“Those who can make you believe in absurdities,
can make you commit atrocities.”

—Voltaire

 

“People are dying because the truth is dying!”

—Benzio

 

The Second Law of Thermodynamics states that systems tend toward maximum entropy, disorganization or chaos. Since 1950, society’s transition into postmodernism—where relativism replaces an agreed upon series of absolutes and truth—marked a pivot point accelerating chaos. When God’s truth is ignored, Satan and the world’s small lies gain traction and, if not corrected, accelerate to absurdity level. Over the last 30 years, growing absurdities about how sex/gender are determined led to an exponential increase of atrocities in the form of “voluntary and willful” chemical upheaval, surgical castration, sterilization and mutilation destroying not just young healthy bodies, but also severely damaging the associated minds and spirits.

 

After believing the only problem leading to their identity confusion, anxiety, dysphoria, anger or insecurity was that God made a colossal mistake and assigned them the wrong sex at birth, and then being sold on the idea that “gender-affirming treatments” would actually fix their problem, these children of God were left realizing these atrocities didn’t solve or fix anything. In fact, they now realize the appalling “treatment” interventions made their intrapersonal confusion and interpersonal isolation even worse, plus they added on a myriad of psychospiritual struggles and permanent physiological mutilations. A growing number of these patients want to reverse these procedures and try to live life as the physical and psychological identity God designed for them. Coming to this revelation is just the first of many steps on the extremely complex route a “detransitioner” has to navigate to live in their true identity and achieve their God-given potential.

 

Understanding the Basics—and the Terminology

Before I equip you, I want to encourage you that God has a divine appointment specifically for you as a healthcare professional, and especially for specialists in this arena, to be an incredible lighthouse shining God’s glory, love and truth. Our patients suffering from gender identity struggles are lost and searching for answers, and you have the privilege of guiding detransitioners through their storm to sanctuary and His design for them. First, let’s clarify some terms you will hear as you help those with gender identity struggles, and then I’ll share some psychiatric insights to help you understand and manage this special population.

 

• Natal or birth sex: biological sex genetically assigned at birth, with only two options: male or female.
• Gender (a conservative definition): same as your natal/birth sex.
• Gender (progressive definition): socially constructed roles, behaviors or activities that society assigns, or which an individual can pick and choose.
• Cisgender: someone who feels they are the gender God assigned them at birth.
• Transgender: someone who feels they are not the gender God assigned them at birth.
• Gender identity: a person’s internal sense of what gender they believe they are.
• Gender dysphoria: the official DSM5 diagnosis for patients who are distressed or emotionally compromised because they believe their gender identity is different than sex/gender assigned at birth.
• Gender expression: the way a person expresses their gender to others.
• Transitioning: when a transgender person makes outward efforts to express a different gender that is not their birth gender.
  • Social transitioning: changes clothes, makeup, hair, name, pronouns, voice, language, etc.
  • Chemical transitioning: puberty-blocking hormones and/or cross-sex hormones, depending on age.
  • Surgical transitioning: surgical interventions to undo birth sex anatomy to try to align with perceived sex anatomy.
• Gender-affirming therapy (GAT): term given to the gamut of transitioning efforts deemed as “therapeutic interventions” to help alleviate gender dysphoria, which starts with social, then chemical and finally surgical. I call this gender avoiding/denying therapy.
• Desistance: general term for stopping of any transitioning, and it is commonly applied specifically to the cessation of transgender identity, thus the individual accepts their birth sex assignment.
• Desister: someone who previously identified as transgender but who now re-identifies with their biological sex before receiving any medical interventions.
• Detransitioner: someone who previously identified as transgender but who now re-identifies with their biological sex, but after having received medical interventions.
• Gender dissonance/incongruence: more “neutral” terms used by the trans community to describe the mismatch between birth sex and perceived sex that do not define it as pathological, a mistake or distressing. Just a mismatch.
• Gender confusion/dysphoria/avoidance/evasion/denial: my terms to describe any discomfort with or inkling to change birth sex.

