Discernment / Faith / Ordinary Life / Pluralistic World

Christian Faithfulness and Gender Dysphoria

Navigating Pastoral Care for People Living with Gender Identity Conflict
(note: the names in this article have been changed)

Oh, the things they don’t teach pastors in seminary.
Recently, I had the privilege of presenting an all-day Pastors’ Forum at a respected conservative theological seminary on the theme of Pastoral Care and Gender Dysphoria. The seminary president attended the mid-day session, and I couldn’t resist the opportunity of teasing him, “Yet again, you’ve failed us pastors.” After the chuckling subsided, he quipped, “We’re trying to keep up.” I believe him. Those entrusted with the work of pastoral training and mentoring face a formidable task of equipping leaders in a relentlessly and rapidly changing cultural landscape. No area of culture has seen greater controversy and upheaval than sexual and gender identity.

At the Pastors’ Forum I asked the 250 leaders in attendance, “How many of you have someone in your congregation who lives with gender dysphoria?” Two or three hands went up. “How many of you know someone in your relational network who lives with gender dysphoria?” A dozen hands went up. “How many of you know your day is coming?” As an uneasy laughter spread across the room, nearly every hand went up.

My day came about two and a half years ago, and I was unprepared.

I have known Chris for nineteen years, for the entirety of my current pastorate. Chris was three when I arrived, a covenant child of one of our core families in the congregation. Over the past two decades, I can say honestly that no one in the church family has been more hospitable than Chris. Yet, the gregariousness often masked an anguished unseen part of Chris’s life. Twice in high school Chris attempted suicide, and Chris’s arms still bear scars from many years of cutting. By the time Chris made it halfway through college, after years of searching the Bible, speaking with counselors, and reading medical literature, Chris had concluded that the terror and torment of life especially post-puberty was the result of gender dysphoria.

Chris is biologically female yet has never known a time, even from age three or four, in which it ever seemed normal to identify as female. Chris’s mom remembers brushing off adamant early childhood objections Chris would make when asked to wear a dress, “Mom, I’m not a girl. I’m a boy.”

My heart breaks when I think about a lifetime of pain Chris has experienced on top of fear of rejection, longing for belonging, and uncertainty about where to go for help. Yet, even in the mysterious recesses of our being and the chaotic avalanche of life, dare we entrust ourselves together to the omnipotent love of God and the promise of the gospel to bring healing and hope? I find myself responding with the same helpless confidence of Peter in his reply to Jesus, “To whom shall we go? You have the words of eternal life” (Jn 6:68).

In the spring of 2015, Chris and I had coffee to talk about the implications of living with gender dysphoria. I have long admired Chris for being smart, motivated, and honest, and I knew that whatever Chris had to say would be carefully thought out. In a nutshell, Chris said, “I want you to know that I am committed to Jesus and to living faithfully as a Christian. I want you to know that I love our church – it’s my family and I feel safe there. And I want you to know I’ve decided present as male. I’m going by Chris. I believe the conflict I’ve been facing in my life related my gender identity is the result of something that’s not working correctly in my body. I know that God did not create us to live with this conflict, and the conflict I’m facing is a result of the Fall. But, I’ve concluded that the only way I can live with any meaningful resolution to this conflict is to live as a male. In fact, I believe that I really am male and that this decision to transition is a move toward the kind of wholeness God has in mind for us.”

Oh, the things they don’t teach pastors in seminary.

My mind was racing as I prayerfully considered how to respond. Here was a young person I love and genuinely like and value, a covenant child whose pain and struggle over the years had drawn me into deep concern and prayer, a friend who was trying both to survive and to live faithfully. What do I say? Of course, there was much to affirm in what Chris had shared, not the least of which was an enduring faith in Christ and a commitment to the Body of Christ. Thanks be to God! As I pondered what to say to Chris, I knew (obviously) that I had much to learn and that I did not know how to evaluate the decision Chris was making to identify as male. But I replied to my friend, “I’m willing to know you as you want to be known. I have no doubt that you fear the possibility of rejection and even anger in response to this decision, but I promise you that I will never shame you and I am committed to standing with you as your friend. I’m proud of you for the courage it takes to take these steps, and for your commitment to live by faith. Is that enough for now?”

Chris nodded gratefully, ands o began my journey into pastoral care and gender dysphoria.

Where to begin?
Since that conversation with Chris, several books by Christian authors related to gender identity and the transgender movement have rolled off the presses. Most helpful to me has been Mark Yarhouse’s Understanding Gender Dysphoria which lays out a challenging framework within which parents and disciplers can work out a plan of pastoral care and within which those living with gender dysphoria can find some moorings to map a way forward.

One of the most important reminders Yarhouse makes repeatedly is: “when you’ve met one person with gender dysphoria… you’ve met one person with gender dysphoria.” Chris’s story is one story, not everyone’s story. And this is my one story about learning to serve and shepherd Chris and our church family.

Because of its basic character in our lives, much of our so-called understanding about sex has been assumed. It’s the water in which we as humans have been swimming for our entire history, and as Jonathan Grant reminds us in Divine Sex, those watery currents are hard to see unless together we find ways to step back. So, I think it’s important to affirm that as we collectively embark on this study of gender and sexuality, we are engaging in a work that will likely take a long time to complete. We would do well to remember that the Christian Church did not settle the doctrine of the Incarnation until the 5th Century. And while sexual and gender identity are essential to humanness and therefore of great importance to human flourishing and Christian sanctification, it is not of the same order of doctrine as the Incarnation. Fear entices us to believe otherwise. We need to learn how to give these matters a just measure, the weight they are due.

My prayer is that my thoughts here will be a small contribution to a much larger ongoing conversation that needs to mature within the Church. These thoughts are not the final word on the subject, and I still have much to learn. Plus, I’m keenly aware that I’m writing as an outsider. That is, I do not live with gender dysphoria, so I must endeavor to write with humility as one who continues to listen and learn. My most immediate concern is that I be a faithful shepherd to the flock entrusted to my care.

Chris sees himself as member of the LGBTQ+ community, but he does not represent the transgender movement. Similarly, everything going on in the transgender movement playing out sensationally in the media and politics does not represent Chris. Chris is one person, and my responsibility is to walk faithfully with Chris in the story of his life.

Yes, I just used the male pronoun. More on that later.

What is gender dysphoria?
Mark Yarhouse, one of the few biblically faithful Christian clinicians and researchers specializing in sexual and gender identity, defines gender dysphoria as “the experience of distress associated with the incongruence wherein one’s psychological and emotional gender identity does not match one’s biological sex.”(1) Gender dysphoria exists when one’s interior(2) identification (I am male, I am female) conflicts with one’s exterior characteristics (I have a male body, I have a female body).

