During the Senate Confirmation hearings of the latest Supreme Court Justice, Ketanji Brown Jackson was asked to define the term “woman.” Her answer reflected the confusion in the culture about gender. How would you define what a woman is? On what basis would you make that determination? How should we think about the number of minor children undergoing gender affirming treatments, and those who are de-transitioning? Join Scott as he discusses these questions and more with his guest Katie McCoy and her new book To Be a Woman: The Confusion over Female Identity and How Christians Can Respond.

Katie McCoy serves as director of Women’s Ministry at Texas Baptists (Baptist General Convention of Texas). She holds a Ph.D. from Southwestern Baptist Theological Seminary, where she previously served on faculty. She blogs regularly on the site blondeorthodoxy.

Episode Transcript

Scott: During the Senate confirmation hearings of the latest Supreme Court Justice, Katonji Brown Jackson was asked to define the term “woman.” Her answer reflected the confusion in the culture generally about gender. How would you define what a woman is? On what basis would you make that determination? How should we think about the number of minor children undergoing gender affirming treatments and particularly those who are detransitioning? We'll answer these questions and more today with our guest Katie McCoy and her new book entitled To Be a Woman. I'm your host, Scott Ray. and this is Think Biblically from Talbot School of Theology here at Biola University. Katie, welcome. So good to have you with us and so appreciate you, the depth and the insight of your book To Be a Woman.

Katie: Hey, Scott. Thank you so much for having me.

Scott: Tell us a little bit about why you are so interested in this area of gender studies, why you wanted to write about it, why you're so passionate about it.

Katie: I started on this topic when I was teaching in feminist theory, feminist ideas and how it's affected the culture, especially the culture within the church, and how we understand what it means to be human as well as the differences between man and woman. And at the time, so many of these gender fluid or gender dysphoric stories were on the fringe and about five to seven years ago, we found that they were moving more and more to the center and not only was this becoming more prominent, but underlying most of these issues were people talking about what it means to be human. They were answering very deep, soul-level questions often of what it means to be a man, what it means to be a woman, our relationship between our bodies and ourselves. And in many cases, these were questions that weren't answered. Rather, people just jumped to basing their identity on self-perception, cultural stereotypes, or any other number of influences. And so, what we happen to be living in is the confluence of a lot of different philosophical and cultural ideas that are intersecting in this gender question. So whenever we're talking about trans issues, non-binary identities, we are confronting a lot that is underlying and driving those very questions.

Scott: All right. We'll get to some of those deeper issues here in just a moment, but I want to go back to a statement that you made just a second ago. Why do you think the number of cases of gender dysphoria have increased so dramatically in the last, five years, for example? And specifically, why are the majority of patients, I'll put those patients in air quotes today, young girls wishing to transition?

Katie: Yeah. So, I like to compare this to a big pot of soup. And into this pot of soup, you put social media, you put a peer contagion—the influence of other people on your behaviors and beliefs and attitudes—and then you also put into it philosophical questions of what it means to be happy, whole and fulfilled. In fact, the sources of our identities. And then, add to that we have a culture that is very suspicious of the majority. In fact, it views anything from the majority or of a majority culture as something that we should view very critically and if not completely dismantle it, displace it and replace it with something else. And so with that, you have suspicion of heteronormativity. You have suspicion of the idea that there are two genders. Put all of that together. And today's teenager who is scrolling through Instagram or TikTok or perusing Reddit, finds some very highly suggestible messages to an already confused and vulnerable identity, sees the positive attention that her friends might be getting by coming out as non-binary and is absorbing or ingesting those suggested messages and reading them onto herself. So much of what we have in our gender confused culture today is, I believe, the exploitation of girls as God made girls to be. God made girls to emotionally identify with their peers. Girls are very likely to what's called co-ruminate, or relive the problems, hash them out over and over again with their friends. And so you combine that with the volatility of puberty, and there is a subculture in America today that is just ripe with the vulnerability of gender messages sent to high school, middle school girls. And really, I believe exploiting the normal insecurity and angst that comes from being a teenager.

