Walt Heyer remembers the moment when he started desiring to be a girl.

When he was just 4 years old, Heyer's grandmother would crossdress him while she was babysitting. She loved seeing Heyer in dresses, and even made him his own purple chiffon dress.

But it was their secret, grandma said - don't tell mom and dad.

At age 7, Heyer brought the purple chiffon dress home with him, and hid it in his bottom dresser drawer.

Heyer's mom soon found the dress, and confronted him about it. That's when he told his parents that grandma had been dressing him like a girl for years.

"You could have set off an atomic bomb in the house for the conflict between my dad and my mom, and my mom and her mom, my dad and his mother in law," he said.

Heyer's parents didn't have the vocabulary or the resources to know how to handle the situation. His dad reacted out of fear, and implemented very stern disciplinary measures. An uncle of Heyer's found out about the story, and started teasing him about it. Eventually, he sexually abused Heyer.

"You see people who have such disordered thinking (gender dysphoria) are hurting," Heyer said.  "The problem is that we don't know what to do with them."  

The desire to be a woman - to be someone other than the abused and hurt little boy - stayed with Heyer into adulthood, even though he had married a woman and had two children. At age 42, he surgically transitioned to a woman and asked his friends to start calling him Laura.

"But it began as a fantasy and it continued as a fantasy, because surgery doesn't change you to a female. It's no more authentic than a counterfeit $20 is authentic. You can't change a biological man into a biological woman."

After less than 10 years, and a conversion experience, Heyer regretted his transition and desired to live as a man again. He now runs a website called sexchangeregret.com, where hundreds of people contact him every year, sharing their own experiences and regrets of sex change surgeries. Most of them follow the pattern of feeling affirmed by their sex change for a time, only to have underlying psychological problems come roaring back after about 10 years, Heyer said.

Heyer told his story in a talk earlier this year at a Courage conference in Phoenix, where dozens of clergy and those in ministry from throughout the country gathered to learn how to best serve those with same-sex attraction in the Church.

Just recently, the ministry has been including talks and resources not just on same-sex attraction, but also on the issue of transgenderism, as transgender advocates continue to garner attention in the public sphere.

How can the Church help transgendered people?

There are few Catholic ministries that exist today that minister particularly to those struggling with transgenderism and gender dysphoria. Other than a handful of local ministries, Courage - the Church's outreach to people with same-sex attraction - is one of the few ministries addressing the issue of transgenderism on a national and international level.

"Until recently, pastoral care to individuals who struggle with their sexual identities as male or female has largely occurred at a local and personal level," said a spokesperson for the U.S. Bishop's Conference Office of Public Affairs.  

(Story continues below)

"As attention to and awareness of this experience has grown, we are seeing more efforts regionally and nationally to respond in a way faithful to the Catholic understanding of the human person and God's care for everyone."

Part of the problem is that the issue of transgenderism and its acceptance in popular culture is so new that mental health experts are still trying to catch up to the trend, said Dr. Gregory Bottaro, a Catholic psychologist with the group CatholicPsych.

"I think the mental health profession hasn't really had time to really thoroughly catch up on it, besides those in the field who kind of just flow with the current of whatever is popular in the moment," he said.

But mental health professionals who are willing to follow any current trend are only "furthering the divide" between Catholic and secular practitioners, he added.  

At the moment, the biggest concern regarding the popularising and normalizing of transgenderism is the effect it's having on children, Dr. Bottaro said.

"With kids, it's really important to recognize that their sexual development is so fragile, and the influence of what's popular in the culture needs to be really, strongly filtered and studied and understood," he said.

"The Catholic response is a return to true anthropology -  male and female he made them - to understand that our biology and our psychology are not separate things, and so to encourage the development of a curriculum of human nature that is consistent with a true anthropology," he said.

And it's not just the Catholic Church that is concerned with the effects of transgenderism on children.

In a paper entitled "Gender Ideology Harms Children," The American College of Pediatricians lays out specific reasons that they are concerned about the popularising and normalising of transgenderism among kids.

"A person's belief that he or she is something they are not is, at best, a sign of confused thinking. When an otherwise healthy biological boy believes he is a girl, or an otherwise healthy biological girl believes she is a boy, an objective psychological problem exists that lies in the mind not the body, and it should be treated as such. These children suffer from gender dysphoria," the group said in its paper.

To encourage a child into thinking that "a lifetime of chemical and surgical impersonation of the opposite sex is normal and healthful is child abuse," they added.  

