The following is adapted from the second of two lectures—the Fifth Annual B. B. Warfield Lectures—delivered in October 2016 at the invitation of Erskine Seminary and First Presbyterian Church, Columbia, SC.

Allow me to introduce my topic by way of three short stories. First, the story of Bill—or rather a bill, namely, House Bill 2. On February 22, 2016, the Charlotte City Council passed by a 7-4 vote Ordinance 7056, the stated purpose of which was to prohibit discrimination on grounds of sexual orientation or gender identity in public accommodations, include public bathrooms. This provoked a vigorous debate because the ordinance would have given a biological male who claims to have a female gender identity the legal right to use a public bathroom designated for women (and contrariwise for a biological female who claims to be male). The following month, the North Carolina Senate and House of Representatives passed the Public Facilities Privacy & Security Act—popularly known as House Bill 2 (HB2)—which legislated that in government buildings people may only use bathrooms that correspond to the sex on their birth certificates.

HB2 ignited a firestorm of debate across the nation. It was widely and vehemently criticized for discriminating against transgender people and thereby violating their civil rights. Some opponents characterized it as the most anti-LGBT legislation in the United States to date. Prominent celebrities, businesses, and sports associations vowed to cancel events and withdraw investment from North Carolina because of HB2. In addition, the U.S. Department of Justice announced that it would be suing North Carolina Governor Pat McCrory, the North Carolina Department of Public Safety, and the University of North Carolina, on the grounds that HB2 violates Title VII of the Civil Rights Act, Title IX of the Education Amendments of 1972, and the Violence Against Women Act.

The second story comes courtesy of the New York Times. On September 16, 2016, the newspaper published an article in its “Modern Love” series with the title “From He to She in First Grade.”^[1] The article began thus:

When our son turned 6, my husband and I bought him a puppet theater and a chest of dress-up clothes because he liked to put on plays. We filled the chest with 20 items from Goodwill, mostly grown-man attire: ties, button-down shirts, a gray pageboy cap and a suit vest.

But we didn’t want his or his castmates’ creative output to be curtailed by a lack of costume choices, so we also included high heels, a pink straw hat, a dazzling fairy skirt and a sparkly green halter dress.

He was thrilled with these presents. He put on the sparkly green dress right away. In a sense, he never really took it off.

The author recounted how her son continued to wear dresses and other girls’ clothing right up until the day he started school. His mother and father discussed with him whether he wanted to wear those clothes to school, knowing that he would probably be ridiculed and bullied, but he insisted that he wanted to do that—and that’s exactly what he did.

At the end of the first week of school, the boy was quite upset at bedtime, so his mother told him that he could go back to wearing boys’ clothes if he wanted. Her son replied, “No, Mama. I already decided about that. I never think about that anymore.” The author concluded:

He had already decided. He didn’t think about that anymore. And he—she—never looked back. She grew out her hair. She stopped telling people she was a boy in a skirt and started being a girl in a skirt instead.

And we, as a family, decided to be open and honest about it, too, celebrating her story instead of hiding it.

Two years later, our daughter still sometimes wears the green dress, for dress-up and to put on plays, as we imagined her doing in the first place. Now that she can be who she is on the inside and on the outside, on weekdays as well as on weekends, at home and everywhere else, the sparkly green dress has once again become just a costume.

The third story comes from a 2008 article in the Christian Research Journal by Joe Dallas.^[2]

Kim was the most handsome client ever to step into my office. As a pastoral counselor, I work with men wanting to overcome sexual sins, many who, as a first impression, present themselves as self-absorbed, male model types, so an attractive man asking for help wasn’t unusual. But tall, muscular, and square jawed Kim immediately stood apart.

“Since this is your first appointment,” I said, while Kim completed an intake form, “let’s talk about the problem that brought you here.”

My new counselee signed the form, fixed a steady gaze on me and dropped the bomb.

“The problem is my chromosomes. I was born female.”

I was astonished, and after two decades of counseling porn addicts, homosexuals, prostitutes, and an occasional sex offender, I don’t shock easily.

“I’ve lived most of my life as a man,” she continued, “and it’s worked! I finally had sex change surgery three years ago, and I’ve been living with a woman since then. But two weeks ago I got saved at a Harvest Crusade. I’m a new Christian, so… now what?”

Clearly these three stories share a common theme: the rise of transgenderism, both as a social phenomenon and as a cultural movement. But they present very different perspectives on that common theme, and they invite different kinds of responses from Christians. The first story is primarily political in nature. The second story is more broadly cultural and raises issues about parenting. The third highlights the pastoral challenges presented by transgenderism. Together they underscore what a complex and challenging cluster of issues we find before us as Christians.

Why is transgenderism an issue all of a sudden? Where did it come from?

