In Public Discourse a few months ago, Carlos Flores provided what he called "a stern and necessary critique of transgenderism." His critique is indeed stern but perhaps not sufficiently nuanced as to be necessary.

In speaking of “the absurdity of transgenderism,” Flores seems to share the common conservative assumption that genitalia are the sole differentiator in determining whether one is male or female. However, a more complex though still complementary view of gender will be more helpful in these conversations. Under such a view, transgenderism need not remain the contemporary antagonist of gender complementarity. Rather, transgenderism, understood as a disconnect between one’s self-perceived gender and the most obvious gendered attributes of one’s exterior anatomy, can help us further penetrate the mystery of the human person, particularly the mystery of sexual difference.

At a recent lunch, a woman told me the story of her son. Natalie was born anatomically female. She had a happy and normal childhood; both of her parents held stable jobs as professionals. She did well at her public school. Unknown to her parents, around fifth grade she started attending school as “Jack.” Her parents didn’t discover until high school that their daughter attended school as a boy. Jack didn’t have any trouble with classmates or teachers; to anyone else, he was a normal kid.

But this wasn’t normal for his parents. As soon as they found out, Jack’s parents sought the help of counselors and therapists to understand what was going on. They wanted to support their child, but they didn’t know what to do: affirm Jack’s “chosen” gender or reinforce Natalie “as she had been born”? Was this just a phase? Why was this happening?

Eventually, they contacted other parents whose children had undergone similar experiences. One woman told them about “vanishing twin syndrome,” in which one twin disappears while in the womb. In some cases, the other twin will absorb his or her sibling and retain the twin’s DNA in some parts of the body. Natalie underwent some DNA testing, and her parents discovered that, in addition to XX chromosomes, some parts of Natalie’s body had XY chromosomes, the chromosomes of a fraternal twin they never knew existed. Natalie’s identity as Jack wasn’t just a phase or an illusory experience, but the manifestation of the complex realities of the embodied person.

The New England Journal of Medicine has studied such cases of “chimerism,” where a hermaphroditic person has both XX and XY chromosomes, which “must have resulted from amalgamation of two embryos, each derived from an independent, separately fertilized ovum.” Transgenderism in these cases might have once been dismissed as mere personal preference in rejection of the created body. But in reality there exists a complex relationship between transgenderism and intersexuality, and we ought not be too quick to reject the former simply because we cannot easily see the latter.

The transgender experience is diverse and varied, with many possible causes and explanations. A transgender person can have contrasting sex chromosomes, genitalia, brain sex, hormone levels, and psychological dispositions, making it difficult to clearly decide whether that person is male or female. This does not mean that male and female do not exist, but it does mean that this distinction can be ambiguous and unclear for and in certain individuals. This ambiguity is often not simply about arbitrary preference.

One response to these realities would be to simply choose a person’s genitalia as the deciding factor in determining gender. In asserting that “gender reassignment surgery is not medicine,” Flores argues that “our bodily faculties are ordered toward certain ends” and that gender reassignment surgery “involves the intentional damaging and mutilating of otherwise perfectly functioning bodily faculties by twisting them to an end toward which they are not ordered.”

One must ask, however, of the transgender person: to what end is his or her body ordered?  If sexual difference touches upon various non-genital—as well as genital—aspects of embodiment, the question of determining gender and how to encourage or integrate this gender within the rest of one’s life can become quite complicated. Could it be that, for some, brain or chromosomal sex may be closer to a person’s ontological gender—that gender with which each person is created and which is manifested, albeit imperfectly at times, in our bodies—than his or her genitalia?

Gender is not simply about reproductive processes, but about man and woman in the entirety of his or her being. Like any embodied reality in an imperfect world, gender may not be so easy to understand and identify.

Flores makes an excellent point in identifying the limits of some non-genital factors in determining gender. He notes that brain structures develop and change with time, experience, and habit. Because of this, he argues that the fact that a person has brain structures that “resemble that of a woman’s” while having male genitalia, does not mean that this person is a woman. He continues:

We don’t even need to grant that the presence of such-and-such brain states is relevant at all. For example, we may suppose that, through habitually behaving as a sixteen-year-old, the brain activity of [a] seventy-year-old … ‘resembles’ that of a sixteen-year-old’s. Does it follow, then, that the seventy-year-old really is sixteen years old?

The comparison falls short, in that some seventy-year-olds are developmentally sixteen-year-olds, not because they chose to act like sixteen-year-olds their entire lives, but because, in part, their brains never fully developed. Flores’ comparison risks inflaming the not-infrequent tendency of “healthy” and “normal” people to treat the weak and vulnerable as a societal aberration to be rejected, as are unborn children with Down Syndrome and the infirm elderly in many Western societies. In some cases, it may be best to push someone to “act his age,” but to push those whose neural development ceases prematurely because of an enduring biological reality is ridiculous and cruel. Such cruelty may lead to shame, societal ostracization, marginalization, and a belief that the only way to fix one’s life is to end one’s life.

As Melinda Selmys has pointed out, Flores’ comparison may be helpful in some ways, but in its full presentation and ultimately weak analogies it suffers from a fundamental flaw: He charges transgender people “with mental illness in order to harness the stigma associated with the mentally ill—but without providing the compassion and understanding that we extend to people who genuinely suffer from serious cognitive conditions.”