Introduction
I recently watched the controversial documentary – What is a Woman? by the political commentator Matt Walsh. The documentary explores the changing concepts of sex and gender in the digital age, particularly the transgender rights movement, transphobia, and what it means to be a woman. While made to be somewhat humorous, I couldn’t help but empathise and feel curious for those navigating the challenges of what is commonly called gender dysphoria (we will touch on this later).
Growing up we all used to use sex pronouns – a penis defined a man, a vagina a woman, and no one thought to think otherwise. Our biology distinguished us male and female – and isn’t that obvious? It didn’t matter how you felt, since when did the subjective experience you have of yourself overpower the fixed way of things in nature? Biology is black and white.
On the other hand, perhaps reality isn’t so black and white. Doesn’t the inner world of thoughts, feelings and emotions matter? Don’t they point to something valid? Something we were made for? Perhaps our modern age should make room to accommodate those who identify outside the traditional criteria of male and female.
To further complicate things, a modern faultline has opened up between some in the feminist movement and the trans community, with TERFs (Trans Exclusionary Radical Feminists) vociferously contending with trans rights advocates over who gets to call themselves a woman.
The “transgender situation,” in which a person claims that their gender identity is at variance with their biological sex, raises a whole bundle of difficult questions, after all, how should we define male/female if not through biology? Is sex malleable? Is it right to do whatever we want with our bodies, even if that means denying and reshaping their very nature?
The rest of this essay will be an exploration to answer those critical questions on gender and sexuality, with a voice from science, sociology and theology.
What is gender dysphoria?
To understand gender dysphoria, we better start with our definitions. When we refer to someone’s “sex”, we are commonly referring to their male or female biology. Sex is primarily identified by chromosomes, hormones, internal reproductive anatomy and sexual organs. There may also be secondary characteristics like facial hair on men or breasts on a woman. Your biological sex is an objective reality.
“Gender identity”, on the other hand, is usually understood as one’s personal identification with the psychological, social and cultural aspects of masculinity and femininity. Our gender refers to our personal experience of ourselves related to cultural expectations of what it means to be masculine or feminine. Someone could consider themselves to be male, female, neither (nonbinary) or a changing mixture of masculine and feminine attributes (gender-fluid), among other combinations.
Gender identity is often associated with “gender norms.” Therefore nowadays, people often identify with a particular gender according to the affinity they feel for typical societal male and female cultural norms. This includes but is not limited to – interests, hobbies, career pursuits and so on. Your gender identity is a subjective reality.
Gender dysphoria is when someone perceives their gender identity, the physiological and emotional way they fit into a social framework of male and female, as not matching their biological sex and so they find themselves dissatisfied. You could be born biologically male yet feel more of a psychological and social affinity with traits that society considers feminine, or vice-versa. Dysphoria means to be generally dissatisfied with something, therefore gender dysphoria is a dissatisfaction with your biological sex. So at the heart of the transgender experience is gender incongruence, an internal sense of gender at odds with your birth sex.
The fact is we know very little about what directly causes gender dysphoria. Whether it’s caused by contributions from nature, biological aspects or key events in someone’s upbringing, their environment – perhaps all have an impact. There is no theory that is convincing enough to show what clearly causes gender dysphoria. Years of research and debate within the medical community regarding the cause have been inconclusive.
It may well be that there are multiple pathways to the same endpoint. There are so many experiences that knowing one transgender person tells you very little about transgender people as a group. There is no one-size-fits-all explanation of transgenderism, nor a one-size-fits-all response to the pain experienced by transgender individuals. So, with this in mind, we ought to be compassionate with those experiencing this and remember what we often forget – that we are dealing with people. We’re complex beings.
Over the last decade, the number of children and young people presenting to gender clinics has steadily risen. There has been a dramatic rise in the number of children and young people either experiencing, or experimenting with, a gender different from their biological sex. Such situations can give rise to difficult questions – theological, philosophical, medical, ethical, legal, psychological, educational and pastoral.
Now, how should we address gender dysphoria? Let’s say, for argument’s sake, that your child is gender dysphoric. How should you, as a parent, respond? Should you raise your gender dysphoric child in the identity of the child’s biological sex? Should you facilitate cross-gender identification? Should puberty blockers be used to provide time for that kind of decision-making? Does your child need therapy to resolve the conflict? Should you encourage hormone treatment and sex-reassignment surgery? And how often are these procedures actually helpful to people? What are the long-term effects? Or should you take a “wait and see” posture with the assumption that the dysphoria will fade over time? And on top of all that, how should the rest of society respond? These are complicated questions that deserve our attention, and we will touch on them throughout the essay.