 

Meeting the Need in the Exam Room—Levels of Care

Opportunity knocks! You walk into the exam room to see an ongoing patient, or maybe even a new patient. Your patient tells you they’re ready to acknowledge their God-given sex/gender at birth is the sex/gender they want to live life as. Being a detransitioner, they want to stop any further medical interventions that undermine or deny their birth sex. Depending on the chemical and surgical interventions, extended and, in some cases, life-long medical monitoring and care is required. But more importantly, psychiatric/psychological treatment is also an absolute must, so let’s dig in.

 

Suicide is a frequent outcome for those with gender struggles, so if the detransitioning patient in your practice is actively suicidal with plan, intent, means and no impulse control to stop it, then locked inpatient care for supervision and safety is important. However, if the patient can contract for safety (or after the short inpatient stabilization), an intensive Christian residential treatment center for 40 to 60 days would be highly recommended. Supervised intensive residential care significantly initiates and accelerates the detransitioner’s inner psychospiritual healing process. This level of care is medically necessary if they are struggling with a life-interfering addiction, self-harm or symptoms causing significant distress or dysfunction. When the patient is ready to transition from residential to outpatient, or if the patient is unable to afford or their insurance won’t cover residential care, engaging an experienced psychotherapist and psychiatrist is the next and ongoing course of action. Ideally, this psychiatric treatment team will be in the patient’s life for several years, establishing trusted continuity to work on a long list of complex issues. Also, as patients unpack and process their inner world, they often uncover significant hurts, losses and traumas, which might periodically require inpatient or residential care for safety, supervision and treatment intensity to navigate these episodic storms or disrupting insights.

 

I’ve been blessed to treat gender-confused patients as an outpatient psychiatrist, therapist and medical director at a Christian residential treatment facility. Over these 34 years, I’ve discovered that significant in-depth and long-term psychotherapy is key to addressing a plethora of significant psychological issues, struggles and traumas. The path to a fully psychospiritual healed, accepting, forgiven and God-centered mindset is accessed when several of the 15 prominent struggles listed below are tackled, processed and navigated. During treatment, symptoms occasionally escalate, causing distress or dysfunction. Oftentimes, psychotherapy is thus complemented by psychopharmacological or other somatic therapies (think light therapy, transcranial magnetic stimulation, neurofeedback, supplements, electroconvulsive therapy, etc.) as neurocircuit patches or band aids. This patch lowers the intensity of symptoms and the probability of harm, allowing the patient to more safely, efficiently and deeply engage in talk therapies to navigate their difficult psychospiritual healing journey. Another therapy lever to pull is increasing the treatment level of care, as outlined below.

 

• Outpatient is one to two hours per week, while living at home. The most common modality.
• Intensive outpatient is three to nine hours per week, while living at home.
• Partial hospital program, otherwise known as day treatment program, is 15 to 30 hours per week, while living at home.
• Residential treatment center is for 24/7 clinical supervision and six to seven hours per day of treatment, while living at the facility. Usually 30-90 days.
• Inpatient care is locked unit with safety, 24/7 supervision and acute stabilization usually taking over three to seven days. Not much in-depth therapy is accomplished, but safety and acute medication management are prioritized. Usually 3-7 days
• Detox is when either opioids, tranquilizers, alcohol or some intense stimulants, chronic and intense cannabis use or other intense hallucinogens need to be stopped and the patient needs medically supervised or managed services to avoid medically dangerous outcomes and ensure compliance when withdrawal symptoms are experienced.

 

Navigating the Psychological Aspects of the Healing Journey

Now let’s talk about what the detransitioner needs to work on in the above listed treatment levels of care. The following are 15 common and significant issues I’ve helped detransitioners process and overcome as they navigate their complicated healing journey. This is certainly not a complete list, nor does every detransitioner experience each one, but they all have most, if not all of these, pop up at some time that need to be processed. The issues are written from the patient’s perspective using clinical verbiage.

