(iii) Third, among the vices of the old self that all believers are called to discard are covetousness and deception. I draw attention to these two particular sins because of their relevance to transgenderism. As to the first, many who struggle with gender incongruence are sorely tempted to desire a body other than the one they have been given. That desire, to be frank, is a form of covetousness. Paul’s advice is blunt: “Put to death,therefore, whatever belongs to your earthly nature:sexual immorality,impurity, lust, evil desires and covetousness,which is idolatry” (Col 3:5). As to the second, the aim of those who seek to transition genders is to “pass” as being the opposite sex to what they, in fact, are. This is deception. Again, the apostle pulls no punches: “Do not lie to each other, since you have taken off your old self with its practices and have put on the new self, which is being renewed in knowledge in the image of its Creator” (Col 3:9-10). In short, faithfulness to Christ cannot be separated from how a person manages their gender identity challenges.⁷⁷ No Christian is at liberty to attempt to change their gender. Robert Gagnon puts the point strongly but helpfully: “[W]hile redemption is unmerited, an active pursuit of a ‘transgender’ life would be at odds with minimal standards for repentance, faith, transformation, and a claim to ‘faithfulness’ to Christ.”⁷⁸

(iv) Fourth, just as there are vices that believers are called to ‘put off’, so there are virtues that we are called to ‘put on.’ Four are of especial relevance to our subject: endurance, patience, joy and thanksgiving. Development of such Christ-like characteristics is repeatedly encouraged in Scripture, but these four are brought together by the apostle Paul in his prayer for the Colossian Christians:

¹¹ May you be strengthened with all power, according to his glorious might, for all endurance and patience with joy, ¹²giving thanks to the Father, who has qualified you to share in the inheritance of the saints in light. (Col 1:11-12)

Endurance and patience are vital for sufferers of gender dysphoria, particularly for those whose cross-gender identification is strong and persistent over time. No one is helped by underplaying either the distress of such a condition, or the force of the temptation to alleviate it in disobedient and self-destructive ways. The battle to be faithful can be painful and exhausting, and the desire to end the struggle by ending one’s own life can be acute for some. However, resistance and obedience are possible, although much prayer is needed that strength be given to this end. Here is where a healthy perspective on the nature of the Christian life is vital; for it is “through many tribulations we must enter the kingdom of God” (Acts 14:22). Here also is where the importance of the biblical practice of lament is highlighted; for Scripture encourages us to pour out our sorrows and complaints before the Lord (e.g., Ps 102). On the positive side, joy and thanksgiving are also possible – if not for the affliction itself, for the sufficiency of God’s grace (2 Cor 12:9) and the fruit that perseverance bears under the sovereign hand of God (Jam 1:2-4). It is in this way that God’s children are able to rejoice in their sufferings (Rom 5:3-5).

At this point, someone might ask, “But shouldn’t we try to alleviate suffering wherever possible? And, if so, is there not an argument for relieving a gender dysphoric person’s distress by bringing their body into alignment with their mind?” Traditional medical ethics would suggest not. The canons of sound medical practice have typically “ruled against surgical intervention into a living human body except to protect the functional integrity of that body when it was endangered by disease or injury.”⁷⁹ For Christians, the biblical doctrines of creation, incarnation and resurrection all support the view that “the physical structure of our human bodies is not something we are free to change without very careful thought.”⁸⁰ What this means, as Dr. John Wyatt points out, is that we should only use medical and surgical technology “in a way which is appropriate to preserve and protect the original design, to maintain and preserve the creation order embodied in the structure of the human body.”⁸¹

In the case of gender incongruence, it is the mind that is disordered, not the body. “SRS, therefore, is a ‘category mistake’ – it offers a surgical solution for psychological problems.”⁸² Furthermore, “SRS is a ‘permanent,’ effectively unchangeable, and often unsatisfying surgical attempt to change what may be only a temporary (i.e., psychotherapeutically changeable) psychological/psychiatric condition.”⁸³ In other words, because the problem is in the mind and not the body, it should be treated with psychotherapy and not surgery. Consequently, any treatment of gender incongruence that seeks to relieve mental suffering by inflicting harm on an otherwise healthy body cannot be deemed ethical.⁸⁴

(v) Fifth, battles with gender incongruence, whether long term or short, should never be fought alone. Like all who suffer from a crippling disability, those who are afflicted by gender dysphoria are in great need of compassionate and practical support from others. This is one of the reasons why the risen Christ has given his followers the gift of brothers and sisters – not only to keep us accountable, but that we might bear one another’s burdens. So Paul writes:

¹ Brothers and sisters, if someone is caught in a sin, you who live by the Spirit should restore that person gently. But watch yourselves, or you also may be tempted. ² Carry each other’s burdens, and in this way you will fulfill the law of Christ. (Gal 6:1-2, NIV)

This text raises the important question: What counts as ‘sin’ and what counts as a ‘burden’? In my view, the experience of gender incongruence falls most naturally in the latter category (burden). Mark Yarhouse is, therefore, right to point out that “there is a need for the church to be able to cope with the disclosure of gender dysphoria among those who experience it and have the courage to share what they are going through.”⁸⁵ And not just cope, but embrace, love and protect. These precious brothers and sisters require our special care and must be surrounded by much love, emotional, spiritual and practical support, and prayer.

At the same time, and as we’ve already noted, there are ways of managing gender incongruence that, from a biblical standpoint, fall into the category of ‘sin’. What, then, will gentle restoration look like when such sin takes place? To answer this question responsibly in any given case, a range of factors will need to be taken into account: e.g., whether the person is Christian or non-Christian, whether they are spiritually mature or spiritually immature, their level of intellectual and moral capacity, the severity and complexity of the dysphoria, and whether they have other physical and mental health issues. Nevertheless, in light of the clear direction that Scripture gives and the clear boundaries it draws, Yarhouse’s advice – that some believers “may benefit from space to find ways to identify with aspects of the opposite sex, as a way to manage extreme discomfort” – ought not be followed.⁸⁶ All forms of intentional cross-gender identification are inappropriate for those in Christ. The fact that some of God’s people desire such “space” does not mean it is beneficial for them. Repentance, then, will mean seeking to live consistently with one’s God-given sex.