What are and are not the moral questions arising when people change sex?

Many far future science fiction stories imagine a world in which people have available an enormous range of medical modifications.  They can be taller or shorter; they can have wings; they can have huge muscles or be very slight; they can have bones replaced with virtually indestructible alloy; they can be immune to disease or shielded from radiation; and they can change sex at will.

Suppose that there were a technology of that sort that allowed full and complete sex change – so that folk that were at one point male could subsequently become female and have their own children (children that were their own genetic descendants).  What moral questions would such a technology give rise to?

I think almost none of any interest, specific to this situation.  There would be the usual question of how “natural” such a change would be – but exactly the same could be said of a heart transplant or even of surgery to remove a ruptured appendix.  There would be practical questions to be asked about how straightforward psychologically or socially it would be for someone to transition from one sex to the other – but that would be a practical issue, not a moral one (at least not directly moral).  The closest I can get to a genuinely specific moral issue from a Christian perspective would be whether it would be permissible to be married in one sex then (e.g. after one’s spouse had died) change sex before marrying again.  I can’t see any immediate reason why that would be problematic but perhaps I could be missing something.

What seems pretty clear to me is that, at least in Christian morality, there is no notion that one’s gender is a fundamental part of one’s moral identity.  For example, it wouldn’t be that if I started as a woman then changed sex to a man I would still “really” be a woman – as if I had a soul imprinted with a gender, or something of that sort.  In Christianity we are taught that at the most fundamental level we are ungendered – in Christ there is neither man nor woman; and “in the resurrection they neither marry nor are given in marriage, but are like angels in heaven” (note that angels are entirely ungendered).

Thus if we had a technology that truly allowed us to change sex, there should be few, if any, moral qualms about using it.

In our current state of technology, however, we do not have such a technology.  We have no means to make a man truly a woman or vice versa, insofar as, for example, we are unable to provide someone that begins as a man with his own uterus and ova.  All that we are able to do is to provide cosmetic alteration – to provide false breasts, a cosmetic vulva and so on.

This, then, is the real source of the moral issues with our society’s nearest technically available simulation of “sex change”: that all it permits is a form of cosmetic impersonation.  Note that I do not intend the term “impersonation” to imply anything pejorative; I mean it only in the formal sense that our gender reassignment technologies do not allow sex truly to be changed, but only the appearance of change.

Cosmetic impersonation comes in a spectrum, of course.  Let us focus (purely for ease of exposition) on the case of M-to-F “sex change”.  Cosmetic impersonation here can range from simply wearing women’s clothes to having limited physical alterations (such as beard follicle removal) to more radical gender reassignment surgery.  What moral questions does such impersonation give rise to?

[I note in passing that I am not going to touch at all upon that tiny number of people for whom the issue is not gender reassignment but, rather, what we might call “gender clarification” in that they begin with multiple sets of genitals.  The issues there I regard as almost completely separate.]

One set of issues here concerns radical gender reassignment.  Specifically, is it morally legitimate to have oneself permanently neutered or to neuter someone else?  Many people consent to have that done or do that on others, of course, with fallopian tube cutting or vasectomies.  Some modern forms of these operations are often reversible, but not always.  On the flip side, given that we do allow sterilising operations and we do permit cosmetic surgery such as breast enhancement, would it not be inconsistent to disapprove morally of cosmetic gender reassignment surgery?  Why are one person’s false breasts morally inferior to another’s?  There are an interesting range of debates to be had about that, but I don’t have much to add here other than to note the question.

Closely related to this is the set of issues concerning the role of doctors and the nature of the advice they give.  How proper is it to advise someone that he is a “woman trapped in a man’s body” or some more modern rendering of that idea?  And how legitimate is it to encourage such a person to have irreversible surgery on the basis of such an assessment?  There is a whole wasp’s nest of issues that one could grapple with there.

But probably the most obvious set of issues concerning cosmetic gender impersonation are those relating to interactions where others would want to deal with you differently if they knew your actual gender.  I find these interesting because some of these cases are morally ambiguous.

For example, in the film Tootsie, the lead (male) character is an actor who is unable to find work as himself but can as an impersonated woman.  In his case the context is acting, but one could imagine other contexts.  Suppose that a woman presenting herself as a man could get a job she would not get if she presented herself as a woman, because her employers were sexist.  Setting aside issues of employment law, it’s not obviously improper for such a woman not to respect her employers’ preferred attitude if they had known her non-impersonated gender.

But suppose, instead, the situation were a man presenting himself as a woman discussing, with a woman, some details of her bathing or lavatory habits that she would happily discuss with women but never with a man.  Some of us might think her silly not to want to discuss such things with a man; others might agree with her.  But either way, is there not a strong case for respecting her preferences on this point?  By presenting himself as a woman, the man in this case persuades the woman to interact with him in a way she would not (rightly or wrongly) have chosen to interact with him had she known him a man.

The case becomes clearer with certain sorts of sexual interaction.  As above, this comes on a scale.  Consider first interacting with a man at a pick-up joint looking for a one-night stand.  Suppose that such a man would not want to have casual one-off sex with a man that had had gender reassignment surgery.  Personally, I see little reason to respect that man’s preferences in this case – if he doesn’t know and is content to have sex with someone he’s only just met, I don’t see any strong reason why the person that had had the gender reassignment surgery should have to tell him.  However, I acknowledge that that could be argued either way.

On the other hand, consider now someone that was not after a casual pick-up but instead was looking for a life partner to form a family with, hoping for children.  And suppose that such a person accepted that a woman might not happen to be fertile but would not want to marry a man or a man that had had gender reassignment surgery.  I suggest that (as above with the woman discussing her bathing, only perhaps more so) in such a case the preferences of that person should be respected even if one disagreed with them.

Furthermore – and we come now to an issue of policy importance – it seems to me that this principle of respecting people’s preferences on this point even if we disagree with them is a very fundamental part of living in a tolerant society.  A man that did not want to marry a gender-reassigned man should have some means to check he was not being deceived.  I would assert that part of the process of getting married should be that the state verifies that the person I am marrying is, in fact, the gender I think.  If I’m a gay man and want to marry a man, the state should guarantee that it is in fact a man I’m marrying.  If I’m a straight man and want to marry a woman, the state should guarantee that it is in fact a woman I’m marrying.

That means, for example, that – in our society, in which gender reassignment is (for technical reasons that may change in the future but are, alas, the reality for now) only cosmetic, it should not be possible for someone who has had gender reassignment surgery to have their original gender “forgotten”.  For example, there should be some certificate or other indication, available to someone considering marriage, of that person’s original gender.  Part of the process of obtaining a marriage license should be that the state should flag whether one of the parties to the marriage has had gender reassignment.

I would extend that principle to those in prisons for at least lesser crimes.  A woman in prison for, say, six months should not be forced (for example) to shower together with someone she would regard as a cosmetically altered man.

So to summarise, it seems to me to be fairly clear (and I’m not even sure it’s terribly contentious) that if we had available a technology that allowed for full and complete sex change, it would give rise to few, if any, moral issues beyond those associated with all transformative modern medical technologies.  The moral questions associated with what is sometimes referred to as the “transgender community” arise precisely because we do not yet possess a technology that allows us to change people’s sex.  The main such moral questions I have explored (I admit very sketchily, for this article is already too long) are those where people’s preferred interaction with someone will vary depending upon their actual (as opposed to cosmetic) gender.  In some such cases I have suggested we should not respect their preferences, but in others I have suggested we should respect their preferences, even if we disagree with them.  In a few cases (marriage, nakedness in prison) I have suggested there should even be a legal position protecting such preferences.