Gender Dysphoria and Utilitarianism
This is a research paper submitted in partial fulfillment of the requirements for the course DR38405, Worldview and Ethical Theory at Midwestern Baptist Theological Seminary (Kansas City, MO) on March 25, 2023.
Introduction
Over the past approximately one hundred years, gender reassignment has been performed surgically to enable those struggling with gender dysphoria to match the gender they believe they were meant to be.[1] It is through gender reassignment surgery and hormone treatments that a person seeks to solve the problem that they think that they have. Until recent history, it was assumed that those struggling with gender dysphoria needed to be “cured” of their gender dysphoria, but recent history and significant medical advances have brought about the need to think seriously about gender reassignment and hormone treatments from an ethical standpoint.[2] Utilitarianism provides an ethical viewpoint or moral framework to investigate or analyze gender reassignment utilizing a rational methodology. Since the primary concern of utilitarianism is maximizing the most happiness for the most amount of people while limiting any amount of pain, suffering, or misfortune, it is possible to argue for and against gender reassignment and hormone treatments, but it does become clear that the arguments against these issues far outweigh the arguments for these issues.[3]
Arguments for Gender Reassignment and Hormone Treatment
The primary argument for gender reassignment surgery and hormone treatment from a utilitarianism standpoint has to be from the argument that by not allowing a person to have the surgical procedure they are causing unreasonable pains, sufferings, and misfortunes for the person seeking gender reassignment surgery or hormone treatment.[4] In other words, the primary reasoning for gender reassignment surgery or hormone treatment in a utilitarian perspective is predicated on whether the individual was facing unreasonable suffering as a result of their gender dysphoria. Of course, this would be a highly subjective and almost impossible reason to prove within the life of an individual struggling with gender dysphoria—there simply is no way to prove whether there is legitimate harm being done to a person because of their gender identity. In fact, beyond what the individual person states concerning their own emotions or feelings, there are no physiological reasons for gender dysphoria with the exception of possible issues concerning the rare occurrence of ambiguous genitalia or intersexuality.[5] Rather, the individual struggling with gender dysphoria insists that their feelings concerning their gender equate truth regardless of their biological or physical sex.[6] Again, the issue with this is that no one can discern whether the person’s feelings concerning their biological or physical sex constitute undue hardship, legitimate harm, or unreasonable pains, sufferings, or misfortunes—the whole situation is based on what the individual struggling with gender dysphoria feels.
The only other possible argument for gender reassignment surgery or hormone treatment from a utilitarian perspective concern whether the person’s supposed undue hardship or unreasonable pains, sufferings, and misfortunes prove to be a hardship for the society as a whole. The issue with this is that it relies again on subjectivity—the person struggling with gender dysphoria would need to be able to prove that their subjective struggle is a struggle that all ought to be concerned about and that their individual, subjective struggle is a struggle that all people in the society have. Do the metaphysical struggles of an individual or even multiple individuals constitute the need for an entire society to allow for gender reassignment surgery and hormone treatment when the majority is not affected by the same metaphysical struggles to the same degree? If the individual or individuals struggling with gender dysphoria could prove that their struggle is one that causes undue hardship to all society, then gender reassignment surgery and hormone treatment for gender dysphoria ought to be approved and accepted.
Arguments against Gender Reassignment and Hormone Treatment
From a purely utilitarianist perspective, there are at least three reasons why gender reassignment surgery and hormone treatment ought not be allowed in a utilitarian society. The three reasons include further harm for the individuals receiving hormone treatment and gender reassignment surgery, the high cost for these procedures and treatments, and the small number of those even struggling with gender dysphoria in modern culture and society. Though research has shown that only some who start the treatments and follow through with the surgical procedure struggle with regret concerning the procedure,[7] others have suggested that the emotional struggle leading to the individual seeking gender reassignment remains the same with or without the surgical procedure and in some cases causes additional emotional, mental, and spiritual harm. What this means is that with the surgical procedure, many individuals do not attain any sort of mental health benefit from the surgery,[8] which makes the surgical procedure and hormone treatments even more costly when compared to the few potential rewards for the procedures. In addition, research has shown that there are few people struggling with gender dysphoria despite what modern social media and media seem to imply. A good indicator of how many people truly struggle with gender dysphoria is the Diagnostic and Statistical Manuel of Mental Disorders, which states that 0.005-0.014% of adults born as male and 0.002-0.003% of adults born female struggle with any sort of gender dysphoria.[9] Statistically, what this tells us is that very few adults are actually struggling with gender dysphoria; and while the percentages of adolescence gender dysphoria are higher, the reality is that much of the struggle can be explained by looking at the symptoms of puberty and the hormonal changes that occur as a child ages.
Conclusion
Ultimately, when considering the issues of gender dysphoria, hormone treatment, and gender reassignment surgery, the reality is that the issues only apply to a minority of individuals and the cost to remedy their supposed struggle is high when there is very little proof that the struggle is genuinely alleviated. Or in other words, because there is very little empirical evidence that there are genuine afflictions occurring to individuals suffering with gender dysphoria, those that struggle with gender dysphoria are a minority, and the cost of hormone treatment or gender reassignment surgery is high, the utilitarian perspective concerning gender reassignment surgery and hormone treatments must be that it is not appropriate because it does not make happy the most amount of people. Unless empirical evidence becomes available or the cost of gender reassignment surgery or hormone treatment lessens, there really are no good reasons from a utilitarian perspective to allow either.
[1] Farah Naz Khan, “A History of Transgender Health Care,” Guest Blog, Scientific America, November 16, 2016, https://blogs.scientificamerican.com/guest-blog/a-history-of-transgender-health-care/.
[2] Ibid.
[3] John Stuart Mills, “Utilitarianism” in Complete Work of John Stuart Mills, (Hastings, East Sussex: Delphi Classics, 2019), 3002, Kindle.
[4] Ibid.
[5] Amber M. Mathiesen, “Gender Dysphoria,” Magill’s Medical Guide (Online Edition), (Hackensack, NJ: Salem Press, 2022), 2.
[6] Edmund Fong, “Gender Dysphoria and the Body-Soul Relationship,” Themelios 47, no. 2 (August 2022): 361-362.
[7] Valeria P. Bustos et al., “Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence,” Plast Reconstr Surg Glob Open 9, no. 3 (April 2021): 1-11.
[8] Ned H. Kalin, “Reassessing Mental Health Treatment Utilization Reduction in Transgender Individuals After Gender-Affirming Surgeries: A Comment by the Editor on the Process,” The American Journal of Psychiatry 177, no. 8 (August 2020): 764-5
[9] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
