Gender: M or F or Other—Transgender Insights
by Karl Benzio, MD
Today's Christian Doctor - Winter 2015
Editor’s Note: Transgenderism is a hot topic in today’s culture. We feel it is important to respond appropriately in a Christian manner when faced with this topic of discussion, as well as when dealing with it in the healthcare profession. This is the first article on this subject, focusing specifically on the theological and psychological discussion points from a Christian perspective. A second article will be published in a future edition of Today’s Christian Doctor that deals with the practical side of the matter that will help you as you encounter transgender patients in your practice.
It used to be a straightforward prompt on any questionnaire or application: “Gender: Male or Female.” But that once simple question is now confused by the explosion of transgenderism within our culture. Who can use what bathroom? Do we need a third option in public changing rooms? Can you assume the person you’re meeting on a date is really the gender you are attracted to? What if my patient wants to change sex? Should I hire a transgender employee? And that’s just the beginning. Let me help sort out some transgender issues we face as Christians in healthcare so we can be better prepared to be witnesses for Christ in a dark world.
To help clarify the numerous terms existing around this issue, let’s start with some basic concepts and definitions.
- Sex or Birth Sex – A person’s physical reproductive anatomy and resultant secondary sex characteristics. Predominantly, but not always, dictated by genetics guiding uncorrupted fetal development.
- Intersex – People who have anatomy that is not considered typically male or female or have anatomy not matching their genetic sex of XX or XY. Most come to medical attention because healthcare professionals or parents notice something unusual about their bodies or puberty or fertility isn't normal, but some are not known until death/autopsy.
- Ambiguous genitalia – External genitalia not clearly and totally male or female.
- Gender – Social roles and characteristics based on the sex of the individual. (Until more recently, gender and birth sex were understood and used interchangeably.)
- Sexual Orientation – Refers to an individual’s enduring physical/sexual, romantic and/or emotional attraction to others.
- Heterosexual (straight) is opposite-sex attraction (OSA).
- Homosexual (gay, lesbian) is same-sex attraction (SSA).
- Bisexual is attracted to both sexes.
- Gender Identity – Defined as one’s internal sense of being a male or female, man or woman. Now the options include none, both or something totally different. Instead of believing gender is a binary system with only two options, either male or female, some believe gender falls on a more fluid spectrum. Some of those “newer” options include having no gender, having both genders or being even a third gender unique to that individual. Gender expression lies on a spectrum that includes the following:
- Birth Sex Gender Conformity – People who are comfortable with their birth sex, identify themselves as that gender and present themselves fairly consistently as that gender.
- Gender Nonconformity – People who identify with their birth sex but frequently behave in a manner usually associated with the opposite sex, such as males who are effeminate and females who are masculine. During pre-pubescent years, gender nonconformity is normal and common, more so in females than males. But when puberty starts and sexual hormones start to circulate, gender conformity or congruence, that is, behavior and psychological identify, begin to align and are congruent with birth sex.
- Transgender (formerly Gender Identity Disorder) – An umbrella term for an ever-changing and evolving population and subculture of people who feel the gender they were assigned at birth (or in rare circumstances, shortly after birth) is a false or incomplete description of who they are psychologically.
- Gender Ambiguity (GQ; alternatively non-binary) – A catch-all category for gender identities not exclusively masculine or feminine. Cross-dressing (transvestite) is a common subgroup.
- Opposite Birth Sex Gender Conformity (transsexualism) – A person who thinks, feels and acts (if safe to do so) like a member of the opposite birth sex, especially psycho-sexually. If available and affordable, this group will often pursue hormonal and/or surgical sexual reassignment surgeries (formerly “sex change operations”).
“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).
God created man in His image. Then, from man, God created woman, also in His image. God created man and woman with many similarities, but also with key, yet complementary, differences. These differences weren’t just anatomical, but also physiological, especially regarding our body development, reproductive hormones and particularly brain development and functioning. These physiological hormone and brain differences generate psychological differences, such as personality types and relating styles, allowing us to better execute the roles God designed for man and woman in certain non-individualistic systems such as marriage, family, parenting, government and church. In bearing God’s image, although with different design, each sex carries a different yet complementary image of God, but when brought together in heterosexual marriage, man united with woman forms the fullest human representation of God’s image in this world.
Ideally, when egg meets sperm, God’s unique and individual physical design for that person is encoded in their wondrous genetic blueprint. This would include sex, gender, gender identity and sexual orientation. This would be XY = male sex and gender, confidently identifying as a male and psycho-sexually attracted to females. Or XX = female sex and gender, confidently identifying as a female and psycho-sexually attracted to males. God infuses a spirit to complete this spirit-mind-body being.
The next ideal steps would be a pristine gestational period in utero, with no contaminants, traumas or issues, followed by approximately 25 years of living in physically, psychologically and spiritually healthy environments allowing development and maturation of all three spheres. You see, the genetic design is only the start of the process, or the first domino in a sequence of millions. The further execution of God’s design needs the participation of the individual and is based ultimately on the worldview (a God-centered perspective or a world-centered perspective) and emotion management skills of the individual, as these are the main determiners of the decisions the individual makes. Gender identity, sexual orientation and a variety of other life activities are later dominoes determined by the preceding dominoes. These preceding foundational dominoes following God’s initial creating-our-unique-life domino, are made up from our experiences, especially the processing and response to these experiences. To put it quite simply, our life decisions start with our first breath.