Accounting for gender dysphoria
Firstly, how do I as a Christian, account for this? Why is it that some people experience Gender Dysphoria?
We need knowledge, some way of understanding why this can be the case for some people. The fact is, acting on false or ungrounded beliefs usually leads to destructive encounters with reality. People perish for lack of knowledge, because only knowledge permits assured access to reality, and reality does not adjust itself to accommodate our false belief, errors, or hesitations in action. So, we need knowledge. We need a better understanding of our true selves, our sexuality, and how this all fits into the bigger picture. With this knowledge we will have the foundation to navigate gender dysphoria. And then we also need the wisdom to know the best way to respond with grace and truth.
There are three aspects of the Christian framework – creation, fall and redemption – which help explain the Christian view on gender dysphoria. Ultimately, scripture does not specifically address a contemporary understanding of gender as a socially constructed concept different from biological sex. A biblical theology of the body, however, argues for the essentiality of the body in determining our identity. The scriptural witness of the sanctity of the body remains regardless of the shifting cultural understanding of gender.
1: Creation
At the start of the biblical narrative is the account of creation. Genesis 1:26–31 is the account of God creating, blessing, and commanding humanity as male and female. Humans are created in the “image of God” as male and female. The “image of God” refers at least to the role of humanity over creation as representatives of the authority of God. If humanity is meant to represent God over the earth, then human beings must fill the earth. Hence, God’s first command to humanity is to be fruitful and multiply. In all of this, the bodily aspect of male and female is paramount. To be female and male makes it possible to reproduce sexually. God’s creation of humanity as male and female is, at least in part, because God intends for humans to reproduce.
So in the account of creation, God purposely intended two sexes, male and female. But it gets deeper. Research has documented differences in neuroanatomical regions of the brain between males and females. Neural mapping of the brain suggests differences between males and females that are particularly significant in adolescence and into adulthood. Male brains are generally structured to facilitate connectivity between perceptions and coordinated action, whereas the female brain is generally designed to facilitate communication between analytical and intuitive processing modes. Perhaps this explains why, across social studies and among many other results, men, on average, tend to be keenly interested in things, whereas women tend to be more interested in people.
This, among many other things, shows a clear difference between men and women. There is a deliberate and beautiful diversity between male and female that reaches into our very being, our minds and our body. We are structured in different ways. Anyone married knows that. Human beings are ontologically and not merely in appearance male and female, and this diversification between male and female, according to the Christian faith, is sacred. It allows procreation and should be honored.
The deliberate bifurcation of a male and female structure into creation creates a basic need for us to be in relationship, so that in community, not individually, we best reflect God’s image. As 1 Corinthians 11:11 says: “Nevertheless, in the Lord woman is not independent of man, nor is man independent of woman.” In this difference there is a longing to relate to one another as different gendered beings; it highlights the desire for unity amongst the diversity of male and female.
According to the Christian faith, this desire for unity is honored within the institution of marriage, where a man and woman become one flesh. God specifically chose to create two sexes as a man and woman in marriage is meant to signal something of the relationship between God and his people. God wants us to forever think of our relationship with Him through a monogamous, male/female relational analogy. This is probably one of the most common themes throughout scripture and places God in relation to a community that is being restored. The relationship between God and his people is an intimate one, full of significance, purpose and meaning.
Therefore, pulling from the Christian creation account, the purpose of gender is to build a relational structure into humanity intended to direct us to our creator and to foster a longing for God, the ultimate relationship. Our gendered bodies serve as testimonies to our responsibility to live as God’s image and to our incompleteness in ourselves individually. In part, this is the purpose of male-female distinctions.
2: The fall
Then we move on to the second aspect of the Christian narrative – “the fall” God created us in order to love us. Our greatest fulfillment is for us to delight in Him and Him in us. But love comes with the freedom to choose and the basic choice to accept or reject. From the beginning, we have rejected God and this has manifested itself in our rebellion against His moral authority and in the way we place our security and identity in anything and everything apart from God – we call this “sin.”
Since God is the source of our being and all life is ultimately derived from God, and since we have chosen to live apart from him, we live in a world where life is physically and spiritually decaying. This is referred to as “the fall.” Right from Adam and Eve we have chosen to cut ourselves from the source of our wellbeing. The effect can be seen in the disorder in our minds and in our knowledge of God and the world God created. The human mind naturally has rejected the knowledge of our creator.