In many respects, it isn’t a new issue at all. The first documented male-to-female sex reassignment surgery took place in 1930.^[3] Cases of gender confusion—the perception that one’s gender doesn’t align with one’s biological sex—go back even further in history. The practice of transvestitism traces back at least to the time of Moses.^[4] What’s new at this point in human history is the mainstreaming—the normalization—of transgenderism, driven not only by the power of popular culture (the media, Hollywood, etc.) but increasingly with the force of government as well.

Evidently this is a subject that Christians cannot ignore or evade. We need to evaluate and respond to the issue—or rather the issues—very carefully. What’s more, we need to do so in a consistently Christian fashion. In this lecture, I offer an introductory assessment of transgenderism from a Christian perspective.^[5] I will begin with some important definitions and distinctions, before reviewing some basic facts about transgenderism that will set the stage for later analysis. After a brief discussion of the role that worldviews play in shaping people’s views on transgenderism, I will sketch out (drawing on John Frame’s analytical scheme) a triperspectival assessment. Finally, I offer some brief remarks on Christian responses to the challenges presented by transgenderism.

I. Definitions

Clear definitions are essential for responsible discussions of controversial topics, but we should note that definitions are never entirely neutral. They inevitably frame the issues in a particular way, and sometimes in a prejudicial way that nudges us into conceding questionable assumptions or value judgments. If I were to define Presbyterianism as “that form of Protestant Christianity which seeks to model its ecclesiology and sacramentology on the Bible,” I suspect my Baptist brethren would take issue with that definition—and rightly so—because a prior theological evaluation has been built into the definition.

That caveat aside, I hope here to provide some definitions of key terms that are consistent with a biblical perspective but also avoid prejudging the issues by begging the question or “rigging the deck” when it comes to a Christian assessment.^[6]

Ontological sex—a (human) person’s basic sexual identity as either male or female. When you are invited to complete a form by checking one of two boxes—‘M’ or ‘F’—you are being asked, in essence, to indicate your ontological sex.

Biological sex—male or female according to chromosomes (XX/XY) and physiology (both internal and external, e.g., genitalia and reproductive organs).^[7] Throughout human history, biological sex has been the primary indicator of ontological sex; that’s to say, we identify a person as male or female based on his or her physiology. Nevertheless, it’s important to distinguish the concepts of ontological sex and biological sex for the simple reason that we are more than just biological organisms; there’s more to us than our physiology.

Gender—the psychological, social, and cultural manifestations of maleness and femaleness. This is obviously a much broader category than biological sex. For example, our notion of motherhood goes beyond the merely biological notion of being a female progenitor. It includes other non-biological features such as maternal attitudes and social roles. Some aspects of gender may be culture-relative (e.g., wearing make-up is considered feminine in many but not all cultures) while other aspects are transcultural (e.g., military leadership as a characteristically masculine trait).^[8]

Gender identity—how one perceives and experiences oneself as male or female. This is a highly loaded term in contemporary discussions, so we need to be very careful about how we define and deploy it. Arguably the term was coined with the specific purpose of advancing an ideological agenda (cf. ‘sexual orientation’). The use of the word identity here is especially problematic, since it suggests that one’s core identity as a human person is defined in terms of one’s gender.

Nevertheless, such concerns aside, the basic idea behind the term ‘gender identity’ can be grasped by posing this question: Do you feel male or female? Your ‘gender identity’ is your answer to that question. Whether or not we accept the terminology, it seems to me that this is a question most people are able to answer in a meaningful fashion regardless of their views on transgenderism. Indeed, gender dysphoria and transgenderism wouldn’t even exist as topics of discussion were it not for the fact that some people answer that question in ways other than their biology would indicate.^[9]

With these four definitions in place, we’re now in a position to define three further terms: gender dysphoria, transgender, and transsexual.

Gender dysphoria—the (typically distressing) experience of incongruence between one’s biological sex and one’s gender identity. In other words, a man who feels that he is a woman, or a woman who feels that she is a man, has gender dysphoria. Moreover, this internal sense of incongruence can vary in degree: there can be mild, moderate, and severe cases of gender dysphoria.^[10]

Transgender—a broad umbrella term used to describe a person who experiences or expresses a gender identity other than his or her biological sex.

Transsexual—a person who is living as a member of the opposite sex (with respect to his or her biological sex). Such a person may or may not have pursued so-called ‘sex change’ or ‘sex reassignment’ treatment (typically involving hormone therapy and plastic surgery).

II. Facts

Let’s now review some basic facts which a Christian assessment of transgenderism ought to take into account. Just as there are no neutral definitions, there are also no neutral facts. All ‘factual’ claims have been subjected to some degree of interpretation. All ‘facts’ have presuppositions. What I describe here are simply some widely agreed upon claims.

1. According to one recent estimate, about 0.6% of American adults identify with a gender other than their biological sex (i.e., 6 in 1000).^[11] These people would be categorized as ‘transgender’ according to the definition given above.