 

1. My initial underlying psychological struggle(s), which precipitated or accelerated my gender confusion (more on these later in the article).
2. Post-traumatic stress disorder (PTSD) resulting from all the iatrogenic chemical mismanagement and mutilating traumatic surgical interventions.
3. Grieving my losses of fertility, body parts, sexual pleasure and physical health.
4. Realizing I wasted so much time in my misguided healing pursuit. I can never get it back and will always feel behind my peers.
5. My feelings of anger and betrayal toward those with power or influence over me who neglected informed consent while they supported, endorsed or perpetrated malpractice by pushing “gender-affirming therapy.” This includes my behavioral health specialist, physicians, surgeons, healthcare system, parents and more. And if I decided as an adult to transition, then my spouse, siblings and mentors are added to the list.
6. My emotional dysregulation and cognitive impairment from exposing my brain to cross-sex hormones in doses my brain wasn’t intended to be exposed to or process.
7. Further ostracization from peers, family and loved ones while I was lost in my gender confusion struggle and pursuing significant unhealthy social and medical interventions, which negatively spiraled me. These interventions were, at best, confusing to my loved ones, and, at worst, antagonistic to my loved one’s advice or beliefs.
8. Backlash and animosity from the LGBTQ+ community for me being a walking example that their gender-affirming agenda doesn’t work, while also contradicting their theory that sex/gender is fluid and not fixed. I feel like a commodity they used to further their agenda, and that love is conditional, as either side only loves me when I live the way they think is right.
9. I don’t fit in anywhere, as I am not trans anymore, but I’m not whole and normal either.
10. I have body dysmorphia issues prior to the medical interventions, as I believed multiple parts of my body were wrong. And I have body dysmorphia issues after the medical interventions, as several parts of my body are definitely wrong and chronically disrupted and are the source of ongoing physical issues and psychological disruption.
11. I feel intense, episodic or low-grade chronic feelings of anger, shame or self-condemnation directed at myself for ultimately being the one who made the decision to pursue a gender different than my birth gender.
12. Being a lifelong medical patient, I now have ongoing worry about my physical health and longevity, as well as its ripples on my education, occupation, finances, insurance coverage, medical costs and long-term financial stability.
13. Given my mutilation and psychological instability, could someone ever really love and commit to me as a lifelong love interest or marital relationship that most crave, expect to enjoy and dream of as a teenager?
14. Will I ever find a church that, once they find out the depth of my sinful thoughts and action, will accept me? Or will I always have to hide that part of my back story from any spiritual community I become part of?
15. Will God ever fully accept and forgive me for rejecting and mutilating His design and plan for me? And if He does, will I be able to shut off the tapes in my head and truly walk and live in that forgiveness, peace and freedom?

 

Numbers two through 15 evolved after they started questioning their gender and pursued options to change. Number one, on the other hand, predates their confusion, which laid the faulty foundation for the rest of the issues on the list. I really want to take some time to unpack number one a bit more, but before I do, I want to explain an important concept about the mind.

 

Origin of Gender Confusion—Explaining the Unconscious Mind

The foundational principle you need to appreciate to understand and help anyone, but especially detransitioners, is how potent the unconscious mind is. Our unconscious activity is the primary influence on all our decisions, usually without us even knowing we are making a decision. All our experiences, information we’ve learned and especially the interpretations of those experiences and information are stored in a huge database in our memory banks.

 

As we interact with present situations, think about past experiences or anticipate future possibilities, we want to achieve the “best” outcome. Usually that means minimize pain, maximize pleasure. Our powerful mind starts sorting through our database for any files that relate, even just a little, to the task at hand to achieve that optimal outcome. Some of that data bubbles up to our conscious thinking level, and those are thoughts you are fully aware of and can verbalize without effort. However, because of limited RAM to process thoughts consciously, the overwhelming majority of our processing is unconscious, meaning just below the surface of being able to immediately identify or verbalize the thoughts. This is why many with same-sex attraction or gender confusion have trouble seeing their position as a decision; instead, they believe they were born that way.

