Gender Dysphoria

In the Western world we are witnessing significant polarization and consternation regarding people who identify as transgender and who claim they experience, or have experienced, gender dysphoria. Transgenderism and gender dysphoria have become major topics of conversation in our present “culture war” and often get associated and mixed in together with matters regarding same sex attraction and relationships and gender non-conformity. We also find ourselves at a moment in which how one understands gender and gender roles has become quite unsettled, and many find the greater disassociation between sex and gender quite troublesome. How should Christians approach matters relating to gender dysphoria?

We do well to first try to understand what gender dysphoria might be as well as be willing to understand how it might relate to, but also differ from, other issues regarding gender and sexuality. Gender dysphoria, previously described as gender identity disorder, is understood as distress which arises from a perceived disconnect or mismatch between the gender a person expresses physically and the gender which frames the way they think, feel, act, and view themselves. Many people who believe they experience gender dysphoria identify as transgender.

Conversations about gender dysphoria and transgenderism often get caught up in and scrambled with conversations about gender non-conformity and same-sex attraction and sexual behavior. The association might be understandable: many people who identify as transgender recognize a level of gender non-conformity in their lives, and we would even expect them to have sexual desire for those who maintain similar physical genital presentation if indeed they otherwise experience and identify as the other gender. Yet they are all not the same: many who experience gender dysphoria reinforce a gender binary which gender non-conformity would attempt to queer, and the proliferation of different pronouns is not due to transgender people experiencing gender dysphoria. There might be some issues involving same sex attraction or sexual behavior, but not necessarily so, and such is a matter downstream from gender dysphoria.

Many consider the situation of human gender to be fairly cut and dried: God made human beings male and female, and they define males as those who present physically with a penis, and a female as those who present physically with a vulva. In their view, sex and gender are inextricably associated, and thus any suggestion a person might experience dissociation between one’s physical presentation and one’s gender mentality and viewpoint suffer from delusions or have been induced to making corrupt choices by a debased culture, and all in rebellion against God and His created order. Many who hold to such beliefs also make much of particular constructs of what masculinity and femininity should look like.

As Christians we always do best to look to what God has made known in Christ through the Spirit and in the pages of Scripture. While one might think the Bible would have a clearly manifest answer to such things, one might be surprised: what makes a man a man and a woman a woman is not explicitly defined in the pages of Scripture.

Many might scoff at this suggestion, but we encourage every Christian to be a good Berean and search the Scriptures to see what things are so. There is no doubt Israelites and many others recognized the common and “normal” way of things: those who are men generally are those who identify as men and present male genitalia (thus circumcision for male children and the Hebrew idiom of “one who urinates against the wall” for a man; e.g. Genesis 17:10, 1 Samuel 25:22), and women generally are those who identify as women and present female genitalia.

But we must be careful lest we take descriptions of what was understood in general and turn them into exclusive standards. Israelites were aware of the existence of people who, for various reasons, did not maintain a “normal” gender identity. Deuteronomy 23:1 forbade men with crushed or severed genitals from entering the assembly of YHWH; Isaiah extended hope for such eunuchs to have a heritage and monument within YHWH’s temple in Isaiah 56:3-4. When discussing matters of marriage with His disciples, Jesus spoke of those made eunuchs by men, those who were eunuchs at birth, and those who became as eunuchs for the sake of the Kingdom of Heaven (Matthew 19:12).

Throughout history human beings have recognized the existence of people whose gender presentation differed from the norm. “Hermaphrodite” or “androgynous” were the terms used to describe people who might have been born with both male and female genitals but also those whose gender presentation proved ambiguous. Today we generally speak of such people as intersex, and there is a wide variety of ways in which intersex characteristics can be expressed. In fact, many biology teachers and professors have moved away from having students exploring their own chromosomes in the laboratory because of how many were discovering they manifested some intersex chromosomes (e.g. XXY) even if they beforehand did not present with any kind of gender dysphoria! In the Dominican Republic a community of people exist in which many are called güevedoce: at birth they present as women, but around the age of puberty at 12, they develop male genitalia. Scientists are working to understand the genetic and hormonal reasons for this transition; in their culture güevedoces are considered a third sex even though they recognize only two gender roles. This phenomenon is not limited to this community in the Dominican Republic. Various groups among the Indigenous North Americans recognized the existence of the “two spirit,” people who reflected a third sex.

Thus we return to the question: what makes a man a man and what makes a woman a woman? We have seen the Scriptures do not explicitly answer this question, and any assumption the answer would be obvious and assumed remains just an assumption.

