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Tuesday, December 9, 2014

Gender Incongruence and the LDS Church: Frontier of Understanding (Part 1)

by Russ Peterson:

Note: This is Part 1 of a multi-part post to run the rest of this week.

In The Family: A Proclamation to the World, the First Presidency and Quorum of the Twelve have taught that "gender is an essential characteristic of individual premortal, mortal, and eternal identity and purpose." Although we are accustomed to thinking of this doctrine as unique to the LDS tradition, it is in fact among the first truths recorded in scripture:
So God created man in his own image, in the image of God created he him; male and female created he them (Genesis 1:27).
The image of God, which includes male and female, is the image and pattern after which God created Adam and Eve, whereupon which He commanded them to multiply and replenish the earth (Genesis 1:28). Latter-day Saints believe the family is "ordained of God." In other words, we hold the family—consisting of man, woman, and children—to be divinely organized by God for the accomplishment of His work, which is to "bring to pass the immortality and eternal life of man" (Moses 1:39).

The fact that man and woman act together in the creation of life is in accordance with divine design. Latter-day Saints believe that sexual relations within the bonds of matrimony constitute a sacrament of marriage, binding two souls together according to the covenant they have made. This pattern, instituted of God for the happiness of His children, neither originated in nor concludes with the mortal sphere. According to the plan of happiness, the family is the fundamental social unit both in time and eternity.

For the vast majority of His children, the nuclear family—consisting of man, woman and children—is congruent with individual development in terms of biology, identity, and attraction. For example, most individuals that appear to be male have functional male sexual anatomy, experience an internal sense of being male, as well as feelings of attraction toward women. Conversely, most individuals that appear to be female have functional female sexual anatomy, experience an internal sense of being female, as well as feelings of attraction toward men. For the purposes of this article, I will refer to this agreement of biology, identity, and attraction as gender congruence.

Gender congruence is so common to the human experience that it is difficult for many to imagine a state of incongruence between biology, gender, and attraction. Furthermore, gender congruence—the most common outcome of human development—is so innate to personal experience that few individuals outside the social sciences even become aware that biology, gender, and attraction are separate constructs that can and do develop independently of each other.

When we consider the central role of procreation in the Plan of Happiness along with the declaration that "gender is an essential characteristic of individual premortal, mortal, and eternal identity and purpose," it should not surprise us to realize that these teachings undergird a set of cultural beliefs within the Church about those whose experiences are different from the gender congruent majority. These beliefs might be summarized as follows:
  1. Since gender "is an essential characteristic of individual premortal, mortal and eternal identity," matters of gender and sex are always clearly defined in the mortal state.
  2. A loving Father in Heaven wouldn’t create circumstances that give rise to gender uncertainty, gender incongruence, or same-sex attraction.
  3. Uncertainty (or confusion) about sex or gender is a Sign of the Times and/or evidence of the deterioration of society.
  4. Gender incongruence proceeds from an individual’s decision to deviate from the Plan of Happiness.
My purpose is to give members of the Church the understanding necessary to "bear one another's burdens" in terms of gender incongruence, just as we are under covenant to do so with regard to every other problem incidental to the mortal sphere. Although I will not be writing in technical terms, some basic biological concepts bear explanation and discussion; my goal is to do so in a manner accessible to the general membership of the Church.

Biology: "Is It a Boy or a Girl?"

This is the first question parents are asked when they announce they are expecting a baby, and the answer frames a lifetime of expectations. Although a baby's sex is usually obvious from appearance, there are a number of conditions—called disorders of sex development—that can interfere with male or female development according to standard biological templates. Although a detailed review of biological disorders is beyond the scope of this article, I will outline some points that are key to understanding the biological development of sex.

Most are aware that human growth and development is determined by an individual's genetic code, consisting of 46 chromosomes. Most chromosomes come in two similar pairs; however, one pair of chromosomes is different. The sex chromosomes (X and Y) are so called because they determine an individual's sex. Generally, the presence of a Y chromosome causes the development of male sexual anatomy. Absent a Y chromosome, development proceeds according to a female pattern.