 

Unconscious thinking explains why adult children of alcoholics often marry alcoholics. Or why people become conflict avoiders or people pleasers. Or why some crave power and others avoid it. Or why girls are attracted to bad boys. Or why we do things we know are unhealthy. Paul writes about his ineffectiveness to control his unconscious thinking in Romans 7:15-25 (written in my paraphrase): “I’m so confused. The good things I want to do, I don’t. And the bad things I don’t want to do, I do. Woe be me, who will win this war within me between the flesh and the spirit? In my mind (conscious space) I know what’s right, but my flesh (unconscious mind and the distortions/lies stored deep in the database) keeps on driving my decisions to do what is wrong. Wretched man that I am, who will win this battle? Thank you, Jesus, for your grace and the power to one day overcome.”

 

Now let’s apply this to the person struggling with gender confusion. The etiology of gender confusion is psychospiritual, and it is primarily driven by unconscious thoughts and processing. (Note: I use the term psychospiritual because all our psychological activities and functioning are tethered to and guided by our spiritual belief system). Just like the adage, “Garbage in, garbage out,” the gender-confused individual accumulates some misinformed, illogical or incorrect data somewhere along the way and stores this data in their database. This incorrect data unconsciously interferes with their decisions about who they are, how God designed them and how to live out their God-given identity and impact. This illogical data tricks them to believe in the illogical prideful option of thinking they know more than God and that chemical and surgical interventions are the logical solution. Illogical data also makes the logical option of humbly accepting and living out God’s beautiful design for them, look illogical.

 

For the gender-confused person, most of their illogical/incorrect data comes from stored interpretations of their interactions with and observations of their siblings (usually older and same sex), peers (same sex again are more influential) or parents. It could also be a result of premature sexualization (abuse, molest, pornography, etc.) or interactions with other close loved ones and extended family.

 

Let me share several common examples:

 

• The sexual abuse victim believes the perpetrator pursued them because of their biological sex. Unconsciously they reason, if they were a different sex, the abuse wouldn’t have happened, and they will have less chance of being abused in the future.
• A boy has two older brothers who excel at typical male sports, but he himself doesn’t like or isn’t good at sports. To avoid the expectations and comparisons to his older brothers or rationalize why he isn’t good at sports, he unconsciously believes he must be female.
• A female who doesn’t mesh with other female peers, gets bullied or is socially marginalized unconsciously thinks she must be a male, or being a male would escape the lifetime of suffering she anticipates and fears.
• The person who is uncomfortable with their feelings of same-sex attraction unconsciously comes up with a way out. Instead of admitting they are homosexual, it is easier to accept they were mistakenly assigned the wrong sex at birth. So, by changing their own sex/gender, they now are attracted to someone “opposite” their new sex/gender and consider themselves now heterosexual.
• Some children have difficulty attaining healthy resolution of the Oedipal stages of child development (ages three to six). This is the stage when kids are really connected to their opposite sex parent. Girls want to marry daddy, and boys want to marry mommy. Simultaneously, they see the same sex parent as a competitor and are somewhat defiant, combative toward or even reject that parent. When both parents unit as a loving couple then healthily, securely and lovingly manage the child’s thoughts and actions, healthy resolution is achieved. The child realizes their mommy and daddy are together in a safe and awesome relationship. Even though they can’t marry their opposite sex parent, they unconsciously realize if they identify with and obtain the positive attributes of their same sex parent, they will get a great spouse like their opposite parent whose traits they desire. When various disruptions occur in these formative years, instead of having healthy, loving relationships with both parents and identifying in a healthy way with their same sex parent, they interpret their gender must not be correct as one of the main contributing factors to the disruption and unhealthy “resolution” of this phase.
• Persons on the autistic spectrum struggle with social skills, are more concrete and have difficultly abstracting. These complicate their search for identity and hinder healthy interactions with parents, siblings and peers. These spectrum characteristics also corrupt their ability to accurately interpret the real world and the interactions they experience and/or observe. Both these lead to a higher probability of experiencing the precipitation issues listed and more.
• The individual who has characteristics or interests that do not fit classical gender stereotype, such as the girl who is a tomboy, athletic, more direct, less relational and not interested in domestic activities or motherhood. Or perhaps the boy interested in theatre, music, cooking, crocheting, knitting, etc. Many of these resolve when puberty sets in, or soon into adolescence, but if not, and if no one helps them understand that those nontraditional gender interests are fine, no matter what physical body God designed them as, they might start to believe they were born with the wrong sex assignment.

