US National Transgender Discrimination Survey In Ontario the suicide attempt rate for transgen-der people was about 18 times higher than the general population [13]

Stonewall’s Gay and Bisexual Men’s Health survey found that [14]

• 7% of same sex and both sex attracted men deliberately harmed themselves in the last year by cutting, self poisoning or burning.
• Increasing to 15% in people who also had a disability.
• 20% of same sex and both sex attracted women harmed themselves in the last year in some way.
• Increasing to 26% of Black and Ethnic Minority women and 29% with a disability
• Mostly by cutting but also by swallowing pills or objects.
• 56% of same sex attracted young people have harmed themselves in the last year with same sex and both sex attracted girls twice as likely as boys to self-harm (72% vs 36%).
• And rates of self-harm are also high in transgen-der people as well as homosexual people.
• Although the data does appear to show that self-harm is even more common in transgender people.
• For me, as a psychiatrist preparing this talk, I find myself greatly distressed to think of the terrible suffering for the people involved.

Depression and anxiety are common

The rates of depressive symptoms (51.4% for transgender women; 48.3% for transgender men) and anxiety (40.4% for transgender women; 47.5% for transgender men)[16] are high.

• In Stonewall (2012)[14] found that, in the last year, three quarters (74 %) of lesbian and bi-sexual women say they felt anxious or nervous, rising to 78% of bisexual women and 81% cent of black and minority ethnic lesbian and bisex-ual women.

Homophobia and mental health

In their school survey,[17] Stonewall found that more than half of LGB young people experience homophobic bullying.

• 46% of those who experience bullying have symptoms consistent with depression  Compared to 35% who have not experienced bullying.

Alcohol is also a common problem

• Thirty-five percent (35%) of school children of those who were verbally harassed, physically or sexually assaulted, or expelled because they were transgender or gender non-conforming, reported using drugs or alcohol to cope with mistreatment they faced for being transgender or gender non-conforming.
• This compared to 21% of those who did not face these forms of mistreatment in school.
• This number rose to 44% for those who were physically assaulted and 48% of those who had to leave school due to harassment. [13]

There are also very high rates of HIV and STDs among transgender people.

The World Health Organisation (WHO) states that [18]

• Transgender women are around 49 times more likely to be living with HIV than other adults of reproductive age with an estimated worldwide HIV prevalence of 19%;
• In some countries the HIV prevalence rate in transgender women is 80 times that of the general adult population. Little data is available for transgender men or other transgender populations.
• 3%of the National Transgender Discrimination Survey sample were HIV positive
• Rates higher in those who express discrimination bullying and harassment
• Higher among homeless and also among those who had to leave school due to bullying.

More recently

And their 2018 survey LGBT in Britain – Health Stonewall report 2018 gives similar key findings [19]

• Half of LGBT people (52 per cent) said they’ve experienced depression in the last year.
• One in eight LGBT people aged 18-24 (13 per cent) said they’ve attempted to take their own life in the last year.
• Almost half of trans people (46 per cent) have thought about taking their own life in the last year, 31 per cent of LGB people who aren’t trans said the same.
• Forty-one per cent of non-binary people said they harmed themselves in the last year compared to 20 per cent of LGBT women and 12 per cent of GBT men.
• One in six LGBT people (16 per cent) said they drank alcohol almost every day over the last year.
• One in eight LGBT people aged 18-24 (13 per cent) took drugs at least once a month.
• One in eight LGBT people (13 per cent) have experienced some form of unequal treatment from healthcare staff because they’re LGBT.
• Almost one in four LGBT people (23 per cent) have witnessed discriminatory or negative remarks against LGBT people by healthcare staff. In the last year alone, six per cent of LGBT people – including 20 per cent of trans people – have witnessed these remarks.
• One in twenty LGBT people (five per cent) have been pressured to access services to question or change their sexual orientation when accessing healthcare services.
• One in five LGBT people (19 per cent) aren’t out to any healthcare professional about their sexual orientation when seeking general medical care. This number rises to 40 per cent of bi men and 29 per cent of bi women.
• One in seven LGBT people (14 per cent) have avoided treatment for fear of discrimination because they're LGBT.
• https://www.stonewall.org.uk/lgbt-britain-health

And for the rest of the LGBT community there are similar, though possibly less marked findings.

