In the last decade or so, being ‘transgender’ has gone from relative obscurity to being one of the most debated topics in society. Each week we are hit with new headlines: about single-sex-spaces, or the treatment of gender-critical women or the place of transgender people in sport.
At the heart of this is an explosion in the numbers of people - and particularly young girls - who are identifying as trans. The Interim Report of the Cass Review (2022) tracked the numbers of young people who were being referred to the NHS Gender Identity Development Services between 2009 and 2016. The number of boys referred rose from 24 to 426. The number of girls rose from 15 to 1,071. Data from the Final Report shows that in the period between 1 April 2018 and 31 December 2022, very young children had been referred, one as young as just 3 years old.
As Christians, we do not believe that battling against biology is the best way for young people to flourish; God has created us as embodied people, and that is a good thing. We are also highly conscious of the way in which outdated stereotypes have been co-opted in this debate, and have led vulnerable teenagers to conclude that they must be trapped in the wrong body. We have written in far more detail about what wisdom the Bible has in thinking about gender ideology here.
But amid such a heated (and at times, toxic) debate, it can all too easy to forget that at the heart of the discussion are real people, many of whom are desperately looking for solutions to all-too painful questions. Who is the real me? Why don’t I fit in? Why is my body changing? And how can I fix myself?
Although many of these stories have been weaponised by gender ideologues, that does not make them any less real. Each person who experiences distress around their gender is made in the image of God, and fully loved by and precious to Him.
As Christians, we believe in the importance of ‘compassion’, suffering alongside those who suffer, and mourning with those who mourn. Jesus lies at the centre of this idea: the God who did not stand remote and detached from the world we lived in, but who took on human flesh, lived as one of us, suffered just like us, and died. In 2 Corinthians 1, Paul describes what this God is like: “the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God.” As we have been met with compassion ourselves, so we are to walk compassionately alongside others.
Defining Terms
Central to the transgender debate is the distinction made between sex and gender:
Sex: can be male, female, or occasionally intersex, and refers to the biological make-up of the body based on chromosomes and reproductive organs. Biological sex cannot be changed, regardless of gender reassignment or other medical procedures. It is sometimes called ‘birth sex’ or ‘sex at birth’.
Gender: this refers to the socially-constructed roles, behaviours of men and women, typically in relation to stereotypical expectations of masculinity and femininity. It is often used in contrast to sex, as opposed to being used interchangeably.
This has led to a third term entering common use in recent years…
Gender identity: this refers to a person’s internal sense (subjective) of their gender, in line with or in contrast to their biological sex (objective). Although the most common gender identities are male and female, some people are now identifying as ‘non-binary’, ‘genderqueer’, ‘gender fluid’, amongst others (see below). For most people, their gender identity is the same as their biological sex (sometimes called being ‘cisgender’), but for a few people, it differs (which is commonly called being ‘transgender’).
Two other terms - which are medical, rather than philosophical - are worth understanding at this point:
Gender incongruence: The Cass Review defines this as “A marked and persistent incongruence between an individual’s experienced gender and the assigned sex.” The use of the word ‘persistent’ is notable, given the way in which some teenagers have identified as ‘transgender’ for a time, only to later move on.
Gender Dysphoria: This is normally thought of as being the result of gender incongruence. The Cass Review defines it as “clinically significant distress or impairment of function”. It generally refers to the emotional impact of questions around one’s gender.
Some of these terms are controversial; indeed, the term ‘gender dysphoria’ was not widely used until 2013; previously psychiatrists spoke about ‘Gender Identity Disorder’, but this was abandoned by the American Psychiatric Association’s updated manual of mental disorders “to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender.”
The NHS website states that “Gender dysphoria is not a mental illness, but some people may develop mental health problems because of gender dysphoria”. This is not in line with the American Psychiatric Association’s manual, which does classify it as a mental health condition, and some may speculate that the NHS definition has been ideologically motivated.
Not everyone who identifies as transgender will experience gender dysphoria, which typically refers to prolonged distress around the misalignment between body and gender identity. Indeed, not everyone who experiments with various forms of gender expression would even identify as transgender (such as various drag performers). Furthermore, the distress which transgender people might experience is perhaps best thought of as being a point along a sliding scale, with different levels; it is not a simple yes-no binary.
What is the experience of gender dysphoria like?
