EFAC Australia

Rob and Claire Smith begin to address what you have probabaly noticed—that there is a continuing and deepening advocacy in our culture for further revolution in our attitudes to gender and identity.

Rev Rob Smith is an Anglican Minister at St Andrew's Cathedral, Sydney. He teaches theology at Sydney Missionary & Bible College and works for the Department of Ministry Training & Development.
Dr Claire Smith is women's Bible teacher and the author of God's Good Design: What the Bible Really Says About Men and Women (Matthias Media, 2012).

The transgender tipping point
In May 2014, a year before Bruce/Caitlyn Jenner became headline news around the world, the cover story of TIME magazine declared that we’ve now reached a ‘transgender tipping point’. Sociologically speaking, a tipping point is that point in time when a minority is able to bring about a significant change in the minds of the majority, such that long-held attitudes are reversed and the momentum on an issue begins to move in a completely new direction.
That new attitude and direction is, in essence, a new way of thinking about gender. And it really is new. Much of the discourse on homosexuality over the last 40 years has been about the fluidity or variability of sexual orientation, but not about the fluidity or variability of gender itself. In fact, both sides in the same-sex ‘debate’ have tended to view gender as something that is not only binary (i.e., you’re either male or female) but also as something that is fixed (i.e., it’s determined by your biological sex).


What is transgenderism?
The new way of thinking, however, makes a sharp distinction between sex and gender. Sex is still seen as biologically determined, but gender is now seen as entirely socially constructed and/or personally chosen. This means that there is no necessary connection between your gender identity and your biological sex. The two may be the same or they may be different. ‘Transgender’ is the popular term that describes the experience of difference or dissonance between one’s biological sex and one’s gender identity. ‘Gender dysphoria’ is the latest technical diagnostic label for the psychological distress arising from this dissonance.1
Transgenderism, however, must not be confused with the handful of rare conditions that fall under the ‘intersex’ umbrella, where there are varying degrees of genital, gonadal or (even more rarely) chromosomal ambiguity with a person’s biological sex. These are physical variations, and on their own do not involve questions of either sexual orientation or gender identity. In other words, with intersex we are talking about a physiological condition with a clear biological basis, not a psychological condition with no apparent biological basis, as is the case with gender dysphoria.2

Are we ready for the revolution?
As we are very much aware, for some time now the question of same-sex marriage has pre-occupied societies and Christian denominations around the world. But what the enthusiastic media (and social media) response to Jenner’s gender transition reveals is that behind the homosexual revolution (about which much has been written), the transgender revolution (about which much less has been written) has always been present and has been steadily gaining momentum. It is, therefore, now apparent that the move toward same-sex marriage is part of a much bigger set of questions about gender, identity and the nature of human sexuality – captured by the acronyms LGBT, LGBTI or LGBTQ (Q = ‘queer’ or ‘questioning’) – and a much broader ‘gender agenda’ aimed at a radical and thoroughgoing moral, social, psychological and sexual revolution.
The consequence of all this, as societal, political and legislative developments both here and around the world indicate, is that transgenderism is the next major issue that Christians are going to have to come to grips with – theologically, morally and pastorally. And yet, because of the way it has been largely obscured by the homosexual debate, most churches are far from ready for it. But get ready we must, for it is coming like a freight train!

Understanding transgender ideology
Transgenderism has largely grown out of the feminist and homosexual revolutions. If there is no necessary correlation between your biological sex and your ‘destiny’ or life roles (feminism), or if there is no necessary correlation between your biological sex and your sexual orientation (homosexuality), then why should there be any necessary correlation between your biological sex and your gender identity? As it has often been put, ‘sexual orientation’ determines who you want to go to bed with, whereas ‘gender identity’ determines what you want to go to bed as. The bottom line is that biology determines neither!
But there’s a further point. Just as you can choose who you go to bed with, so you can choose what you go to bed as. It is a matter of choice. Nothing is fixed or given; everything is, ultimately, self-selected. What’s more, once we decouple gender identity and biological sex, we are free to recognize that there are many genders, or perhaps none at all, and that gender identity is (potentially, if not actually) perpetually fluid. The end point of such logic is that there is no pressing need for any person to align their biological sex with their gender identity.

The tensions of transgender experience
However, interestingly and paradoxically, not all trans advocates are comfortable with such voluntarism, nor with a radical separation of sex and gender. Indeed, as is the case in the homosexual community, many transgender people argue for a kind of ‘born this way’ determinism.3 That is, they believe that the disparity they experience between their biological sex and their gender identity is not something that has been chosen by them, but is determined by forces beyond their control. But rather than live with this tension, they long for alignment. They feel they’ve been given the wrong body and so want it changed!
Such an explanation sits better with the experience of those who have known gender dysphoria from a young age, and are not part of the majority of sufferers (over 70%) whose dysphoria resolves to a point where they come to accept and embrace their biological sex. Even so, some measure of self-determination seems unavoidable – firstly, at the level of self-belief (e.g., I believe I am a female trapped in a male body) and, secondly, in terms of the chosen way of addressing the perceived problem (e.g., I have decided to change my appearance to align with my self-belief).

