The Tennessee State House Health Committee was considering a bill to ban “gender-affirming” care on minors. During the 2023 hearing, representatives grilled the filmmaker and journalist Matt Walsh. At one point, an opponent of the bill, Caleb Hemmer of Nashville, asks Walsh a number of questions. After replying, Walsh asks a question in return. “Do you think a 16 year old can meaningfully consent to having their body parts removed?” As silence falls over the hearing, Walsh asks again, “Do you?" More silence. Walsh says finally, “No?” There is quiet murmuring before one of the members replies, in the manner of a comedy Gestapo interrogator, “We ask the questions.” 

The refusal of the representatives to answer is telling. Did they feel a glimmer of shame at what they were advocating? Had this question had been asked sixty years earlier, there would have been no hesitation: adults cutting off children’s sexual organs for no good medical reason? Such a thing would be unthinkable. Yet today it is approved and carried out by medical staff in many US states. 

Between 2019 and 2023, gender reassignment procedures were performed on 13,394 youth between 7 and 17½ years old. The procedures involved either the use of puberty or hormone blockers, and gender reassignment surgeries such as mastectomies and penile reconstruction, with the purpose being to change the sex of the child.

In discussing this subject, one must tread carefully. The whole area of sex and gender is a minefield for any social commentator. Those in favor of “gender affirming care”, as it is called, have no hesitation in labeling opponents  “transphobes” and “bigots.” Public figures, such as the author J.K. Rowling, have been subject to vile abuse and even threatened with death for suggesting that a man cannot become a woman. 

Is there a Christian understanding of transgenderism? Are sex and gender the same or interchangeable? Is it possible, or even desirable, to change one’s sex?

The clinical categorization of sex, gender and identity began in the 1950s and was highlighted in the 1980 edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM). This document included the diagnosis of “gender identity disorder of childhood.” By 2013 the heading had been modified to “gender dysphoria.” 

There are numerous criteria that identify “gender dysphoria.” To simplify matters, it is when a boy prefers to be a girl and vice versa. It usually includes a strong dislike of one’s sexual anatomy. There are a host of associated factors, including genetic makeup, upbringing, social conditions, and a history of childhood trauma, that contribute to this condition. 

I do not intend to provide a full exploration of the medical hows and whys. As a Christian I am interested mainly in the theological implications of transgenderism. By theology, I mean that which pertains to our knowledge of and relationship to God. A sound theological understanding informs and guides our relationship to the whole of creation.

With regard to transgenderism, there is no absolute consensus of opinion across the different churches and denominations. The Episcopal Church, of which I am a member, has a strong pastoral focus. Canon law includes "sexual orientation, gender identity and expression" as protected categories against discrimination. However, in the 2022 General Convention, the Episcopal Church went further and explicitly called for public policies that support access to gender-affirming care at all ages and in all forms. 

The Roman Catholic Church also advocates against discrimination for transgendered people. However, unlike the Episcopal Church, the Catholic Church opposes transgenderism per se. This is not because they are afraid of trans people or value them less than other people. The Catholic Church’s objections are theological: to accept the rationale for “trans” means to reject the creative order as established by God.

Any theological reflection begins with what is written in the Bible. Whole books have been written on the relationship between God and humanity as it is laid out there. All I can hope to offer is the briefest of summaries. Suffice it to say that the Bible begins with the story of creation, where we find that God has made humankind in his image. (Genesis 1:26) “Male and female he created them.” (Genesis 1:27) God blesses them and tells them to be fruitful and multiply.

Human beings are therefore differentiated by their sex. This is reflected in anatomical differences between men and women. It seems obvious and even unnecessary to point this out, but it will become relevant when we explore the subject of transgenderism. There are two things to remember. The first is that God blesses human beings. The second is that, in their nakedness, the man and woman were not ashamed. (Genesis 2:25)

One of my favorite lines from the Bible is this:

“For it was you who formed my inward parts; you knit me together in my mother’s womb. I praise you, for I am fearfully and wonderfully made. Wonderful are your works.” (Psalm 139:13-14)

Our design by God is wonderful: we are made in his image and differentiated by sex. Human beings are created whole and unique in body, soul, mind and spirit. It means that the body we are given is in accordance with God’s plan for us. The late Pope Francis said that “the acceptance of our body as a gift from God is vital to welcoming and accepting the entire world as a gift from the Father…learning to care for it and to respect its fullest meaning.”