We can see the fruit of this. Since we have rejected God as the source of our purpose, chaos has reigned in His place. The human condition is evidently disordered. We are mentally, morally and physically imperfect. We were made to live under God’s Spirit, but instead choose to live under the mere natural condition in which we were raised. We were created to be spiritual but instead chose the merely natural. There is not one aspect of being human or the human experience that is unaffected by fallen-ness, including our self-identity and the relations between all aspects of humanity.
None and nothing are free from the effects of “the fall”, although it touches our lives in remarkably different ways. One may be susceptible to depression while another may be susceptible to diseases and illnesses, another faces anxiety and mental health issues while another may struggle with lust that takes the form of immoral sexual addiction.
Dare I say this “fall” may even take effect in the struggles of gender identity? Sin has distorted human nature, even the purpose of gender, male and female. So not every experience, not every physical or psychological reality is a reflection of God’s will. I think the effect of the fall can be seen in the confusion between birth sex and psychological gender identity regarding gender dysphoria, particularly when this is strong enough to cause distress and impairment. The world we inhabit, as well as our experiences of ourselves, are not all as God intended it. This means that not everything natural to me is morally right. Sin has distorted both physical experiences and cultural expressions of gender. The very experience of gender dysphoria is in part an unease with the brokenness of society’s ideas of gender; it shows human society is broken and cut off from God’s ideal, just as scripture claims. In fact, many transgender people would favour a gendered society, but they long for a sense of alignment between their body and their mind. The world is not as God intended it.
It’s interesting that the more a society departs from God, the more these distorted views of gender become practiced and accepted. Without God, we are without ultimate purpose. Without God, objective moral duties do not exist. Moral standards devolve to the level of subjective opinion and are ultimately left to the dictatorship of whatever the human desire wills. It is either “Your will be done God” or “thy will be done.” Cross-gender identification or manipulating one’s sex is a concern in large part because it threatens and denies the integrity of one’s sex and male-female distinctions. It’s an overt attempt at distorting the sacred image of gender ordered by God.
3: Redemption
This brings us to our third and final motif of Christianity – redemption. We are in need of transformation. We recognise that God does not leave humanity in its fallen condition. The beautiful diversity of male and female forever points to an important aspect of the relationship between God and humanity, that it is meaningful, purposeful, and deeply relational. We acknowledge that sin has distorted that purpose and so misguided our knowledge of God and ourselves. Yet God does not leave us lost and burdened.
This is where the gospel steps in. Jesus, on the cross, suffered the ultimate consequences of our moral imperfection, becoming sin to bear its consequences on our behalf. Christ’s resurrection points to the hope that the whole purpose of all creation will one day be restored. Christ has wiped away the penalty of our moral debt, so that God’s grace is sufficient to cover all of what we may encounter, given we accept him. There is hope that truth will one day reign over the lives of our fallen nature, where God will resurrect creation to fulfil its purpose into eternity.
Given this broad narrative, we discover that fulfilment is not ultimately found in resolving our identity discomfort but that healing comes through a relationship with the God who made us. The truth is that God will restore humanity. The gospel promises a relationship between God and his followers which cannot be broken. This is the primary, foundational and ultimate identity for a believer, that we are to become sons and daughters of God.
Christian hope and gender dysphoria
An understanding of “the fall” brings with it a corresponding affirmation of the inherent goodness of creation. Gender Dysphoria, therefore, is understood as part of the fall. It is a sign that our experiences of ourselves are not as they should be. It is a mental health condition as a nonmoral reality, similar to that of an eating disorder, like anorexia or perhaps more closely – schizophrenia. We should recognise that gender incongruence is a reflection of a fallen world in which the condition is a disability, a nonmoral reality to be addressed with compassion, helping those suffering navigate the dysphoria.
Now, the reality of redemption and the hope of resurrection tell us never to give up and that God’s grace is sufficient to cover all of what we may encounter if we are in the right relationship with God. Our “broken” experiences of ourselves won’t have the final word, given we are in union with God. This is the glorious promise of the gospel.
Rather than viewing gender dysphoria this way, instead, the dysphoric person is often encouraged to perceive their identity as primarily defined through their subjective gender identity over their biological sex. This has resulted in the idea that a biological man can be a woman, or vice-versa. So we live in tension. Christians need to uphold the sacredness of male and female by establishing the truth of reality, that male and female are not interchangeable but part of our deepest biological being.
There’s a contradiction in our modern approach to sex and gender. We treat sexual activity as if all that matters is consent and superficial physical pleasure – our biology rules us. Yet we approach trans issues as if all that matters is one’s subjective view of ourselves, with our biology being meaningless. This is perhaps one root of the conflict between certain feminist and trans groups, with the former (known as trans-exclusionary radical feminists) contending that trans people who identify as female aren’t “real women,” and the latter arguing that denying their place as women violates their essential humanity.