The current approach to treatment
Whilst both medical and psychological research continues into gender dysphoria, its cause or causes are a long way from being fully understood. As with same-sex attraction, it appears to be both multifactorial and case specific, with the mix of causal factors varying from person to person. What is common, and contrary to the notion of ‘gender plasticity’, is the desire of those who experience it to achieve some measure of alignment between mind and body. In other words, most of those who experience gender dysphoria want to look on the outside the way they feel on the inside.
Since the 1980s, there has been a trend both in medical practice and in public opinion no longer to regard the experience of dissonance between biological sex and gender identity as a psychiatric illness or thought disorder (hence the nomenclature change from ‘gender identity disorder’ to ‘gender dysphoria’), but simply as a ‘condition’. Even more significantly, the preferred way of responding to this condition is not by focusing treatment on the person’s mental health and psychology, but by seeking to change their appearance, hormones and anatomy. In other words, instead of trying to change the mind to fit with the body, the body is changed to fit with the mind.

The tragedy of this approach
The tragedy of such a shift in both diagnosis and treatment is that ‘sex change’ is actually a biological impossibility, whereas psychological change is not. Chromosomes cannot be redesigned and real, functioning genitalia cannot be surgically constructed. A person’s self-perception, however, can be altered. In short, whatever the best way to classify gender incongruence, it should be treated with psychotherapy, not surgery. However, according to Paul McHugh (Professor of Psychiatry at Johns Hopkins Medical School), the ‘meme’ that “whether you are a man or a woman, a boy or a girl, is more of a disposition or feeling about yourself than a fact of nature” has so permeated our culture that, like the emperor’s new clothes, few are willing to question it.4
Nonetheless, despite its ubiquity and popularity, McHugh believes that the ‘meme’ is a ‘pathogenic’ one, based on a disastrous diagnostic misapprehension that is leaving a train of casualties in its wake. And he says this, as head of a department that was among the first to go down the path of sex-change treatment – a practice it has now abandoned. Rather than treating the condition, those who promote sex-change through hormone treatment and surgery, McHugh argues, are collaborating with and promoting a mental disorder, and encouraging genital mutilation. Not surprisingly, the instance of ‘sex-change regret’ is disturbingly high (and little publicised) and, tragically, the experience of undergoing ‘gender transition’ does little to address the extremely high attempted-suicide rates of transgendered people (over 40%). Indeed, one longitudinal Swedish study found the attempted-suicide rate following transition was some twenty times that of comparable peers.

Personal and political responses
What must not be lost sight of in all this is that those who experience gender dysphoria need our heartfelt compassion and clear-headed help, as do their families and wider support networks. What they do not need, however, is to be encouraged in their disordered thinking and empowered to engage in serious and irreversible self-harm. But if TIME magazine and the response to the Jenner story are any barometer of societal change, then the cultural momentum is with those who have accepted the transgender meme. If so, then we have indeed reached a genuine tipping point and are now engaged in a major social, sexual and surgical experiment the likes of which has not been seen before.
So this is not the time to withdraw, sit on our hands or concede the point. As Christians we must pray fervently and, where possible, agitate publicly and politically for a more responsible and coherent therapeutic approach to the treatment of gender dysphoria. Our task, as Francis Schaeffer was wont to say, is to present the truth with compassion and without compromise.

Theological and pastoral responses
Even more importantly, we need to deepen our appreciation of the Bible’s teaching about the basic, binary nature of human sexuality, the way sex determines gender, and the goodness of being either male-men or female-women (Gen 1:26-28; 2:18-25). We likewise need to understand the impact of sin upon all aspects of our humanity, including our biology, psychology, self-esteem and self-perception, and the need, therefore, for all people to be redeemed and remade into the image of our Saviour, Jesus Christ. For only in Christ can any of us find our true identity and experience lasting contentment. We also need to understand God’s glorious purpose to raise our gendered bodies, removing all imperfections and banishing all disease, dysphoria and disappointment forever.
Finally, with the help of God’s Spirit, we must work out how we speak to and care for those who suffer from gender dysphoria (as well as their family and friends), with clarity and compassion informed by God’s word. And in so doing we need to ensure that the temporary does not overshadow the eternal. As with all people, the greatest need of those who identify as transgender is not for their gender identity confusion to be resolved, or to have their attempts at transition reversed, but to be reconciled to God and adopted as his children. Trans people, therefore, need the gospel of Jesus Christ above all else. For the gospel offers real, existential peace; a better peace than anything this world can ever provide; a peace not just for this life, but for eternity.

1 According to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ‘gender dysphoria’ is a more appropriate diagnostic name, given the symptoms and behaviours it seeks to describe. It is, however, a significant shift away from the earlier term, ‘gender identity disorder’, which identified the condition itself as a ‘disorder.’ Now it is only the distress caused by the condition that is regarded as a disorder.

2 This is why many in the intersex community do not want to be included in the LGBT(I) acronym, and why there has been some criticism of DSM-5’s subsuming of ‘Intersex’ under the category of ‘Gender Dysphoria’. That said, people with intersex conditions can experience significant psychological distress, particularly if they come to reject medical decisions made for them at birth.

3 To date, and despite claims to the contrary, there doesn’t appear to be any biological basis for transgenderism. This, of course, doesn’t mean that no biological component will ever be identified, nor does it rule out other ‘softer’ forms of determinism (e.g. psychological, familial, social or environmental).

4 See Paul McHugh, “Transgenderism: A Pathogenic Meme”, June 10th, 2015. Online at: www.thepublicdiscourse.com/2015/06/15145. Accessed 25 July, 2015.