Can a Christian Affirm Sex Reassignment Surgery?

Forward from the author:

A few years ago I began to hear about students in our community struggling with gender and sexuality. I knew that this had been a concern in other places, but our small community had largely been quiet on this front. I found a desire to think well about sex and gender in order to walk well with students and families who might be navigating the challenges of gender dysphoria. Since I was concurrently studying at seminary, I took the opportunity to begin researching and writing papers in this topic area for class. This paper was initially written for a Christian Ethics course, then edited and expanded to become the paper I wanted it to be (and what you have in front of you).

May you be provoked to thought, prayer and most especially love and grace in considering how we can walk well with people.

Introduction

In 2017 Bill C-16 was passed in Canada, adding the phrase “gender identity and expression” to the Canadian Human Rights Act as prohibited grounds for discrimination. Though transgender concerns and ideology did not begin with the adjustment, 2017 marks a point where transgender rights became commonly discussed in Canadian society. There are many questions wrapped up in how the church wishes (or holds itself responsible) to respond, and this paper will specifically examine and develop a Christian ethic of sex reassignment surgery (alternately termed gender confirmation surgery). As even the above statement shows, there are competing philosophies and worldviews at play that greatly affect how one approaches the conversation. My aim is to define some key terms and concepts, then outline a biblical understanding of body, sex and gender. This will equip us to consider a biblical conception of body alteration and how it might apply to sex reassignment surgery, guided by the question, “Can a Christian affirm sex reassignment/gender confirmation surgery?”

Key Terms and Concepts

There are a number of terms and concepts that need to be defined to properly explore the question at hand. Even in the query above, the very name of the procedure in question reveals ideological assumptions about transgender experience – sex reassignment surgery emphasizes a bodily change while gender confirmation emphasizes an inner reality. This is indicative of the dichotomy society and church are wrestling with between the physical and non-physical realities of personhood. For the purposes of this paper we will refer to “sex” as the biological dimorphic reality of humankind as male or female (with bodies ordered towards the potential to produce life), while “gender” is the internal (psychological) sense and socio-cultural ways one has of being male or female. (Sprinkle, 2021)

There is an ever-growing catalogue of gender identities that one might subscribe to, from gender fluid to transwoman. As such, we will use the umbrella term transgender or trans* to refer to the wide experiences of the trans* community. It is of particular value to further recognize the experience of gender dysphoria, which is diagnosable in the DSM-5 as the distress one feels due to an incongruence between gender identity and biological sex. A more disputed concept is termed “rapid-onset” gender dysphoria, which is what some would use to refer to those who have no history of gender atypicality yet begin expressing and exploring diverse gender identities (or are diagnosed with gender dysphoria) as teens. (Yarhouse and Sadusky, 2020, p. 56)

Within the church, there are a variety of viewpoints and frameworks with which one might approach a conversation about sex and gender identity. (Note: In even laying out the definitions this paper will use for “sex” and “gender”, there are ideological assumptions being made that some conservative Christians refuse as unbiblical. See Preston Sprinkle, “Responding to Claims about Being a ‘Heretical Liar,’” Theology in the Raw, accessed November 27, 2023, https://audioboom.com/posts/8405037-responding-to-claims-about-being-a-heretical-liar.) Mark Yarhouse and Julia Sadusky outline a three-lens framework to understand how one might approach the conversation: the integrity lens, which approaches gender identity as a moral issue or concern and holds strongly to the integrity and sacredness of sex differences established by God at creation; the disability lens, which views transgender experience as variations that occur within nature that arise because of the effects of the fall on all creation; and the diversity lens, which affirms transgender experiences and identities as natural and good variation within God’s creation. (Yarhouse and Sadusky, 2020, p. 79)

At the risk of politicizing the conversation, one might view the integrity lens and the diversity lens as polar positions on the spectrum of viewpoints. The integrity lens holds strongly to the position that God created two sexes with differing biology and roles, and any diversion from the created order is sinful. Generally, it is understood that a transgender identity is chosen and as such is disobedient to God. (“Nashville Statement” 2017) Thus, though not self-identifying with the three-lens framework, Owen Strachen summarizes the integrity lens response to our thesis question well. “In no instance should a pastor or Christian leader commend surgical transition.” (Strachan, 2019, LOC 2114)