Scott: Now, Katie, you refer to this in the book as a social contagion. I think you used the term a minute ago, peer contagion. I take it you mean basically the same thing. Tell me a little bit more about what you mean by that term. And are we suggesting here that someone's gender identity can be something akin to socially confirmed? Is that sort of what we're talking about here?

Katie: That's a great question. So the idea of social or peer contagion has been around for a while in professional psychological studies. So a peer contagion can be anything where someone else's actions, attitudes or beliefs are affecting yours. So anorexia could be a peer contagion. Bullying could be a peer contagion. And a researcher named Lisa Littman studied why is it that so many teenagers and young adults are suddenly coming out as transgender? Especially, since historically transgender patients, those who were afflicted with this psychological malady, were biological boys between the ages of two and four. Now, however, we have biological girls who are 12, 14, 16 and on who professed no prior gender incongruity and are saying that they believe they're trans and want to go on with all of the different social, hormonal and surgical procedures that would be in accordance with gender affirming care. So what Lisa Littman found is that peer contagion or social influence was a significant part of why so many disproportionately teenage girls were adopting a trans identity. The other was coping mechanism. There were so many issues underlying, perhaps it was a mental health issue, it was some type of previous trauma or past negative experience. And to come out as trans or non-binary was a way to deflect or redirect one's pain to get the kind of care that they needed. It doesn't mean they're acting, it's that they were redirecting. And then finally, of course, social media. Social media has just proliferated these messages across multiple mediums and reached children at some of their most vulnerable and tender ages.

Scott: So Katie, when someone, let's say it's a 14, 15 year old girl, when someone starts the journey of transitioning, what's the usual progression that is encouraged and that it often takes?

Katie: Usually when someone professes or expresses a sense of gender incongruity, there's three levels that it takes. The first is social. Now social is generally reversible, but that doesn't necessarily mean that it's benign. So social transition includes things like preferred pronouns or a change in hairstyle or clothes or introducing yourself by a different name. These things are all reversible, it doesn't cause any damage to the body; however, once someone is socially relating according to someone of the opposite gender and they are receiving those social messages back of someone relating to him or her according to the opposite gender, that relationship becomes confirming. It begins to be something that helps that person see themselves according to the opposite gender and as they socialize like that, they want to change the body to fit that self-perception.

The next phase is hormonal. Hormonal happens in two ways. It is either puberty blockers or it is cross sex hormones. Puberty blockers are originally drugs created to heal. They were created to arrest the production of aggressive hormonal cancers like prostate cancer and breast cancer so that the patient would have a fighting chance of chemo and radiation working. However, doctors started prescribing puberty blockers off label and we're still learning the full effects. Things like loss in bone density; our own FDA over a year ago came out saying that it causes a higher risk of brain swelling, so that's encephalopathy I believe or encephalitis of some kind. So brain swelling, higher risk of stroke and then bone density loss and then cross sex hormones also have some horrific effects. My own doctor and internist, general practitioner said, once we see a man who is feminized, presenting himself as a woman, come to the emergency room with any kind of chest pains, we immediately assume pulmonary embolism caused by estrogen. We immediately assume that this man has been taking estrogen, some type of cross sex hormone, and then, along with that, the effects of testosterone injections on women. We're still learning some of the effects of that, not only in secondary sex characteristics like appearance, but also that person is consigned to lifelong infertility.

And then finally, surgical transition methods. Surgical transition methods are the amputation of healthy sexual organs and then the prosthetic construction of organs that have the appearance of belonging to the other sex.

Scott: Katie, you mentioned just a few minutes ago the example of anorexia. And I think it strikes me—and this is the observation you make in the book that I think is right on target. In most cases with young girls, our society tells them to avoid body shaming, accept their bodies for what they are, you know, as it has to do with weight, appearance, skin tone, things like that. But with their biological sex, the social consensus seems to be just the opposite of that. That we accept, you know, we accept their discomfort with their body as gospel truth and encourage and affirm efforts to make those changes. What do you think accounts for such a stark difference in the way the culture talks to young girls about the way they feel about their bodies?