Gender dysphoria is rare, yet I believe there are sound reasons to believe that it can be a real condition that exists apart from sexual experimentation, rebellion, or views of fluid sexuality often common in the transgender movement.

Because the experience of gender dysphoria is completely foreign to people who do not face gender identity conflicts, it can be difficult to understand or even to regard with credibility. Gender coherence, or the absence of gender dysphoria, is so universally common that some people who are cynical about the existence of gender dysphoria make ungracious and demeaning quips like, “Just look down your pants – what more evidence do you need about whether you’re a man or a woman.” Therefore, some people suggest either that gender dysphoria is one more kind of mental confusion or that it is cultural capitulation, a caving to social ideology or influence. But I disagree with that one-size-fits-all perspective.

Regarding the first suggestion (it is mental confusion), research gathered and cited by Mark Yarhouse and Oliver O’Donovan strongly suggests that genuine gender dysphoria is not delusion. According to their research, delusion usually manifests across a broad range of areas in life and personality, and usually that is not the case with gender dysphoria. Furthermore, people living with gender dysphoria are fully aware (painfully so) of the biological realities and the conflicts they experience.

The second suggestion (it is the result of influence) implies that gender dysphoria is a choice (perhaps the result of peer pressure or desire for sexual satisfaction), or the impact of early childhood abuse. Indeed, these influences may be contributing factors for some. Consequently, these factors should be carefully and honestly explored, and not casually dismissed. But there is indisputably no evidence that anyone wants to live with gender dysphoria. To the contrary there is consistent evidence that those who live with gender dysphoria will go to great lengths to relieve themselves of the pain and chaos that accompanies the conflict. People who live with gender dysphoria want to be whole people and coherently sexed as male or female.

While not every person with gender dysphoria experiences the conflict with the same level of intensity, the pain is commonly so great that 41% of people who experience gender dysphoria attempt suicide (this percentage is disputed by no one familiar with the experience of gender dysphoria). Christian ethicist, Robert Song, describes gender dysphoria as “a body that is at war with itself.”(3)

Although medical researchers continue to try to unravel the mystery of the conflict, they have unearthed no specific cause for gender dysphoria. The conflict often has early onset manifesting in childhood, sometimes as early as 3-5 years of age – this matches Chris’s story. In the majority of instances, according to case studies, the conflict dissipates or even disappears by age 18 (post puberty). This means that we (parents, counselors, pastors, doctors, etc. together) need to learn how to do everything possible to help conflicted pre-pubescent children wait and delay conclusions or interventions until it is clear that the conflict persists. In fact, influential social critic, Camille Paglia (a non-Christian who self-identifies as transgender) refers to pre-pubescent interventions as “child abuse” and “evil.”(4) However, for those for whom the conflict persists, some report that they find some degree of relief by exploring a range of interventions from better understanding to surgery. More on these interventions below.

O’Donovan regards gender dysphoria as a “condition which has so far proved intransigent to every mode of psychiatric treatment.”5 He muses that it should be no surprise, then, that those with this condition may seriously consider a change of expression or a change of physiology to resolve the incongruity with their identity. In fact, he continues, “their very insistence in pursuing the hope of surgical intervention shows with what anguish they experience the dividedness of physical sexuality from gender identity.”(6)

Gender dysphoria, as a painful conflict or a distressing condition, like many results of the Fall we all experience, is worthy of sorrow, but is not in itself a sin that requires repentance.

Gender dysphoria involves conflicted identity and, as researchers have observed and those who experience the condition have testified, it frequently does not involve sexual attraction. In fact, many people with gender dysphoria report greatly diminished sexual attraction.

Gender dysphoria exists when the constituent elements of a person’s sex, which usually work together coherently to define a person’s sex, are in conflict with one another. “In its divided nature [the body has] become a sign of the fallen creation.”(7)

Now, at this point I need to acknowledge that there is a divergence of views about what defines a person’s sex. Some Christians regard anatomy (genitalia, chromosomes) as the objective visible features which define a person’s sex. These brothers and sisters regard anatomy as the orienting feature which determines how other discordant sexual components must resolve. This is a reasonable position, but is not a view I share. X’s and Y’s do not seem to answer all the questions manifest in the conflict. Jonathan Grant acknowledges that there are “confirmed aspects of male and female sexuality that go beyond our different bodies and reproductive capacities.”(8) The view I share is that a person’s sex is recognized by the coherence of those constituent elements in body and spirit(9) which comprise a person’s sex. I believe that genuine gender dysphoria is possibly much like an intersex condition in which elements of both sexes appear to be present in the same person.

Gender dysphoria is not new. It is not an invention of the modern sexual revolution. There are historical and anthropological studies that identify cultures which recognize a middle or ambiguous sex(10), and theologians as far back as Augustine (345-440) affirm the existence of cases that share the characteristics of gender dysphoria. Note what Augustine observes in The City of God (16.8): “As for Androgynes, also called Hermaphrodites, they are certainly very rare, and yet it is difficult to find periods when there are no examples of human beings possessing the characteristics of both sexes, in such a way that it is a matter of doubt how they should be classified.” Jesus himself, without commentary, acknowledges that there are some people who are “born eunuchs” (Mt 19:20). That is, throughout human history, there have been born people who have lived with ambiguous or uncertain gender identities as well as sexual dysfunctions.

How do we begin to frame pastoral care for those living with gender dysphoria?
I’ve posed the question in terms of pastoral care because I’m focusing on how we love, counsel, guide, and walk with those we love within our Christian community. This is a family conversation, not an ecclesiastical statement about the transgender movement. I leave that work to my betters.

As Christians committed to God’s glory, our starting point is God’s creation. We bow to his wisdom and will as he directs us by his word. But we bow as broken people. God promises to give us new hearts that love him and desire to do his will. Even still, our hearts are divided, conflicted, and influenced by the old way of life. David pleads that the Lord will unite his divided heart (Ps 86:11). Are we not like Peter who, devastated by his betrayal of Jesus, still confesses, “Yet, I love you, Lord” (Jn 21:15ff). Furthermore, we are broken of mind and body. These “dirt jars” (2 Cor 2:4) truly bear God’s image, yet they do not function as they should. In more ways than we are willing to admit or able to recognize, we cannot live as our first parents were created or as we will live resurrected in the world made new. Even at our most glorious, we hobble and improvise. As a result, in this life our path toward resurrection is varied and incomplete – the strong carry the weak, the courageous lead the fearful, the wise guide the foolish as together we work out our salvation with fear and trembling (Rom 15:1; 1 Cor 12:22-26; Phil 2:12).