When we place these statements against those of the transgender movement, it is clear that there is a fundamental divergence in understanding. This may be due to the definitions employed. What do we mean by sex and what do we mean by gender? The National Institute of Health defines sex as “a person’s biological characteristics, whereas gender refers to socially constructed roles and norms.” With regard to gender, the term “socially constructed” is vague and could mean anything. This official definition leaves out is its most important element: the psychological.  

Note that traits of masculinity and femininity are not exclusively sex related. Some boys have feminine traits and prefer the company of girls. Some girls have masculine traits and prefer playing with boys. A human being is both a wonderful and complex organism. Although sex is determined at conception - not “assigned at birth”, as some would have you believe - our personalities carry a multitude of influences and characteristics.

There are those who say that they are born in the wrong body - for example, they identify as a woman but their sex is male. Consequently, a man can dress as a woman and live, to a limited extent, in the guise of a woman. But the biological differences between men and women are fixed from the beginning. They are extenuated in the way men’s and women’s bodies and minds develop differently. For this reason, a man who wants to be a woman - and vice versa - will never completely become one. This is true even after gender realignment surgery, when the sexual organs are removed and new ones fashioned from what is left over.  

This still leaves us with the question about people who believe they are born in the wrong body. Is surgery the correct treatment for people suffering from “gender dysphoria”? And at what age should sex re-alignment begin? We begin to answer these questions by referring back to our understanding of the God-given order of creation, where men and women are created and blessed by God. As created by God, our bodies are inherently “good.” While we are not meant to be defined solely by our sexual identity, the sex into which we are born will have a primary determining influence over who we are.

This becomes most apparent during adolescence, when hormonal changes are experienced differently by boys and girls. This can be a time of uncertainty and vulnerability. While sex is binary - you are either one or the other - gender, we are told, is fluid. If gender really exists - and some doubt that it does - then there is a spectrum of genders from which a person can self-identify. This is attractive to some people who do not wish to commit themselves one way or the other. But when the choice of gender becomes binary, it usurps the place of sex as a human determinant.

What are the influences that make a person convinced they are in the wrong body? They are many and varied: parent, teacher, counselor, doctor, peers and digital media. The ideal type of influence is one where the child who is confused about his or her identity is encouraged to grow into maturity before making any decision to radically alter their body. Consequences of transitioning can include sterilization and loss of sexual response. Can a 14 year old fully comprehend what they are letting themselves in for? 

This is a pastoral situation requiring the greatest delicacy and sympathy. Should it be the child or the parent who decides to begin a medical intervention? And if the body is already fundamentally healthy, does that not imply that the problem is psychological? Studies show a significantly higher than average incidence of childhood sexual abuse among transgendered people. While this may not be true in every case, it suggests that the origins of gender dysphoria could be deeply rooted in early personal trauma.

Another influence is the internet. In particular, children can access pornography online and become addicted to it. Pornography has the effect of warping children’s minds and creating a false understanding of sex as it relates to the human body. Social pressure can also play a part. In her 2024 review into Britain’s NHS gender youth services, Dr Hilary Cass highlighted the role of social media and influencers in driving the popularity of trans identities among young peoples. 

The promotion of transgenderism by schools and other institutions has created pressures that did not exist before. The author Walt Heyer recounts a high school coach who told him that there is a fear that “not identifying as either lesbian, gay, bisexual or transgender will lead to exclusion. It is perceived that adopting one of these identities is necessary to fit in.” Schools across the country today are encouraging children as young as 5 and 6 years old to think of themselves as gender fluid. Teachers apply subtle pressure to young children to buy into the “trans” ideology. In New Jersey, a father brought a legal action against a school for “transitioning” his child without his knowledge.