Conversely, the diversity lens understands that while God did, in fact, create a number of binaries, such as day and night, these binaries are not sharply divided (daybreak or sunset do not fit perfectly into either day or night). Similarly, gender exists on a continuum that displays the glory of a creative God. Those who experience gender incongruence with their biological sex live into this creative diversity, not so much choosing an identity as accepting who God has made them to be. Therefore, the answer to our thesis question is a resounding “yes.” As Justin Sabia-Thomas asserts, “Christians with gender dysphoria have a right to pursue treatment that offers the greatest possibility for their health and well-being…including hormone replacement surgery and gender confirmation surgeries.” (Sabia-Tanis, 2019, LOC 5038)

Filling the middle position is the disability lens, which understands gender dysphoria as an experience resulting from the fall (similar to the integrity lens) yet also sees that a trans* identity is not necessarily a choice (similar to the diversity lens). What perhaps distinguishes this lens further from the other lenses is the arena of response. While those adhering to the integrity lens understand transgender concerns to be moral or sin problems (and those under the diversity lens see little concern at all), the disability lens presents a careful response in medicine and health. Bluntly, the disability lens understands trans* experience primarily as a health issue rather than a sin issue. (Amongst all the lenses there is room for nuance. The integrity lens does allow for health concerns, as does the diversity lens, and the diversity lens does acknowledge sin at work in people. Yet the primary and underpinning understandings differ.)

Essentially, the disability lens allows one to consider transgender experience in light of medicine and psychology most clearly while still considering a traditional biblical ethic. This framework is of further importance as one considers where to best seek counsel while walking with a family member or in their own trans* experience. As the integrity lens views transgender concerns as primarily moral and sinful in nature, the lens recommends treatment in the church or with religious authorities. However, our question is in regard to a medical intervention, and clinical psychologists and medical doctors are the gatekeepers for medical interventions like cross-sex hormones, puberty blockers and sex reassignment surgery. Thus, the disability lens allows us to best straddle the acknowledgement that there are health concerns and moral concerns wrapped up in the question.

A Scriptural Understanding of the Human Body, Sex and Gender

One of the great difficulties for a Christian navigating questions of sex and gender is the difference in base worldview between the secular realm and the church. Over the course of the previous hundred years, the common understanding of humanity has become existential rather than essential. (Favale, 2022, p. 62.) That is to say, humanity is something that a person becomes rather than something common to all people. The popular zeitgeist is one of expressive individuality where authenticity and true meaning are found inside oneself, and one must remake the world around them to fit the internal reality. In the West, this is further nuanced by the understanding that humans are primarily sexual beings whose fulfillment (if any can be found) is sexual. (Trueman, 2020).

These core beliefs manifest as a sort of dualism where the human body is devalued and even detached from personhood. What is inside a person is what really counts; the psychological and internal sense of self, rather than the biological and outward being. (Pearcey, 2018, pp. 19–20.) This conception of humanity works itself out in a variety of contemporary hot-button topics, yet stands in direct opposition to a scriptural understanding of humanity. Though the Bible was not written with these concerns as primary (or even conceivable) to the authors, the biblical account affirms bodily existence, sexual dimorphism and gender differentiation.

Affirming Bodily Existence

Almost any Christian conversation about what it means to be human begins with the creation account in the first three chapters of Genesis, including conversations about sex and gender. In the wide scope of creation that Genesis 1 depicts, God creates humankind in his own image, “…male and female He created them.” (Genesis 1:27 NASB95) A surface reading indicates that both male and female humans are created by God, and just as with every other facet of creation, God calls it good. This is important to note as it is physical matter that God is creating and affirming. God does not create spiritual matter, call it good, then clothe it in lowly flesh as a humbling or disciplinary measure. Rather, God affirms that what he has made (physical bodies and biological matter) is good.   

After the Israelites have been freed from Egypt, God makes a covenant with them. The parameters of this agreement become Israel’s defining law, setting them apart from the nations surrounding them and leaving no part of life untouched. While the law covers a variety of spiritual practices, God seems to care about how the Israelites conduct themselves physically in the world, protecting physical human life and establishing physical rhythms such as sabbath (Exodus 24:8-11) and postpartum spousal sexual abstinence (Leviticus 12, 15:19-23). (McCoy, 2016, p. 84) This too affirms that God cares about physical existence.

Perhaps the strongest affirmation that physical matter and the human body is good is the incarnation of Jesus. Scripture portrays Christ’s condescension as a humbling of himself (Philippians 2:6-8). This affirmation that God became human and lowered himself is not a judgment upon human flesh but an articulation of how much he loves his people. God values humanity as he made them enough to take on their state rather than simply rapture them out of embodied existence. In his ministry, Jesus not only delivers people from spiritual bondage but also physically heals and restores them.

