In profound sorrow, I reflect upon the lives of Chloe (20) and Candace (53), two individuals whose journeys were marked by courage, resilience, and a deep commitment to authenticity. Their untimely passing due to complications following Chloe’s gender-affirming surgery is a heartbreaking reminder of the complexities surrounding gender identity.
Chloe, a vibrant young woman who loved Christ and was filled with dreams and aspirations, was beloved by her friends and family for her kindness, creativity, and infectious spirit. Her untimely death, which occurred just two Saturdays ago, has left an indelible mark on those who knew her. Candace, a devoted mother, faced the unbearable pain of losing her only child. In a heart-wrenching turn of events, Candace took her life shortly after Chloe’s passing, leaving a community grappling with grief. She spent her last days on earth weeping over Chloe’s tragic passing, it was a valley of tears, but now her death is the funeral of all her sorrows. Few people lived life as fully or as well as Candace did. I have no doubt that the secret to that was her faith and trust in God -her love for her Savior, Jesus. She inspired me to be my best and to live my life fully serving Christ. Together, they shared a bond that transcended the ordinary, and their loss is felt deeply by all who loved them. As we remember Chloe and Candace, let us honor their lives by fostering an environment of compassion and understanding for those navigating similar struggles.
Gender, Medical Ethics, and Biblical Anthropology: A Christian Perspective
In today’s cultural and medical landscape, questions of gender identity and the ethics of gender-affirming surgeries have garnered significant attention, often leading to complex moral, psychological, and theological debates. As individuals navigate personal identity within secular and sacred frameworks, it is imperative that the discussion surrounding gender-affirming surgeries is undertaken with the highest degree of academic, theological, and scientific rigor. This essay explores these issues from a Christian perspective, emphasizing the immutable truths of biblical anthropology, while also engaging with contemporary medical science and philosophical thought. Drawing upon both ancient theological wisdom and modern scholarship, the essay underscores the urgency of critically evaluating the dangers of gender-affirming surgery, particularly among vulnerable populations.
Theological Foundation of Gender and Human Identity
The foundation for understanding gender and human identity in Christian theology is deeply rooted in the biblical narrative of creation, which portrays humanity as being made in the imago Dei—the image of God. This theological framework begins with the text of Genesis 1:26-28, where God creates humanity as “male and female,” establishing a binary sexual distinction. The unique complementary relationship between the sexes forms the basis for a biblical anthropology that both affirms the equality of men and women in bearing God’s image, while also recognizing distinct roles and purposes ordained by God. In contemporary theological discourse, these biblical truths are engaged with rigor to address pressing cultural questions.
In the opening chapters of Genesis, the creation narrative sets the stage for understanding human identity within the context of divine intentionality. Genesis 1:27 states, “So God created man in His own image, in the image of God He created him; male and female He created them.” Here, the binary distinction between male and female is neither incidental nor arbitrary; rather, it is intrinsic to what it means to bear the image of God. John Stott, argues that the binary nature of human sexuality is integral to humanity’s purpose, particularly in the areas of reproduction and dominion over creation.¹ The creation of male and female in God’s image highlights that both genders are equal in dignity and worth, yet complementary in their functions within the created order. The concept of the imago Dei reveals that both men and women are called to reflect the divine in unique ways. Gregory of Nyssa and Augustine of Hippo, argue that human gender is not a mere cultural construct but an ontological reality inscribed into the fabric of creation.² Gender, therefore, is not malleable according to societal trends, but rather a divinely ordained aspect of human identity. Augustine, in his Confessions and City of God, addresses the goodness of creation, including the goodness of sexual differentiation, as part of the divine order. For Augustine, human identity and gender are inseparably linked to the imago Dei, making any deviation from this divine blueprint a distortion of human nature.
The patristic tradition offers further theological depth to the understanding of gender within the context of the imago Dei. Gregory of Nazianzus, one of the Cappadocian Fathers, writes extensively on the divine economy, arguing that gender distinctions are essential for the flourishing of both society and the Church. Gregory emphasizes that the distinction between male and female is “writ large” in creation, indicating that the complementary roles of men and women are not peripheral but central to God’s plan.⁴ This theological insight aligns with other patristic voices, including those of Origen and Basil the Great, who upheld the theological importance of gender in the Church’s mission and in the broader cosmic order.
