A great letter from a doctor:

I wanted to respond to the post “A Christian Doctor in Our Brave New Trans World”, as I think that a several issues have been conflated in your initial post about transgender babies (which I will explain below is a misnomer), in the Christian medical student’s response  to your post and her reflections on her medical school experiences, and in the responses to these posts in the comments sections. The conflated issues are: 1) babies born with ambiguous genitalia and assigned a sex at the arbitrary preference of surgeons 2) sex change surgeries in older children and adolescents 3) and one’s status as a Christian vis-a-vis being a physician.

I’m a young Roman Catholic resident physician. Admittedly, I’m not a pediatric urologist or a psychiatrist, but I think that I may offer some insight on these issues.

Some babies are born with ambiguous genitalia. These children are not transgendered. As infants they are not capable of feeling any disconnect between gender identity and the gender they were born into since they have, as of yet, no gender identity and it isn’t clear what gender they are born into. They may be full-on XY males and have had interruption of their genital formation or they may land somewhere on the spectrum of intersexuality where some intermediate step in the sex hormone synthesis pathway is interrupted. They may have a problem with sex hormone receptors. Some are mosaic, meaning they are XX, XY, and XXY in various parts of their bodies. Often these mutations are de novo and idiosyncratic. A simple karyotype (XY vs XX) is not sufficient to determine the child’s sex or gender.

The traditional solution to this problem has been to treat these infants with a surgery which gives them “normal” appearing external genitalia. It is far easier, from the standpoint of surgical technique, to give most of these infants normal appearing female genitalia. These children are then raised as female, and many (most?) of them do not identify as female when they are older. This is because the material causes of gender identity are most likely related to some combination of genetics and the patient’s hormonal milieux in utero. It is now generally considered in the child’s best interest to fix any malformations that would lead to problems with continence or recurrent infection and to delay definitive cosmetic surgery until the child “declares” him or herself as male or female at a later time. This is what the Slate article was mostly talking about, unfortunately it used the word “transgender” and drifted off into an unrelated topic, which is pretty common on Slate. Delaying surgery in cases of ambiguous genitals is not a particularly controversial position, and is one that Paul McHugh, former Chair of Psychiatry at Johns Hopkins, advisor to the Vatican, and hardly a liberal, has argued for in First Things (it should be noted that some of his other conclusions are controversial).

The problem of intersexuality is not easily explained away, and anyone, Christian or otherwise, who takes modern science at all seriously has to engage with it. It has knowable material causes. If intersexuality is a social construction of post-modernity, foisted onto us by extreme Jacobins, it is no more or less so a social construction than many other medical conditions, and to treat it specially as a social construction would seem to call into question much of current medical epistemology and nosology.

The vast topic of gender identity is far more murky, and here I feel less able to give clarity since this involves medical and philosophical questions, far, far, out of my depth. Indeed, clarity may not really be anyone’s goal. I’ll admit that I’m shocked by the talk of hormonal suppression and surgery in children. I went to a famously progressive medical school on the West Coast, even did a pediatric psychiatry rotation, and I never heard anything about this. A few points:  my understanding is that the Catholic church does allow sex-change surgery as a treatment for body dysmorphism in extreme cases. Sex changes in older children, are a very niche practice, and while I suppose it could become the norm in several generations, the fertility implications of such treatments bring it into undeniable conflict with other deeply held secular values regarding autonomy and bodily integrity. This make it less likely that it will become the same sort of widely held cultural norm that the acceptance of gay marriage and pronoun changing. You can’t really undo a hysterectomy the way you can change your pronoun or haircut; this is pretty hard to deny.

I’m sure many readers of this site would consider me a “liberal” for my predilection for Karl Rahner, Herbert McCabe, and certain elements of liberation theology, but I’m quite orthodox in my beliefs (or at least no less orthodox than Rahner, McCabe, and Gustavo Gutierrez ), am married, go to Mass, Confession, etc. I’ve consistently found that medicine is very conducive to being a Christian, and have been surprised by how many committed Christians, Muslims, and Jews there are in medicine.  This is true even on the coasts, and in some of the more elite hospitals in the country. Yes, there are a lot of secular athiests/agnostics, but I would guess that 30-40% of my residency are pretty committed religiously and another 10-20% religious in the sense that they observe Christmas/Easter/High Holy Days/Weddings. The number of people who in some sense can be called religious gets close to 50%, which is hardly a wasteland of atheism.

Notably, LDSs and practicing Muslims are very over-represented in medicine. I’m at one of the most competitive residencies in one of the most competitive specialties, and we have women who wear the hijab, people who perform salah, and men who went to BYU, went on missions and had 3 kids when they applied to residency, and people who have served in the Israeli army. There is no way that these people can keep their religious identity in any way secret, many of these things show up on their CV, and these identities—Muslim, Orthodox Jewish, and LDS—are far more unconventional and threatening to the ascendant secularism than almost any form of mainstream Christianity, including conservative Protestantism. I don’t think wearing a cross would matter much at all in a residency interview, except maybe in very small programs, where people really care about how you would fit in with the program. Specialties like Dermatology, Radiation Oncology, and Neurosurgery are often tiny (1-3 people per year), and residents typically have a lot of say in who matches.  It would be conceivable that a program filled with a bunch of atheists would blackball a Christian, although, I’ve heard rumors  that is some parts of the country it would cut the other way as well.

I will agree with the medical student that one of the most difficult things about being a Christian in medical school and residency these days is social.  People like the young medical student and me who, for a variety of reasons, often having to do with social class, social skills, or geographic background, are not put into the “fundy-Christian-nut-job” by box by others, often find that when they spend time with secularists, they are inadvertently subjected to anti-religious screed. This is no fun, and can be very isolating. It is a strange time in American life when all it takes is drinking a few beers and knowing the lyrics to some rap songs for people to assume that you are a raging secular materialist with whom they can share their hatred for religion. Obviously such people have not contemplated the theological content of “Tha Crossroads” and “Only God Can Judge Me”.

Yes, there are areas of medicine in which it would be pretty difficult to be a Christian, OB/Gyn and Psychiatry most notably. In OB, you would have to learn to do procedures like dilation and curettage (D&C), which while it has uses other than abortion, I’m pretty sure you would be pressured to do elective abortions. You would also have to be willing to to tubal ligations and place contraceptive devices that even the most Jesuitical of arguments couldn’t turn into something else. These difficulties aside,  in most of medicine, on a day to day basis, you are so far from anything ethically controversial, and in fact doing unambiguous good, that it is pretty easy to be doctor and a Christian. Far easier than say, being a doctor and being transgendered.

Feel free to post any or all of this.  The email address is my real name and you can google me and see that my claim of being a resident physician who has trained at elite hospitals and universities is true, although please, keep me anonymous if any of this is posted.

I googled him, and it’s true. Thanks for such a thoughtful letter. Readers, your comments?

UPDATE: The doctor writes in the comments section:

I am the person who wrote the letter to Rod. I did read the Slate article, twice, and I now know why I was so confused–I completely missed the point. Had I gotten the point, I probably would have just ignored the article. Thanks to those of you who gently pointed out my mistake, as well as to those who offered kind words.

I won’t be quitting my day job anytime soon and becoming a blogger. Its harder than it looks. Classic overconfident doctor. At least this is anonymous.