This too plays out in the eschatological hope that Christ’s followers bear. After his resurrection, Jesus’ new body is marked by both physical (he eats and drinks) and non-physical (he passes through walls) traits. The Christian hope, as stated by the apostle Paul, is that Jesus “…will transform the body of our humble state into conformity with the body of His glory…” (Phil. 3:21a). This is not some disembodied existence in a spiritual realm but rather a new mode of physicality, set free from the corruption of sin and death! (Wright, 2018, p. 154) Rather than rescuing people out of physical existence, God’s plan is to transform physical existence into something greater.

Together with a high view of the human body one can see a high value of human life in scripture. God’s people are not to murder (Exodus 20:13) and Jesus commands his followers to love all people, even their enemies (Matthew 5:43-45). In fact, just as the incarnation affirms physical being, Jesus’ death and resurrection affirm human life as it is by this work of God that humanity might live (Romans 5).

Even in all this, the relationship between body and soul is a complicated one. One can find and construct arguments supporting both dualism and monism from scripture. (Hammett and McCoy, 2023, pp. 303–8) Rather than tease out the complexity of the human composition, let it suffice that people are ensouled bodies or embodied souls and that both the physical and non-physical parts of personhood are important according to God’s word.

Affirming Sexual Dimorphism

Though there are theologians on every side of the debate, that the bible affirms the two sexes in humans is pretty explicit. God creates humankind with one of two sexes, male or female. They are distinct from one another, yet both are created in the image of God. In addition to ruling over the earth, God further commands them to “be fruitful and multiply.” (Gen. 1:28) This indicates a purpose in humanity that the male and female are made for each other to accomplish what God has ordained. Nowhere in scripture is there a third sex or less than two sexes for humanity (we will discuss the biblical treatment of eunuchs below). In fact, humanity has been created male and female with the specific purpose to love and give oneself in love. (Favale, 2022, p. 42) (This is not to denigrate singleness as a God honouring life. Scriptures such as 1 Corinthians 7 affirm both marriage and singleness as Godly life choices for humanity, exhorting the believer to holiness and humility in every relationship.)

This relational purpose is, in fact, strengthened by the differences that males and females see in the other. (McCoy, 2021, p. 54) While complementarity has specific theological underpinnings and a potential conservative connotation, men and women are biologically different from each other and understand themselves better by seeing what they are not (as reflected in the other).

Now, it has been suggested that just because God created humanity male and female does not mean that all people must be in that mold. “Are [Adam and Eve] the pattern that God established for all people or the first parents…Are they the exclusive model for all humans or the statistical majority?” (DeFranza, 2019, pp. 147–78) This question helpfully points out that we take many assumptions into our reading of scripture, yet also creates a false dichotomy. Scripturally Adam and Eve are the parents of humanity and biologically it is unquestionable that male and female are a statistical majority, yet this does not make the opposing statements untrue. Adam and Eve can be both parents and pattern, both model and majority. If one sets aside all preconceived notions of a sex binary before reading the Genesis account they can make room for a fluid concept of sex, but there is nothing in scripture to confirm that fluid concept and it must be imposed. (Fast, 2023, pp. 4–5)

There are also those who are born with differences of sex development (DSDs), commonly referred to as intersex. People born with DSDs may or may not be distinctly male or female (not producing gametes, have chromosomes other than XX or XY, have ambiguous genitalia). However, biological exceptions do not disprove a rule, they are in fact exceptions to the biological majority. (Sprinkle, 2021, p. 38)

Affirming Gender Differentiation

The question of how the bible articulates an understanding of gender is relatively recent, as our postmodern conception of gender as something distinct from biological sex really only becomes dominant in Judith Butler’s writings in the 1990s. (Favale, 2022, p. 72) As stated above, the bible does not see gender (in the modern sense) as a primary or even secondary concern. Male and female are part of being made in God’s image, not roles which humans are meant to fulfill. (Bartlett, 2019, p. 82) Yet, just as the bible affirms that men and women are distinct in their biological sex, the bible assumes that men and women will interact with the world around them differently.

Some primary examples of this are found in the Old Testament law. Due to the biological differences in men and women, there are certain laws that pertain to men and women differently, such as the laws surrounding ejaculate and menstruation (Leviticus 15). At the least this indicates that the biological differences between men and women will have societal ramifications.

