Dr. Paul Hruz, an associate professor of pediatrics and cell biology and physiology, speaks about the treatment and ministry for transgender individuals during a half-day workshop at the Archdiocese of Portland Pastoral Center this fall. (Katie Scott/Catholic Sentinel)
Dr. Paul Hruz, an associate professor of pediatrics and cell biology and physiology, speaks about the treatment and ministry for transgender individuals during a half-day workshop at the Archdiocese of Portland Pastoral Center this fall. (Katie Scott/Catholic Sentinel)

At a recent workshop sponsored by the Archdiocese of Portland, a medical doctor told attendees that Catholics should minister with compassion to transgender individuals but should challenge recent cultural and medical treatment trends, which he believes are driven by ideology rather than science.

“We have to have compassion for the real suffering people have” and collaborate with transgender activists to fight against injustice and discrimination, “but must maintain the truth,” Dr. Paul Hruz told the nearly 70 people who attended both in person at the pastoral center and remotely through a livestream.

The suffering of those who identify as transgender is acute. According to numbers analyzed by the American Foundation for Suicide Prevention in 2014, more than 40 percent of transgender individuals try to kill themselves at some point in their lives, compared with under 5 percent of the general population. 

Hruz, who also spoke after the archdiocese’s annual White Mass for health care workers, is an associate professor of pediatrics and cell biology and physiology at Washington University School of Medicine in St. Louis. He’s certified in health care ethics by the National Catholic Bioethics Center in Philadelphia and is the recipient of awards in biochemistry and bioethics. During the workshop, he presented arguments based on scientific studies that align with Catholic understandings of human sexuality and offered suggestions for ministering to those with gender dysphoria. In a sign of the ongoing controversies within the field, he diverged from the widely accepted science-based positions and treatment recommendations presented by the Endocrine Society, the American Psychiatric Association and the American Academy of Pediatrics.

Attending the Oct. 26 workshop, which included question-and-answer sessions, were priests, therapists, youth ministers, and school and parish staff. Archbishop Alexander Sample sat in the front row and listened attentively.

In opening remarks, Msgr. John Cihak, pastor of Christ the King Parish in Milwaukie, said the goal of the workshop was to show how all present could respond in their own spheres of influence, drawing from medical and faith-based truths.

Dr. Tom Pitre, a Portland physician and a past president and current board member of the Catholic Medical Association, introduced Hruz after highlighting resources, including the National Catholic Bioethics Center, which offers books and online materials to guide Catholics through thorny modern bioethical issues.

What should treatment look like?

Hruz explained that the American Psychiatric Association previously used the term “gender identity disorder” for individuals who identify as transgender but in 2012 changed the label to “gender dysphoria.” The APA defends the change as based on new science-based understandings of transgender people. It defines transgender as “having a gender identity that differs from one’s sex assigned at birth.”

Hruz argued that the change was based on ideology rather than science. He said it is more accurate to view a discordance between one’s sex and gender as a mental disorder.

Studies published thus far have found that more than 80 percent of children who once reported various degrees of gender discordance ended up eventually giving up their transgender identity.

Hruz said youths with gender dysphoria therefore should be encouraged to identify with their sex. They should be in family therapy and receive help working through underlying psychological causes.

Common treatment focuses instead on affirming the perceived gender, said Hruz. He said potentially harmful hormone therapies can begin at 16 years old and irreversible surgical interventions at age 18, when children become legal adults.

Hormone treatments may increase the likelihood of osteoporosis and possibly of cancer, among posing other risks, Hruz said. Sterility also can occur.

Such approaches are in part presented as suicide prevention; rates of depression go down following a transition to the identified-with gender, and many patients experience initial relief. But Hruz said that’s only according to short-term studies. In his view, there is not sufficient evidence to conclude that transitioning to the opposite sex will decrease the future likelihood of suicide — making the argument for what he sees as risky treatment all the weaker.

Hruz also argued there’ve been no randomized controlled studies examining the consequences of using the pronouns requested by transgender individuals and allowing them to use bathrooms of their choice.

“We need to be thinking from an ethical standpoint — by accepting someone’s desired pronoun use are we cooperating with that biological falsehood being put forward?” asked Hruz.

Again, there is some disagreement among scientists. Recent research, which Hruz did not address in his talks, has been conducted on pronoun use. Earlier this year a team of researchers at the University of Texas at Austin found that when people use the name and pronoun requested by a transgender youth it reduces depressive symptoms and suicide risk.

For additional information on the biology of sex and gender, Hruz encouraged attendees to turn to a report he’d drawn from for the workshop. Entitled “Sexuality and Gender: Findings from the Biological, Psychological and Social Sciences,” the report was published by The New Atlantis journal, affiliated with the conservative Ethics and Public Policy Center in Washington, D.C.

A number of scientists have been critical of the report. The journal Scientific American ran a 2016 article quoting a former geneticist at the National Institutes of Health, who called it “a selective and outdated collection of references and arguments.”

‘Image and likeness of God’

Hruz said the key to treating and ministering to individuals with gender dysphoria is first to “affirm their human dignity.”

“People struggling with gender identity issues … see themselves as less than who they fully are,” he said. The solution is to “remind them they are created in the image and likeness of God.”

Hruz spoke about the importance of accompaniment, of listening to an individual’s story.

“We don’t do these individuals any favors if we are putting up signs saying, ‘You are not welcome here.’ We need to engage them, because if we don’t do that they are going to go elsewhere — if they haven’t already.”

Jason Kidd, director of the Office of Marriage and Family Life, said in an interview after the workshop that he’s received calls from pastors and parents struggling with how to help young people with gender identity issues.

Kidd believes the church recently has done a poor job addressing issues around sex and sexuality and commended the archdiocese for hosting the workshop.

“Even though it’s messy and awkward and sensitive, we need to be willing to enter into this discussion, even risk being misunderstood,” he said.

“I appreciate that some time and care and attention are being given to this topic,” added Father Eric Anderson, pastor of St. Stephen Parish in Southeast Portland and chaplain for EnCourage, a ministry to family members of those who are homosexual.

“We need to know how to respond in a way that is helpful and understand the issue in terms of our faith,” he said.

John Garrow, principal of Central Catholic High School in Portland, said the issues addressed in the workshop “come up among all the Catholic high schools.”

At Central Catholic, “we try and support students as best we can within church teaching,” said Garrow. “We do our best not to be judgmental, to be patient and to see how we can help them. It’s a tricky and vulnerable situation.”