What can we affirm from the teaching of scripture about what it means to be sexed beings, male and female? What responsibilities do we bear to live within what God has made clear in his word?
We begin with a commitment to the goodness of God’s creation. This is God’s own declaration of what he made, and we say “Amen” when we make these affirmations:

1. In the beginning God created humans male and female (Gen 1:26-27; Mk 10:6). These two sexes, distinctly yet together, bear God’s image (Gen 1:27), form society (Gen 1:28; 2:18), and establish marriage (Gen 2:24).(11) Sex (the noun) is who we are: male and female. Gender is how we live in the ordained social constructs of image-bearing, societal formation, and marriage. However, in popular culture, sex and gender have become reversed and indistinguishable so that gender now defines sex as a fluid socially constructed self-declaration. In the popular view the social dynamics of gender define sex, and sex is defined autonomously (“You can be whatever you want to be”). But this is contradictory to the biblical view in which gender is the social expression of sex.

2. We are to honor the sex we possess as well as the sex possessed by others because it is in and through the male/female distinction-in-community that in significant ways God makes himself known in the world (Gen 1:26) and in the Church (Eph 5:32).

3. Cultural expressions that identify maleness and femaleness range widely. They are not necessarily right and wrong in themselves (some are, some aren’t – we need to be discerning), and we must learn to reject lazy gender stereotypes (for instance: males are strong, like blue, and play with trucks while females are emotional, like pink, and play with dolls). But the ordained purpose of meaningful gendered cultural expressions is to distinguish maleness and femaleness, a distinction which is critical to applying biblical ethics for sexual behavior and to forming relationships. Therefore, the implication is that we are to use contemporary cultural forms to express clearly our sex and our sexed relationships (most critically, marriage). Paul refers to male and female hair styles in Corinth as situationally distinctive cultural indicators of sex and marital status in the order and worship of a local congregation in 1st Century Greece (1 Cor 11:2ff).(12) While the primary intent of Dt 22:5 is to prohibit same-sex sexual behavior, it also prohibits falsely gendered sexual presentation for the purpose of sexual exploitation and sinful sexual behavior.(13)

4. Every person since Adam and Eve is fallen, and no person (except for Jesus) has ever experienced an uncorrupted or complete understanding and expression of sex. Because of God’s covenant with Noah (Gen 8:22), we can live with the expectation of substantial order in the world. The rhythm of seasons and the regularity of the physical universe assure us that, in spite of humanly irreparable dis-order, God’s preservation of the world allows all people to experience significant continuity within his creation. But we inescapably experience this simultaneous order and dis-order in many different ways including sex.

5. While we all certainly have more to learn on this point, based on what we do know, it’s my opinion that a person’s essential or ontological sex is unalterable. When God made Adam and Eve human, he also made them male and female. Even when a coherent unity of the constituent parts that work together to comprise and reveal a person’s sex is absent (thereby leaving that person uncertain about his/her ontological sex), that ontological sex still exists and cannot be changed. In our age of increasing scientific and technological manipulation of the human body, I believe it’s important to affirm that there are some aspects of what define us sexually that are beyond our reach to control or our ability to change. As such they endure as critical fixed pieces that contribute to gender identity. Thus, given the role of unalterable and inaccessible characteristics, any attempt to move from an incoherent toward a coherent ontological sex will always be limited and incomplete.

Chris and I disagree about this point. He is more optimistic that changes toward coherence actually establish gender identity. I am not convinced. I believe it is important to affirm that sexual ontology is not something we can manipulate – there are aspects of our sex which are beyond our reach and ability to control. We can no more change our sex than we can change our species. However, I very cautiously believe that therapeutic interventions may possibly enable a person to live more coherently with one’s ontological sex. I make that allowance fully aware that those who define gender identity based exclusively on genitalia and chromosomes will disagree with my allowance for this possibility.

Having offered something of a biblical baseline for this discussion, I want to emphasize some important qualifications:
1. Given the reliability of the body to reveal a person’s sex, exceptions are rare. We should rely on physiology as an indicator of sex unless we have significant reasons to believe otherwise.

2. Given that God created sex as the basis for relationship with himself and others, exceptions are to be recognized in community, not autonomously. Exceptions require corroborating support from those in a position to speak knowledgably about a person’s mind, body, spirit, affections, and chemistry. It is no small thing to conclude that a person’s anatomy is communicating inaccurate information about that person’s sex, and self-diagnosis (while important) is insufficient in itself to justify an exception.(14)

3. Given that sex is a complex and deeply mysterious gift from God, we must be humble about over-simplifying that complexity and speaking with improper confidence about matters we know only in part. God assures us that he will give us sufficient knowledge to live faithfully, but he offers no reason to believe that we can know anything comprehensively. This assurance is true when we are making difficult decisions about understanding and charting a way through deep conflict and uncertainty related to sex.

4. Given God’s covenant, we should not be surprised by the regularity of life that results from his covenant faithfulness. But we must not mistake this stability for the eradication of brokenness and the impact of sin in this life. We experience change and healing by his redemptive and sustaining grace, and we give thanks for the predictability of life due to his providence. By his grace it is common for us to rest in self-knowledge and to delight in the knowledge of others.

5. Given the nature of evil and the devastation of sin, we should not be surprised by the degree to which we can witness the distortion of God’s good creation. Evil is present in the world and in us before we act and make our own contribution to this present evil age. There is no part of the universe untouched by the Fall, evil, and sin. So, we know that we will witness creational upheaval in the most profound and disorienting ways in every area of life, including sex.

6. Given the resurrection of Jesus and the promise of God, we may live together with our brokenness and sadness in hope knowing that he is making all things news. One day, he will wipe away all tears, and we will stand in his presence known by name, male and female, whole, complete, without conflict, and full of glory.

How do we place our understanding of gender dysphoria within the comprehensive call to Christian faithfulness?
Recognizing gender dysphoria as a condition does not mean that we are helpless or hopeless. The acknowledgement of condition is not resignation, nor is it an assumption that we can do nothing. God is always and everywhere present in the fullness of his redemptive power and purpose. How then do we live?

• We are to live with humility and commitment to the goodness of God’s creation.
• We are to live with compassion and courage in the face of the limitations of our
• We are to live with grace and patience as we struggle to work out the tension between
commitment and limitations.

1. We live with humility and commitment to the goodness of God’s creation.

We take Creation seriously, and we live by faith. Maleness and femaleness are essential to humanness in God’s good creation, and sex informs many of the ethical commands in God’s word. We are to honor these as God’s design for us and our relationships. Bending our lives to the arc of God’s will can be hard and frequently requires cross-bearing sacrifice and courage. But the Spirit, by his indwelling power, helps us understand God’s design as well as order our lives for his glory and our good.