The Judeo-Christian creation story speaks to both sides of this very modern clash. On one hand, if the world was made by an intelligent mind who established humanity as His authoritative image, our internal subjective experience matters and we are more than physical pleasure-machines. We have valuable souls that should be protected from sexual abuse through committed, loving relationships. On the other hand, the idea that God created the physical world and called it “good” asserts that our biology also matters. Sex, as God’s idea, is essentially powerful and good, and, contrary to advocates of trans conversion therapy, our sexual male/female biology matters.
Men and women, biblically speaking, are defined clearly by their biology. Now there is nothing wrong with being a feminine male, or a masculine female, that’s perfectly fine, but there is a problem in disregarding your male-female distinctions. Such practice of “transitioning” is fundamentally incompatible with the identity of God’s people. The sanctity of the distinctiveness between the two created sexes is to be maintained.
In popular culture today, the idea is that being a man or woman has nothing to do with your biology, but that the male-female definition is entirely subject to the feelings of the individual. So, while we previously understood that God defined male and female through basic biology, now we have stepped into God’s shoes to define ourselves through our own feelings.
The unquestioned liberal assumption of most Western cultures is that people should be free to live as they desire. That people should be permitted, if not actually enabled, to do what they want. From this, we get an overall culture of sensuality, in which people are almost totally governed by their feelings. Feelings have become our guiding north star.
This sounds an alarm bell to the church. For all Christians, cross-gender identification is a concern in large part because it threatens the integrity of male-female distinctions. For Christians, what is called “sex reassignment” is a denial of the integrity of one’s own sex and an overt attempt at marring the sacred image of maleness and femaleness formed by God. To tamper with one’s creation as male and female is sacrilege. We are stewards of all that God gives us, from the smallest of creatures to the uniqueness of our own body.
The cynical history of transitioning
Now, you may be asking – where did this notion that you could become the other sex even come from? How did it start? Sure, you may be a man but feel like a girl, but that doesn’t mean you can actually become one? What’s the history of it all, and how has the process of “medical transitioning” become so popular?
It all kicked off with one person – Alfred Kinsey.
Kinsey was an American biologist and sexologist who, in 1947, founded the Institute for Sex Research at Indiana University, now known as the Kinsey Institute for Research in Sex, Gender, and Reproduction. He was a social reformer who desired to rid society of Judeo-Christian values when it came to sexuality. To be fair, he largely succeeded. We have witnessed the steady erosion of biblical moral norms governing sexual behaviour. Secularism has given way in the broader culture to more permissive understandings, and new, more fundamental challenges have emerged to the very notion of biological complementarianism itself.
Kinsey and his colleagues gathered thousands of “interviews” in which he or his researchers asked detailed questions about the sexual backgrounds of research participants. Kinsey compiled the findings from these interviews into two books that were the opening salvos of the sexual revolution that soon swept the United States: Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953). Both works contain many sweeping assertions and often move quickly from tables full of data to moral speculation about the “repressed” sexual ethics of America.
Now, what has become clearer in the years since the publication of the Kinsey reports is that Kinsey was not merely gathering information about other people’s sexual experiences, but he was also engaging in assorted sexual practices with various members of the research team. Instead of the staid atmosphere most people associate with academia, his Institute for Sex Research became a kind of sexual utopia for the gratification of the appetites of Kinsey and his team. Kinsey decreed that within the inner circle men could have sex with each other; wives would be swapped freely, and wives too, would be free to embrace whichever sexual partners they liked. Kinsey himself engaged in various forms of heterosexual and homosexual intercourse with members of the institute staff, including filming various sexual acts in the attic of his home.
Make no mistake, Kinsey was an agenda-driven reformer bent on changing the sexual ethics of a nation. he wanted to “relieve” America of Christian sexual ethics, which he found “stupid”. Kinsey all-out dismissed traditional morality as mere superstition, so that we should no longer look at sexual behaviour in the categories of right versus wrong, but instead in the categories of more common versus less common. In summary, Kinsey believed that children are sexual from birth, and that true happiness was found in a life of perverse sexual experimentation, regardless of age.
Kinsey’s work has been heavily critiqued over the years. A closer look at Kinsey’s research reveals many problems with his findings. The most glaring problem with his data is the source of his sample. While the sample for “Sexual Behavior in the Human Male” numbered over 5,000, a disproportionate number came from prison inmates, many of whom were sex offenders. That’s right, his conclusions were often based on data he collected on sex offenders and child molesters (chapter 5). Furthermore, Kinsey over-sampled people recruited via homosexual-friendly organizations or magazines. College students also represented a disproportionate number of his sample. So the main problem with Kinsey’s sample is that it is obviously not the type of methodology a person would implement if he or she were trying to get a representative outlook on the sexual behaviour of the general population. In many ways, Kinsey’s sample assured he found what he was hoping to find: statistical confirmation of sexually adventurous behaviour.