2. The numbers of adults clinically diagnosed with gender dysphoria is markedly lower, because the criteria for that diagnosis are much stricter. According to one estimate, fewer than 1 in 10,000 adult males and fewer than 1 in 30,000 adult females suffer from gender dysphoria.^[12] (Estimates vary widely, partly because the criteria for diagnosis are not consistently understood and applied.)

3. Among pre-pubescent children who experience gender confusion, the majority discover that it decreases over time as they enter and pass through adolescence.^[13] Nevertheless, a significant proportion of them go on to identify as either homosexual or bisexual in adulthood.

4. The causes of gender dysphoria are basically unknown.^[14] As one might expect, there is a vigorous debate over whether the condition is primarily a matter of nature or nurture, but there is nothing close to a scientific consensus on the issue. It remains an open question. Consequently, there’s an equally vigorous debate over how gender dysphoria ought to be treated.

5. People who identify as transgender are at a significantly higher risk of mental health problems such as depression, anxiety, and substance abuse.^[15] That is an established statistical fact, although the explanation of that fact is debated. Furthermore, suicide rates among transgender people are significantly higher than for the U.S. population in general.

6. Shifting focus to the cultural and political spheres, here is another fact: there is a growing movement within our culture and within the government to include ‘transgender rights’ under the umbrella of civil rights, alongside racial equality and sexual equality. One prominent illustration comes from a briefing report by the U.S. Commission on Civil Rights published in September 2016. I quote here from the “Letter of Transmittal” contained within the report (emphasis added):

The United States Commission on Civil Rights (‘the Commission’) is pleased to transmit our briefing report, Peaceful Coexistence: Reconciling Nondiscrimination Principles with Civil Liberties.

The report examined the balance struck by federal courts, foremost among them the U.S. Supreme Court, in adjudicating claims for religious exemptions from otherwise applicable nondiscrimination law.

The Commission heard testimony from experts and scholars in the field and a majority of the Commission made findings and recommendations. Some of those findings were that:

1. Civil rights protections ensuring nondiscrimination, as embodied in the Constitution, laws, and policies, are of preeminent importance in American jurisprudence.

2. Religious exemptions to the protections of civil rights based upon classifications such as race, color, national origin, sex, disability status, sexual orientation, and gender identity, when they are permissible, significantly infringe upon these civil rights.^[16]

The point is this: there is a significant political movement pushing for so-called transgender rights, and these rights are understood to conflict at points with religious freedom and exemptions to protect the consciences of religious believers. This is openly acknowledged by people on both sides of the debate.

III. Worldviews

How you think about transgenderism will depend largely on your anthropology, that is, your view of human nature—what we are and what we’re supposed to be. Furthermore, your anthropology will depend in turn on your broader worldview: your view of God, ultimate reality, truth, meaning, value, and so forth. Having discussed at length the relationship between anthropology and worldview in my previous lecture, I want now to apply that broader framework to the specific issue of transgenderism.^[17] So let’s consider briefly how worldviews have shaped thinking about this issue among both non-Christians and Christians.

Here’s a summary of what we might call the “mainstream narrative” on transgenderism—the narrative we find represented in most mainstream media outlets, in popular movies and TV shows, and by progressive politicians and celebrities. In the past, people took for granted that gender and sexuality were simple matters: you were either born a man or a woman, and that was the end of it. But now we know better: we understand that gender and sexuality are more complex than previous generations understood.^[18] There’s a difference between biological sex (or ‘birth sex’) and gender identity. Some people have a gender identity other than their biological sex, and thus we have cases of “a man born in a woman’s body” and “a woman born in a man’s body.” In fact, gender identity is itself complex: it’s a continuum rather than a binary. Some people are just more male than female and vice versa. Indeed, some people are neither male nor female; they don’t identify with either gender. Thus, we need new categories such as ‘genderqueer’ and ‘genderfluid’.^[19]

Amidst all this complexity and fluidity, however, there is one central axiom: gender identity reflects a person’s true identity. It represents “who they really are.” Consequently, they should be able to express that gender identity as they see fit, without fear of judgment or disapproval or discrimination. It’s a basic human right for a person to live according to their gender identity.

This means that gender identity must trump everything else: biological sex, physiology, birth certificate, and so on. And if a person is unhappy with their biological sex, physiology, etc., they have the right to pursue whatever means are available to ‘correct’ it. What’s more, everyone else must respect and support their right to do so.

The most recent chapter in this narrative pertains to parenting. Parents now need to be aware that they might have a transgender child, and those who do have an obligation to affirm and accommodate their child’s gender identity.

