Some Reactions to the Nashville Statement

Nashville logoThis week the Council on Biblical Manhood and Womanhood released a series of affirmations and denials regarding human sexuality and gender. Titled the Nashville Statement, the document was signed by a group of conservative theologians, professors, and pastors. The statement trended on Twitter and has led to numerous blog posts and news articles.  In this post, I will link to three of them and then provide a few reactions to aspects of the statement. If you haven’t read the statement, you should do so before reading the rest of the post.

The Statement Gets Ahead of Science

Mark Yarhouse, my partner in the development of the sexual identity framework, weighed in and asserted that the dogmatic assertions in the statement are far ahead of the data on gender dysphoria. Here is a sample from his post, On the Nashville Statement:

When I wrote Understanding Gender Dysphoria, which was published in 2015, I noted that transgender presentations were a wave that was going to crest on evangelicals and that the church was not prepared for it. I noted that we needed to think deeply and well about gender identity and to engage with some humility what we know and do not know from the best of science, as well as learn from mistakes made in how evangelicals engaged the topic of sexual identity and especially how evangelicals treated the actual people who were navigating sexual identity and faith. I was suggesting we could learn from that experience and make some adjustments as we encounter the topic of gender identity.
I’m afraid the Nashville Statement, perhaps out of a desire to establish the parameters for orthodoxy on gender identity concerns, gets ahead of evangelicals because it doesn’t reflect the careful, nuanced reflection needed to guide Christians toward critical engagement of gender theory, while also aiding in the development of more flexible postures needed in pastoral care.

An Unhelpful Exclusive Statement

Historian Chris Gehrz had a somewhat stronger post at the Pietist Schoolman. He writes for those who feel in the middle on GLBT issues. Here is a sample:

But then the Nashville Statement doesn’t allow for the possibility of Christians disagreeing on such issues. I’m sure anyone paying any attention already knew what these authors and signers thought about sexuality and gender identity. If that’s all it addressed, I’d just try to ignore the statement. But then there’s Article 10…
We affirm that it is sinful to approve of homosexual immorality or transgenderism and that such approval constitutes an essential departure from Christian faithfulness and witness.
We deny that the approval of homosexual immorality or transgenderism is a matter of moral indifference about which otherwise faithful Christians should agree to disagree.
Wait, so… Is salvation at stake for queer Christians and their supporters? Is there to be any continuing communion or collaboration with those who have departed “from Christian faithfulness”? And are those of us who do think it’s possible to agree to disagree also making such a “departure”?

Gehrz also sees the statement as a Trump-like expression which trolls the gay affirming crowd and affirms those who oppose gay rights.

Nor that the authors have chosen to condemn “transgenderism” just days after Pres. Trump began to implement a ban on transgender persons serving in the military, only feeding the perception that whatever daylight separates Trumpism and evangelicalism is vanishing. (After all, that ban was reportedly discussed with Trump’s much-maligned evangelical advisers before he first tweeted his intentions last month.)
The Nashville Statement strikes me as theology for the Age of Trump because it’s being thrust into social media for little purpose other than to energize allies and troll enemies — distracting our attention from more pressing problems in order to demonize minorities whose existence causes anxiety among the many in the majority.

All Words and No Words-Made-Flesh

Although opposed to the statement, Jonathan Merritt doesn’t think it will have much effect. Writing at Religion News Service, Merritt says:

When it comes to issues of sexuality and gender, a statement like this is unlikely to move the needle with those who aren’t already in agreement. It is all head and no heart. It speaks to your mind but fails to look you in the eyes. It is intellectual, but not pastoral. It dialogues about people, rather than with them. It acknowledges the theology of these issues but never the humanity. It is all words and no word-made-flesh.
So progressives who hope for change should take a deep breath and stay the course. Keep comforting your friends. Keep making space for those whom others refuse to welcome. Keep loving your neighbors, and don’t forget that these signers are your neighbors, too.
Like so many before it, this statement won’t change anything. But if you keep leading with love, you can change everything. Proclamations don’t shape history; people do.

Bad Timing

Generally, I think the timing of the statement was poor. In the midst of an epic natural disaster and the national conversation on racism, a document which singles out a minority doesn’t seem wise. I suppose the reaction would have been negative at any time, but I think some of the intense negative reaction relates to increased awareness of the document this week.