"So while there are biological abnormalities (children born with ambiguous genitalia or an extra chromosome), they're certainly not circumstances to build philosophical systems on, so we see those as abnormalities and anomalies," Dr. Bottaro explained.

Learning how to best serve transgendered persons

When asked, the U.S. Bishop's Conference Office of Public Affairs referred back to Courage as an example of a ministry that was providing pastoral care and guidance on transgenderism at a national and international level.

Dioceses that have their own chapters of Courage to accompany those with same-sex attraction are also "in a good position to help people who have questions regarding their sexual identity as well," the spokesperson said.

Father Philip Bochanski is the executive director of Courage International. He said the organization will continue to discern how best to serve transgendered persons and their families.

"There seem to be some similarities between the experience of confusion regarding one's sexual identity and the experience of same-sex attraction, but there are also many differences," Fr. Bochanski said.

In the meantime, the ministry's outreach for parents, called EnCourage, is already actively engaged with parents and families who have a transgendered loved one, Fr. Bochanski said.

The goal of EnCourage is to help parents and family members of those with same-sex attraction, or transgendered persons, to maintain strong family ties while also holding to their understanding and teaching of the faith.

"Our EnCourage members pursue these goals by striving to grow in their own prayer lives, to learn more about what the Church teaches and how to present it in a loving way, and to find ways to show love and support without either condemning their sons or daughters, nor condoning immoral decisions."

"Like the experience of same-sex attraction, questions regarding sexual identity have a profound impact not just on the individual but on his or her whole family," he said.

"I'm glad that our EnCourage members and their chaplains have the opportunity to share their experience of speaking the truth in love in their own families with other parents and spouses who are striving to understand and support their loved ones who identify as transgender."

Heyer said first and foremost, the Church must gently but firmly challenge people, rather than affirm them in their gender dysphoria.

"If we affirm them in changing genders we're actually being disobedient to Christ, because that's not who they are. He made them man and woman," Heyer said.

He also said that pastors and those in ministry in the Church need to be better informed about the long-term physical and emotional consequences of sex change surgery.

"Because we're not talking about the consequences. We're only talking about them transitioning, which all looks really good for 8-10 years," he said, at which point many people desire to go back to their original gender.

"So if we can get a bigger set of glasses and look long term...then we can look and see the destruction that happens and begin to address the destruction."

Pastors and psychologists, working together

Deacon Dr. Patrick Lappert, a permanent deacon and plastic surgeon, also addressed the clergy and ministry leaders at the recent Courage conference. In his talk, he addressed the medical background of transgender surgeries, as well as the terminology used when discussing the issue.

It's important for those in ministry to be well versed in the issue, both from a catechetical standpoint and from a medical and secular standpoint, Dr. Lappert told CNA.

"One of the dangers in the subject is that ignorance causes people to respond in unhelpful ways - sometimes in anger, sometimes confusion, revulsion, all kinds of emotional things that do not serve anyone, and certainly do not serve the Church," he said.

"Be so fluent in the issue (and the terminology) that nothing surprises you, so that you can serve the person justly with the truth and with love," he advised.

It is also important for priests and Church leaders to have good working relationships with psychologists and psychiatrists who share a Christian anthropological view of the human person, and would not encourage people in their gender dysphoria, Dr. Lappert said.

Dr. Bottaro said he has seen an increase in good working relationships between pastors and psychologists who believe in a true Christian anthropology.

"I think priests are becoming more and more aware of the need for it, the more volatile the situation becomes, the more obvious and pressing the need is for mental health expertise from a Catholic perspective," he said.  

He said that he thinks Courage is a good place to start as far as ministry goes, because they have the "experience and expertise to sort of bridge the gap."

"It could become a whole separate ministry, but it's definitely related to what Courage is already doing, so it could become a branch of it, or they could decide that there's many more people suffering from the effect of transgenderism," he said.

But the issue of transgenderism extends beyond just those struggling with gender dysphoria, he added. It's a cultural issue even more so than a psychological one, and it needs to be addressed on the levels of education and improved family life and catechesis just as much as it needs to be addressed on an individual basis.

Throughout the process of discerning and pastoral care for both people with same-sex attraction and with gender dysphoria, the most important thing is to remember the foundation of everyone's identity, Fr. Bochanski added: "That of being created in the image and likeness of God the Father, and of being called to share in God's grace as his sons and daughters."

This article was originally published on CNA Feb. 9, 2017.