Furthermore, much of what Kinsey called “data” was actually vulgar, pornographic material with no morally redeeming value. He also performed horrific sexual experiments on children, some under the age of one. His most influential book “Sexual behaviour in the human male” contains an infamous chart entitled table 34, which documents the orgasms of very young kids, including babies. Perhaps the most painful reading in the male report is the description of children who supposedly experienced orgasm, a description supplied by adults who had sex with children, describing the children “groaning, sobbing, or more violent cries, sometimes with an abundance of tears (especially among younger children)” and also children who “will fight away from the partner.” This final description sounds like a terrified child being molested.
It’s strange, given his perverse, morally absent views, that Kinsey is celebrated today by academia and Hollywood. His ideas have formed the foundation for sexual education in public schools today.
The next major figure on this subject, following from Kinsey, was a man named John William Money (July 8, 1921–July 7, 2006). Money was a psychologist and sexologist from Harvard University, internationally known for his work in psychoendocrinology and developmental sexology. He defined the concepts of gender role and identity.
Gender ideology was his brainchild. Money coined the terms gender identity and gender roles. He believed that babies are gender neutral at birth and that ultimately the environment determines whether a person is a man or a woman. He did not really believe in two genders as an absolute. His theory was that a boy could be raised as a girl, and be fine, and vice-versa.
In 1965 two twin boys were taken to be circumcised at eight months old. The first twin, Bruce, had his penis accidentally destroyed during a botched circumcision. Of course, the parents stopped the procedure on the other twin. The parents didn’t know what to do or how they would raise the child now his penis was effectively burnt off. Then Money stepped in. Money convinced Bruce’s parents to transition him into a girl. He also conducted sexually abusive experiments on the twins throughout their childhood, including forcing them to simulate sex acts on each other. Money recorded up to the age of 10 that this was a success.
It wasn’t. Bruce couldn’t accept the gender identity he was raised in, his parents told him the truth and he “transitioned” back to a boy, taking on the name “David.” In adulthood he spoke out about the abuse Money did to him as a child. Both twins suffered the trauma. Bruce’s brother died of an overdose and at the age of 38, David committed suicide after struggling with depression. Money showed no remorse. Instead, his ideas form the basis of gender ideology today.
The work of Kinsey and the later views of Money have formed the basis for gender ideology and transgenderism popularised today.
The bitter truth of sex-reassignment
Following the foundations of Kinsey and Money, we now live in a world in which the gender dysphoric person is told they can actually reassign their sex.
The dysphoric person is told that the way to deal with their dysphoria is to show a preference for their internal sense of gender as representing their true self over and against their body, so that they alter their physical characteristics, through surgery, to fit better with the gender identity. The body does not have a vote. Sex reassignment is an attempt to manipulate your sex in order to align to your perceived gender identity; the subjective over the objective.
This all presses the question – what determines your identity?
The gender dysphoric person perceives themself as not living up to those standards, rules and goals related to gender roles around their birth sex, which causes that person to raise the question “well where do I belong?” No doubt this is a difficult position to be in. The Christian narrative tells us that our identity most fundamentally flows from God and that He, through biological sciences, has defined us as male and female. But now that’s fading and our identity is often left to the shift of social views and personal feelings. To many, our innermost concept of ourselves determines our gender identity. This has resulted in the situation where a child’s mere beliefs about themselves—including their race, sex or gender—can determine their primary identity.
Beliefs about a child’s sex being assigned, perhaps by others, at birth or earlier, are fast becoming accepted as mainstream in Western society. In some important contexts the notion of biological sex is being replaced in law by gender identity. Once gender has been accepted as assigned, it can later be re-assigned through medication, by surgery, or simply by clothing and language (social transitioning). This view, which seeks to settle gender incongruence by simply affirming and normalising the child’s self-belief, is known as the “gender affirmative model”. Whilst providing psychological support this medical intervention often begins with using puberty blockers from as young as 10 years of age. This gives the child some time to think about how they want to move forward, whether they should want to continue with the sex they are born with or transition later. Puberty blockers help suppress sex hormones like testosterone and estrogen. Once these hormones are “blocked,” the physical changes that would occur during puberty are “paused.”