Some Additional Reactions

While I don’t have reactions to all 14 articles, I will provide a few additional thoughts.
I was intrigued by the inclusion of Article VI:

WE AFFIRM that those born with a physical disorder of sex development are created in the image of God and have dignity and worth equal to all other image-bearers. They are acknowledged by our Lord Jesus in his words about “eunuchs who were born that way from their mother’s womb.” With all others they are welcome as faithful followers of Jesus Christ and should embrace their biological sex insofar as it may be known.
WE DENY that ambiguities related to a person’s biological sex render one incapable of living a fruitful life in joyful obedience to Christ.

I see it as a plus that the statement recognizes disorders of sex development (once commonly referred to as “intersex” conditions). However, I think the statement could have gone further to wrestle with the implications of what Jesus said as recorded in Matthew 19: 11-12.

11 Jesus replied, “Not everyone can accept this word, but only those to whom it has been given. 12 For there are eunuchs who were born that way, and there are eunuchs who have been made eunuchs by others—and there are those who choose to live like eunuchs for the sake of the kingdom of heaven. The one who can accept this should accept it.”

I realize I am a layman but this sounds like a recognition that the rules are different for some people. Not everybody is going to get married and not everyone has the requisite interests for heterosexual marriage. Jesus said so without condemning them. Some scholars have amassed linguistic evidence which suggests a eunuch could include persons who do not have inclination for opposite sex relations, such as gays and lesbians.
Practically, the Nashville signers don’t give us a clue how people Jesus referred to here can “embrace their biological sex.” Referring to GLBT people, I don’t know what that means. The Nashville statement certainly goes beyond Jesus’ words in Matthew 19. Given that the teaching from Jesus is pretty slim on this point and the Nashville Statement is vague in guiding “eunuchs,” I strongly disagree with the Nashville Statement’s Article 10 which states:

WE AFFIRM that it is sinful to approve of homosexual immorality or transgenderism and that such approval constitutes an essential departure from Christian faithfulness and witness.
WE DENY that the approval of homosexual immorality or transgenderism is a matter of moral indifference about which otherwise faithful Christians should agree to disagree.

As Mark Yarhouse said in his post, this statement is way out in front of what we know for sure. I will add that for “eunuchs” however defined, the statement is vague and severely limits sincere differences of interpretation and opinion among people who are orthodox. On that basis alone, I think the CBMW should go back to the drawing board.
Along similar lines, I think Articles 4, 12, and 13 may be at odds with existing research on gender differences and sexual orientation. For instance, Articles 12 and 13 sound like a theological statement of religiously-based reparative therapy which does not work to eradicate (“put to death”) attraction to the same sex.
Article 4 speaks of “divinely ordained differences between men and women.” What are those differences? While there are real differences which show up in research studies, the list of them would differ significantly from church to church and denomination to denomination. The lack of clarity invites abuse and misunderstanding.
Finally, I think Jonathan Merritt is probably correct that the conflict will die down and the statement will become a short hand for those who signed it but accomplish little else.
 
 

The Editor of The New Atlantis Responds to My Critique of the Mayer and McHugh Article

On August 25, Adam Keiper, editor of The New Atlantis emailed to give me his reaction to my initial critique of the new article by Lawrence Mayer and Paul McHugh on sexual orientation and gender. Please review that post before you read his remarks.
I appreciate Keiper’s professionalism in his remarks. I also appreciated a cordial phone call we had on Thursday. Keiper gave permission for me to publish his remarks. They are reproduced in full from the email. I plan to add my reactions over the next day or two within this post. I wanted to post his thoughts while the issue is current. My reactions to the part of the article on sexual orientation (I have yet to really examine the section on gender identity) are interspersed below.

In what follows, I would like to offer a few responses to some of the points you raise. I invite you to post this e-mail as an addendum to your piece on Patheos. I must note at the outset that I am not here writing on behalf of the authors of the report, nor as a scientist or physician (as I am neither), but rather as an interested reader of your piece and as the editor of The New Atlantis who worked closely with the authors on the report over the course of several months.
You begin by pointing out that “Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences” is not a study. You are correct. It is, as you rightly remark, a scientific review of the literature.
You are also correct in noting that The New Atlantis is not a peer-reviewed scientific publication. It is, rather, editorially reviewed — like many other journals and magazines intended for a wide public audience (such as Democracy Journal, National Affairs, The American Interest, The New Yorker, The Atlantic, etc.). When we publish essays and articles on technical subjects, our fact-checking process is especially rigorous, and in such cases we often ask experts to help our editorial team in its work. In the case of “Sexuality and Gender,” both our editorial team and the authors consulted with a range of experts in different fields. Peer review can be a very important part of the scientific publishing process. Our aim, however, was not to publish an original research study but rather to translate into accessible prose the scientific findings that were already published in peer-reviewed publications.
You next say:

Even calling the paper a new study isn’t accurate, there are no new studies in the paper. A bunch of old ones are missing as well.