• Fergusson[20] (for example) found that elevated rates of reported suicide attempts in youth who identified as Lesbian, Gay and Bisexual, were associated with significantly higher rates of depression, generalized anxiety disorder and conduct disorder than were observed among heterosexual youth.
• HIV and other sexually transmitted diseases retain their very high prevalence among homosexual communities. Since the 1980s, men who have sex with men have remained the group most at risk of HIV in the UK. In 2016, the most recent data avail-able, there were 101,200 people with HIV in the UK. Of those an estimated 47,000 were men who have sex with men[21] . This means roughly 1 in 20 men who have sex with men aged 15 to 44 are living with the virus. The prevalence rate is 4.9% nationally among this group, rising to 9% in London.

And very importantly, violence and abuse…

…is common; utterly wrong and traumatising. And there is very real ongoing suffering as a result of it.

Those who expressed a transgender identity or gender non-conformity while in grades K-12 reported alarming rates of harassment (78%), physical assault (35%) and sexual violence (12%)[13].

Comment

Although we do also know that other groups including Christians frequently experience harass-ment at work and elsewhere, but do not suffer the same set of negative outcomes. Which might not be a surprise really, as all protected groups are, by definition, different.

Does transition help?

A Swedish study[22] of 324 sex reassigned adults undertook long-term follow-up of transsexual persons undergoing sex reassignment surgery and 20  sought to estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons. Data came from Swedish people between 1973 and 2003.

PARTICIPANTS: All 324 sex -reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973-2003. Random population controls (10:1) were matched by birth year and birth sex or reassigned (final) sex, respectively.

RESULTS: The overall mortality for sex-reassigned persons was 2.8 times higher during follow-up (aHR 2.8; 95% CI 1.8-4.3) than for controls of the same birth sex. Death from suicide was 19.1times higher. (aHR 19.1; 95% CI 5.8-62.9). Sex-reassigned persons also had an in-creased risk for suicide attempts (aHR 4.9; 95% CI 2.9-8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0-3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls.

The study concluded that “Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.“

Outcomes from the US National Transgender Discrimination Survey

Clearly transition does not eliminate all suffering etc. Although we should add to that (see later) that many do indeed report that they think it was helpful and positive.

In the US transgender study they state that of those who successfully transitioned and are in employment 78% said they felt better afterwards. That group 78% is , in fact, a minority part of the sample. 60% of the larger sample were employed and about 50% of the sample had transitioned.

The positive finding in this study is balanced by the reality that being in employment is a predictor of health and staying in employment is therefore an indicator of being one of the people with a satisfactory outcome. So in fact, the 78% who said they felt better were among the group expected to have had the best outcome.

What are the outcomes of male to female transition?

In people who transition from Male to Female, less than a quarter establish heterosexual relation-ships. And the largest proportion become bisexual. [13]

What is clear is that male to female transition does not commonly lead to a simple heterosexual outcome. It is far more complex than that.

What causes the bad outcomes for LGBTIQ plus?

I can only really offer some reflections on this. 
And here they are.

• The LGBT movement rightly states that bad out-comes occur due to bullying, violence and harass-ment. I do not think there is any doubt about that.  
• Is that the full explanation?
  • All of the outcome measures that are independent from the discrimination (HIV, relationship breakdowns, life events drug abuse, chem sex etc etc) are all recognised causes of the same outcomes in non LGBTIQ people.
• Are the outcomes due in part to discrimination?
  • Undoubtedly yes
• Are the outcomes only due to discrimination  
  • Possibly no

Summary so far

• There is a huge amount of suffering: when I look at the data it horrifies me to see so much suffering.
• That suffering is happening among trans people, people who are hoping to transition, people who have transitioned and also with same sex attracted people.
• What does that mean and what can we do about it?

What does the Church teach and state?