For an adolescent, or an adult, to be provided with an official diagnosis of gender dysphoria, they must meet at least two of the following six conditions, according to the most recent edition of the American Psychiatric Associations’ ‘Diagnostic Statistical Manual of Mental Disorders’:
“A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)
A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
A strong desire for the primary and/or secondary sex characteristics of the other gender
A strong desire to be the other gender (or some alternative gender different from one’s assigned gender)
A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)
In order to meet criteria for the diagnosis, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.”
The number of people who are given an official diagnosis of Gender Dysphoria is extremely low: the American Psychiatric Association estimates that this happens for around 0.003-0.004% of people, whereas around 0.33-0.47% identify as transgender.
The Christian psychologist Mark Yarhouse explains: “It is relatively rare for someone to experience gender dysphoria to the extent that we would diagnose that person with Gender Dysphoria, but because it resides on a continuum, any estimates here are likely low when we think of children, adolescents, and adults who experience gender dysphoria somewhere along the continuum but likely do not meet criteria for the formal diagnosis as such and are not going to a specialty clinic.”
Although ‘significant distress’ is a condition of being diagnosed with gender dysphoria, some of those who experience it, regardless of whether or not they have been given an official diagnosis, may find that their experience of distress becomes extreme, including the desire to self-harm, or suicidal thoughts. Although surveys quoted by gender activists can be misleading (one often-quoted statistic, which suggests that around 48% of those who experience gender dysphoria attempt to commit suicide, was based on a self-selecting study of just 27 participants), it is undeniable that for some people, their experience can be exceptionally painful.
Yarhouse writes: “In one of the first exchanges I had with a male-to-female transsexual Christian who I will refer to as Sara, she opened the exchange with, “I may have sinned in the decisions I made; I’m honestly not sure that I did the right thing. At the time, I felt excruciating distress. I thought I would take my life. I can’t imagine going back. What would you have me do?”
That is a pretty disarming exchange. This is not someone who has made a commitment to a worldview and philosophy bent on deconstructing meaningful categories of sex and gender. If you had come to argue with Sara about a sexual ethic, you would not have found an opponent. She might have agreed with you, in fact. How does a person like Sara maintain a posture of repentance and a soft heart toward God in light of the impossible decisions she faced? Is there a Christian community that is willing to stand next to her in these impossible circumstances?”
What causes gender dysphoria?
In his book ‘Understanding Gender Dysphoria’, the Christian psychologist Mark Yarhouse explains some of the key theories around causation, including brain-sex theory (which proposes that male and female brains are different, but that differentiation of brains occurs after differentiation of the genitals), Blanchard’s typology (a controversial theory linking gender identity to two main forms of sexuality), and multifactorial models with an emphasis on psychosocial factors (which, for biological males, can cover everything from feminine appearance, to shyness, insufficient adult male role models, parental wishes for a girl, or even sexual abuse).
Yarhouse concludes: “I have been told, “If you know one transgender person, you know one transgender person!” In other words, there are so many variations in experience and presentation that knowing one transgender person tells you very little about transgender persons as a group. That may be true. Important questions remain about etiology [causation], and we have already established that the transgender umbrella is quite broad. I am not optimistic that one unifying theory will explain the myriad presentations that exist under that particular canopy.”
Historically, the number of biological males who were questioning their gender was higher than the number of biological females. However, in recent years, the rates of young girls (in particular) identifying as transgender have risen exponentially. Some of the reasons for this increase have been documented elsewhere, and include increased mental health problems, neurodiversity, access to social media and the availability of pornography. Keira Bell has described how when she was growing up, she was a classic tomboy, enjoying football and spending more time with boys than with girls. However, when she became a teenager, her body began to change:
“Then puberty hit, and everything changed for the worse. A lot of teenagers, especially girls, have a hard time with puberty, but I didn’t know this. I thought I was the only one who hated how my hips and breasts were growing. Then my periods started, and they were disabling. I was often in pain and drained of energy. Also, I could no longer pass as “one of the boys,” so lost my community of male friends. But I didn’t feel I really belonged with the girls either.”
Keira’s experience will feel familiar to many; puberty can be a particularly confusing time for young people. Although this can be the case for boys as their voices break and they begin to grow body hair, it is especially the case for many teenage girls, whose very body-shape begins to develop in different ways. This is amplified by the way in which girls are often expected to hold to certain standards of beauty, and objectified by men.