In Romans 1:18-20 Paul spoke of how God has made known aspects of Himself and His divine power in the things which He has made. Through scientific exploration humanity has been able to better understand how we have been wonderfully and gloriously made by our Creator. Despite the often contentious relationship between Christians and science, Christians often rely on what has been understood through scientific exploration when it comes to many aspects of the faith. For instance, you will not find anywhere written in Scripture how human life begins at conception or implantation. For most of human history people did not well understand the biological mechanics of conception and embryonic and fetal development, which itself led to all kinds of contentions and disputes about when a person became a living being. Today Christians do not think twice when they affirm, believe, and argue how human life begins at conception or implantation; they have combined a more robust scientific understanding with a high valuation of the value and power of life from the witness of Scripture.

What if we do something similar for gender and sexuality? For most of human history people have not well understood the biological mechanics by which men become men and women become women. From the same type of scientific investigation which has led us to understand how human life begins at conception or implantation we learn all human embryos begin as female. At around six or seven weeks of gestation, embryos with a Y chromosome will induce changes which will lead to the development of the testes; at around nine weeks, such embryos begin producing testosterone which leads to the development of both the male genital presentation and male sex characteristics in the brain. Embryos with two X chromosomes will remain female. Throughout the human development cycle significant changes take place when males produce surges of testosterone and females produce estrogen.

Thus, just as we understand human life begins at conception or implantation from our investigations how God has made us, we also see how human gender and sexuality are encoded by chromosomes and hormones. And such might well be why the Scriptures have not explicitly defined what makes a man a man and a woman a woman: our physical presentation is a result of chromosomes and hormones, and not the other way around.

Christians often insist on the picture of humanity at the beginning: God made human beings, and He made them male and female (Genesis 1:26-28). Such is well and good, but it is not the end of the story. The first man and woman sinned, and because of their sin death and corruption entered the creation (Genesis 3:1-27, Romans 5:12-21, 8:18-23). Thus we all have been made in God’s image, but we also suffer the effects of the corruptions and decay inherent in the creation since the Fall. Christians generally do well at understanding how this explains how it is possible for babies and innocent people to suffer even though they have done nothing wrong; we have all inherited the consequences of the transgressions of their ancestors, and it has been written into the very code by which we have been made. Christians are doing better these days at understanding neurodivergence in similar terms: we thus do not intend to understand neurodivergent or disabled people as “deviant” or insufficiently human but to understand how each and every one of us has been created with a collection of “gifts” built into our genetic code, and while many of those “gifts” we consider “good,” some of those “gifts” present challenges.

In this way we can make sense of how some people might well and truly experience gender dysphoria according to a Christian anthropology. The majority of people will still conform to what we have understood as “normal” development: their chromosomes and hormones will manifest the same gender in mind and body. But on account of the corruption of the creation we can understand how it might be possible for a person’s chromosomes or hormones to express one gender physically but another gender in brain development. We are all witnesses of the power of testosterone and estrogen in human development; would there not be serious consequences if a person who physically presents as a woman is bathed in a lot of testosterone, or a person who presents physically as a man is bathed in a lot of estrogen?

As Christians we must grapple with a challenging question: on what basis do we have the right to expect anyone who might experience gender dysphoria to privilege and identify themselves primarily in terms of the gender which they physically present? Can we really sustain a strict absolute definition of a man as a person with male genitalia and a woman as a person with female genitalia when the male and female genitalia develop on the basis of chromosomes and hormones which also affect the brain, and rarely might affect the brain differently than what is physically presented? And how comfortable can we remain with such a strict absolute definition when, in the whole witness of Scripture, God never seemed to feel the need to thus explicitly define men and women?

What a person may decide to do on the basis of having gender dysphoria is another conversation which would be good to have; yet such a conversation is downstream from whether Christians should recognize the existence of gender dysphoria and how they should treat people who identify as experiencing gender dysphoria. We have attempted to better understand matters of sex and gender in terms of what Scripture has explicitly revealed and what we understand regarding how God has made us according to our present scientific understanding. In so doing we hopefully can recognize the difficulties involved in stridently suggesting absolute strict definitions of men as those who physically present male genitalia and women as those who physically present female genitalia, and in humility recognize this may not be true of every person in every situation. We then do well to recognize people who experience gender dysphoria as human beings made in God’s image who might well be experiencing a real phenomenon which cannot be written off as a delusion or a culturally induced choice, worthy of love, acceptance, and belonging among the people of God, able to be saved by God in Christ through the Spirit. May we in all things seek to glorify God in Christ, ever cognizant of our human limitations and frailty, and seek to display love, grace, humility, and patience toward all!

Ethan R. Longhenry