Katie: It's a confluence of two ideas or beliefs that our culture has unknowingly adopted. The first is that SOGI is your true identity, so, sexual orientation and gender identity is the most important thing about you. It's the most defining aspect and characteristic of who you are. It's how you organize and understand your entire identity. And then, second, but along with that or running concurrent with that, is the belief that who you feel yourself to be is who you truly are. This is the idea of expressive individualism, that who you are on the inside is your true authentic self, that only you can tap into that and that any other authority that is external to you, whether that be religion, government, family, politics, and then even your own body—your own physical body—has no bearing or no superseding authority over your emotional self. So the psychologized self, to borrow from the way Carl Truman describes it, trumps the physical or the biological self. So when you put those two things together, you have the unusual and really the atypical response as you just mentioned related to gender, where every other aspect of a young woman's life, we would tell her to accept herself, to feel pride in who she is, to receive herself as having inherent dignity, no matter what her body shape, her skin tone. And yet, when it comes to her gender, everything is reversed. Now we say, you're right. You should completely change and even amputate your body in order to fit your emotional self. And behind it, what is driving it are these two core messages of who we are as human beings that our SOGI equals our true selves and that our true selves are emotional selves.

Scott: I guess Sigmund Freud is still alive and well.

Katie: Very much, very much. In fact, we see his ideas, I mentioned this in the book, you see how Kinsey took off on his ideas and proliferated them and that has had some lasting effects in our culture. And then Wilhelm Reich as well, combining Freud with Marx to have some very alarming suggestions of children's sex education and I think we are seeing that happen in public schools today. So much of what we're seeing about book banning rhetoric versus, no, we just don't want to have our children read pornographic material. All of these things are a fundamental philosophical clash of the role of the state in sex education and that we can trace back to Wilhelm Reich.

Scott: I never envisioned that Freud and Marx together would be such a toxic brew, but I guess not entirely unpredictable. I wonder, Katie, if these fundamental ideas are at least some of the things that contribute to the passion and the intolerance of gender ideology advocates.

Katie: Yes, some of the most vitriolic hate-filled speech comes from those who profess to be preaching tolerance. When we really boil it down, I talk about this in chapter three of the book. We've already mentioned Marx, I believe that most true gender idealists, most true ideologues on this issue, if they're being honest, will acknowledge their affinity for Marxist ideas. So Marx, we know how he understood the economy, that everything in the world was this clash between the haves and the have-nots. It was the economic clash and all of that conflict. But then Marx also said some fascinating things about how that conflict and dynamic was able to continue. He called for the dismantling of anything outside of the economy that could be perpetuating capitalist ideas and power, including religion and the family. Marx and Friedrich Engels called for the abolition of the family. They even called wives the first, I think, slave relationship where women married out of an economic compulsion and that if we got rid of that, it would create true freedom and equality between men and women. So in other words, get rid of understanding yourself according to family and we would have true equality. Well, every vacuum gets filled, as we know, and that vacuum of core ideological self-organization moves from the family to the state. I think we're seeing this in real time in things like trans refuge states. I believe it's Minnesota, I think it was, that created the trans refuge state where a child can travel to their state and, with or without their parents' knowledge or consent, receive whatever surgical or hormonal procedure he or she wants. Because this is treated, this is the new civil right. And if a family member were to object, if a parent were to have reservations, then the state steps in between the parent and the child, circumvents that relationship because we're seeing the issue of SOGI, sexual orientation and gender identity, not only come to the fore of how we define ourselves, but now as a society, we are looking to the state to protect that as a fundamental civil right. This is going to continue resulting in a clash with families. And I think we're going to keep seeing this school board by school board, state by state. I realize how almost, like right wing news that can sound, but we have evidence for that. That I believe is why we have this clash going on. This is not just a clash of what books go in the school library or what curriculum is taught in your children's public school. This is a clash of fundamental authority to form and shape the self.

Scott: Now, Katie, we often hear that if parents or teachers or influential adults in an adolescent's life push back on their desire to transition, that we're just encouraging them to commit suicide or putting them at higher risk of committing suicide. But there's a lot of debate about this. What in your view, what's the real story of the connection with gender dysphoria and suicidal ideation?

