How should Christians react to gender dysphoria?

Question 11103

Gender dysphoria is a subject on which the church has managed to be both too loud and too silent, and the people caught in the middle of it are suffering. There are Christians who talk about it only as a culture war headline, and there are others who are so anxious about causing offence that they will not say anything at all. Neither serves the young woman sitting in the third row who has hated her own body since she was eleven and has never told a soul.

I want to try something harder than either. I want to hold two things at once: that what Scripture says about male and female is true and unalterable, and that the distress involved here is real, severe and deserving of patient care. Those two commitments are not in tension. It is only when we drop one of them that we become either cruel or useless.

What gender dysphoria actually is

Let us start with definitions, because a great deal of confusion in this area comes from people using the same words to mean different things. Gender dysphoria is the term used for significant, persistent distress arising from a mismatch between a person’s sex and their internal sense of themselves as male or female. It is a clinical description of suffering. It is not a philosophy, a political position or a lifestyle choice.

The distress is not trivial. People who experience it describe a persistent, grinding sense of wrongness about their own body, often accompanied by shame, isolation and depression. Rates of self-harm and suicidal thinking in this group are high, and any Christian response that does not begin by taking that seriously has already failed at the first hurdle.

It is also worth saying that experiencing gender dysphoria is not itself a sin. A person does not choose to feel this way any more than a person chooses to feel crushing anxiety. Feelings arrive. What we do with them is where moral responsibility begins, and even there the situation calls for a good deal more gentleness than it usually receives.

What Scripture says about male and female

The foundation is laid in the first chapter of the Bible. Genesis 1:27 says that God created man in his own image, in the image of God he created him, male and female he created them. Two things sit together there. Humanity bears the divine image, and humanity exists as male and female. The second is not an afterthought appended to the first.

Jesus treats this as settled. When questioned about marriage in Matthew 19:4 he answers by asking whether they had not read that he who created them from the beginning made them male and female. He grounds his teaching in the created order rather than in the customs of his day, and he treats the twofold pattern as a given.

So the biblical position is that sex is a creational reality, given rather than chosen, and that it is good. This is why I cannot accept the framework in which an inner sense of identity overrides the body. It is not that the body is more important than the person. It is that in Scripture the body is not a container the real self is trapped inside. That idea is much older than the current debate and it comes from Greek philosophy rather than from Genesis. See my answer on gender as biological reality.

The body is part of who you are

Christianity is the most body-affirming faith there is, which surprises people who have been told otherwise. God made matter and called it good. The Son took a real human body and still has it. The believer’s body is called a temple of the Holy Spirit. Our future is not escape from the body but resurrection into a better one.

That matters enormously for how we think about gender dysphoria. If the body is part of who you are rather than packaging around the real you, then a settled conflict between the sense of self and the body is a wound rather than a revelation. Something has gone wrong, and the wound is worth taking seriously precisely because the body matters.

Psalm 139:14 says we are fearfully and wonderfully made, and I have known that verse to be almost unbearable for someone in this position. It should be handled with care rather than quoted as a rebuke. The point is not that you ought to feel differently about your body. The point is that God’s estimate of it is not determined by yours.

Why affirmation is not the kindness it appears to be

The prevailing cultural answer to gender dysphoria is affirmation: accept the person’s stated identity, use the requested language, and support social and medical transition. It presents itself as compassion, and those who resist it are presented as the ones causing harm. I want to explain, without heat, why I think this is mistaken.

Compassion means suffering alongside someone. It does not mean agreeing with everything they believe about themselves. If a person is convinced of something that is not the case, telling them it is the case is not love, however warmly it is done. We understand this instinctively in every other area of distress about the body. With gender dysphoria we are asked to make a single exception, and no coherent reason is offered for why.

There are also serious practical questions that have become difficult to raise. Puberty blockers were introduced with far less evidence than their widespread use implied, and several European health systems have since narrowed their use after reviewing the evidence. Cross-sex hormones and surgery carry permanent consequences including sterility. A significant proportion of children who experience gender dysphoria find that it resolves through adolescence if it is not medically entrenched. Those are matters of fact, and a person’s compassion is not measured by their willingness to ignore them.

Distinguishing the distress from the ideology

Here is a distinction I would press on every Christian who wants to speak about this well. Gender dysphoria is a condition that individuals suffer. Gender ideology is a set of claims about reality: that gender is a spectrum, that it is separable from biology, that identity is self-determined and self-authenticating. The first is a person. The second is an argument.

We are entitled to disagree strongly with the argument. I do. It cannot account for what a body is for, it produces incoherence the moment it meets sport or safeguarding or medicine, and it rests on a view of the self that Scripture does not share. I have set that out at more length in my answer on how Scripture addresses gender ideology.

But arguments are not people, and the person in front of you did not invent the framework they are using to describe their pain. They reached for the only vocabulary the culture handed them. Winning the argument in their presence, at volume, will not help them and will very probably ensure they never speak to a Christian about it again.

What about intersex conditions?

This question is often raised as though it settled the matter, so it deserves a straight answer. Differences of sexual development, sometimes called intersex conditions, are rare physical conditions in which sexual development has not followed the usual course. They are real, they are medical, and the people who live with them deserve far better than being used as a debating point.