 

As you can see, these experiences and their associated unconscious interpretations are ground zero then early accelerants of identity confusion, insecurity, anxiety, depression, anger, loss and trauma. If not addressed and corrected closely after the events, they escalate to mood and anxiety disorders, PTSD, body and eating issues, self-harm (which chemical and surgical procedures are part of), addictions, intra- and interpersonal struggles, moral injury and significant spiritual distance or antagonism. In my experience, the leading reason why most who struggle with gender confusion comeback and decide to identify with their genetic sex is because all their “gender-affirming therapy” efforts never cured any of these underlying psychospiritual struggles as promised. In fact, after a short honeymoon period of some superficial psychological improvement that some attain, they have not only their initial problems, but also now the myriad of physical issues and the long list of psychospiritual issues listed above to contend with as well.

 

Rebuilding Identity in Christ

You probably realized the detransitioner is going through a great deal of turmoil internally, but hopefully this article shared more tangible internal etiology and pathways for why they pursued the odd changes you see on their outside. Also, I pray I am clear about the essential need for professionals to provide intensive Christian psychological expertise to treat, mentor and disciple this hurting person from pain to peace, bondage to freedom and rejection from to belonging to God.

 

This psychospiritual work is difficult and painful, just like getting rid of cancer takes effort and incurs pain. Nevertheless, don’t allow Satan to deceive you or the patient into thinking the old gender-confused way was less painful or less costly. Your encouragement, prayers, empathy, compassion, love and wisdom can be the blessed professional voice they need to continue their path to wholeness and their God-given potential when their resolve wanes and they want to quit their restoration journey. You are like Nehemiah, helping them transform the rubble, debris and chaos of their identity and rebuilding their identity and life on the rock of Jesus Christ.

 

In conclusion, psychological services are primary in helping detransitioners accept and live in their God-given potential psychospiritually, while also accepting the physiological limitations and losses brought on by their misguided decisions. You will be a significant support, encourager, case manager and discipler as they try to pick up the broken pieces and stop trying to write their own instruction manual of how to get the most out of their lives. Instead, you can guide them to allow our Designer and Author of Great Comebacks show them the amazing comeback story He’s written specifically for them.

 

 

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About the Author

Karl Benzio, MD, is a board-certified psychiatrist. He received his BS in biomedical engineering from Duke University and his MD from Rutgers-New Jersey Medical School, and then he completed a psychiatric residency at University of California-Irvine. Dr. Karl is Christian residential facility Honey Lake Clinic’s co-founder and Medical Director and the American Association of Christian Counselors’ Medical Director. Fueled by God’s healing of his own struggles, Karl hates when Satan wins anything. His specialty is deconstructing decision-making mechanics/sciences to show how Satan steals, kills and destroys, but, more importantly, also revealing powerful healing available through practical spirit, mind and body integration, which he calls practical neurotheology. Karl’s passion is integrating the Bible with psychiatric sciences helping people of all ages and backgrounds operationalize biblical truths into biblical living, regardless of their psychospiritual struggle. Karl’s calling is to reignite Jesus’ behavioral health revolution, and, while being a Nehemiah, collaborating with Nehemiah-likes to rebuild the battered city of healing Jesus initially built. He loves Jesus, his wife Martine, their three incredible daughters/son-in-laws/granddaughter, the Jersey Shore, ice cream and pickleball!