For many, their feelings of gender incongruence and gender dysphoria will dissipate as time goes on; statistics suggest that for around 80% of children who experience them while growing up, the feelings will desist in adulthood. This was the case for Keira Bell herself, who, in her words, “recognized that gender dysphoria was a symptom of my overall misery, not its cause.”
It is also possible that someone may experience gender dysphoria, but that this may be linked with their experience of other conditions, such as anxiety and other mental health conditions.
Indeed, one of the findings from the Cass Review was that feelings of dissatisfaction with one’s gender were far higher in young people who were autistic or neurodiverse, considerably higher in young people who did not identify as straight, and similarly, higher in those who had experienced traumatic events in childhood: “11-67% combined neglect or abuse; 53% and 49% maternal mental illness or substance abuse; 23-25% exposure to domestic violence; 15-20% physical abuse)”. Links have also been drawn with eating disorders and those who watch pornographic content.
However, it would be reductive - and not true - to say that this is everyone’s experience, or even that gender dysphoria always begins during adolescence. Some people who experience gender dysphoria would state that they felt they were in the wrong body from childhood; others testify to having experienced ‘late-onset gender dysphoria’, where their feelings only manifested themselves in adulthood.
Some people have attempted to distinguish between two types of gender dysphoria: a historic experience of gender dysphoria as it was traditionally understood, where a patient has felt a persistent, innate sense that they really are of the opposite gender, and the more recent experience we have witnessed within society, where young people are increasingly questioning whether they want to be constrained by gender norms (and where, for instance, one girl ‘coming out’ as non-binary has then led to several of her classmates following suit).
Although there may be some merit in making such a distinction, the causes of gender dysphoria are often complex. There is no one single theory of everything which explains it away.
How should Christians respond?
By this point, it should be clear that there is more to a Christian response than just ramming the truth about two biological sexes down somebody’s throat. As Christians, we do believe that God has laid out his design for humanity in the Bible, and that living in accordance with the Creator’s design helps us as humans to flourish. But truth without grace is harshness, and can lead to hearts hardening. Jesus himself came from the Father full of both truth and grace (John 1:14).
We know that the heart is an unreliable teacher (and very often, is not consistent, as we can see from the stories of ‘detransitioners’), whereas God’s law “is perfect, reviving the soul” (Psalm 19:7). Christian theology is not dictated by experience.
But Christian relationships are at least shaped by it. We are to “rejoice with those who rejoice”, and to “mourn with those who mourn” (Romans 12:5). We are to reflect a God who is “close to the broken-hearted” (Psalm 34:18) and who collects their tears in his bottle (Psalm 56:8). And - in a debate which is so often marked by toxicity - we are to love those who we disagree with (Matthew 5:44), who might see us as their enemies, even if we do not see them in the same way.
It is notable that ‘sinners’ actually wanted to spend so much time with Jesus, whereas they are less likely to want to do so with Christians today! Jesus was willing to associate himself with, and talk to, and eat alongside, those who the world looked down upon. He was not ignorant of their decisions, or blase about wrong-doing, but would lovingly lead people to understand God’s better story for their lives. Think of the sinful woman who anointed him with perfume, or the woman at the well, or Zacchaeus the tax collector. In each case, Jesus did not begin with what was ‘wrong’ with them; and yet in each case, they left him restored.
If there is to be anger - and this is an understandable, and perhaps even a right response, when we hear about the damage which has been done to the bodies of teenagers (and in particular, teenage girls) in the name of gender ideology - let it be channeled in the right direction. Let us not pile additional misery and condemnation upon vulnerable, distressed young people, but upon the ideologues who have led them there: the Cass Review exposed a woeful lack of evidence behind supposed gender-affirming care, and that trials had effectively been conducted upon children. Some forms of treatment, such as puberty blockers, actually prompted “concern that they may change the trajectory of psychosexual and gender identity development”.
Jesus warned, “If anyone causes one of these little ones—those who believe in me—to stumble, it would be better for them if a large millstone were hung around their neck and they were thrown into the sea” (Mark 9:42).
As Christians, we can tell a better story about gender dysphoria: a story which recognises people’s pain, rather than minimising it, which walks alongside those who are hurting, and which offers - ultimately - hope of a day when suffering is washed away. I once had a conversation with someone who suggested to me that what LGBT people truly need from us is to be loved better than what their LGBT community can offer them. As we offer them the forgiveness and life in all its fullness that Jesus offers, let us aspire to do just that.