From bathroom laws to birth certificates, transgender rights often occupy the headlines. While we listen to these highly charged political conversations happening in the public sphere, there are also people in our churches who are personally experiencing transgender feelings. This can be difficult and confusing to respond to as a Christian, and it’s something that the church is only recently learning to respond to. As Christians it’s important that we give thought to these issues. I hope this article will give a framework for doing this, and that together we can work out how to best love our brothers and sisters who are struggling with gender confusion.
Longing for change
It looks different for each person, but generally the term ‘transgender’ applies if someone’s sense of gender identity and biological sex don’t align. It’s feeling like your body and mind don’t match up; like the body you have is wrong for who you actually are. The transgender experience is often one of longing for change—for a new body that expresses the person you feel you truly are. The intensity of these feelings can vary. Many people with transgender feelings opt not to express this in an obvious way. Some, however, experience gender dysphoria, where these feelings are acutely distressing and debilitating. (Studies suggest a prevalence of around 1 in 10,000 men and 1 in 30,000 women experience this.) People experiencing dysphoria are much more likely to pursue bodily change through hormone therapy and/or surgery.
What causes this inner conflict? There are various theories about the hormones experienced in utero and various childhood factors, though no-one is sure quite how it all works. But fundamentally, the answer is that it’s because this world is broken. Genesis 3 and Romans 8 remind us that since the sin of the first man and woman, all of creation is out of whack—not least, us humans. The Fall is responsible for this painful experience of confused gender identity. It is through no particular fault of their own that Christian brothers and sisters sometimes face these feelings.
The difficulty with change
How, then, should a Christian respond when a brother or sister struggles with gender identity issues? We need to listen, care, help them love and serve Jesus, and seek biblical wisdom. We must remember that these feelings are not the result of a sinful choice, but a symptom of living in a fallen world. Yet we must also hold onto this: that gender is a good thing, given by God. It has a high value because it is used to reflect things of high value. Genesis 1:27 suggests that the unity and difference of male and female reflects something of God’s own person. Even more, the way we relate as men and women in the home and in church is intended to depict the gospel. A big reason gender is such a good thing is the way it is used to reflect Christ and the church (Eph 5:22-33). As we take on our gender roles, we get to imitate the precious story of Christ’s sacrificial love for his people and their joyful response to him. This is something to embrace!
Yet we mustn’t downplay the fact that for some this will be a struggle. What’s more, some cultural gender norms are unhelpful and alienating. Christians should seek not to be overly constrictive. The Bible disapproves of rejecting gender distinctions (which are usually expressed in culturally recognisable ways), but getting this right ultimately comes back to having a right attitude, rather than having the right stereotyped hobbies or dress etc. We can help those who wrestle with their gender identity by not equating manhood with being muscly and sporty or womanhood with a love for baking and rom-coms. Nevertheless, gender is a good thing to accept and trying to blur boundaries or identify as neither gender is not good (consider Deuteronomy 22:5 and 1 Corinthians 11).
But what do we make of changing the body to fit the mind? This is an understandable desire, but Christians tend to advise against this for the sake of the person’s wellbeing as well as for theological reasons.
On the theological level, the normal Christian understanding is that God’s intention is for the body to generate gender. The Fall does not change this pattern, though it sometimes frustrates it. Body and soul are intertwined and both are given to us by God. In the case of a disharmony between the two, most Christians see the brain as the location of this disconnect. If it feels like mind and body are in conflict, the logical way to try and harmonise the two would be through counselling. There are often other psychological issues that individuals in this situation need to address too; so the first step is always to seek help in this regard. (This is not at all to say that counselling will solve everything or is the only valid consideration, but it is certainly the first response.)
Further, some argue that any changes to the body will always be artificial and won’t go the whole way to being able to express all that God intended for gender to be. Christian ethicist Oliver O’Donovan suggests that there is a teleology to biblical sex and gender—it has a purpose, a narrative written by its Creator. Movements away from truly male or female bodily sexuality represent a movement away from the acceptance of God’s full intent for gender. Further to this is the fact that the Bible never endorses anyone living outside of their birth sex but does condemn cross-dressing in Deuteronomy 22:5. For these and other reasons, many Christians do not feel comfortable condoning any movement away from one’s birth sex.