Katie: Yes. And we can never forget that or dismiss those concerns because the reality is among non-binary or transgender people, the rate of attempted suicide and completed suicide is horrifically high. It is horrifically high and it's something that we must be giving greater attention to. The thing that we're not hearing though is why is it horrifically high? What gender advocates will say, gender ideology advocates will often say is that society just needs to be more welcoming. Well, we're living at a time where it has never been more inclusive and more welcoming, more of a protected class to be a gender or sexual minority. And so, the idea that society is still needing to be reformed is, I think, incongruent with the entire direction that society is going. What therapists are sounding the alarm on, and it's difficult to find in part because their research is either censored or canceled, is that suicidal ideation related to gender confusion or non-binary identity is treated successfully the same way suicidal ideation occurs for any other number of psychological or mental health issues. In other words, when you treat a gender dysphoric person for depression or suicidality, you do that the same ways that you would treat any other person for depression and suicidality. And those two treatments are, generally speaking, talk therapy and medication. What our culture says today is that if you were to push back on someone's self-perception, not go along with someone's self-perception, in other words, you even see people on social media in tears because someone called them by different pronouns, called them by a different name and they can't handle it and it is deeply distressing. Well, I'm not dismissing that distress at all, but I think we do need to consider from a therapeutic standpoint, how is that helping that individual to live in a world where people don't treat you the way you want them to treat you? We're not talking about being disrespectful or unkind, but this therapeutic method that says all of reality should conform to your self perception or you will become suicidal is first of all, unique in the psychotherapeutic world. There's no other psychological malady that I can find that prescribes everyone else would adhere to one's self perception rather than help that person's self perception conform to reality. And two, it can also create a separate social contagion of suicidality itself. In other words, by telling suggestible vulnerable people that if they don't receive some type of response they're going to become suicidal, then when they don't receive that response, they become suicidal. So there are therapists sounding the alarm on using suicide as the reason for persisting in gender affirming care saying, look, you are also spreading suicidality among gender dysphoric teens and young adults.

Scott: So Katie, it sounds like you're suggesting that in lots of cases of gender dysphoria, there are underlying mental health issues that are either being ignored or otherwise not being treated. And by that, are you suggesting that in those cases, gender confusion is often not the main issue?

Katie: That's what many therapists and psychologists have been saying. So I think of someone like Miriam Grossman who just wrote a book on this transgender surge, and she's been treating this issue from a psychological perspective for decades. I also think of the psychologist who gave a congressional testimony just a few months ago. She's with Family Research Council, and she noted that I think it's somewhere around 75% of transgender or non-binary people say that they also had a history of sexual abuse or sexual trauma. We cannot ignore that gender dysphoria itself is a symptom, and it's a symptom of something else that's going on. I'm not a counselor or a psychologist, so I can't necessarily speak authoritatively on what it is a symptom of, but some of these things can be a symptom of suggestions from peers, from parents, from social media. Some of these things can also be confusion over what it is to be a boy or a girl. Some of them can also be a form of insulation from something that they have witnessed or experienced. For instance, there was one young girl who said she was a boy, and she wanted to be a boy. And when the therapist got into, why is it that you feel you want to be a boy, found that because her mother's boyfriend had been physically abusing her, and she as a child is witnessing this and reasoning that perhaps the world is not safe if I'm a little girl. I would be safer if I were a boy. And so sometimes these things are expressing other issues that are very easily addressed. Sometimes they are messages that children grow up with and internalize about themselves. But in nearly every case that I've read about, it is a symptom of something else. And that also should help us remember just our responsibility of compassion, that someone who has gender confusion or gender dysphoria is likely expressing and experiencing the symptoms of something else that is going on.

Scott: One of the things I thought the most insightful in the book is something I never thought about before, where you insist that the very stage of human development most clarifying for a girl's gender identity is what gender affirming care prevents. Explain what you mean by that.

Katie: This was staggering. So conservative estimates say that if a child with gender dysphoria is simply allowed to develop normally and go through puberty, uninfluenced and with no transition, that child will conform to the gender that corresponds to his or her biological sex. And the rate at which that happened was somewhere between 80 and 90%. Between 80 and 90% of gender confused children aligned with the gender that corresponded with their biological sex by the time they hit puberty. Well, we have activists calling for children to get on puberty blockers at younger and younger ages. And they're saying that this is entirely reversible, it is entirely safe, it is medically necessary, and that it's just to press pause on puberty. It is essentially, as someone else has said, pathologizing puberty. And it is doing such a disservice for the children out there who do have gender confusion because with puberty, that normal human development, not only biologically, psychologically, and even relationally, when you learn to relate to people shifting away from child to young adult, we are robbing children of that. And it is robbing them of the opportunity to clarify their own self perception. And so not only are we going to find in a few years, if it's not suppressed, just how damaging puberty blockers are, but we're going to see more and more de-transitioners say, I didn't need puberty blockers, I needed counseling. I didn't need testosterone, I needed therapy.