Such is the mainstream narrative, and we can identify some key themes that drive this narrative:

• Gender identity (understood as a core identity, defining “who I am”)
• Sexual diversity and liberty
• Civil rights (the LGBTQ movement being understood as the latest front)
• Tolerance and non-discrimination
• Science and technology (the main hope for solutions to human problems)

The mainstream narrative on transgenderism is just one among many interrelated cultural narratives that are being promoted in our day. We need to recognize, however, that cultural narratives aren’t self-sustaining or free-floating. They need to be situated within a worldview that makes them meaningful, intelligible, and plausible. Simplifying somewhat, we can identify two secular worldviews that have shaped and supported the mainstream narrative outlined above.^[20]

Naturalism

Naturalism is the view that nature is all there is, where ‘nature’ is basically understood as whatever can be studied scientifically. For the Naturalist, the natural universe—the physical cosmos—is the only reality that exists (or at least the only reality that matters). According to Naturalism, everything has (ultimately) a scientific explanation, and that must include human nature and human experiences.

According to the standard origins story of Naturalism, we are the products of undirected naturalistic evolutionary processes. We’re highly evolved animals with some unique abilities. On this view, there is no transcendent purpose or meaning to human life. If there is any meaning to human life, it is one that we create for ourselves.

It’s no secret that Naturalism has a hard time accounting for objective moral laws ^[21] On what basis can a Naturalist argue that some human behaviors are objectively morally right while others are objectively morally wrong? If Naturalism were true, why would there be laws of morality that stand over us? How could there be?

In the absence of any better moral theories, Naturalists will commonly adopt some version of utilitarianism, according to which morality is defined in terms of whatever maximizes pleasure and minimizes pain—“the greatest happiness for the greatest number,” as Jeremy Bentham famously expressed it.

How then would a Naturalist view of transgenderism? A Naturalist will typically want to say that gender identity is a psychological phenomenon rooted in the physical brain. For the Naturalist, all human experiences reduce to brain science. And so there have been various scientific studies seeking to demonstrate some correlation between gender identity and brain structure or brain chemistry.

Furthermore, a Naturalist will be inclined to say that transgenderism is just one facet of human biological diversity, of natural variation within a species. There’s no right or wrong about it. Transgenderism isn’t a disorder or dysfunction because, on the Naturalist view, there’s simply no right way or a wrong way for a human being to be. We are what naturalistic evolutionary processes have made us—end of story.

If anything can be said to be ‘wrong’ it’s that some people are unhappy with their bodies. They have a male body and a female brain, or vice versa, and that incongruity causes them pain; it causes emotional suffering. Thus, if they’re going to be happy, one or other—the body or the brain—needs to be changed.

So which must change? For the Naturalist, it’s the body that will have to change, for two basic reasons: first, it’s generally easier (and safer) to modify the body than to tinker with the brain; secondly, our personal identity is more closely associated with our brain, because the brain is the seat of consciousness (and thus of self-consciousness). From the Naturalist’s perspective, then, it makes sense for a transgender person to pursue ‘sex reassignment’ treatments.

Postmodernism

Postmodernism—to simplify matters to an almost criminal extent—can be characterized as the view that there are no absolute norms and there is no objective reality. According to this worldview, reality isn’t something objective “out there” to be discovered. It isn’t something that exists independently of our thoughts and our language. Reality is something we create or construct by the way we think about and speak about our subjective experiences. That means, of course, that truth is always relative; it is relativized either to the individual subject or to groups of subjects (communities or societies).

Consequently, the Postmodernist will have quite a different take on transgenderism than the Naturalist. For the Postmodernist, ‘gender’ is a fluid social construction that isn’t anchored to any objective biological categories. It isn’t a category imposed on us by nature; rather, it’s a category we invented and which we impose on our ourselves. So gender identity isn’t rooted in brain physiology (as the Naturalist holds) but is entirely a matter of personal preferences and self-perceptions.

Put simply: what you are is what you perceive yourself to be. In fact, more strongly: what you are is what you conceive yourself to be. For self-conception is more powerful than mere self-perception. On this radical view, you have the freedom and the right to define yourself, indeed to redefine yourself, without limit. And if your physical appearance doesn’t currently align with your self-defined identity, then your physical appearance needs to get in line.

Thus, we have before us two secular worldviews which, in quite different ways, provide a broader framework for the mainstream narrative on transgenderism. The great irony is that these two worldviews aren’t consistent with each other. They make some fundamentally incompatible claims. On the Naturalist view, gender identity is a kind of biological fact; it’s an objective truth about a human being that can be scientifically explained and justified. On the Postmodernist view, however, gender isn’t a biological fact but rather a social construction; it’s something we created rather than something nature gave us. Gender identity, to adapt a phrase, is “created, not begotten.”

Despite these fundamental disagreements, however, we find that these two worldviews frequently get mixed up together whenever the mainstream narrative on transgenderism is defended. What’s more, we should recognize that these two worldviews—Naturalism and Postmodernism—do have one tenet in common: an axiomatic commitment to human autonomy. Both proceed from an absolute denial of any transcendent divine norms.