They do not, however, establish that sex is a spectrum. A condition in which development has gone atypically is precisely a departure from a norm, and you cannot recognise a departure without the norm being there. In the same way, the existence of congenital heart defects does not show that hearts have no design. What these conditions do show is that we live in a creation that has been damaged, which is exactly what Romans 8 tells us to expect.

It is also worth noting that the overwhelming majority of people who experience gender dysphoria have entirely typical bodies. The two subjects are related in public argument and almost never related in an individual life. Conflating them helps nobody and it uses one group of suffering people as ammunition in a dispute about another.

Children and the duty of care

I hold a firmer line where children are concerned, and I make no apology for it. An adult may make decisions about their own body that I believe to be mistaken, and I will still love them and keep the door open. A child cannot give meaningful consent to interventions whose effects they will carry for life and whose full weight they cannot yet imagine.

Adolescence is a period of profound instability in self-understanding for nearly everyone. Distress about the changing body is common at that age and is usually temporary. Where gender dysphoria in childhood is left without medical intervention, a substantial proportion of those young people become comfortable in their own bodies by early adulthood. Locking in a course of treatment during the very years when identity is most fluid strikes me as the opposite of caution.

None of this means abandoning a distressed teenager to get on with it. It means offering exploratory, unhurried support that treats the whole young person, addresses the anxiety and depression that so often accompany the picture, and does not assume the conclusion before the work has begun. Parents in this situation need enormous support from their church, and they are frequently given advice instead.

Pronouns and the practical questions

Believers ask me about language more than about anything else, usually because it is the point at which conviction meets an actual conversation. I do not think there is a single answer that fits every situation, and I would resist anyone who tells you there is.

My own practice is to use a person’s chosen name readily, since names change for all sorts of reasons and nothing is affirmed by using one. Pronouns are harder, because they make a claim about what a person is rather than what they are called. I will not say something I believe to be untrue, and I will also not turn every encounter into a confrontation over grammar. In practice it is usually possible to speak warmly to someone while using their name and avoiding the construction altogether.

Where a professional or legal requirement is involved, believers will have to weigh their conscience and may face real cost. That is a matter for prayer and for the counsel of mature Christians who know the circumstances, and I would not want to bind anyone’s conscience from a distance. What I would say is that the person with gender dysphoria in front of you is not a test case. They are somebody’s child.

How I would actually speak to someone

Begin by asking questions and meaning them. When did this start? What is the hardest part? Who else knows? Most people carrying this have rehearsed an argument in their head a hundred times and have almost never been asked what their life is like. Simply being interested rather than alarmed is a considerable gift.

Do not rush to state your position. It will come out in time, and it will land far better once the person is confident you are not going to discard them. When it does come out, be honest rather than evasive. People can tell when they are being managed, and a Christian who will not say what he thinks is not experienced as kind. He is experienced as slippery.

Stay for the long haul. Gender dysphoria does not resolve in a conversation, and the person may make decisions you think are wrong. Keep turning up anyway. The parent of the prodigal did not go with his son, and he also never stopped watching the road. There is a way of holding a conviction that keeps the door open, and there is a way that slams it, and the difference is almost entirely in the tone.

The gospel is larger than this question

There is a mistake that conservative churches make repeatedly, which is to treat this as the defining issue of a person’s life. It is not. A man is not chiefly a set of opinions about gender, and neither is he chiefly his distress. Every human being stands before God as a sinner in need of a Saviour, and that is true of the person with gender dysphoria in exactly the same way and to exactly the same degree as it is true of me.

Paul lists a range of behaviours in 1 Corinthians 6:11 and then says: and such were some of you. But you were washed, you were sanctified, you were justified. That congregation was full of people whose past the respectable world would not touch. The church has always been a place where people arrive as they are and are then changed, slowly and by grace, rather than being required to sort themselves out beforehand.

I would also say plainly that change in this area is not guaranteed, and I distrust ministries that promise it. Some believers live with gender dysphoria for many years while walking faithfully with the Lord, in the same way that others live with chronic pain or unwanted singleness. Faithfulness is not the same as relief, and the resurrection is where every unresolved thing is finally answered.

So, now what?

If someone tells you they are struggling with gender dysphoria, your first job is not to correct them. It is to thank them for trusting you, and to keep listening long enough to understand what their life is actually like. You can hold your convictions perfectly well while your mouth is shut.

If you are the one struggling, please tell somebody. There is a Christian somewhere near you who will not flinch, and carrying this alone is costing you more than you know. And if you are in leadership, would your church be a safe place for that conversation to begin? It is worth finding out before you need the answer.

So God created man in his own image, in the image of God he created him; male and female he created them. (Genesis 1:27, ESV)

For Further Study

Those wanting to work through the theological foundations will find the doctrine of humanity treated carefully in Millard Erickson’s Christian Theology, particularly his handling of the image of God and the unity of the person, and in Lewis Sperry Chafer’s Systematic Theology, whose analysis of body, soul and spirit remains useful even where his conclusions are debated. Charles Ryrie’s Basic Theology gives a clear and accessible summary of creation and human nature from a dispensational standpoint, and Arnold Fruchtenbaum and J. Dwight Pentecost are worth consulting on the created order and its restoration in the age to come. For the historical and medical background, the reviews commissioned by several European health services in recent years are more informative than most popular Christian writing on the subject, and readers may also find the wider discussion in my answer on gender identity and biological sex a useful next step.