2. We live with tenderness and compassion in the face of the limitations of our brokenness.

We take the Fall seriously, and we love. We live in a broken world as broken people. Every one of us is broken in ways that are sometimes obvious and sometimes not obvious. In some dimensions of brokenness, we experience, by God’s grace, substantial healing. In many dimensions, we suffer and endure disabilities we cannot change so that, by God’s grace, we wait for transformation in the world made new. In addition to God’s word, we look to God’s world (his common grace) for help in bringing some coherence, healing, and relief to the persistent disorder of the world. These efforts to bring order and relief, while real and meaningful, are always partial and imperfect – we lean hard on God’s grace to sustain us through a life marked by suffering at every turn. While we are always to live with God’s creational goodness in view, we admit that no efforts in this life to undo our fallenness are fully successful in restoring the creational ideal. We cannot escape the brokenness of life.

3. We live with grace and patience as we struggle to work out the tension between the Fall and Resurrection.

We take Redemption seriously, and we wait with hope. That is, we live between Christ’s resurrection and return, between the promise and fulfillment. Redemption is a certainty even though we experience profound and sometimes terrifying uncertainty as we live through the process of being redeemed. We are not yet what we will be. As a result, we live in tension between the concurrent realities of redemption and fallenness.

Central to living in that sometimes chaotic and confusing tension of a world longing for completion is our need for belonging to community. It is in community that we make sense of ourselves and the world. In community we belong to something more than ourselves that gives shape, meaning, and purpose to identity and life. Christian community offers the security of family by saying: “you belong because none of us is like Jesus – none of us is what we should be or will be, and all of us are desperately dependent on grace and mercy.” Each of us enters Christian community confessing our brokenness and sin, and each of us remains in Christian community with the hope that God’s presence, power, and providence will shape how we live together toward resurrection.

In Christian community we live with simultaneous commitments to being faithful to biblical truth and ethics and to living patiently and lovingly with the unresolved brokenness and chaos that we experience in our lives. In a profound sense that we will never fully grasp in this life, our brokenness and incompleteness are gifts to the community even as God through the community graciously delivers wisdom, joy, strength, and courage to those who suffer. Specifically, Chris is a gift, a bearer of grace to brothers and sisters who offer grace in return that together we might learn to live together before the face of God. Beyond conformity to what God has made clear, the path of living through that tension often will look as different as the people who make up the community into which God has called us to live.

Through what lens can we view our experience and make sense of our brokenness?
Here I lean on the analysis and tri-focal framework suggested by Mark Yarhouse as a context for pastoral care.

Much of the culture around us places a high value on autonomy and independence. In the name of diversity, individuals pride themselves in doing what is right in their own eyes, in being “true to themselves,” and in being authentic. “For many people today, to set aside their own path in order to conform to some external authority just doesn’t seem comprehensible as a form of spiritual life. The injunction is… ‘Only accept what rings true to your own inner self.’”(15) As a result it is easy to reject any notion of the binary male/female paradigm rooted in creation.

However, diversity also keeps in view the individual nature of our life circumstances and the way sanctification gets worked out in our lives. Living faithfully requires an attentiveness to the distinctive aspects of our personal make up and our life circumstances. God’s grace unfolds in individual lives so that we each have our own story to tell of how the Lord changes and sustains us, and we can find community with others whose similar stories offer us insight and camaraderie.

C.S. Lewis opens Mere Christianity by observing the nearly universal awareness that things are not the way they are supposed to be. We all experience the impact of the Fall both globally and personally in forms that include disease and disability. Those who suffer with gender dysphoria are only one of the more visible examples of how we all live with some form of topsy-turvy brokenness. Even those parts of our being that we are tempted to call “normal” are damaged in ways that can be difficult to see.

Many in the culture around us as well as in the Church confront the brokenness of life
predominantly by means of compassion. We hurt with those who hurt. However, in the name of love, too many of us give each other permission to make choices based solely on personal fulfillment, healing, and happiness.

But, our disabilities, by God’s design, serve to drive us to God’s ability, his grace and providence. We cast our cares upon him (1 Pet 5:7) and trust him for grace to change and heal us or grace to sustain us when our disabilities persist (2 Cor 12:7-10). When we view our disabilities through the lens of God’s providence, knowing the compassionate heart of our Father, we choose in love to live for God’s glory whether or not we experience deliverance from our disabilities. Living faithfully means that we resist the temptation to look at God and ourselves through the lens of our disabilities. Such a perspective inevitably leads to measuring God’s trustworthiness by our happiness.

One of the hallmarks of historic Christianity is fidelity to God’s word. As Christians we believe in obedience as a life of love for the God we serve. Jesus’ prayer in the Garden was surely a prayer he uttered every day of his life: “Not my will, but may your will be done” (Lk 22:42). Do we not desire for this prayer to flow from our heart every day as well. So, when it comes to choices related to our gender identity, we conform ourselves to God’s law even as we are transformed into Christlikeness by the Spirit of Christ.

However, God does not speak with uniform clarity about every situation of life. In areas in which the scriptures are less explicit we must proceed carefully, determined to affirm what God’s word says, no more, no less. As I’ve already noted, there are important affirmations God makes that influence our understanding of and response to gender dysphoria. But because many questions remain unanswered, we must guard against an over-confident legalistic spirit.

Many Christians respond to the troubles of life simply by listing God’s rules. In the name of duty, some Christians insist that our only response to brokenness is conformity to obligations. Even many non-Christians operate with heavily loaded formulistic language of what we must say, do, or allow. Indeed, we are bound to obey what God has made clear. But as we continue to learn more and more about the world and every area of life, here, too, we must be patient as we act in faith on what we know and as we wait in faith for what we do not know.

If we leave diversity, disability, and duty as compartmentalized responses, we will obscure our need to keep the whole redemptive picture (Creation, Fall, Redemption, Glorification) simultaneously and constantly in view. This means that for exceptionally difficult situations in life, like gender dysphoria, the best response we can offer is not individually to honor duty, disability, or diversity (or, truth, compassion, and wisdom). Rather, we must practice and learn together in Christian community to inhabit the biblical tri-focal paradigm of faith, love, and hope.

How then does a person who struggles with gender dysphoria live in a way that trusts God and his providence and honors what God intends sex (maleness and femaleness) to be? Similarly, how does a person who loves a sister or brother who struggles with gender dysphoria walk alongside that person in a way that encourages a faithful trust in God, his providence, and his wisdom?
I’m aware of five possible ways in which a person might seek a resolution or relief from the pain and incongruity of gender dysphoria. Within the scope of this essay, I have space only to identify these for you. But let me emphasize strongly that we have to evaluate each option both in the context of living by faith in the Triune God as well as in the context of living in response to God as we struggle together to live faithfully as followers of Jesus.