I disagree with your characterization; there are some recent studies and papers that are mentioned in the report, including a handful that were published in 2015 and 2016. All told, I believe the report is quite up-to-date. I also would not say that old papers are “missing” per se; that seems to imply cherry-picking, which is an unsupported charge. Of course the authors of the report could not have discussed every paper in the vast scientific literature, but they selected the papers that they discussed on the grounds of their quality and scientific significance — emphasizing literature reviews and meta-analyses, pointing out when other significant papers contradict or criticize the literature reviews and meta-analyses, and then discussing more recent papers and studies that fill in gaps or further advance knowledge. Some older papers in the literature were deemed to be neither sufficiently important nor sufficiently rigorous to warrant discussion.

While The New Atlantis article was thorough, I still don’t think Mayer and McHugh captured everything necessary to make the claims they make. More on that below.

We are gratified to learn that Professor Bailey agrees with some (even if not all) of the report’s major findings; namely, that the social stress model does not alone account for all of the mental health difficulties experienced by LGBT people, that the empirical evidence does not support the idea that gender identity is innate and fixed, and that all of these issues should be studied more openly and rigorously by scientists. (Professor Bailey also mentions that “Sexuality and Gender” does not discuss his review of the literature on sexual orientation. Professor Bailey’s paper is very recent, and so our authors were unable to include a discussion of it before “Sexuality and Gender” went to press.)

Bailey’s paper was published online on April 25, 2016. Given the quality of Bailey et al’s work, I think the paper should have been included in their review or they should have waited to publish until they were able to include it.

Moving on to some of the topics that you suggest ought to have been included in the report but were not:

Mayer and McHugh’s paper is missing any serious discussion of epigenetics.

It is true that, other than a passing reference, this report does not discuss epigenetics. There is a good reason for that: the literature on epigenetics and sexual orientation remains inconclusive with regard to the question of whether homosexuality is innate and fixed. It is in the nature of epigenetic markers that they are (for the most part) acquired rather than inherited, and so, without a well-supported theory about why (for instance) gay men have distinctive patterns of DNA methylation, the fact that they have such markers does little to explain the origins of homosexual attractions, behaviors, or identity. (For what it’s worth, the Bailey paper only dedicates a single short paragraph to epigenetics [on page 77], and that paragraph basically says that the evidence doesn’t amount to much.)

This is exactly why the recent work on epigenetics should have been included in both papers. One would not need to go into it much in order to say that the line of research is intriguing and may yield answers after more studies are done. Mayer and McHugh’s paper needed to do this because they made a very definite claim: “The understanding of sexual orientation as an innate, biologically fixed property of human beings — the idea that people are “born that way” — is not supported by scientific evidence.”
Since epigenetic research may indeed be relevant to that claim, I believe it was an oversight not to discuss the where that research program could lead. Keiper’s statement, ” without a well-supported theory about why (for instance) gay men have distinctive patterns of DNA methylation, the fact that they have such markers does little to explain the origins of homosexual attractions, behaviors, or identity.” I agree that such a theory doesn’t exist. However, I am not making strong claims against innateness. Given the state of research at present, I don’t think making such a strong claim is warranted. More on this point at the end of the post.

You go on to claim that

[Mayer and McHugh] overlook the new genetic linkage paper involving gay brothers

I believe you are incorrect. “Sexuality and Gender” does mention the 2015 genetic linkage paper involving gay brothers (Sanders, et al., including Bailey). If this is not the paper to which you are referring, please let me know.

You are correct. I am sorry for that oversight and have corrected that error in my original post.
Having said that, I believe Bailey et al’s discussion is more thorough. They note the need for very large samples in genome studies and tell us that findings approaching significance were found in the large 23andMe study (see Bailey on page 77 and Mayer and McHugh on page 32). While 23,000 sounds like a large sample, there were only a few over 1,000 exclusively gay males in the study. We learn that from Bailey et al, not Mayer and McHugh. In other words, the methods we have available at present may not be sensitive enough to find the very fine biological differences which may move one individual toward same sex attraction and another toward opposite attraction unless very large numbers of people are involved.