It must be noted that there are those who have undergone gender re-alignment surgery and are satisfied with the results. A famous example is the actress Ellen Page, who in her 30s underwent surgery and now identifies as the actor Elliot Page. On the other hand, there are many who have undergone surgery and regret having done so. For those who were children at the time, they feel a justifiable anger and bitterness towards the adults who encouraged them. When you read some of their stories, including the details of the operations and what went wrong, you learn that surgically enhanced transgenderism is not something neat and settled. 

Is transgenderism therefore is consistent with the Church’s core beliefs? From a theological point of view, the answer has to be “no.” A core belief is that every human being is made in the image of God. Our sexual characteristics - whether male of female - are therefore God-given. Any attempt to take it upon ourselves to change the nature of God’s gift are contrary to God’s will. 

In his document Amoris Laetitia, Pope Francis writes, 

“It is one thing to be understanding of human weakness and the complexities of life, and another to accept ideologies that attempt to sunder what are inseparable aspects of reality. Let us not fall into the sin of trying to replace the Creator. We are creatures, and not omnipotent. Creation is prior to us and must be received as a gift. At the same time, we are called to protect our humanity, and this means, in the first place, accepting it and respecting it as it was created.”

Where the body is sound and healthy, medical interventions to change the body should not be supported. Dr Farr Curlin, writing in the Wall Street Journal, says that 

“Traditionally, medicine treats a mental disorder by helping the patient align perception with reality—like the reality of a healthy body. Medicalized gender transition turns this norm on its head, ‘affirming’ the child’s disordered perception and treating his healthy body as a diseased one.”

When a Christian supports medical transitions, in effect they are saying that God made a mistake. The person was not “wonderfully made” after all, but inexplicably given a wrong body. And if, after transitioning, the person changes their mind again, as often happens, what then? Has the procedure addressed the symptom or the cause? 

The novelist Lionel Shriver recently reported from a conference called Genspect, which provides a platform for those who oppose the pro-Trans movement. The dangers of transgenderism often go unreported. Shriver spoke to one mother whose son had transitioned, then changed his mind and “detransitioned, was shunned by the trans ‘community’ and took his own life.” 

Not so long ago it wasn’t unusual to meet someone who possessed non-traditional mannerisms and behavior. Girls who dressed and acted like boys often outgrew this phase as an adult. The journalist Ben Appel, who grew up a boy but felt more like a girl, later realized he was gay. He believes that children need to be told they are fine as they are and don’t need to be “fixed.” “Instead of making space for non-conformity,” he writes, “we’re medicalizing it.” 

When a child feels genuine confusion about their identity, a rush to judgement can create long lasting problems. Adolescence is a time of change requiring sympathy and support. The Catholic Bishops of England and Wales affirm that

“In each and every pastoral situation is the truth that the individual person, no matter how distressed or disturbed in their own sense of self and reality, is known and loved by God in all their complexity, including confusion about their gender identity.”

The Church is to be a place of welcome for all people. I have often described the Church as a hospital for souls, with God our physician who mends us when we are sick. The physician’s tools are acceptance and love, understanding and compassion. At the same time, the Church is governed and directed by its understanding of the nature of God and of God’s creation. The Church adheres to fundamental beliefs about creation as related in the Bible. One of these is the goodness of the human body and the rightness of its design for each one of us.

The Tennessee lawmakers were silent when asked to voice their support for the surgical removal of children’s healthy sexual organs. It was an example of “cognitive dissonance”, when what you believe is so offensive you cannot actually utter it. Either that, or none of them wanted to be recorded as saying so. 

“Never relinquish your incredulity.” Lionel Shriver cautions us not to accept the unacceptable, or lose our common sense under the pressure of transgender advocacy, or become complicit in supporting what she calls “this vast medical scandal.” 

By succumbing to the ideology of transgenderism, we have harmed our children and damaged our standing as stewards of God’s creation: of ourselves and of our bodies. I predict that twenty years from now we will look back, shake our heads and say, “what were we thinking?” Then this practice, like lobotomies of old, will be consigned to the dustbin of history. In the meantime, Christians should not be afraid to put forward an alternative viewpoint, informed by theology and grounded in love.

Father David