Before going further, I believe it is important to recognize that within the transgender movement, people pursue change for many reasons. In the spirit of the sexual revolution some people want to throw off any sort of boundaries and restraints so that they can live the way they want to live. Such a posture, from the Christian perspective, would be one of the many expressions of human rebellion. Some are motivated by sexual desire. But I am focusing on those people who live with the conflict of gender dysphoria and are seeking wholeness.(16)

1. A Prayer for Divine Intervention
This is asking for God’s healing grace. We pray, and we entrust our brokenness to God’s mercy, with the hope that he will resolve the pain and incongruity by his own power. Prayer will be a constant regardless of what other combination of options a person pursues in an effort to find a measure of relief that makes the conflict manageable.

2. A Change of Thinking
This is changing how one thinks of one’s self and identity both creationally and sexually. Sometimes a better understanding of God, the gospel, one’s self, or the condition of gender dysphoria is enough of a gentle rain to damp down the dust thereby enabling the person with gender dysphoria to breathe and find relief.

3. A Change of Influence
This is changing how one relates to significant situational influences. The goal is to reduce or remove environmental factors that may otherwise intensify or feed on the root conflict. In addition to the messages to which we give audience and credibility, we can be discerning about the influence of friendships we cultivate or tolerate; of books, music, art, and films we allow to stimulate our imagination and senses; of the foods we eat that nourish or debilitate our heath; of devotional practices and worship that nurture our faith and character; of light and space that shape our living environment; of physical exercise and rest.

Attending to those variables within our reach can possibly prevent additional conflict from piling onto the root conflict. To the extent we can clear the deck of obstacles which obscure our perception, understanding, and experience of the root conflict, the more we can make adjustments and decisions that more directly impact the conflict that seems insurmountable.

4. A Change of Expression
This is changing how one presents oneself so as to identify with the sex opposite to one’s physiological sex (through name and/or pronoun change or change of dress). Many people with gender dysphoria discover that a change of expression sufficiently quiets the conflict. In fact, the majority of people with gender dysphoria do not find it necessary to take further steps to find relief.

I noted earlier that I have chosen to address Chris as “he,” and I’m aware that not all Christians will agree with me about this decision. But I’ve decided to recognize Chris as male, not as an ontological declaration about a situation clouded by anguished uncertainty, and not as an ethical truth statement, but a simple recognition of my friend as he wants to be known. It is an accommodation of love for my friend and a commitment to using situationally sensitive language.(17) Chris is now known to his larger world as male, and many people now know him only as Chris (and have never known him any differently). I have occasion to meet Chris’s friends (including those he invites to church), and for their sake I honor his desire to be known as male. Perhaps this imperfect comparison will help. Mrs. Smith may divorce against pastoral counsel for unbiblical reasons that make her action a sin (I’m not implying that Chris’s decisions are sinful). But after her divorce, I do not stubbornly insist on calling her Mrs. Smith because I am convinced her decision to divorce was sin. If she wishes to be known by her unmarried name, Ms. Jones, then that’s how I will address her. No Christian virtue is advanced by my determination to punish her by calling her Mrs. Smith and labeling her as “divorced.” She is now Ms. Jones who is free to tell her own story. So, too, with Chris. I’m not simply playing along when I refer to him as male. I know Chris’s story, and I am making the choice to regard him as male.

5. A Change of Physiology
This is changing the physical characteristics of one’s body through some combination of hormone treatment or surgery. No doubt this is the most controversial option, but it makes sense that people pursuing gender coherence want that identity to be expressed to some degree physically. Research is just beginning to explore the degree to which hormone treatment or surgical changes provide long-term relief – Chris certainly expresses gratitude that the steps he has taken have significantly dampened the conflict in his life. For the relief he is experiencing, I give hearty thanks to the Lord.

But the underlying controversy over physiological intervention is whether such actions are moral or medical. By moral, are such actions mutilations of the body which would be unethical biblically, or are they rebellious manipulations of the body to live with self-creating autonomy which would also be unethical biblically?(18) Or, are these actions medical. By medical, are these interventions therapeutic in nature? If so, while the relationship between diagnosis and treatment is unclear, we have room to respond patiently and graciously with suffering people sometimes taking severe measures to find relief.

What pastoral guidance can we as a church family offer?
What, then, can be said pastorally to the person living with gender dysphoria and to the congregational community to which that person belongs? Above all else, we are on the journey together as members of Christ’s Body. Therefore, we are learning together to live in that dynamic triad of faith, hope, and love. Faith: obedience to God’s word and trust in God’s presence, power, and purpose. Love: sacrificial commitment to one another’s honor and glory. Hope: confident expectation because Jesus’ bodily resurrection ratifies the Father’s promise to make all things new, that all will be well.

Each week as we celebrate the Eucharist in congregational worship, I watch Chris take the bread and the cup to his lips as together we pray, reaffirming God’s covenant faithfulness, confessing our sin, declaring the reality of our new life in Christ, renewing our vow to live faithfully, and tasting a hint of the world made new. This Body of which we partake with the Body as a means of grace nourishes our confidence that one day this mortal will put on immortality. Our struggle with sin will be behind us, and all that is disordered in this life will be made whole and complete in the shalom of God’s kingdom.

Also, this bread and cup is the Body that died for our sin. In coming to the Sacrament, we taste the reality of God’s forgiveness for Jesus’ sake. Why? Because, though redeemed, all we do is fraught with sin. Especially in areas in which we live with great intensity (either exhilaration or pain), it’s easy for us to overlook or excuse sin. Walking with one another means that we are committed to encouraging each other to live faithfully – to obey what God has made clear in his word, to live wisely for his glory in choices that require great discernment, to act as members of the Body that need each other in the economy of God’s grace.

Until that day of rest and completion, what can we say and do as we struggle together to live faithfully in our fallen but redeemed bodies?

1. For the person living with gender dysphoria.
Whether you are considering committing your life to Christ or whether you are trying to live out your commitment to Christ, we as a Christian community want you to know that our love for you begins where we are together right now. We want to be a community in which together we can increasingly experience the richness and fullness of relationships for which God has created us and Christ has redeemed us. We are committed never to shame or shun you, and we are committed to honor you as a person made in God’s image and in Christ as a person made righteous by his grace. We want to walk alongside you recognizing that each of us lives with profound brokenness because of sin and the Fall, often in ways we never fully understand. That means we know there are a lot of things we need to learn together. We are committed to offering you every possible encouragement, and we are committed to helping you know and trust God more fully as well as understand and apply the teaching and promises of God in his word. We want to live together with the confidence that God’s grace is sufficient to sustain us through all the incompleteness, suffering, and sorrow that is a part of life as we know it. We want to encourage each other with God’s promise to wipe away our tears and make all things new.