Scott: Yeah, I think a lot of us have read some of those stories, these transition stories, those are incredibly heartbreaking. And for people, especially for girls who have these incredible regrets about this road that they've gone down, and, in lots of cases, irreversibly. A couple other questions that I'm curious about, you made another observation that I hadn't thought about. Yeah, that is that the majority of people who desire to transition are middle class white girls. What's the significance of that?

Katie: Abigail Schrier first noted that in our culture today, much of the way that people sort of calculate their social capital, or the degree to which they deserve to be heard, is the number of minority statuses that they inhabit. And this is where, and I talk about in the book, intersectionality, there's the descriptive and the prescriptive. The descriptive aspect of intersectionality says that a person who has different minority statuses, when you compound those, they have an experience that is exponentially different from someone who ticks all of the majority boxes. And that is observationally something that is likely very true. Who could deny that someone who is an immigrant, who is unable to walk because of some condition, has the same experience as someone who is able bodied and Caucasian here in America. So observationally that can be accurate. Where it's prescriptive and it goes off course is saying that those who have the greater number of minority statuses have the greater market on truth. They have the purer perspective. They have the ideas that we need to be listening to and that we, who inhabit the majority boxes, are unaware of and so we need to displace that majority or dismantle the majorities and recenter the minorities. Now, that's something that has taken our society over so much it's in the water. We don't even really notice it at this point. But where that affects teenage girls, if they are middle class, able bodied, white, Christian background, practically speaking, that leaves them not being very special by today's standards. And you heard some of the testimonies, you could read some of the testimonies of young girls who said after they came out as transgender that they talked about the one sliver of Jewish that they had in them to try to not be fully white. And they talked about how it gave them a sense of affinity of some type of social cause that now they could fight the cis hetero patriarchy that was oppressing the rest of them. And so much of what the appeal is or the attraction is, is it's a way to feel a sense of belonging, a sense that you are part of something greater than yourself—and these are very human things. They're things that God created us to want to find. And oh, by the way, the Christian worldview gives us all of that in a way that honors and celebrates the diversity that God created. And so, we have a culture that is trying to achieve the means of the Christian worldview by using it only in terms of power and using power dynamics to achieve that which Christ gives us by a reconciled identity in him. And we're seeing it trickle down in things like teenagers identifying as a sexual minority to feel like they matter.

Scott: Interesting. Wow. Katie, this has been so insightful. So appreciate the work that you've done on this, your research, and just how coherent the message is relating the ideas to the behaviors. And I think pointing out some of the hypocrisies and the inconsistencies involved in how we treat mental health issues, how we encourage women to accept their bodies, except in this one area, there's just so much really good insightful stuff. So I want to commend to our listeners your book, To Be a Woman, by Katie McCoy. This is just a really outstanding piece. You've done a great job with this.

Katie: Thank you.

Scott: And it's just really a delight to have you on with us. So thanks so much for your insight, for your time, and for your very good work on this.

Katie: Thank you, Scott. I hope that the book serves people well.

Scott: Well, this has been an episode of the podcast, Think Biblically, Conversations on Faith and Culture. Think Biblically podcast brought to you by the Talbot School of Theology, Biola University, offering programs in Southern California and online, including those in our Institute for Spiritual Formation. Visit biola.edu/talbot in order to learn more. If you'd like to submit a comment, ask a question, make suggestions on issues you'd like us to cover or guests you'd like us to consider, you can email us at thinkbiblically@biola.edu. That's thinkbiblically@biola.edu. If you enjoyed today's conversation with Katie McCoy, give us a rating on your podcast app, and be sure to share it with a friend. Thanks so much for listening, and remember, think biblically about everything.