What then is the overarching lesson to draw from these observations? Simply this: when we approach the issue of transgenderism, we need to be aware of how the issues and the overarching narrative have been supported and shaped by secular worldviews that are committed to human autonomy. We must not look at the issue through those warped lenses. Rather, we must view the issue through the lens of a Christian worldview: a worldview that represents a biblical perspective on God, creation, revelation, human nature, moral laws, the fallenness of this world, and what God has done and is doing to redeem this fallen world.

IV. A Triperspectival Assessment

Let us turn now to what I trust is a distinctively and faithfully Christian assessment of transgenderism, both as a condition (i.e., gender dysphoria and its treatment) and as a cultural movement. As a guiding schema for that assessment, I propose to make use of John Frame’s triperspectival approach to ethics, which is developed in greatest detail in his book The Doctrine of the Christian Life.^[22] Frame contends that any issue in Christian ethics can be considered from three complementary perspectives: the normative, the situational, and the existential. Let us consider then the issue of transgenderism through these three conceptual portals.

Normative Perspective

The normative perspective invites us to ask, “What are the norms or standards that apply here?” Perhaps the first and most general thing to say is that God himself is our ultimate norm.^[23] God himself is the final standard of what is true, good, and beautiful. That entails an utter repudiation of the kind of human autonomy reflected in the two secular worldviews outlined above.

God, as the author of creation, defines his creation. God, as the creator of humankind, defines what it means to be human. We simply do not get to define what we are or who we are!

In matters of Christian ethics, God’s norms are expressed to us primarily in his laws. God’s laws are what we might call our proximate norms. In the first place, we have what Reformed theologians have called creation ordinances: moral laws grounded in the order and design of creation.^[24] The most immediately relevant creation ordinance is that of human sexuality and family relationships:

So God created man in his own image, in the image of God he created him; male and female he created them. And God blessed them. And God said to them, “Be fruitful and multiply and fill the earth and subdue it…” (Genesis 1:27–28)

Therefore a man shall leave his father and his mother and hold fast to his wife, and they shall become one flesh. (Genesis 2:24)

It could hardly be clearer from the creation account that God did not intend sexuality and gender to be fluid and expressed on a continuum. Indeed, the assumption throughout the Bible is that there are two sexes, male and female, and the primary determiner of a person’s sex is physiology. We’re embodied beings and our sexuality is expressed through our bodies. The creation account thus establishes some foundational norms of human sexuality.

Secondly, we have the Decalogue—the Ten Commandments—which the Reformed tradition has consistently taken as a summary of God’s moral law. A number of these commandments are directly relevant to transgenderism.

The First Commandment: “You shall have no other gods before me.” Once again, we find here an implicit repudiation of human autonomy, which is a form of idolatry—treating the creature as though it were the Creator. We should recognize that the LGBT movement represents a form of idolatry: treating human sexual experiences as a greater authority than the Word of God. Whatever our response to transgenderism, gender dysphoria, and so forth, it must be a response that seeks to interpret human experiences in light of God’s Word rather than the reverse.

The Fifth Commandment: “Honor your father and your mother.” This commandment presupposes parental authority and leadership. It stands firmly against the idea that a child should set the agenda regarding his or her ‘gender identity’. The commandment also implies parental oversight and care for children, and thus the protection of children within a proper family structure. This clearly has major implications for ‘transgender parents’ (especially the cases of ‘transgender men’ who conceive and give birth, cases which we should expect to increase in number as transgenderism becomes even more mainstreamed).^[25]

The Sixth Commandment: “You shall not murder.” This commandment enjoins the preservation and protection of human life, and thus has implications for (among other things) ‘sex reassignment’ treatments, many of which carry significant health risks.

The Seventh Commandment: “You shall not commit adultery.” This commandment presupposes the biblical understanding of marriage as a covenant between one man and one woman, which in turn presupposes the basic binary of sexual differentiation established in Genesis 1 and 2.

The Ninth Commandment: “You shall not bear false witness.” According to the Westminster Shorter Catechism, “The ninth commandment requireth the maintaining and promoting of truth between man and man, and of our own and our neighbor’s good name, especially in witness-bearing.” This has obvious implications for ‘sex reassignment’ treatments: if biological sex is indeed the primary indicator of ontological sex, then such treatments are a form of deception—an elaborate charade—in which people attempt to present themselves falsely as members of the opposite sex.

We can see, then, that from a normative perspective the Bible has much to say about how we should understand and evaluate these issues.

Situational Perspective

The situational perspective invites us to ask, “How does our situation bear on the issue?” Our situation typically includes our environment, facts about nature, our cultural circumstances, and so forth. Ethically relevant information about our situation can come not only from the Bible but also from sources outside the Bible, such as responsible scientific research.