“Cast all your cares upon the Lord because he cares for you” (1 Pet 5:7). Continue to entreat the Lord both for transforming as well as sustaining grace. Name your fears; rehearse what is true (including God’s character and your identity in Christ); affirm your faith, hope, and love; confess your sin and believe in God’s forgiving mercy; ask questions; make your requests known to God; give thanks.

Stay connected to mature Christian community.
You are not alone. Continue to value peer friendships as well as connection with those who most deeply understand what you experience. But also lean on those whose spiritual maturity and life experience help you live with a large view of God’s providence. It is God’s design for all of us to benefit from the resources he has entrusted to the members of his Body. Know and believe that you are God’s grace gift to the community.

Keep learning.
Keep asking questions about gender, healing, community, identity. Learn all you can from medical professionals and those discovering more about gender dysphoria. You are making decisions about your body and your health, so as an act of responsible stewardship, fully engage the skill and wisdom of the medical community. Learn all you can from wise skilled counselors who offer informed insight about the mind, the heart, relationships, and our interior lives. You are making decisions about how to apply understanding to life and how to gain an understanding of self that leads toward wholeness. All those who love you urge you not to succumb to the temptation to believe either that you are your best physician or that you know yourself better than anyone else – because neither is true.

Remain in close conversation with those who pastor you.
Keep asking questions about God, faith, the scriptures. Endeavor, with the help of your shepherds, to make your gender-related choices before the face of God. Even though you will be living as part of Christian community that is committed to charity, you know that not everyone will understand, support, or agree with you in the same way. But if your pastors are in close conversation with you, they can be present with you in your journey. They can share in your joys and sorrows. Together you can look to God’s word for instruction, truth, correction, and encouragement. They can stand for you and witness to your heart for God as the community learns how to walk together in truth and love.

Be courageous.
Life is hard, and following Christ is not easy (Jesus describes it as taking up a cross in Mt 16:24). Endurance requires courage because we live through many things in life that we cannot resolve or repair. To live with courage means that we are to live valuing something or someone more than ourselves (Rom 12:10; Phil 2:3). For Christians courage displaces self-centeredness with a loyalty that flows from a deep love for and trust in Jesus. Living with courage is daring to say back to our God the words of Jesus, “Not my will – may your will be done” (Mt 26:39; Mk 14:36; Lk 22:42; Jn 6:38), trusting that his will is actually what is best for us. Our deepest joy comes when we live out the conviction that God has made us for holiness, not happiness.

Be cautious
Give yourself enough time and space to make informed decisions as you pursue options that promise resolution or relief. Allow for the possibility that things can change over time for the better: healing, maturity, knowledge, skill, courage, hope, and other virtues. However, if you become convinced that you need to alter your expression or physiology, take the least invasive steps possible and do as little alteration as possible. Remember to come to these conclusions in close conversation with godly counsel and as an act of faith before the face of God.

Be patient.
People (like me) who do not live with gender dysphoria have a difficult time understanding the pain and chaos created by the condition. While you can’t change the way other people think about you, you can, “if it is possible, as far as it depends on you, live at peace with everyone” (Rom 12:18). Be as respectful as you can be with others who make an effort to understand you as you want them to be of you – not everyone will agree with your understanding or choices. Some people will be confused or alarmed; none more so than parents who are guiding their children through questions of sex, gender, boundaries, and identity. As you well know, very practical matters like use of bathrooms and participating in gender-based groups call for communication and humility. You are learning to live wisely within the tension of sacrificial love and necessary self-care. Be as patient as possible with others as you want them to be of you. Focus on learning to love others where they are in the situations of their lives.

Act in faith.
Every decision we make expresses what we believe. For us as Christians, every choice is inextricably tied to our faith, so much so that “whatever does not proceed from faith is sin” (Rom 14:23). Everything we do confirms or denies our loyalty to Christ. The gospel is to be the ground upon which we “live and move and have our being” (Acts 17:28).

2. For the person loving someone with gender dysphoria
We love one another in community. That is, our love for and faithfulness to one another are not isolated acts, but are expressions of our shared commitment to one another. Therefore, we begin with the commitment to love each other for the people we are – created for relationship and community, made in God’s image, and in Christ clothed in his righteousness. We are committed never to shame or shun one another. We want to walk alongside one another, repenting of our own sin and confessing our own profound brokenness because of sin and the Fall, often in ways we never fully understand. We want to be agents of grace as we help each other more and more to know and trust God as well as to understand and apply the teaching and promises of God in his word. We want to live together with the confidence that God’s grace is sufficient to sustain us through all the incompleteness, suffering, and sorrow that is a part of life as we know it. We want to encourage each other with God’s promise to wipe away our tears and make all things new.

Pray for our friends who live with gender dysphoria.
Intercede for their safety, peace, courage, integrity, healing, hope. Stand with them before the throne of grace, and stand with them publicly. Jesus is not ashamed of us and of being known as one of us. So, too, we must not be ashamed of one another.

Pray for your own heart and mind.
Repent of your anger, pride, impatience. Ask the Spirit of Christ for understanding and wisdom. Ask the Spirit to make clear to you how your friend who lives with gender dysphoria is God’s gift to you and the community.

Learn all you can about gender dysphoria and issues that surround it.
Be careful to distinguish gender dysphoria from the many cultural issues that are frequently (often unfairly, unkindly, and inaccurately) attached to it – for instance, gender dysphoria is not same-sex attraction or transvestitism.

Consider the three-framework approach (faith, love, hope).
Wrestle with keeping the three lenses together: honor God’s word and creation, acknowledge disability and fallenness, and allow the path forward together to be imprecise and even messy.

Live with integrity.
Do not violate your conscience, but remember that there is always more to learn. Living with conviction does not require you to be judgmental or unkind. Be willing to speak the truth, but also to honor those who do not share your conclusions and convictions.

Live with compassion.
Do not harden your heart to the struggles of others, but practice selfless love and generosity.

Live with hope.
Believe that God’s grace will sustain and preserve us until his work in creation is complete.

Resist the urge to fix people.
Be convinced that only God’s Spirit can change our hearts and give us new life in Christ.

Show hospitality to those who live with gender identity issues.
Build trust through honest friendships, and learn to see the world through someone else’s eyes. Demonstrate a selfless hospitality that delights in seeing other people flourish.

Be courteous.
Prayerfully consider recognizing our friends with gender dysphoria as they wish to be known. Practice a mutual respect that extends the same degree of generosity and courtesy you would like extended to you. As was previously noted, very practical matters like use of bathrooms and participating in gender-based groups, call for communication, patience, and humility. If you have difficulty knowing what to say or do, seek the counsel of your pastors.