As simple as it would seem, chromosomes do not completely determine an individual's sex. During fetal development, genes within chromosomes cause sex hormones to be produced, and it is the sex hormones that cause certain embryonic tissue to develop into male or female sex organs. In general, a Y chromosome causes testosterone (the male sex hormone) to be produced, and it is testosterone that causes the fetus to develop as a male. In the absence of a Y chromosome and the resulting testosterone, development proceeds according to a female pattern.

Each of these major factors that steer the biological development of sex—chromosomes and hormones—is subject to the same kinds of errors incidental to the mortal state. Each time the genetic code is copied errors can be introduced. The endocrine (hormone) system is also subject to problems, a few of which we will consider in due course. Once again, it is not our purpose to undertake a comprehensive review of the literature; however, there are some basic concepts that are important to understand and that provide context for our broader discussion.

Among the most common problems of sex development are the those that feature an extra or missing chromosome. Males have one X and one Y chromosome (XY); females have two X chromosomes (XX). However, extra chromosomes can be present in the egg or the sperm, whereupon an individual can develop with three sex chromosomes (XXX, XYY, or XXY). Of these, an XXY presentation—also called Klinefelter's syndrome—causes the most problems for sexual development. Those affected "are often tall and produce relatively small amounts of testosterone. As a result of this hormone imbalance, affected males have incompletely developed secondary male sex characteristics."1

Sperm or egg cells can also lack a sex chromosome, leading to the development of Turner's syndrome. Individuals with Turner's syndrome have a single X chromosome but no Y or second X chromosome. Those affected "experience abnormal growth patterns, are short in stature, generally lack prominent female secondary sexual characteristics and are sterile."1 Beyond the presence or absence of entire chromosomes, there are a host of conditions that involve errors and mutations of individual genes. These conditions—while relatively rare—are too numerous to list. Time will permit only a brief glimpse at a few of them.

We considered earlier that the development of sex is a function of the interplay between an individual’s genetic code and the hormones produced during development. One genetic error causes a condition known as congenital adrenal hyperplasia. When untreated, genetically female (XX) individuals "develop an outwardly male appearance. This disorder, also called adrenogenital syndrome (AGS), results from a genetically caused deficiency of cortisol, a steroid hormone produced by the adrenal cortex."1

There are still other disorders that arise from an inability of bodily cells to recognize androgens (the male sex hormones). In androgen insensitivity syndrome, individuals that are genetically male (XY) develop breasts and female sex organs due to a genetic mutation wherein cells lack the receptors to recognize and respond to male sex hormones. As per our previous discussion, in these cases, sex development proceeds according to a female pattern, and most of these individuals only discover the problem when they marry and find they are unable to conceive.

Finally, there are a number of "intersex" conditions wherein children are born with sex organs that are neither clearly male or female. Most often these presentations are found to be caused by the same kinds of genetic and/or hormonal problems we have already discussed. Often medical or surgical interventions are sought in an effort to help such individuals lead normal lives as male or female.

Considering that we have listed only a few of the more than 30 known disorders of sex development, it should come as no surprise that the overall incidence (1.7%) is fairly high.2 To put this in perspective, on average these conditions will affect 4-7 individuals in a typical LDS ward. Although we may not share their challenges, these individuals deserve our love, understanding, and support.

(to be continued) ...

1World Health Organization, “Gender and Genetics,” (accessed September 15, 2013).
2Anubhav Mittal, “Disorders of Sexual Development,” (accessed September 27, 2013).

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Russ Peterson grew up in Idaho Falls, Idaho and is an avid outdoorsman with interests ranging from astronomy to wilderness survival. When not camping or backpacking, Russ is a mental health counselor with interests in gender and suicide prevention. He lives in the Intermountain area and enjoys spending time with his five children. Reach him at rhpeterson <at> gmail dot com.
 photo Line-625_zpse3e49f32.gifImage credit: Peretz Partensky (used with permission).

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