However, perhaps the most common verse cited regarding gender differentiation (and transgender concerns) is Deuteronomy 22:5. “A woman shall not wear man’s clothing, nor shall a man put on a woman’s clothing; for whoever does these things is an abomination to the LORD your God.” Generally speaking, cross-dressing was frowned upon in the ancient near east (even outside Israel) and was only acceptable regarding pagan rituals of worship. (Vedeler, 2008, p. 468) There seems to be wide agreement that the point of laws such as this are to keep Israel distinct from their neighbours especially in regard to such cultic practices. Yet to explain the biblical prohibition against cross-dressing as purely a polemic against pagan worship disregards the wider biblical testimony to male and female difference. As such, the law seems to affirm that distinct gender categories are important to God.(Vedeler, 2008, 460–61)

It ought to be noted that the complementarian and egalitarian argument has waged back and forth over the previous decades. It is beyond the scope of this paper to weigh in on that debate, yet without conceding to either side it seems best to affirm that men and women are biologically different and relate to each other (and the world) somewhat differently. Defining those differences according to scripture (if indeed scripture defines those differences) is not in view of the question at hand.

Effects of the Fall

Broadly speaking, scripture affirms a high view of the human body as part of a complete person, a sex binary for humanity and general gender distinction. God created the world, including men and women, and it was good. Unfortunately, the effects of the fall are far-reaching and as a result, human bodies die and decay. Relationships are broken between God and people, between people with people, and even between individuals and themselves. All of creation suffers under the effects of the fall (Romans 8:20-22).

No conversation about intersex or gender dysphoria should forget that these are not just issues but are people concerns. People wander through their own feelings and struggle, looking for identity, security and love regardless of their experiences or biology. This is in large part why the unfortunately named disability lens is compelling. Whether we understand the source of these struggles as spiritual, physical or psychological, they are rooted in the fall and are not God’s plan for creation. As such we have the opportunity to intervene with people to find healing, whether that healing is miraculous or through the medical systems of the day. One of the interventions available in our day is sex reassignment surgery, which alters the human body. Thus, is it pertinent to consider what the bible says about changing and altering the human body.

Altering the Human Body

On this topic scripture is far from silent. There are a variety of passages that talk about alterations to the human body, or how humans with altered bodies are to be included (or excluded) from fellowship in God’s people. Though the most common body alterations today are likely tattoos and piercings, these have only a little reference in scripture (Zelyek, 2005 pp. 12–21) and have little bearing on the alterations considered by sex reassignment surgery. Of far more interest is the biblical treatment of circumcision and castration.

Circumcision itself is a body alteration demanded by God of his covenant people in the Old Testament and then dropped by the New Testament church as they recognize that God has called the Gentiles to himself also (Acts 15:13-21). In short, circumcision functioned as a sign that a person was a part of the covenant people of God. That God required it of the Israelites indicates that alteration of the body is not in and of itself immoral, but rather the purpose of that alteration is what is immoral.

We see this exemplified in the story of Abraham, who circumcises himself together with his son Ishmael (Gen. 17:23). The story indicates a double paradox which we might name as the Sarah paradox and the Ishmael paradox. (Cohen, 2005, p. 13) Sarah (and other Jewish women) are not circumcised and yet are of the covenant people of God. Ishmael is circumcised, yet is not part of Abraham’s covenant line. Further, we understand that circumcision was not wholly unique to the ancient Israelite nation and that other people groups practiced the ritual. (Doyle, 2005 pp. 279–85) It seems obvious to state that a circumcised Baal-worshipping pagan is not one of God’s covenant people despite the physically appropriate alteration. Thus, the physical act is not the pleasing aspect to God but rather the sign of allegiance circumcision indicates.

On the other hand, castration is disdained in scripture. Eunuchs occupy a place of tension, being both disparaged and venerated. In Deuteronomy 23:1 we read, “No one who is emasculated or has his male organ cut off shall enter the assembly of the LORD.” While the assembly of the LORD could refer to the entire covenant community of Israel or more specifically to the worship assembly, the exclusion of the eunuch (as well as foreigners and illegitimate children) from the community is explicit. (Fast, 2023, p. 5) This narrative begins to turn with the prophet Isaiah in chapter 56, where God says, “To eunuchs who keep My Sabbaths…to them I will give my house…I will give them an everlasting name which will not be cut off.” (56:4-5) Jesus further holds up eunuchs as an example for his disciples in Matthew 19:11-12. (Though Eusebius reports that Origen castrated himself, the early church did not interpret the passage as promoting castration, rather understanding eunuch as a term for unmarried. (DeFranza, 2015) Regardless, the point stands that Christ used the image of the eunuch in a non-negative, inclusive light.) Then, as confirmation that the gospel is for eunuchs as well, the Ethiopian is baptized as a follower of Jesus (Acts 8:26-40).  

