If you sign up for Facebook, one of the ways you’re asked to describe yourself is your “gender.” It used to be a simple matter of “male” or “female.” But Facebook now boasts a total of 59 different genders to choose from—the 59th being a fill-in-the-blank option.
As we noted previously, biological sex refers simply to being “male” or “female.” Gender, on the other hand, relates to one’s social and psychological experience of being male or female. But in recent years there’s been increased attention given to those whose experience of gender does not match their birth sex. How might we think our way through this?
DEFINITIONS OF TERMS
We start by appreciating the sheer complexity of the issue. Let’s start by defining some terms:
- Gender dysphoria: The experience of distress related to having a psychological and emotional gender identity that does not match one’s birth sex.
- Transgender: An umbrella term for the many ways in which people experience and/or present, express their identities differently than those whose sense of gender identity is congruent with their biological sex.
- Genderqueer: An umbrella term for the ways in which people experience their gender identity outside or in between a male/female binary (e.g., no gender, gender fluid—using pronouns such as “one” or “ze”).
- Intersex: A condition where a person is born with sex characteristics and/or anatomy that does not allow them to be identified clearly as male or female. This could be chromosomal, gonadal, or genital.
For some of us, there may be a temptation to shake our heads in disgust, or reduce prominent members of the transgender community (such as Caitlin Jenner) to the butt of a cruel joke. We must resist that temptation. Studies show that of those who experience gender dysphoria, 41% commit suicide. We must approach this issue with compassion.
LIVING WITH DYSPHORIA
It’s important to draw a distinction between gender dysphoria and sexual orientation. The two concepts may overlap, but they are quite different. And what’s equally important is that gender dysphoria manifests itself in a series of developmental stages:
- Gender dysphoria most frequently begins in children as early as age 6; they may even begin engaging in certain cross-dressing behaviors or playing with toys geared toward the opposite gender.
- By age 11 they are experiencing a great deal of internal confusion, magnified by the onset of pubery.
- By age 18 they are trying to reason with their own internal confusion. They are fully aware that “something is wrong with me.” Some may even try to privately research their condition.
- By age 27 they have begun to address the conflict. For some that means seeking counseling. Others may engage in cross-dressing behavior—whether in public or in private.
- By age 35 they have decided to “come clean” and disclose their condition to their spouse or significant other—or maybe to family and close friends.
- By age 47 many seek resolution. For some that means accepting their condition, while for others it means transitioning into the opposite gender through more cross-dressing, hormonal treatments, through surgical interventions, or some combination of the three.
That means that if you were to meet someone from the transgender community, there’s a good chance you’re walking into their story at chapter 5 or 6 or more. There’s been a lengthy history behind them; this wasn’t a choice that they made on their own.
Where can we even begin to start thinking through such a complex issue? Yarhouse suggests that there are three general approaches we might take.
APPROACH 1: THE INTEGRITY FRAMEWORK
For Christians, the most tempting approach is the integrity framework, which sees gender dysphoria as a sin to be repented of. For instance, some English renderings of 1 Corinthians 6:9 say that “the effeminate” “will not inherit the kingdom of God.” Similarly, Deuteronomy 22:5 says that “A man’s item shall not be on a woman, and a man shall not wear a woman’s garment,” which we might apply to the practice of cross-dressing.
But the command in Deuteronomy might not translate so well into modern society.
“It is likely that, in keeping with God’s covenantal concern to persevere the holiness of his character reflected within the covenant community of Israel, and to avoid anything which threatened Israel’s existence and harmony, the cross-dressing prohibition was introduced to prevent involvement on the part of the Israelites in contemporary Canaanite religions rituals of the day, which involved swapping of sex roles and cross-dressing.”
Further, the early onset (and undesired nature) of gender dysphoria suggests that people are not experiencing this condition as a matter of choice. So while we must not ignore the Bible’s strong language, we must also avoid reducing the Bible to an “ethical cookbook.”
APPROACH 2: THE DISABILITY FRAMEWORK
The “disability framework” sees gender dysphoria as a disability that needs to be treated. Just as the fallen world produced “thorns and thistles” under God’s curse (Genesis 3:18), so too might human DNA and neurology be shaped away from God’s good design.
The value of this approach is that it removes the possibility of condemnation and treats the person with compassion. The problem, however, is that this approach fails at a practical level. The cause of gender dysphoria is not well known, so it’s difficult to know how such a disability might best be treated.
Additionally, if the danger of the integrity framework was the emphasis of morality to the neglect of disability, then the danger of the disability framework is the neglect of the moral dimensions of gender dysphoria. Even if we assume that individuals have little or no control over their internal struggles, the way they manage these struggles by acting out or sexual behavior represents a falling short of God’s moral standards (Romans 3:23).
APPROACH 3: THE DIVERSITY FRAMEWORK
From a cultural point of view, the most common approach has been the diversity framework, which sees gender dysphoria as something to be embraced as a symbol of the diversity of Western culture.
The problem is that some of the best available research has revealed that trying to change one’s gender through medical means has not resolved the distress of those who struggle with their gender identity. In 2014, Paul McHugh, former head of the psychiatry department at John’s Hopkins, wrote an important piece for The Wall Street Journal explaining why his hospital had—at least at one time—stopped performing “sex-reassignment surgery:”
“A … long-term study—up to 30 years—followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable non-transgender population. …Claiming that this is civil-rights matter and encouraging surgical intervention is in reality to collaborate with and promote a mental disorder.”
In reading McHugh’s article, I can’t help but reflect on something similar written by Peggy Noonan some years ago. Noonan was reflecting on a high school graduation she had attended, where she witnessed an expecting, unwed mother walking across the stage. The audience applauded her achievement. On the one hand, Noonan observed that such a response was “a right and generous response for a young girl with grit and heart.” But on the other hand, while “the old America would not have applauded the girl in the big graduation gown, but some of its individuals would have helped her not only materially but with some measure of emotional support.” But this doesn’t happen anymore, Noonan observed. “For all our tolerance and talk we don’t show much love to what used to be called girls in trouble. As we’ve gotten more open-minded we’ve gotten more closed-hearted.” Noonan concludes with a message to society: “What you applaud, you encourage…Watch out what you celebrate.” 
What we applaud, we celebrate. The tWorld may have reacted to gender dysphoria with less than acceptance, but the iWorld’s applause may do more damage yet. Compassion—true, fearless, Christian compassion—demands that we not “collaborate with and promote a mental disorder.” Instead, the gospel calls us to understand the brokenness of our neighbor, and to meet them where they are rather than merely where we’d like them to be. These issues are real; they are complex. They demand a fuller vision of the gospel, and a richer understanding of the love of God.
 From Mark A. Yarhouse, Gender Dysphoria: Navigating Transgender Issues in a Changing Culture, p. 20.
 Ibid., 115.
 Ibid., 46-7.
 Evangelical Alliance Policy Commission [EAPC], Transexuality: A Report on the Evangelical Alliance Policy Commission, p. 45.
 Yarhouse, 48-9.
 Ibid., 50-51.
 Paul McHugh, “Transgender Surgery is not the Solution,” June 12, 2014, http://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120
 Peggy Noonan, “You’d Cry Too if it Happened to You,” Forbes magazine, September 14, 1992, archived online at: http://www.peggynoonan.com/47/