Seek counsel.
If loving a friend who lives with gender dysphoria puts you in a situation in which you are confused or alarmed, do not to react in the moment, but seek out one of your pastors or an informed confidant to pray with you and offer you some guidance.

Act in faith.
How does your commitment to Christ constrain how you love someone with gender dysphoria? How do your responses and attitudes proceed from the gospel?

There is of course much more that can be said on all these matters, but let me give the last word to the Apostle Paul:

For we do not want you to be ignorant, brothers and sisters, of the affliction we
experienced. For we were so utterly burdened beyond our strength that we despaired of
life itself. Indeed, we felt that we had received the sentence of death. But that was to
make us rely not on ourselves but on God who raises the dead. He delivered us from such a
deadly peril, and he will deliver us. On him we have set our hope that he will deliver us
again. You also must help us by prayer, so that many will give thanks on our behalf for the
blessing granted us through the prayers of many. For our boast is this, the testimony of our
conscience, that we behaved in the world with simplicity and godly sincerity, not by earthly
wisdom but by the grace of God, and supremely so toward you.
(2 Cor 1:8-12)

Copyright © 2018 Steve Froehlich

Steve Froehlich has served as senior pastor of New Life Presbyterian Church (PCA) in Ithaca, NY since 1998.  He completed graduate theological and pastoral studies at Reformed Theological Seminary (MDiv, 1991) and Gordon-Conwell Theological Seminary (DMin, 2015).  His doctoral thesis, Faithful Presence: How Community Formation Shapes the Understanding and Practice of Calling, engages the ideas of James Davison Hunter’s To Change the Worldand explores their impact on discipleship in Christian community.  Previously, Steve served as assistant to the founding pastor of Highlands Presbyterian Church (PCA) in Ridgeland, MS; Executive Vice President of Reformed Theological Seminary (Jackson, MS); and board chair of Chesterton House Center for Christian Studies at Cornell University.  Steve and his wife, Sheryl, have three sons and four grandchildren.  Sheryl, a gifted speaker, writer, and teacher, serves as Assistant to the Director of Admission at Ithaca College, Ithaca, NY.  The views expressed in this article are his own and do not speak for any of the organizations with which he is associated.