Eunuchs had the difficult position of being both trusted servants and ostracized for their physical mutilation. (Solevåg, 2016, pp. 81–99) Most commentators agree that the reasoning behind exclusion from membership in Israel was theological: castration was associated with numerous Canaanite cults and at minimum a eunuch was not a circumcised male. (Fast, 2023, p. 5) (The few portions of scripture that talk about piercings and tattoos have a similar implication: worship or fealty to another deity is offensive to God. (Zelyek, 2005 pp. 12–21)) Thus, it is not their altered body per se that excludes them but rather their allegiance to another deity.

In view of our thesis question, this seems to be an important distinction. If God himself ordered his people to perform a specific body alteration, it cannot be the act of changing one’s body that is itself wrong. Rather, commentators seem to agree that body-altering practices from castration to tattoos are prohibited because they are associated with pagan worship. (Sklar, 2014, p. 250) God desires his people to be holy, set apart from the nations around them in spirit and in body. Thus, the underlying reason for body alteration is incredibly important. Does the alteration in question proclaim an identity formed by secular ideology (service to another deity)? Does it mark one as God’s own? Or is it done without religious purpose and rather for health reasons?

Implications for Sex Reassignment Surgery

Can a Christian affirm sex reassignment surgery? Anecdotally, in recent months I had two congregants each answer that question differently. One stated an immediate “no” and the other an immediate “yes.” Even with the broad theological understandings outlined above there are situations and criteria that need to be considered. Since we are considering the disability lens, perhaps we can frame the question with a couple of hypothetical situations.

If a person has a cut on their hand that turns gangrenous and (Christian) medical professionals decide that the only way to save them is to take off their hand, what would we counsel them to do? We have a high view of the human body, yet we also have a high view of human life. In fact, we generally have little issue with any body part being removed (including genitals or gonads) if we understand that to do so will prolong human life.

On the other hand, we might frame our discussion with a different situation. Say a person with a physically hale body has extreme phantom pain in their hand for which doctors and psychologists can find no solution. Would we then counsel them to remove that hand? What if their suffering was crippling and due to the phantom pain, they are unable to work or socialize? What interventions might we encourage them to seek?

It seems as though this is where the difficulty enters. In each of the above situations, it is not the experience of suffering that is in question, but the source (and therefore treatment) of that suffering. How can we best understand gender dysphoria, the anxiety that one experiences based upon an incongruence between their internal sense of gender and their biological sex? That there are those who suffer extreme discomfort is not in question (Sprinkle, 2021, pp. 17–28) but the way we understand the source of this suffering will greatly affect our counsel. It has been suggested that perhaps gender dysphoria is a sort of intersex brain condition, (Yarhouse and Sadusky, 2019, p. 107) yet data to suggest this is far from conclusive and comes with a host of other ethical and philosophical problems. (Sprinkle, 2021, pp. 127–41. 15) There does seem to be some link between hormones in utero and gender development, yet here too research is not definitive. (Jelsma, 2022 pp. 130–148) Indeed, it is possible (even likely) that gender dysphoria has multiple sources and is not solely biological or psychological but can result from a variety of factors.

The conversation is muddied further when we consider how access to sex reassignment surgery has changed. In the past, sex reassignment surgery to help these people cope with their discomfort has been one of the last resorts in seeking to help them live well. (Joyce, 2021) Yet in our modern day the number of those seeking such treatment has skyrocketed well beyond what one would expect, (Yarhouse and Sadusky, 2020, p. 56) and there is some evidence that the so-called rapid-onset gender dysphoria experienced by adolescents has other components. (Littman, 2018, pp. 30–31) Where traditionally those seeking surgical transition were middle-aged men, this has flipped completely with the primary group now being adolescent natal females. (Favale, 2022, p. 167) Activism has made it difficult to study transgender concerns unless they affirm the activist-promoted dominant narrative, and the voices of detransitioners (those who have transitioned away from and then back to their birth sex) are systematically silenced. (Joyce, 2021, pp. 50–51) What little data we have regarding those who have surgically transitioned is conflicting, indicating that some find their dysphoria alleviated while others are still uncomfortable. (Yarhouse and Sadusky, 2020)

The story of psychologist Kenneth Zucker displays a measure of the difficulty surrounding the entire conversation, both regarding the societal pressures to conform to a mode of thinking and in defending a single method of treatment. (Singal, 2016) Zucker formerly practiced at a gender clinic in Toronto where he would only recommend more invasive interventions such as surgery and hormones after working to alleviate other patient struggles such as depression or anxiety. For some, this proved sufficient to manage their gender dysphoria, while others progressed to surgical treatment. Unfortunately, Zucker was attacked and publicly slandered for his methodology and though he was eventually vindicated, he now practices at a private firm.