A great deal could be said about transgenderism from the situational perspective, so I must be very selective here. Perhaps the most fundamental thing to say about our situation is that we live in a fallen world. The human race is a fallen race. We are broken people: morally, physically, emotionally, psychologically. Furthermore, the natural world in general is under a curse.^[26]

One crucial implication is that in a fallen world we need to draw a distinction between what is natural and what is normal. That something occurs ‘naturally’ does not imply that it is right or good. (This stands in direct contradiction to the “born this way” narrative promoted by many LGBT campaigners.) This basic fact about the world also means that human experiences must not be treated as normative. Our experiences, feelings, and perceptions are all corrupted by sin, and thus they always need to be interpreted and critically evaluated in the light of God’s revelation.

The situational perspective also encourages us to incorporate relevant scientific information into our assessment, such as the following:

• The causes of gender dysphoria are presently unknown, although the evidence indicates that it is a genuine psychological condition, that it can vary in degree, and that it’s typically something people find themselves with (rather than something chosen or self-imposed).^[27]
• The majority of childhood cases of gender dysphoria resolve naturally over time.^[28]
• While a number of studies have been conducted, there is no solid scientific evidence that sex reassignment treatment is an effective solution to gender dysphoria.^[29] Sex reassignment surgery is a major undertaking and has significant health risks associated with it.^[30] It is very far from being risk-free or harm-free. We must not overlook the central fact that many advocates of such treatment want us to overlook: it involves the surgical alteration of an otherwise healthy human body. It doesn’t correct a physical deformity, but rather deforms what is otherwise physically correct.
• From a scientific perspective, it is impossible to change one’s biological sex (a fact underscored in the most excruciating way by the cases of ‘transgender men’ becoming pregnant).

One last point to note under the situational perspective: that something is scientifically possible doesn’t mean it is ethically permissible.^[31] This ought to be too obvious to state, but unfortunately we are faced with a major problem today inasmuch as public ethics and public policy, rather than constraining scientific research and technological developments, are being dragged along in their wake.

Existential Perspective

The existential perspective in Christian ethics places the spotlight on the individual person involved in moral decisions and actions; that person’s character, motives, emotions, experiences, and internal faculties. The existential perspective focuses especially on what the Bible calls the heart: the inner core from which all thoughts, words, and actions proceed.

As with the other two perspectives, numerous points could be raised and discussed under this heading; I will restrict myself here to two particularly pertinent ones.

First, we must acknowledge that the human heart in its natural state is fallen and corrupt. “The heart is deceitful above all things, and desperately sick; who can understand it?”^[32] All of us ought therefore to be very skeptical about what our hearts are telling us about who we are, what is right for us, how we should find fulfilment, and so on. Spurgeon hit the nail on the head when he quipped, “The most difficult book you will ever read is your own heart.” We ought to have a natural distrust of our self-perception. This obviously has implications for how we think about ‘gender identity’ and thus how we evaluate gender dysphoria.

Secondly, the existential perspective draws our attention to issues of self-identity. What defines us? What makes us who we are? In what should we locate our identity? I believe we can see two closely related errors in the transgender movement:

• the idea that we should locate our identity in our gender or sexuality
• the idea (and the deeper error) that we ourselves define our identity

Both are expressions of autonomy and idolatry. The biblical view is that God defines us and we find our identity in him—more specifically, if we are believers, we find our identity in Christ.^[33]

Summary Conclusions

Tying together the threads of this triperspectival analysis, I draw the following conclusions:

• Gender dysphoria is a real condition and is best understood as a psychological disorder or dysfunction (and perhaps more deeply as a spiritual disorder).
• Sex reassignment treatment is not the way to address gender dysphoria. If anything, it exacerbates the root problem rather than alleviating it.
• The transgender movement is merely the latest phase of a moral and cultural revolution which is grounded in secular worldviews committed to human autonomy and thus to a wholesale repudiation of the God of the Bible.
• While we must hold fast to the biblical truth that every human being is made in the image of God and precious in God’s sight, we must also affirm that every human being—every last one of us—is fallen in sin and sexually broken. Gender dysphoria and other forms of gender confusion are but one manifestation of that sexual brokenness.
• While the biblical worldview provides the only solid foundation for human rights, we must reject the idea that those human rights include what are now called ‘transgender rights’ (the right to live in accordance with one’s gender identity and the right to have that gender identity affirmed by others).

V. Christian Responses

In this final section, I will make some brief remarks on Christian responses to transgenderism based to the foregoing assessment. I say ‘responses’ rather than ‘response’ because the various challenges posed by transgenderism invite different kinds of response. We should distinguish, for example, between a cultural response (to the transgender movement) and a pastoral response (to individuals who suffer from gender dysphoria or self-identify as transgender). Recall the three stories I recounted in the introduction: each one calls for a different kind of response from Christians, even though each response will be directed by shared principles grounded in a Christian worldview. It’s important to avoid letting one kind of response drive the other kinds. In the current political climate, there’s a particular danger of allowing the ‘culture wars’ to shape our pastoral response. In any case, I offer the following thoughts on the two kinds of response I distinguish above, recognizing that a great deal more needs to be said.