• The Church does proclaim that all sexual relationships should be within marriage, between man and woman and open to life. And that is both a challenge and a calling for everyone.
• She teaches that sexual relations outside of marriage are “gravely contrary to the dignity of person and the sexual act”. (Catechism of the Catholic Church 2353)
• And that “Sexual pleasure is morally disordered when sought for itself, isolated from its procreative and unitive purposes.” (Catechism of the Catholic Church 2351)
• And that “Lust is disordered desire for or inordinate enjoyment of sexual pleasure.” (Catechism of the Catholic Church 2351)
• Most commonly heterosexual couples struggle with that. Although it is also very clearly a major challenge for same sex attracted people and trans people.
• But the Church does teach that any sexual relations outside of a validly contracted marriage is against God’s desire for people. Which means that most of those sexual relationships which are outside of a validly contracted marriage will, therefore, be heterosexual and not same sex relationships.
• In other words, the Church states that the natu-ral order which is wanted by God for mankind is the union of man and woman, in marriage and open to life. And the Church then states, that Same Sex relationships cannot be that.
• So, the Church’s teaching on this is primarily a defence of the sanctity of marriage and therefore neither heterophobic nor homophobic. Indeed, she sets out huge care and compassion towards people with same sex attraction and toward trans people as well.
• Many may dislike that view. But that is what the Church states.

Specifically on homosexuality the Church states very clearly that LGBT people “...must be accepted with respect, compassion, and sensitivity. Every sign of unjust discrimination in their regard should be avoided. These persons are called to fulfil God's will in their lives and, if they are Christians, to unite to the sacrifice of the Lord's Cross the difficulties they may encounter….

The Church does not state that being same sex attracted or trans is a sin. But it does call same sex attracted and trans people to chastity.

Church teaching on marriage and the family

The primary vision of the Church is based upon her vision of Marriage, the family and the gift of life and love.

That vision is most expressed in Humanae Vitae[23] which not only sets out marriage between a man and a woman as the fundamental building block of society, but also states how important openness to life is to married relationships. Humanae Vitae’s vision is this. Christian Marriage is

• Fully human
• Total (100% committed permanent and indissoluble)
• Faithful (to the exclusion of all others) and between one man and one woman
• Open to life

That is a truly beautiful vision. But also, one which the Church has really struggled to present in the last 50 years.

Substantial positive data on marriage and living in accord with Humanae Vitae

As an aside, there is substantial positive data on marriage and living in accord with Humanae Vitae.

There is some very positive data comparing couples who use Natural Family Planning with other Catholic and other non-Catholic couples, which shows some very positive outcomes in terms of psychological measures, communication between husband and wife, and also marital stability.

Here is some data from Dr Mercedes Wilson[24, 25] which was presented in 2000 to the Knights of Malta in New York. Wilson M. (2000). The data is not as robust as much of the other data I have presented today, but I think the findings are of worth and give some real hope. Essentially using Natural Family Planning appears to be associated with

• Marriage
• Rarely associated with divorce
• Staying married in stable relationships
• Self description as a successful family?
• Many appear not to be from a background you might expect
• Other data suggests better communication in marriage
• Here are some comments from NFP users. “Truly sharing responsibility about sex builds relationships and married love”
• “It was found that NFP provides a vocabulary and method for discussing the most intimate aspects of a couple’s personal life.“
• “If you can communicate about the signs of fertility, you can talk about anything”.
• Prof John Marshall found that over 75% of his (large) sample found NFP satisfactory.
• Here’s a quote from his study. “The... method has helped my husband and myself to be happier in our sexual relationship than we have been at any time previously in our 19 years of marriage, and consequently the whole of our relationship is more loving.”

Natural Family Planning is also effective in the management and treatment of infertility.

Billings, Symptothermal, NaProTec are all used to achieve pregnancy. And are all as effective or more effective than IVF.

Can the Church’s teaching help us?

Now the controversial bit!

• People have told me in the past that Church teaching is designed (by God of course!) to be good for you. It may well be hard, but it can bring great gifts and benefits. Very humbly, I am bound to say that that has been my experience in life. Again, I recognise that others have not found this to be so, but it has been my experience.