For further reading: Mark Yarhouse,Understanding Gender Dysphoria, InterVarsity Press, 2015. Steve Froehlich, “Gender Dysphoria: A Pastoral Letter”, from which this article is excerpted. The Christian Medical Fellowship Statement on Gender Dysphoria RECOMMENDATIONS: “I genuinely appreciate the thoughtful, pastoral reflection on gender dysphoria offered by Steve Froehlich. His attempt to bridge the gap that so often exists between theology and pastoral care is greatly needed and will be a benefit to many Christians.” Mark A. Yarhouse, Psy.D., Professor of Psychology and the Rosemarie S. Hughes Endowed Chair, Regent University, author of Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture. “Steve Froehlich’s research and careful biblical reflection on how we should think about gender dysphoria is the most helpful and practical work that I have read on this topic. This will be of enormous help to pastors and others who seek to offer sensitive and biblical care to those who are struggling with this issue and to their families and friends.” Richard Winter, M.D., Professor Emeritus of Applied Theology and Counseling, Covenant Theological Seminary. “As a Christian couple that has been dealing with a transgendered child over the last few years, we have been encouraged by Rev. Froehlich’s pastoral care for families who are going through this, even outside of his own congregation. We have struggled with how to make sense of this issue from a biblical point of view while still extending love and grace to our child, and his paper has been helpful to us in the process. We appreciate his genuine compassion and desire to understand the issue from a personal point of view while still holding firm in his biblical and theological convictions.” Parents (name withheld) Pastor Froehlich’s letter “is a worthy effort in terms of research and quality of thought. And it breathes a wonderful spirit of Christian compassion.” John Frame, J. D. Trimble Professor of Systematic Theology and Philosophy, Reformed Theological Seminary. “Gender dysphoria is an issue which was not even in our vocabulary, until we suddenly found ourselves faced with the need to become educated about it quickly. As Christian parents, we were desperate to understand what God’s word as well as pastors, teachers, researchers, and counselors said about the subject. Steve Froehlich helped to meet that need and show us a faithful way forward. His writing is immersed in scripture, and he has laid out the material with clarity and wisdom. His loving and compassionate shepherd’s heart can be heard in every word he writes. Steve’s research has answered many of the nagging questions we had (Was it my fault? Is it sin? How can we live with hope?) He opened our eyes to a way of navigating the complexities as we trust God’s word and live by faith. The Lord has used him to restore joy in our family. Thank you, Steve, for this much-needed resource for Christian families!” Parents (name withheld) “As an adult who has lived with gender dysphoria all my life, I appreciate what Pastor Froehlich has written. One refreshing aspect of his writings is that he stops short of classifying treatment options as ‘moral’ or ‘immoral’ for all gender dysphoric people in a ‘one-size-fits-all’ fashion. There are some in the Christian community who feel as if they can speak conclusively on the subject, when the information we currently have from the Bible and medical science is better suited to speaking of possibilities. It is a real possibility that an intersex condition underlies at least some forms of gender dysphoria. In intersex situations, where different aspects of the body give contradictory indications of sex, the Bible does not tell us which aspect (or combination of aspects) takes precedence. While people will have opinions about this, they should be recognized as opinions that lack the authority of a clear statement from the Bible. Many want to draw a bright line that none may cross, desiring to issue moral imperatives to every person with gender dysphoria without ever needing to meet them or learn how God (who knows their true sex) is leading them. Pastor Froehlich is an important voice in this discussion precisely because he does not fear the very real possibilities that lie on the other side of the lines that others have already drawn.” A friend (name withheld), seminary graduate, serving faithfully in vocational Christian ministry FOOTNOTES 1)Mark Yarhouse, Understanding Gender Dysphoria, 20. 2)I believe we should not regard the interior aspects of our whole being as immaterial or non-physical. 3)Robert Song, Studies in Christian Ethics, 500. 4)Camille Paglia in a video excerpt from The Battle of Ideas 2016: www.youtube.com/watch?v=I8BRdwgPChQ 5)Oliver O’Donovan, “Transsexualism and Christian Marriage” Journal of Religious Ethics, 136. 6)Ibid., 147. 7)Song, 500. 8)Jonathan Grant, Divine Sex, 97. 9)Rob Smith, "Responding to the Transgender Revolution" (www.thegospelcoalition.org/article/responding-to-the-transgender- revolution), October 12, 2017 quoting John Cooper, Body, Soul, and Life Everlasting: Biblical Anthropology and the Monism-Dualism Debate, 78. Smith affirms that sex is more than the body, but concludes that the spirit and body can never be at odds with each other. "'Biological processes are not just functions of the body as distinct from the soul or spirit, and mental and spiritual capacities are not seated exclusively in the soul or spirit. All capacities and functions belong to the human being as a whole, a fleshly-spiritual totality.' In other words, scripture understands 'human beings holistically as single entities which are psychosomatic unities.' We are dealing, then, with a both-and: an ontological duality (a distinct body and soul) within a functional holism (an integrated person)." In my opinion, it’s not at all clear how Smith’s appeal to Ps. 139 supports his claim that functional holism is an incorruptible aspect of humanness and sex. Smith concludes that "there is, then, no person or soul or spirit that has been created independently of the body and then placed in the body (or perhaps in the wrong body)." We agree in rejecting such a radical dualism. Nevertheless, while functional holism is nearly universally normative, we must acknowledge (and in fact be unsurprised) that the effects of the Fall may be far-reaching enough as to sometimes create a dysfunctional holism, a disruption of the integrity of sex and gender. 10)See the works of Richard Winter, Megan DeFranza, or Gilbert Herdt for historical/anthropological evidence of a “third sex,” a category that includes but is not limited to gender dysphoria. 11)Along with other results of the Fall, disregard for creationally gendered relationships contributes to 1) the defacing of God’s image and glory -“They exchanged the glory of the immortal God for images” (Rom 1:23); 2) the corruption of society -“They were filled with all manner of unrighteousness, evil, covetousness, malice. They are full of envy, murder, strife, deceit, maliciousness. They are gossips, slanderers, haters of God, insolent, haughty, boastful, inventors of evil, disobedient to parents, foolish, faithless, heartless, ruthless” (Rom 1:29-31); and 3) the violation of marriage -“They gave up natural relations” (Rom 1:27). 12)Anthony Thistelton, The First Epistle to the Corinthians, 830-831, 836-837. “Paul insists that a socio-symbolic expression of gender identity cannot be brushed aside.... [T]he gospel does not revoke expressions of the divine will established in the order of creation, or even sensitivities of perception within a surrounding culture....Gender differentiation relates to that which God wills, decrees, and expresses in creation or in the creation order.... [Quoting Judith Gundry-Volf] ‘Humanity exists in community centered around the creation of male and female.’” Paul “insists” that gender differences be maintained for the Church to exist and function with integrity. 13)Peter Craigie, The Book of Deuteronomy, 287-288 -Dt 22:5 “does not refer simply to fashions or styles of dress as the warning contained in the final clause makes clear. It refers” either to transvestitism “associated with certain forms of homosexuality” or with “practices associated with the cults of certain deities.” Allan Harman, Deuteronomy, 202 -“Such interchange of clothing was associated both with types of homosexuality and also with particular forms of heathen worship. That these... aspects are in view seems confirmed by the way in which the practice is described as an abomination.” Christopher Wright, Deuteronomy, 240-241- Dt 22:5 "is not about styles or fashions in clothing, though it has been quoted in earnest" to that end. "Almost certainly it is about the perverted crossing of genders either in orgiastic rites involving transvestitism, or in some form of pagan worship, or both. The final phrase of the law shows that some form of serious immorality or idolatry was involved." JPS Torah Commentary: Deuteronomy, 200 -Plausible readings of Dt 22:5 include “disguising one’s self as a member of the opposite sex [to] facilitate... fornication” and “a perverse means of sexual stimulation or homosexual role playing.” Raymond Brown, The Message of Deuteronomy, 213 - Dt 22:5 is “a warning... not to identify with degrading sexual and homosexual practices.” Gordon McConville, Deuteronomy, 337-“The concern [of Dt 22:5] is either to discourage homosexuality or to prohibit transvestite practices found in [pagan] worship.” 14)Andrew Walker, God and the Transgender Debate, 43. "The self is not such a good place to look to for authority, knowledge, and trustworthiness." Walker is correct with respect to authority, but he overstates the case regarding knowledge and trustworthiness. We value knowledge in community and the wisdom of many counselors (Prov . 15:22). However, reliable self-knowledge is essential to navigating the many choices and circumstances in the life of faith. Humans' competence in acquiring knowledge is the basis for our moral accountability to worship God (Rom 1:18-22). The scriptures assume that individual humans possess the ability and responsibility to deduce trustworthy knowledge as a basis for making wise choices (1 Cor 11:14; Prov 6:6). As Calvin pens the opening lines of the Institutes (I.1.i), he affirms with equal emphasis the necessity of knowledge of God and knowledge of self, pondering that "which one precedes and brings forth the other is not easy to discern."There is knowledge I cannot know apart from divine self-disclosure in revelation, and there is knowledge others cannot know about me apart from personal self-disclosure in relationship. Therefore, we must listen to one another's stories and begin by receiving them as true. 15)Charles Taylor, A Secular Age, 489 16)Dr. John McHugh, a pioneer in sex-change surgeries at Johns Hopkins, now repudiates such surgeries. Given his important involvement in sex-reassignment surgeries (as they were known at the time), it is understandable that many people would rely on his opinions about transgender issues. Some of his opinions are correct. But with all due respect to his medical experience, his assessment of why people pursue sex-change surgeries is mistaken. This erroneous motivational assessment is foundational to his commentary, and therefore it undermines the usefulness and reliability of his conclusions. In his opinion, in his practice, there were two groups of people who desired sex-change surgery: "One group consisted of conflicted and guilt-ridden homosexual men who saw a sex-change as a way to resolve their conflicts over homosexuality by allowing them to behave sexually as females with men. The other group, mostly older men, consisted of heterosexual (and some bisexual) males who found intense sexual arousal in cross-dressing as females" (www.firstthings.com/article/2004/11/surgical-sex). But his categories simply to not correspond to the testimony of people living with gender dysphoria and looking for relief. His assumptions about the reasons people might seek surgical intervention distort the lens through which he views gender dysphoria and the remedies people pursue to relieve the conflict. 17)I appreciate Rosaria Butterfield’s comments about how in love and humility she addresses neighbors who are same sex parents. She is attentive to how two female partners, for instance, want to be named and known, and the principle she employs offers insight about how to address friends with gender dysphoria who change their names and pronouns. Butterfield writes in The Gospel Comes with a House Key: Practicing Radically Ordinary Hospitality in Our Post-Christian World, 53: “I remember the right names so that I don’t confuse the children raised in LGBT homes. I know who is Mama and who is Mommy and I teach my children to get it right too.” 18)Aside from matters of character (vanity, discontentment, etc.), there seems to be little controversy among Christians about the biblical ethics of body modification such as ear piercing, plastic surgery, etc.