You also note that the report ignores “work on ‘gay rams.’” It is true that “Sexuality and Gender” does not discuss homosexuality in non-human animals. While there is evidence of apparently exclusive homosexuality among domestic rams, this is not very convincing evidence that homosexuality is innate and fixed in human beings. And as Bailey and his colleagues note in their review (pages 68–69), although homosexual behaviors are frequently observed among wild animals, exclusive homosexuality has never been documented for animals in the wild. (It is worth acknowledging that documenting exclusive homosexuality among wild animals would be a difficult task, and so it is possible that there are exclusively homosexual animals that have not been discovered — but this only shows the need for more research on these questions.)

The gay ram research is important because of the parallels with research in humans. One would not posit weak fathers or child abuse to explain rams who prefer other rams. Apparently, something in the biology of the rams is involved. We are not rams but there are similar brain structures involved, some of which show up in studies of human brains.

You claim that

[t]he TNA authors minimize the neural differences between gays and straights, calling them ‘minor differences in brain structures.’ How do these authors know what differences are minor and which are not? In fact, the differences in symmetry and brain activity are quite provocative and have not been accounted for by any environmental theory.

The neurological differences between homosexuals and heterosexuals represent some interesting correlations, but they cannot be used to accurately predict whether a person is heterosexual or homosexual. (Moreover, as anyone familiar with the fMRI literature can tell you, it is very easy to find brain differences in brain-scan studies; e.g. this study found that when people were aware that they were drinking Pepsi or Coke, this “brand knowledge for one of the drinks had a dramatic influence … on the measured brain responses.”) I don’t see much distance between the ending of your last sentence quoted above and what the report says, as in the executive summary: “… [S]uch neurobiological findings do not demonstrate whether these differences are innate or are the result of environmental and psychological factors.”

Continue reading “The Editor of The New Atlantis Responds to My Critique of the Mayer and McHugh Article”

The New Atlantis Study on Sexual Orientation and Gender Identity That's Not a Study

UPDATE: In a post out on 8/27/16, Adam Keiper, editor at The New Atlantis magazine responds to this post with a rebuttal to my points below. I urge you to go read it. I in turn respond to him. I also make a correction in my original post below based on his communication to me.
————————————————- (original post below)
Over the past year, hot discussions of sexual orientation have been pushed aside by controversies over gender identity and bathrooms. A new article from The New Atlantis shows that both topics have plenty of life. Yesterday, social media was buzzing about a new “study” of sexual orientation and gender identity by Lawrence Mayer and Paul McHugh. Actually, the article was not a study but a review and summary of empirical studies. As far as I can tell, it is being touted most by conservative leaning and anti-gay organizations.
The New Atlantis describes itself as a “Journal of Technology and Society.” However, the article did not receive peer review and it shows. Lawrence Mayer, the first author, is not well known in sexuality research circles but the second author is. Paul McHugh is retired from Johns Hopkins and was responsible for discontinuing the sex reassignment program there. He also was an advisor to the Repressed Memory Foundation in the 1990s.
Quickly, the National Organization for Marriage touted the paper as “Groundbreaking New Research.” Even calling the paper a new study isn’t accurate, there are no new studies in the paper. A bunch of old ones are missing as well.
In this post, I want to include some initial reactions and then some notes from Michael Bailey, professor at Northwestern, who was cited several times in TNA paper. I am going to focus on their points about sexual orientation and leave the gender identity points for a future post.
Here is their summary of research regarding sexual orientation:

● The understanding of sexual orientation as an innate, biologically fixed property of human beings — the idea that people are “born that way” — is not supported by scientific evidence.
● While there is evidence that biological factors such as genes and hormones are associated with sexual behaviors and attractions, there are no compelling causal biological explanations for human sexual orientation. While minor differences in the brain structures and brain activity between homosexual and heterosexual individuals have been identified by researchers, such neurobiological findings do not demonstrate whether these differences are innate or are the result of environmental and psychological factors.
● Longitudinal studies of adolescents suggest that sexual orientation may be quite fluid over the life course for some people, with one study estimating that as many as 80% of male adolescents who report same-sex attractions no longer do so as adults (although the extent to which this figure reflects actual changes in same-sex attractions and not just artifacts of the survey process has been contested by some researchers).
● Compared to heterosexuals, non-heterosexuals are about two to three times as likely to have experienced childhood sexual abuse.
● Compared to the general population, non-heterosexual subpopulations are at an elevated risk for a variety of adverse health and mental health outcomes.
● Members of the non-heterosexual population are estimated to have about 1.5 times higher risk of experiencing anxiety disorders than members of the heterosexual population, as well as roughly double the risk of depression, 1.5 times the risk of substance abuse, and nearly 2.5 times the risk of suicide.
● Members of the transgender population are also at higher risk of a variety of mental health problems compared to members of the non-transgender population. Especially alarmingly, the rate of lifetime suicide attempts across all ages of transgender individuals is estimated at 41%, compared to under 5% in the overall U.S. population.
● There is evidence, albeit limited, that social stressors such as discrimination and stigma contribute to the elevated risk of poor mental health outcomes for non-heterosexual and transgender populations. More high-quality longitudinal studies are necessary for the “social stress model” to be a useful tool for understanding public health concerns.

First, here is Michael Bailey’s quick reaction:

1. Their review of sexual orientation is not up to date (A major omission is that it neglects to cite our recent magnum opus on this topic: http://psi.sagepub.com/content/17/2/45.full.pdf+htmlf). The idea that sexual orientation is fluid has some plausibility for women, but not for men.
2. I agree with the authors that discrimination alone is unlikely to completely explain differences between heterosexual and homosexual people in mental health profiles, although it may contribute.
3. They are right on that the idea of innate, fixed gender identity is not consistent with empirical evidence. I differ from them, however, in believing that sex reassignment is still the best option for some individuals.
4. Most importantly, I agree that all of these issues should be openly discussed and researched. There is little government support for open-minded investigation for these controversial issues. That is unfortunate and exactly backwards. Support should be directed to resolve the most contentious issues.

As I reviewed the sexual orientations sections, I agree with Bailey. I especially agree that readers should read this major review of research on sexual orientation published earlier this year. Mayer and McHugh’s paper is missing any serious discussion of epigenetics, they overlook the new genetic linkage paper involving gay brothers, (they do address it, see the follow up post) as well as work on “gay rams.” The TNA authors minimize the neural differences between gays and straights, calling them “minor differences in brain structures.” How do these authors know what differences are minor and which are not? In fact, the differences in symmetry and brain activity are quite provocative and have not been accounted for by any environmental theory. Of course, we need more research with larger sample sizes but Mayer and McHugh just shrug these studies off as inconsequential.
Regarding sexual abuse, the authors review several studies which demonstrate higher rates of sexual abuse among GLB people as opposed to heterosexuals. For the most part, they report the relevant details but they failed to catch the mistakes in the Tomeo study and report it incorrectly (see this post for the problems with using Tomeo). Even though some who are touting the study miss this, the authors provide caution for those wanting to see homosexuality as the result of sexual abuse:

In short, while this study suggests that sexual abuse may sometimes be a causal contributor to having a non-heterosexual orientation, more research is needed to elucidate the biological or psychological mechanisms. Without such research, the idea that sexual abuse may be a causal factor in sexual orientation remains speculative.

They say “sometimes.” I would say infrequently or rarely and would add that we really don’t know. What we do know is that most people who are GLB were not abused. The TNA paper affirms that observation.
On the “born that way” claim, I find it contradictory that the authors express uncertainty about the causes of orientation but then say with great certainty that the “born that way” theory isn’t supported by scientific evidence. This line is apparently meant to hook the social conservatives which indeed it has. I mentioned the misleading “Groundbreaking New Research” headline from NOM, and then I just saw Liberty Counsel’s email which leads: “Scientific Research Debunks LGBT Propaganda.”
For readers wanting a more thorough review of the literature, please see the paper from Bailey and colleagues linked here.
 