Now, we are told that puberty blockers are completely reversible, that once a person stops using this medication their body continues through the process of puberty just as it would have. That is not true. One of the puberty blockers used is Lupron which has a long list of side effects and is most commonly used in chemical castration. Now, because puberty blockers have only recently been introduced (at shockingly high rates), we don’t really know the full side effects. The current generation is, in effect, the lab rats.
Next, the teenager is offered opposite sex hormones (although usually they are advised to wait until 18 years of age). For males transitioning to females, such treatment can cause breast growth, body fat redistribution, softened skin, and decreased testicle size. With these opposite-sex hormones, it’s normal for the user to experience high blood pressure, weight gain, sleep apnea, elevated liver enzymes, heart disease, infertility, tumours of the pituitary gland in the brain, blood clots, and other serious conditions.
Then, finally, after they have lived in a social role appropriate to their “gender identity” for at least twelve months, can they undergo Gender reassignment surgery (GRS). In many cases this treatment causes permanent infertility.
For trans women, the surgical options to change male genitalia include orchiectomy (removal of the testicles), penile inversion vaginoplasty (creation of a vagina from the penis), clitoroplasty (creation of a clitoris from the glans of the penis) and labiaplasty (creation of labia from the skin of the scrotum). The new vagina, clitoris and labia are typically constructed from the existing penile tissue. Essentially, after the testicles and the inner tissue of the penis is removed and the urethra is shortened, the skin of the penis is turned inside out and fashioned into the external labia and the internal vagina. A clitoris is created from excess erectile tissue, while the glans end up at the opposite end of the vagina; these two sensitive areas usually mean that orgasm is possible once gender reassignment is complete. The major complication of this surgery is the collapse of the new vaginal cavity, so after surgery, patients may have to use dilating devices.
Trans women may also choose to undergo cosmetic surgeries to further enhance their femininity. Procedures commonly included with feminisation are blepharoplasty (eyelid surgery); cheek augmentation; chin augmentation; facelift; forehead and brow lift with brow bone reduction and hair line advance; liposuction; rhinoplasty; chondrolaryngoplasty or tracheal shave (to reduce the appearance of the Adam’s apple); and upper lip shortening. One last surgical option is voice modification surgery, which changes the pitch of the voice.
For trans men, as with the “male-to-female” transition, “female-to-male” candidates may begin with breast surgery. Now, usually, trans men stop there as 40% of trans men who undergo genital reconstructive surgeries experience complications including problems with urinary function, infection and fistulas.
Female-to-male genital reconstructive surgeries include hysterectomy (removal of the uterus) and salpingo-oophorectomy (removal of the fallopian tubes and ovaries). Patients may then elect to have a metoidioplasty, which is a surgical enlargement of the clitoris so that it can serve as a sort of penis, or, more commonly, a phalloplasty. A phalloplasty includes the creation of a neo-phallus, clitoral transposition, glansplasty and scrotoplasty with prosthetic testicles inserted to complete the appearance.
There are three types of penile implants: The most popular is a three-piece inflatable implant, used in about 75% of patients. As with trans women, trans men may elect for cosmetic surgery that will make them appear more masculine.
The first time I read about all these surgical procedures I was shocked. It’s a mammoth to take in. Currently the “affirmative model” which often consists of these three steps – (1) Hormone blockers, (2) opposite-sex hormones and (3) sex reassignment surgery, has become the dominant form of treatment offered to children and adolescents diagnosed with gender dysphoria in most Western nations. Now ask yourself – do you really think this is healthy for a young adult to go through? Consider what Scott Newgent (a transgender man) has to say about his experience:
“I endured medical complication after medical complication due to transgender healthcare. I lost everything I’d ever worked for… In a battle to survive, I went from ER to ER, trying to solve a mystery of why my health was failing. I learned firsthand the truth about how dangerous and perilous medical transition really is. I learned the hard way that if you get sick because of transgender health, you will witness physicians throwing their hands up and saying one of two things: 1) ‘transgender health is experimental, and I don’t know what’s wrong’ or 2) ‘you need to go back to the physicians who hurt you in the first place.’
My medical complications have included seven surgeries, a pulmonary embolism, an induced stress heart attack, sepsis, a 17-month recurring infection, 16 rounds of antibiotics, three weeks of daily IV antibiotics, arm reconstructive surgery, lung, heart and bladder damage, insomnia, hallucinations, PTSD, $1 million in medical expenses… All this, and yet I cannot sue the surgeon responsible—in part because there is no structured, tested or widely accepted baseline for transgender healthcare…”
What ignites me is that the medical industry has even encouraged children to transition. That is crazy. You don’t butcher and chop up your body to be something you are not. Use your intuition – don’t you think there is something wrong if a 16-year-old girl wants to chop her healthy breasts off? Clearly, there are going to be long-term side effects.