Practically speaking, sex change is very invasive and experienced medical professionals have unpopularly observed that it often isn’t helpful in the long run. You can’t change someone’s sex on the DNA level, so you’ll always be fighting against this by ongoing use of hormones. Some studies of people who’ve had Sex-Reassignment Surgery (SRS) have noted positive outcomes in the short term, but the most comprehensive and long-term study into this area shows very negative outcomes. It is noted that post-surgery transsexuals have much higher suicide and death rates and poorer mental health than population controls in the long run. This might be partly due to poor follow-up treatment or social stigma, but it may also be an indication that surgery and ongoing hormone use really do have a negative effect in many cases.
Some consider SRS to be a legitimate last resort; unideal but a concession that may sometimes be necessary given the crippling nature of dysphoria. Many experts are convinced that surgery does not deliver the relief and wholeness that sufferers crave and instead burdens them with numerous new health problems and risks. For this reason, Christian health professionals tend not to advise this course of action for those experiencing dysphoria. Like many other aspects of living in a broken world, this is a difficult situation where the way forward can be very hard to navigate. The clear preference for the Christian is to seek to reconcile with one’s birth-sex as far as possible. This corresponds with biological reality, affirms one’s God-given identity and the full purposes of gender, and is the least invasive option.
Whatever you make of these arguments, they should never lead us to fear or malign any transgender person. And if someone who expresses their gender identity in an unconventional way comes to our church, our priority remains to speak to them the good news of the risen Lord Jesus. We must be people who show love by listening and seeking to understand the other person’s experience. But if a member of our church is grappling with transgender feelings, we mustn’t be afraid to suggest that there are very good reasons not to seek to change their body.
Looking forward to change
We can’t solve the messiness of living in this world. There will never be an easy answer. But there are some things that are clear. The Christian who endures this struggle can await with joy the day when God will remake all things. Through Christ he has mercifully atoned for our sin and will one day free all of creation from suffering. The one who hungers now will be released from their hunger. When Jesus returns, we will be changed in mind and body (1 Corinthians 15). For those who experience a disconnect between the two, that painful tension will be gone. This day might feel far too far off, but it is coming.
And in the mean time, we wait. Waiting is the task of every Christian, yet some feel this more acutely. Each one of us has the privilege and responsibility of praying with and for our brothers and sisters who are struggling. Grappling with gender identity will be a difficult burden for some. We need to remind them that it’s not sinful to experience these feelings, and point them to Jesus’ compassion for the broken. We need to pray alongside them for self-acceptance and a sense of wholeness in Christ, acknowledging that these might not be fully achieved in this life. We long for the complete restoration of ourselves and creation at Jesus’ return; meanwhile we weep with those who weep (Rom 12:15). Creation groans, awaiting its freedom from bondage to decay, and it’s right that Christians groan too, longing for this day (Rom 8:19-23). And so, as we look to the future promised to us in Christ, we stand beside those experiencing gender dysphoria, sharing their burdens as best we can and encouraging them to persevere until the glorious day when our Lord Jesus returns.
Vaughan Roberts, Transgender (The Good Book Company).
Mark Yarhouse, Understanding Gender Dysphoria (IVP Academic). 
Patricia Weerakoon, ‘Intellect—Sex, Gender and Identity’, Wagga Wagga Baptist Church (Vimeo), 24 March 2017.
 Please note that this article is written specifically to address the topic of gender dysphoria in adults. When experienced by children, gender non-conformity, gender experimentation and even cases of gender dysphoria must be understood along different lines. Recently, medical practictioners have been quick to commence social and physical gender transitioning if a child expresses these feelings, yet researchers who do not share a bias towards modern gender theory are unanimous to point out that for the vast majority of these children, these feelings subside naturally if intervention is not given. For more on this topic, see the work of Dr John Whitehall.
 Mark A Yarhouse, Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture, IVP Academic, Downers Grove, Illinois, 2015, p. 112.
 Zucker, Lawrence and Kreukels, ‘Gender Dysphoria in Adults’, Annual Review of Clinical Psychology, vol. 12, March 2016.
 For more, see Oliver O’Donovan, Begotten or Made?: Human Procreation and Medical Technique, Oxford University Press, Oxford, 1984.
 Cecilia Dhejne et al., ‘Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden’, PLOS ONE, vol. 6, no. 2, February 2011: e16885.
 Now would be an appropriate time to mention that pastoral workers should always be quick to refer to mental health professionals when someone is struggling. We listen, pray and offer our thoughts when appropriate but must never assume the role of a psychologist or doctor without the necessary training.
 Yarhouse takes a position that hormone treatment or surgery might be a necessary (though unideal) last resort in some cases. It should be noted that other likeminded Christian experts in the field who had previously agreed with this position have since concluded that this doesn’t ultimately help and just creates new problems for the person concerned.