Iowa Civil Rights Commission Releases Revised Sexual Orientation and Gender Identity Public Accommodations Brochure

This just in from the Iowa Civil Rights Commission:

Iowa Civil Rights Commission Releases Revised Sexual Orientation & Gender Identity Public Accommodations Brochure
The Iowa Civil Rights Commission announced today the publication of its Revised Sexual Orientation & Gender Identity Public Accommodations Brochure.  The revision replaces the previous version which had not been updated since 2008 and clarifies that religious activities by a church are exempt from the Iowa Civil Rights Act.
“The Iowa Civil Rights Commission has never considered a complaint against a church or other place of worship on this issue,” said director Kristin H. Johnson. “This statute was amended to add these protected classes (sexual orientation and gender identity) in 2007 and has been in effect since then. The Iowa Civil Rights Commission has not done anything to suggest it would be enforcing these laws against ministers in the pulpit, and there has been no new publication or statement from the ICRC raising the issue. The Commission regrets the confusion caused by the previous publication.”
The revised brochure may be found at this link: https://icrc.iowa.gov/sites/default/files/publications/2016/2016.sogi_.pa1_.pdf

This new language is more clear:

P L A C E S O F W O R S H I P
Places of worship (e.g. churches, synagogues, mosques, etc.) are generally exempt from the Iowa law’s prohibition of discrimination, unless the place of worship engages in non-religious activities which are open to the public. For example, the law may apply to an independent day care or polling place located on the premises of the place of worship.

By independent day care, the Commission means a day care renting or leasing a place of worship and not being conducted by the church as a part of the church’s ministry. Ms. Johnson clarified that to me earlier in the week.
For background on this issue see these posts: Link, link

Information and Misinformation on Gender Dysphoria from Wallbuilders and the American College of Pediatricians, Part One

Tuesday on Wallbuilders Live, Dr. Michelle Cretella represented tiny pediatric breakaway group the American College of Pediatricians. She briefly discussed the organization’s position paper on responding to gender identity issues. In doing so, she said something which caught my irony sensor. It also occurred to me, as it repeatedly has in the discussion of gender dysphoria, how difficult it is to avoid taking extreme positions.
Listen to her response to a question from host Rick Green about how much harm gender dysphoria is causing.

I want to address two claims that came up in this segment. In this post, I address the claim that 80% of gender dysphoric children will accept their biological sex with therapy. In a future post, I will write about the claim about suicide rates.
Cretella says:

They’re [advocates for transgender children] cooperating with, at least, mental confusion.  You know, initially, we know that there is psychiatric literature that shows if you work with these children one on one and with their families, the vast majority, over 80% will come to accept their biological sex after puberty before adulthood. So yes, to put these children to reaffirm their confused thinking, to put them on puberty blockers, and then cross-sex hormones to make them quote unquote the other gender, you are permanently sterilizing children. It’s insanity.

Cretella is correct that persistence rates are low (gender dysphoria continuing into adulthood) among gender dysphoric children, but this is not the case with adolescents who remain gender dysphoric or those who experience it with an adolescent onset. In their paper, ACP uses the American Psychiatric Association’s DSM-V as an authority. The section of the DSM-V cited by ACP supports the claim about persistence but does not fully support Cretella’s claim about the role of therapy.

Rates of persistence of gender dysphoria from childhood into adolescence or adulthood vary. In natal males, persistence has ranged from 2.2% to 30%. In natal females, persistence has ranged from 12% to 50%. Persistence of gender dysphoria is modestly correlated with dimensional measures of severity ascertained at the time of a childhood baseline assessment. In one sample of natal males, lower socioeconomic background was also modestly correlated with persistence. It is unclear if particular therapeutic approaches to gender dysphoria in children are related to rates of long-term persistence. Extant follow-up samples consisted of children receiving no formal therapeutic intervention or receiving therapeutic interventions of various types, ranging from active efforts to reduce gender dysphoria to a more neutral, “watchful waiting” approach. It is unclear if children “encouraged” or supported to live socially in the desired gender will show higher rates of persistence, since such children have not yet been followed longitudinally in a systematic manner. For both natal male and female children showing persistence, almost all are sexually attracted to individuals of their natal sex. For natal male children whose gender dysphoria does not persist, the majority are androphilic (sexually attracted to males) and often self-identify as gay or homosexual (ranging from 63% to 100%). In natal female children whose gender dysphoria does not persist, the percentage who are gynephilic (sexually attracted to females) and self-identify as lesbian is lower (ranging from 32% to 50%). (APA, DSM-V, p. 455)

To the DSM-V, I can add the description of persistence developed by the World Professional Association for Transgender Health (WPATH) in their standards of care.