So

• Maybe those who are able to live their lives more closely in accord with Church teaching on marriage and family seem to have better health out-comes and a more stable setting for bringing up children etc. I was recently told that the longest living group of people in the UK are Methodists. I am not sure that’s true and I haven’t seen the data. Maybe the Catholics drink too much!

Living in discord from Humane Vitae

• Looking at the data and other data on children, family stability and upbringing etc, I wonder if the further you depart from Church teaching, the worse the psychological and social outcomes. Chaotic heterosexual love with multiple partners also produces negative measures of depression, self harm and sexually transmitted diseases.
• It is not hard to conclude that in heterosexual couples we see the effects of that discord from the Church’s vision of married love in many heterosexual relationships. I may be wrong in that and many may well argue that I am wrong, but then again, I do find myself wondering that.
• And perhaps we also see that among same sex attracted communities and also among transsex-ual people.
• If that is true, the Church must, humbly, accept that it must express that vision of married love gently, clearly and beautifully. We must offer that vision but cannot and must not condemn those who cannot see embrace or understand that vision.
• Even more, we must not and cannot criticise those for whom the failure of the Church to teach and communicate the message has been so great that they have never even heard that message.
• And we must admit that we have failed to express it well for 50 years now.

We are Biological beings  

• We are biological beings
• To live, we must work with and cooperate with that biology, resisting our weaknesses and disease sometimes. If we do not eat, we die. If we do not drink, we die. We must breathe, go to the toilet etc. We can walk, but not fly. We can only exist by cooperating with the way we are created.
• In life we tend to live longer and do better if we can cooperate and foster our healthy biology (while also robustly fighting diseases).  Challenging that biology (smoking, overeating, lack of exercise) leads to shorter lives while sexuality expressed within the natural law brings a lot of improved sexual and psychological outcomes.
• The data presented above perhaps hints that in our sexual lives, when we cooperate with our natural, God given, biological fertility and sexual-ity we seem to fare better medically, socially and emotionally: i.e. we are healthier.
• I just find myself wondering if it could be that such a strenuous attempt to resist a person’s biology is a part of the challenges faced by transgender people?
• Do we need to support such people in continu-ing to cooperate as much as they can with their biology and sometimes perhaps not setting out to robustly challenge and deny that biology?
• As a society we are very honest about the outcomes of diet, smoking and lack of exercise. Should we be more mindful (while showing great care, compassion, and understanding of the difficulties and challenges faced by people who have GID and same sex attraction and by heterosexual people in challenging and difficult relationships), do we also need to be honest, and to discuss the difficulties that those people face?

A Christian approach to transgender people?

• We must show great care, compassion, and understanding of the difficulties and challenges faced by people who have GID and same sex attraction.
• We attest the humanity, dignity and worth of each and every person and must aim to support each and every person whom we meet as best we can, while also not doing or supporting things which we believe, in conscience, to be wrong
• We must seek to protect people from harm, and especially protect the young from harm.
• To do this we must
• Be willing to think about, discuss and em-brace the difficulties faced by people with GID and same sex attraction.
• Be willing therefore to understand the high rates of Gender fluidity, relationship instability and relationship breakdown
  • Depression
  • Self harm
  • Suicide
  • Substance misuse
  • Sexually transmitted diseases including HIV Etc.
• Be willing to explore to what extent those difficulties are the result of prejudice, stigma and discrimination and as well as to what extent they may be outcomes of GID and same sex attraction themselves.
• And we must be willing to view actions which are abusive as abuse even wherever they occur.

Let me finish with a quote from Dietrich von Bonhoeffer, who was a Lutheran pastor executed by the Nazis in April 1944.

For myself, it is the burden of people’s suffering which has so distressed me while preparing this talk.

As Dietrich von Bonhoeffer said

“We must learn to regard people less in terms of what they do or omit to do, and more in the light of what they suffer”.

Dietrich von Bonhoeffer,
Lutheran Pastor and Nazi Prisoner, 1941