Cultural Response

It’s imperative that Christians—and especially church leaders—adopt a prophetic stance in the face of these challenges to God’s design for human sexuality. We need to speak clearly and consistently about biblical norms. The title of Dr. Albert Mohler’s most recent book has it exactly right: We Cannot Be Silent.^[34] This means we need to ready and willing to engage in public debate and dialogue. We also need to present a compelling counter-narrative. If we fail to do that, the mainstream narrative will win by default; theirs will be seen as the only plausible position to take.

There are two good reasons why there needs to be a strong cultural response from the church. First, there is our responsibility as Christians to promote the public good, especially when it comes to protecting children from damaging parental practices and destructive ideologies. Like the Jewish exiles, we should seek the welfare of the cities (and towns and villages) in which God has placed us.^[35] Secondly, there is the need to preserve religious freedom—above all the freedom to preach the Bible and proclaim the gospel—which is increasingly threatened by the demand for LGBT rights (a demand that invariably translates into the suppression of those who continue to stand firm on biblical norms).

I strongly suspect that we’re not yet at the end of the road (or perhaps the end of the rope) in this cultural battlefield. There is more to come, and it will be even more shocking to us. Just consider, for example, what the category of ‘genderfluid’—rejecting the binary of male and female—implies with respect to the kinds of reconstructive surgery that will be demanded in the future.

Pastoral Response

Pastoral responses will be as multifarious as the pastoral cases that give rise to them. Some pastors are going to have to deal with some very messy and heartbreaking situations in the wake of the transgender revolution that will require the wisdom of Solomon to disentangle. We can, however, broadly outline two categories of response:

To those who suffer from gender dysphoria and gender confusion in general. We need to cultivate in our churches the kind of Christian communities where people can share their struggles and confusions without fear of being rejected or ostracized. We must openly acknowledge that we are all broken people. The challenge for the church is walk the tightrope between, on the one hand, modeling healthy gender norms, and, on the other hand, not alienating people who struggle to align with those norms. I suggest it’s also important for us to distinguish between universal and cultural gender norms. We shouldn’t uncritically assume that what is regarded as normal for a man or a woman in our own culture signifies something essential to manhood and womanhood, lest we find ourselves making biblically unwarranted judgments about how people present themselves.

Concerning treatments for gender dysphoria, whatever we recommend (and there are various kinds of treatments available) should be consistent with our view that ontological sex rather than gender identity is normative for a person. That rules out attempts to change a person’s physiology to align with their psychology; the change should be in the opposite direction.^[36]

To those who have actively pursued a transgender lifestyle. These present the most challenging scenarios, especially when irreversible surgical procedures have been utilized. The first line of response should be to call for confession and repentance—indeed, from a gospel perspective, we might say that’s the only essential response. Beyond that, our general counsel should be to correct or reverse any steps that have been taken in the wrong direction (whether hormone treatment or reconstructive surgery) to the extent that is possible without causing further harm. While transgenderism undoubtedly presents new and vexing challenges for Christian pastors and counselors, I suggest that the governing principles for dealing with such scenarios have already been recognized and applied to other kinds of situations in which it proves impossible to ‘undo’ what has been done without causing further harm and suffering to the people entangled in those situations.^[37]

In any event, we may take encouragement from the fact that the transgender revolution did not take God by surprise. He foresaw it even as he fashioned the first man and the first woman. Thus, we can be confident that God’s Word will be a sure and sufficient guide as we navigate these stormy seas, that our heavenly Father will grant wisdom and comfort to those who seek his face in humility and faith, and that the atoning work of Christ will prove sufficient to cleanse and restore those called to be conformed to his image.