An important difference between gender dysphoric children and adolescents is in the proportion for whom dysphoria persists into adulthood. Gender dysphoria during childhood does not inevitably continue into adulthood.V Rather, in follow-up studies of prepubertal children (mainly boys) who were referred to clinics for assessment of gender dysphoria, the dysphoria persisted into adulthood for only 6–23% of children (Cohen-Kettenis, 2001; Zucker & Bradley, 1995). Boys in these studies were more likely to identify as gay in adulthood than as transgender (Green, 1987; Money & Russo, 1979; Zucker & Bradley, 1995; Zuger, 1984). Newer studies, also including girls, showed a 12–27% persistence rate of gender dysphoria into adulthood (Drummond, Bradley, Peterson-Badali, & Zucker, 2008; Wallien & Cohen-Kettenis, 2008).
In contrast, the persistence of gender dysphoria into adulthood appears to be much higher for adolescents. No formal prospective studies exist. However, in a follow-up study of 70 adolescents who were diagnosed with gender dysphoria and given puberty-suppressing hormones, all continued with actual sex reassignment, beginning with feminizing/masculinizing hormone therapy (de Vries, Steensma, Doreleijers, & Cohen-Kettenis, 2010).
Another difference between gender dysphoric children and adolescents is in the sex ratios for each age group. In clinically referred, gender dysphoric children under age 12, the male/female ratio ranges from 6:1 to 3:1 (Zucker, 2004). In clinically referred, gender dysphoric adolescents older than age 12, the male/female ratio is close to 1:1 (Cohen-Kettenis & Pfäfflin, 2003). (WPATH, p. 11).

The irony of Cretella’s confidence in psychiatric intervention relates to the expulsion from ACP membership of George Rekers who was infamous for his own personal decline and his discredited treatment approach to what was then called gender identity disorder. In fact, we don’t know the role, if any, therapy plays in influencing the current persistence rates. While there is reason to think parental permission to transition in childhood might increase the persistence rates, there isn’t sufficient research to say for sure.
After listening to Cretella and reading the ACP paper, I wonder what the ACP recommends for the 10-20% of people with gender dysphoria persisting into the late teens. Do they favor reassignment for those persons? They focus on the data which make their point but don’t seem to have an answer for the rest of the people involved.
Another problem with ACP’s confidence in psychiatric interventions for gender dysphoria is that they also oppose a frequent end point in the trajectory of many gender dysphoric children: homosexuality (see image at the end of the post). One of the reasons George Rekers tried to re-orient gender dysphoria was to prevent homosexuality. Furthermore, one of the prime objectives of reparative therapists like Joseph Nicolosi is to prevent homosexuality via the alteration of parenting behaviors toward gender nonconforming children. ACP should stop pretending to sympathize with gender dysphoric children when they also write letters to school personnel promoting reparative change therapy for gay people.
Summary
Cretella is right that studies of gender dysphoric children (mostly with boys) find low rates of persistence of gender dysphoria into adulthood. However, she should have distinguished between prepubescent children and teens. The outcomes for these two groups do not appear to be the same. No doubt her listeners will not make that distinction.
Cretella was wrong to invoke psychiatric treatment as the reason for low persistence rates. If anything, some treatments have been shown to be harmful in some cases while others may not be harmful but may not cause a reduction in gender dysphoria. From her presentation, one could get the impression that advocates for gender dysphoric children know these treatments work but are motivated to undermine the natural family and therefore withhold appropriate medical care. While there is strong disagreement among experts and some advocates might oppose traditional families, it is simply not true that gender dysphoria could be easily treated if only activists would get out of the way.
Another important factor is that the treatment advocated by Cretella and the ACP is an outdated, discredited, psychoanalytically based approach which has not shown success. Even among those in the mainstream who are skeptical of puberty blocking drugs, the treatments advocated by ACP are rejected.
Gender Dysphoria After Childhood
The following image comes from a 2012 study by Devita Singh on gender dysphoric boys. Note the columns titled “sexual orientation in fantasy” and “sexual orientation in behavior.” By far, the most common end point for gender dysphoric children across studies is some level of same sex attraction. Gay advocates have in the past confided to me that they are ambivalent about supporting interruption of puberty because such interventions may interfere with a natural homosexual outcome. Please see this common sense article by Michael Bailey and Eric Vilain on the dilemma many parents of gender dysphoric children face.
Singh table