A Pastoral Approach to Gender Dysphoria

In today’s climate of political polarization, calls for civility are becoming more and more frequent. Now more than ever, Christians are called to speak the truth in love. This task can be challenging as the fallen human heart is often tempted to compromise elements of truth in order maintain social harmony or relentlessly seek victory in argument without respect and sensitivity for the persons involved. While common and understandable, both tendencies result in distortions of Christian charity. Such charity is especially needed today in addressing the delicate topic of gender dysphoria.

In his book Understanding Gender Dysphoria, Evangelical Protestant psychologist Mark Yarhouse repeatedly emphasizes the need to distinguish between “pastoral care” and “cultural engagement.” This book, released by a Christian publishing house (InterVarsity Press, 2015), appears to be written primarily for Christians and often comes across as a corrective intended to help Christians understand better the experiences of those with confusion about their sexual identity and strike a more compassionate tone in relating to them and welcoming them into our churches. The book is replete with stories of gender dysphoric individuals, including many who have struggled with their Christian faith or were hurt in some way by Christian leaders. These anecdotes help the reader empathically connect with the pain, confusion, and isolation such individuals and their families often experience. This aspect of the book is quite helpful in developing a keener sensitivity to these suffering souls and broadening one’s awareness of the vast diversity and complexity among those who experience confusion about their sexual identity.

As he has done in previous works, Yarhouse also does a masterful job of reviewing the relevant scientific research in a way that is honest, fair, and accessible to the lay reader. Indeed, it is not a stretch to say that Yarhouse has established himself in Christian circles as one of the best in this regard. Following his usual style, he relies upon and cites primary sources from professional journals while explaining both the key findings and the methodological limitations of the research. Thus, if the reader approaches this book with the expectation of receiving a basic education in the science of gender dysphoria, he will not be disappointed.

Alongside these positive elements, there are some areas of concern with Understanding Gender Dysphoria. Parents, church leaders, and Christian professionals are hungry for answers regarding how to help young people struggling with confusion about their sexual identity in ways that are consonant with their Christian values. They want to understand the available options in such situations and how to discern the best path to follow. This is an especially urgent need as cultural pressure is mounting to view “transitioning” as both acceptable and inevitable.

Yarhouse provides some help in this area but stops short of providing a thorough moral analysis of the different treatment approaches and possible accommodations in response to a young person experiencing sexual identity confusion. Following the professional literature, Yarhouse distinguishes between childhood cases and adolescence/adulthood cases. For childhood cases, he lists the following options:

· psychosocial treatment to decrease cross-gender behavior / identification

· watchful waiting

· psychosocial facilitation (i.e., social transitioning)

· puberty suppression.

The options are similar for late adolescents and adults:

· seek to resolve the confusion in line with the sex of the body (perhaps through therapy or other means)

· manage the confusion and concomitant distress through intermittent cross-gender behavior (e.g., occasional cross-dressing or other behavior not in line with typical sex roles)

· adopt a cross-gender identity and roles, which may include cross-sex hormone treatments and/or surgery.

Yarhouse describes these various options and presents information about their outcomes and effectiveness in decreasing the subjective distress of the individual. However, he does not give a thorough moral analysis of them. While he notes that “theologically conservative” Christians may be uncomfortable with the thought of gender transition and/or sex reassignment, absent from the discussion in Understanding Gender Dysphoria is any moral absolute, such as the principle that mutilating a healthy human body for the purpose of simulating the opposite sex is intrinsically evil and, therefore, harmful to the individual. Furthermore, there is no discussion of the issue of cooperation with evil that arises when Christians are pressured to use opposite sex or alternative pronouns and names for people whose real sex is known. Yarhouse does not consider, for instance, whether such accommodations constitute bearing false witness.

Yarhouse summarizes his position in this way:

I see the value in encouraging individuals who experience gender dysphoria to resolve dysphoria in keeping with their birth sex. Where those strategies have been unsuccessful, there is potential value in managing dysphoria through the least invasive expressions (recognizing surgery as the most invasive step toward expression of one’s internal sense of identity). Given the complexities associated with these issues and the potential for many and varied presentations, pastoral sensitivity should be a priority.

These principles are fine as far as they go, but they lack any clear moral boundaries as to how far is too far. Without such clear guidelines, there is no backstop to prevent suffering individuals from falling off the cliff of self-alienation and mutilation.

Yarhouse’s book is a respectable attempt to meet a pressing need for the Christian community and has much to offer. However, it ultimately comes up short because his whole analysis is not sufficiently grounded in an adequate anthropology that sees the body—and the sex revealed therein—as intrinsic to both the fundamental identity (son or daughter) and vocation (father or mother through spousal love) of every human being. Yarhouse pays some respect to the Christian drama of creation, fall, redemption, and glorification, but fails to fully see the anthropological vision flowing from the Trinitarian God embedded within it. Without this firm foundation, one is left grasping for moral principles to guide the response to sexual identity confusion and left with the well-intentioned, but slippery-slope principles offered in Understanding Gender Dysphoria. Our churches always have room for growth in compassion and welcoming—a crucial task to be sure—but without objective truth to guide us, our charity risks sliding into a kind of sentimental enabling which may ultimately result in harm coming to sexually confused individuals and their families, including further alienation from Christ, the source of all Truth about what it means to be human.

Andrew J. Sodergren, Psy. D., is an adjunct professor at the John Paul II Institute for Studies on Marriage and Family in Washington, DC, and a licensed psychologist at Ruah Woods, OH.