Long term effects
The most thorough follow-up of sex-reassigned people – extending over 30 years and conducted in Sweden, where the culture is strongly supportive of the transgendered – documents their lifelong mental unrest. Ten to 15 years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to 20 times that of the general population. The reality is that because sex change is physically impossible, it frequently does not provide the long-term wholeness and happiness that people seek.
The Aggressive Research Intelligence Facility, which conducts reviews of health care treatments for the National Health Service, concludes that none of the studies provide conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, which skewed the results in favour of physically changing sex. There was no evaluation of whether other treatments, such as long-term counseling, might help transsexuals, or whether their gender confusion might lessen over time.
In 2014, a new review of the scientific literature was done by Hayes, Inc. (a research and consulting firm that evaluates the safety and health outcomes of medical technologies). Hayes found that the evidence on long-term results of sex reassignment was too sparse to support meaningful conclusions and gave these studies their lowest rating for quality.
The Obama administration came to similar conclusions. In 2016, the Centers for Medicare and Medicaid Services revisited the question of whether sex reassignment surgery would have to be covered by Medicare plans. Despite receiving a request that its coverage be mandated, it refused, on the ground that we lack evidence that it benefits patients. Here’s how the June 2016 “Proposed Decision Memo for Gender Dysphoria and Gender Reassignment Surgery” put it:
“Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria. There were conflicting (inconsistent) study results—of the best designed studies, some reported benefits while others reported harms. The quality and strength of evidence were low due to the mostly observational study designs with no comparison groups, potential confounding, and small sample sizes. Many studies that reported positive outcomes were exploratory type studies (case-series and case-control) with no confirmatory follow-up.”
These outcomes should be enough to stop the headlong rush into sex reassignment procedures. They should prompt us to develop better therapies for helping people who struggle with their gender identity. Contrary to the claims of activists, sex isn’t “assigned” at birth—and that’s why it can’t be “reassigned.” As Christian doctrine is affirmed by scientific investigation – sex is a bodily reality that can be recognised well before birth with ultrasound imaging.
Come to terms with who you are
As we have said, gender dysphoria ought to be seen as a nonmoral mental health illness. If we don’t recognise it this way, we may attempt to discard biological sex. The fact is, being a man or woman is defined from the moment you are conceived. This is the created order of things. You can’t pick whether you are a man or a woman. It just doesn’t work like that.
For example, there has been much debate over the use of gender pronouns. Popular culture rightly asserts that language is subjective and evolves, yet it simultaneously asserts that each person’s subjectively preferred personal pronouns should be treated like objective truths by everyone else. It’s one thing for me to consider myself “sexy” and “intelligent,” but another thing entirely for me to insist you always only call me by those chosen adjectives. That doesn’t make sense. You may feel a certain way, but that doesn’t mean everyone has to agree with how you feel, or that reality must adhere to your feelings.
We live in a dangerous era where to be politically correct we must deny that anything is objectively wrong. The fact is, you can’t magically change your sex, just like how can’t magically change your age or your race. These are physical objective realities. Society has adopted the idea that your subjective experience of yourself acts as your own definition of who you are. It doesn’t. Feeling a certain way doesn’t determine who you are. Reality does not adjust itself to your own feelings and thoughts. Reality is. Feeling like a woman doesn’t make you a woman. Feeling like a man doesn’t make you a man.
If you take the route of divorcing gender from biology so that biology doesn’t determine gender, then how do you know what a man or woman even is if not defined through biology? For instance, if I ask you “what is a woman?” Try to answer that without using the term “women” (since that would be circular). How can you, without referring to biology? It doesn’t make sense. The conceptual distinction between male and female based on reproductive organisation provides the only coherent way to classify the two sexes. Apart from that, all we have are stereotypes.
Now you may use surgery to appear as a man or woman. but the truth is, you’re not. These medical procedures will butcher your body. They will harm you. There are risks. There are side effects. Medical transition is experimental, and the only long-term studies show that sex reassignment surgery doesn’t meaningfully resolve mental health issues associated with gender dysphoria.
Christians have a responsibility to avoid cooperation with actions that risk unnecessary damage, or which limit a young person’s future possibilities for healthy human growth and development. Health professionals should not disable or destroy healthy bodily organs or systems, or perform and/or advise actions that render a person incapable of parenting a child.
Christians also hold that humanity was originally created good. Each life is a gift with an inherent purpose and meaning which is to be discovered and celebrated. Our bodies, as biologically male and female, are a good God-given thing. For these reasons, Christianity rejects the “affirmation model” which prompts “transitioning” via hormonal and surgical treatment.