Ultimately, it seems as though there may be situations in which a Christian can affirm sex reassignment surgery, yet the purpose and intent are vitally important. Recall that eunuchs were not excluded for their physical differences but for what their alterations signified: allegiance to another deity. Many modern people are swept up into gender ideology (queer theory), a movement that exhibits numerous cult-like traits. (Favale, 2022, 178) Thus, though sex reassignment surgeries are called a medical procedure to help an individual find good health, they may be as much motivated by a specific ideology that isn’t actually concerned with good health. Is an individual seeking surgery to alleviate gender dysphoria or are they enslaved by a political and theological ideology that does not know Jesus? For example, if an individual has grown up with traditional gender dysphoria, entered adulthood and found life to be unbearable, might affirming their decision to transition surgically be appropriate? Yet if the ideology behind a different person’s desire to transition is founded in an identity not springing from Christ, would affirming such a decision be wrong?

Pastorally, it is further important to consider grace. Whatever decisions one might make (or be coerced into making) regarding their body, as with the eunuch they are welcomed into the people of God through the gospel of Jesus. If (as the disability lens articulates) we believe that gender dysphoria is a result of the fall, we walk together with people as they seek healing in their suffering. God is the source of all healing in this world, whether through miraculous means or through the brilliant minds that comprise our medical systems, and we give him the glory for the wellness that people find. We may not always know the right decision or advice to offer, and at times people may make decisions that we disagree with. Yet in grace, we can maintain relationships and continue to offer love and truth.

Conclusion

Can a Christian affirm sex reassignment surgery? It seems as though there are multiple levels to an answer. Of primary importance is the lens through which one views gender dysphoria and transgender identity. If one sees through the integrity lens, the answer is no. If one looks through the diversity lens, the answer is yes. However, if one looks through the disability lens the answer becomes more nuanced. Scripture affirms bodily existence, sexual dimorphism and some level of gender differentiation while acknowledging that sin’s entrance into the world has caused all manner of spiritual, physical and psychological suffering. Bodily alteration does not seem to be prohibited or affirmed on the basis of physical sanctity but rather on the underlying allegiance pledge such an alteration represented. As such, the motives one has in seeking any surgery to alter their body are very important.

I would suggest that there are at least four areas of study that could help Christians think carefully about this topic. First, continued research into the causes (both biological and psychological) of gender dysphoria are needed. Second, longitudinal studies of those who have traditional gender dysphoria and transition as adults (or don’t transition as adults) could help us better understand the aid that surgery may or may not provide. Third, developing a robust theology of suffering would be of service to consider how one should live with disorder and disability. Fourth, articulating a clear telos or purpose for humanity (including what human flourishing looks like) is likely pertinent to the conversation.

Unfortunately, there is not a simple answer to the question, “Can a Christian affirm sex reassignment surgery?” An individual’s lens will dictate at least in part how they answer that question. Even in utilizing the disability lens, there may be circumstances that would point to a “yes” but data and understanding are still lacking. Though scripture does uphold a high view of the body, a sex binary and gender distinction, the effects of the fall are still pervasive in the world. Treating those effects, even medically, is not an evil pursuit.   

Note from the author: Since this essay was written prior to the WPATH leak as published by Mia Hughes, as well as the Cass Report from the UK, there are a few clarifications that need to be stated. At minimum, those two documents seem to suggest that we must be even more cautious when considering such invasive body-altering procedures as there is little research underlying the policies and recommendations of many North American gender clinics. Indeed, the WPATH leak particularly indicates further that medical ethics have been severely lacking in many situations as young people have not been made aware of the variety of long-term consequences of cross-sex hormones, puberty blockers and various surgeries.

I wish to state as clearly as possible the conclusion that, while there may (not definitely) be a time to affirm sex reassignment for health reasons, most situations today do not fit the traditional models of gender dysphoria, as the greater than expected numbers of those seeking intervention indicate. As such, the potential to affirm such a decision comes with prayer, a lifelong (beginning in childhood) experience of gender dysphoria, having gone through the physical changes that puberty brings, and allowing the brain to develop well into the mid-late 20s.

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