1. Laurie Frankel, “From He to She in First Grade,” The New York Times, September 19, 2016, http://www.nytimes.com/2016/09/18/fashion/modern-love-transgender-child-identity-parenting.html. ↑
2. Joe Dallas, “The Transsexual Dilemma,” Christian Research Journal 31, no. 1 (2008), http://www.equip.org/article/the-transsexual-dilemma/. ↑
3. Horatia Harrod, “The Tragic True Story behind The Danish Girl,” The Telegraph, February 28, 2016, http://www.telegraph.co.uk/films/2016/04/14/the-tragic-true-story-behind-the-danish-girl/. ↑
4. Deuteronomy 22:5 ↑
5. I wish to underscore that this is just an introduction to a highly complex issue with many overlapping dimensions, only some of which can be addressed here. ↑
6. A number of these definitions are adapted from Mark A. Yarhouse, Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture (Downers Grove, IL: InterVarsity Press, 2015). I recommend Yarhouse’s book as a reliable guide on the clinical issues, although I have disagreements with way he approaches the broader theological and moral questions. ↑
7. Biological sex is often now referred to as ‘birth sex’, although that’s a loaded term, implying as it does the possibility of a change of sex at some time after birth. ↑
8. I realize that some may dispute my specific examples here, in which case I invite them to substitute their own! The distinction itself I assume most readers will grant. ↑
9. In my view it would be more accurate to speak of ‘gender experience’ or ‘gender self-perception’, but for simplicity’s sake I adopt here what has become the standard terminology. ↑
10. It’s worth noting that the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders—the standard reference manual used by psychiatrists—not only replaced the earlier label ‘gender identity disorder’ with ‘gender dysphoria’ but also added the criterion of distress to its definition. Thus, in the most recent edition, the experience of incongruence between one’s biological sex and one’s gender identity is counted as a mental disorder only if that experience is deemed to be distressing. This definitional shift has been controversial, because the newer definition tacitly assumes there’s nothing clinically abnormal about the experience of incongruence as such. This underscores my earlier remarks about loaded definitions. ↑
11. Lawrence S. Mayer and Paul R. McHugh, “Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences,” The New Atlantis, no. 50 (Fall 2016): 4–143. ↑
12. Kenneth J. Zucker, Anne A. Lawrence, and Baudewijntje P. C. Kreukels, “Gender Dysphoria in Adults,” Annual Review of Clinical Psychology 12 (2016): 217–47; Yarhouse, Understanding Gender Dysphoria, 92. ↑
13. Mayer and McHugh, “Sexuality and Gender.” ↑
14. Yarhouse, Understanding Gender Dysphoria, 61; Mayer and McHugh, “Sexuality and Gender.” ↑
15. Mayer and McHugh, “Sexuality and Gender.” ↑
16. “Peaceful Coexistence: Reconciling Nondiscrimination Principles with Civil Liberties,” Briefing Report by U.S. Commission on Civil Rights, September 2016, http://www.usccr.gov/pubs/Peaceful-Coexistence-09-07-16.PDF. ↑
17. James N. Anderson, “What Are We? Three Views on Human Nature,” Reformed Faith & Practice 2, no. 1 (May 2017), https://journal.rts.edu/article/three-views-human-nature/. ↑
18. Exactly how we came to ‘know’ this is less than obvious. ↑
19. By 2014, the social media website Facebook was offering its users more than 50 gender options, including a ‘custom’ option for those who couldn’t identify with any of the predefined options. ↑
20. For more discussion of these two worldviews and their respective anthropologies, see Anderson, “What Are We?” ↑
21. James N. Anderson, Why Should I Believe Christianity? (Fearn, Ross-shire: Christian Focus Publications, 2016), 106–15. ↑
22. John M. Frame, The Doctrine of the Christian Life (Phillipsburg, NJ: P&R Publishing, 2008). ↑
23. Ibid., 133–35. ↑
24. John Murray, Principles of Conduct: Aspects of Biblical Ethics (Grand Rapids, MI: Eerdmans, 1957), 27–44. ↑
25. Jessi Hempel, “My Brother’s Pregnancy and the Making of a New American Family,” Time, September 12, 2016, http://time.com/4475634/trans-man-pregnancy-evan/; Olivia Crellin, “The Transgender Family Where the Father Gave Birth,” BBC News, September 23, 2016, http://www.bbc.com/news/magazine-37408298. ↑
26. Genesis 3:17–19; Romans 8:18–21. ↑
27. Yarhouse, Understanding Gender Dysphoria, 61. ↑
28. Mayer and McHugh, “Sexuality and Gender.” ↑
29. Ibid. ↑
30. Craig Kline and David Schrock, “What Is Gender Reassignment Surgery? A Medical Assessment with a Biblical Appraisal,” Journal for Biblical Manhood & Womanhood 20, no. 1 (Spring 2015), http://cbmw.org/uncategorized/studies-what-is-gender-reassignment-surgery-a-medical-assessment-with-a-biblical-appraisal/. ↑
31. To think otherwise would be to commit the so-called naturalistic fallacy. Frame, The Doctrine of the Christian Life, 60–61. ↑
32. Jeremiah 17:9 ↑
33. For some insightful reflections on questions of identity, see Rosaria Champagne Butterfield, Openness Unhindered: Further Thoughts of an Unlikely Convert on Sexual Identity and Union with Christ (Pittsburgh, PA: Crown & Covenant Publications, 2015). ↑
34. R. Albert Mohler, We Cannot Be Silent: Speaking Truth to a Culture Redefining Sex, Marriage, and the Very Meaning of Right and Wrong (Nashville, TN: Thomas Nelson, 2015). ↑
35. Jeremiah 29:6 ↑
36. I am not speaking here to the complex issue of intersex cases, those rare instances where, due to a congenital abnormality, a person develops a combination of male and female sex characteristics. ↑
37. Two examples: (1) cases of remarriage after an unbiblical divorce; (2) cases of polygamists (e.g., African tribesmen) who are converted to Christ. ↑