An increasing number of medical professionals support the Biopsychosocial model, which is more closely aligned with a Christian worldview, as it is a family-centred, more holistic approach. In this model, practitioners promote ongoing psychological support for the child or young person through engaging with families and thorough inquiry into family dynamics. Their research, together with a substantial body of work, reveals a high correlation between childhood gender incongruence and family dynamics including what are known as “adverse childhood events.” By discovering the child’s and family’s stories, practitioners are better placed to understand the gender variance felt by the child or young person within the context of family and their domestic environment. They treat adverse childhood experiences alongside the gender incongruence by using a trauma informed model of mental healthcare.
The fact is, research data strongly suggests that for the vast majority of children and adolescents, gender incongruence is a psychological condition through which they will pass safely and naturally with supportive psychological care. Portman Clinic’s treatment of a great number of children diagnosed with gender discomfort since 1989 revealed that 80% who maintained a lifestyle consistent with their birth sex chose to maintain gender identity consistent with their birth when they become adults. It’s interesting that those who resolve their dysphoria by sticking with their bodily sex never make the headlines.
Practical steps
So, what is the right way to deal with gender dysphoria? Here are just a few practical ways we can tackle this tricky situation.
As a Christian I see the value in encouraging individuals who experience gender dysphoria to seek support in keeping with their birth sex. There is evidence that someone can reduce the distress of their gender dysphoria by fostering positive relationships with others of the same sex, and feelings about their sex.
Another thing to note is that your environment has an impact. Society, which includes all of us who are not gender dysphoric, has a responsibility not to impose rigid gender stereotypes but allow someone to gravitate to his or her own interest without being ridiculed for not fitting certain cultural expectations of their gender. When someone feels ridiculed, they feel alienated; when they feel alienated they will often try and escape that stereotype to make room for their interests, even if that may mean looking to the other sex. So a person may end up questioning their gender identity because of pressures based on fears rather than on anything else.
For example, let’s say a boy likes the colour pink and his friends insult him, asking “aren’t you a boy? That’s a girl’s colour!” The young boy starts thinking he isn’t “man enough” to be male, and considers himself, as his friends have said, a girl. But these cultural expectations of masculinity and femininity, such as the idea that boys like football and girls like dolls are just generalisations, they’re not definitions for male and female.
This is one inconsistency in the modern progressive approach to gender dysphoria: we claim that “gender norms are a social construct” so they can be changed, yet we insist that if someone isn’t comfortable with the social norms of masculinity and femininity it’s not society that needs to change but their biology.
We should not treat cultural expectations of male and female as definitions. As a rule, do not impose a rigid stereotype, let the young boy admit he likes the colour pink and not be told he is less of a man for doing so. Either we say that gender is not a social construct and society is objectively correct that pink is a girl’s colour (so he’s a girl), or we just say he’s a boy who likes pink. Rigid cultural stereotypes of masculinity and femininity are thus unfortunate and undesirable because they can create unreasonable pressure on children to present or behave in particular ways.
Another way to deal with dysphoria is to be wise about what triggers the discomfort. Some who experience gender dysphoria will often use methods of self-discipline to avoid whatever experiences or events cause the discomfort to increase or to intensify. Just as an alcoholic would be wise to avoid the pub, so the dysphoric individual would also be wise to avoid the environments which trigger their discomfort too much.
Also, as a final thought, and from a Christian perspective, we have faith. Experience teaches that feelings of incongruity between one’s birth sex and gender identity usually do not instantly disappear just because a transgender person finds faith. Of course, the same is true for other mental illnesses, besetting sins and long-term struggles such as substance addiction. While there are genuine testimonies of instantaneous deliverance, these are rare. Trusting and following God usually consists of a long obedience in the same direction.
Many times there isn’t any one practical solution that will satisfy our heart’s longing. Someone’s gender dysphoria doesn’t take them away from God the same way my temptations and natural struggles do not take me away from God. It’s acting upon our natural desires through immoral resolutions which damage our relationship with God. The gospel’s message is redemption, that those who redirect their lives back to God will one day be with God, separated from the pain and struggles at war in this world. As Christians we have the hope of eternity in God’s grace and perfection, a work of love which will abide forever, an identity which does not change, is not moved and cannot be taken. On this identity as a child of God, all other discomforts weaken. So, for any Christians experiencing gender dysphoria, keep your eyes on the hope set before you.
Further Reads:
What Is a Woman?: One Man’s Journey to Answer the Question of a Generation – By Matt Walsh
Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture – By Mark A Yarhouse