“…Your adversary the devil prowls around like a roaring lion, seeking someone to devour. Resist him, firm in your faith, knowing that the same kinds of suffering are being experienced by your brotherhood throughout the world” (1 Peter 5:8-9, ESV).
“The thief comes only to steal and kill and destroy. I came that they may have life and have it abundantly” (John 10:10, ESV).
Unfortunately, as we see throughout the Bible, when God has a plan, Satan is immediately on the prowl with disruptive intent, hoping for the exact opposite of what God intends. Satan, the Great Deceiver, attacks. Satan’s primary tactic is deceit, deception or lies. Satan’s goal is to keep us out of relationship with God, so he attacks all those elements pertaining to relationship. Not only does he want to disrupt our understanding of healthy relationship concepts, but he also wants to thwart our decision-making process as it pertains to self-identity, our needs and how to engage in healthy relationships. Satan’s spiritual warfare strategically exposes us to wounds, trauma and loss via relationships so we’ll feel incompetent in and afraid of relationships with the intent that we’ll reject the opportunity for the ultimate relationship with God.
So Satan attacks early and often. Even before we are born, Satan attacks our mothers with “normal” fears, doubts and worries about parenting tasks like being a good mother, living in the right neighborhood, teaching the right principles, getting to the pediatrician on time, etc. This worry causes the secretion of chemicals that cross the placental barrier and affect body, brain and receptor development, leading to pathological physiologic changes. This is accentuated when the unborn child is exposed to toxins such as alcohol, nicotine, heroin, lead, benzodiazepines, thalidomide and numerous others, as well as when trauma (domestic violence, accidents) or disease (diabetes, lack of nutrition) occur.
By far, Satan’s most significant attacks occur during our childhood years, as these years blend the highest degree of brain neuroplasticity with high gullibility and our poor ability to precisely interpret and process the situations around us. These attacks wound, hurt and traumatize all of us, leading us to commit a significant number of mistakes and sins. In response, we all develop defenses which become a set of beliefs about ourselves and the world, which then allows us to understand, manage and then self-heal the wounds to protect ourselves from further harm.
Ideally, these defense mechanisms or life management strategies are developed from biblical truths and principles. But Satan knows how to prick our fleshly desires and our sin nature to influence a corrupted repertoire of life management paradigms and decisions. Unfortunately, we all have some distorted information and interpretations producing misguided defense mechanisms. For some, same-sex attraction or gender identity disorder is the paradigm they develop to manage and make sense of the hurts, wounds, traumas, distresses and inaccurate data they have accumulated in their lives with the intent of minimizing any further harm to themselves. Most of these strategies are not intentionally or pragmatically determined but develop organically and unconsciously over several years or more, so the individual believes no overt or definitive conscious decision was ever made. Rather it feels like a reflex or even created design or wiring from as early as they can recall.
Transgender occurs when a person with a psychospiritual issue is looking for a physical solution. It’s the boy who is abandoned by his father, so he yearns for a father’s love and seeks the love of a man. It’s the boy whose father is absent, so he is raised predominantly by his mother. He is very connected to and deeply identifies with his mother, has a sensitive disposition and doesn’t want to be lumped in the male category, so he develops a transgender paradigm. It’s the young girl molested by a male who believes her womanhood was the culprit, so she denies her femininity in an effort not to attract males, and then she seeks sexual connection with safer females instead of males. All these are examples of people faced with overwhelming circumstances and hurt who don’t have caretakers to help them process, and they had to come up with some paradigm on their own to adapt to these confusing life experiences in the spiritual war that is our world. Situations like these, as well as variables we do not know, can shape how we view our gender.
Is transgender sinful?
“For those who live according to the flesh set their minds on the things of the flesh, but those who live according to the Spirit set their minds on the things of the Spirit” (Romans 8:5, ESV).
Homosexuality is a sin, but transgender isn’t as clear cut, although Deuteronomy 22:5 and 1 Corinthians 11:14 discuss gender expression with some prohibitions. God has selected and given to each person, even before conception, a unique identity and design. A significant component is our gender. To deny this gift and be someone different would be denying God’s will, and that would be a sin. God designed male and female differently, and these unique and intentional distinctions should be maintained while guarding against the blurring or fusion of gender roles.
With this said, we should recognize the attacks of sin on mankind (genetic mutations), as well as Satan’s attacks during gestation on the unborn child’s development. Although rare, genetic sex and physical development can be mismatched or unclear, and we want to make sure we are not judging a person’s situation with wrong assumptions or incomplete data. If their transgender pursuits are not from these biological/physiological in-utero attacks and actually come from post birth attacks, we need to recognize that the transgender individual is, like all of us, a wounded person needing to find their true identity in Christ.
Transgenderism is a complex issue. Those struggling with it are wounded and in pain, and they are looking for soothing and healing. In our efforts to soothe them, falling into the trap of acquiescing to their needs and wishes seems the loving course and the path of least resistance. But to really understand transgenderism, offer hope and provide a cure, we need to unpack all three spheres of spirit, mind and body, as all three are involved in the evolution of this struggle. The biological is where we have significant training, but we need to understand and use accurate biblical principles to address the psychological struggles and implement the psychospiritual remedy. Above all else, as Christian healthcare professionals, we must be the relationally-prioritizing and compassionate ambassadors for God as He divinely appoints and inserts us into the life journey of someone needing an encounter with God through us.