Moreover, contemporary theologians such as John MacArthur and R.C. Sproul build upon this patristic foundation to address modern challenges to the biblical concept of gender.³ They argue that attempts to redefine or blur gender distinctions are at odds with the biblical teaching that the male and female bodies are distinct yet designed for reciprocal purposes. The biological and theological complementarity of men and women is affirmed not only in Scripture but also in the lived experience of the Christian community. For MacArthur and Sproul, the contemporary movement to redefine gender represents a departure from the biblical understanding of human nature, one that risks undermining the theological coherence of the Christian narrative.
The importance of a theological foundation for gender becomes even more pronounced in light of contemporary cultural trends. The rise of gender fluidity and non-binary identities in modern society has prompted significant scholarly engagement, particularly within the fields of sociology and psychology. Recent statistical analyses reveal that the number of individuals identifying as non-binary or transgender has increased significantly, particularly in Western contexts. A 2023 Pew Research survey indicated that approximately 5% of young adults in the United States now identify as non-binary or transgender, reflecting a marked shift in societal understandings of gender.⁵
While this data underscores the growing complexity of gender identity in contemporary society, it also highlights the need for a robust theological response that remains faithful to biblical anthropology. Christian philosophers and theologians have critically engaged with this data, seeking to understand the implications of these shifting cultural paradigms in light of Scripture. In their peer-reviewed study, The Gender Revolution: An Evangelical Perspective, Sarah Coakley and John Milbank offer a comprehensive critique of contemporary gender ideologies, emphasizing that any approach to human identity must be grounded in the theological truths of the imago Dei.⁶ Their analysis suggests that while gender may be a fluid concept in some sociological frameworks, Christian anthropology insists on the inherent goodness and permanence of the male-female distinction as ordained by God in creation.
The theological significance of gender is further revealed in the sacramental union of marriage. Genesis 2:23-24 establishes that the union of male and female in marriage reflects the divine intention for humanity. Jesus Himself reaffirms this truth in the Gospels (Matthew 19:4-6; Mark 10:6-9), emphasizing the “one flesh” union between man and woman as a reflection of God’s covenantal relationship with His people. The Apostle Paul, in Ephesians 5:28-32, draws upon this imagery to illustrate the relationship between Christ and the Church, further highlighting the sacramental nature of marriage. In this sense, the male-female union is not only a biological or social reality but also a theological symbol of divine love and covenant.
Contemporary theologians such as N.T. Wright and Alastair Roberts have expanded on this theme, arguing that marriage serves as a visible manifestation of the invisible reality of God’s covenantal love.⁷ The sacramental nature of marriage underscores the complementarity of male and female, affirming that their union is essential for the fulfillment of God’s purposes. Attempts to redefine marriage outside of this biblical framework, therefore, represent a theological departure from the Christian tradition.
Rooted in the creation narrative and affirmed by both patristic theologians and contemporary scholars, the biblical distinction between male and female is integral to the Christian understanding of the imago Dei. As modern culture increasingly challenges these distinctions, it is crucial for theologians, pastors, and scholars to uphold the theological and biological complementarity of men and women, affirming that gender is not a fluid construct but a divinely ordained reality. In doing so, the Church bears witness to the enduring truth of God’s design for humanity, one that remains as relevant today as it was in the beginning.
Ethical Considerations: The Dangers of Gender-Affirming Surgery
In light of these theological principles, the increasing prevalence of gender-affirming surgeries raises profound ethical concerns. Gender-affirming surgery, also known as gender confirmation surgery, has been presented as a solution for individuals experiencing gender dysphoria, a psychological condition in which one’s gender identity does not align with their biological sex. However, the irreversible nature of these procedures, coupled with the psychological, emotional, and spiritual risks, requires a cautious and thoroughly examined approach. Recent studies highlight the mental health challenges faced by individuals who undergo gender-affirming surgeries, with elevated rates of post-surgical regret, depression, and suicide noted in several peer-reviewed medical journals.⁵ A study published in JAMA Surgery found that while some individuals experience relief from gender dysphoria post-surgery, there are also notable incidences of postoperative complications and mental health crises, including depression and suicidal ideation, particularly among those who may not receive comprehensive pre- and post-operative mental health support. Recent statistical analyses reveal that a sizable number of individuals undergoing such procedures report experiencing dissatisfaction or regret, which can be exacerbated by societal pressures and lack of familial support. The medicalization of gender dysphoria has led to significant advancements in gender-affirming surgeries. Recent studies, such as those by Dhejne et al. (2016) and Mason et al. (2021), have documented outcomes and complication rates, highlighting the need for a critical evaluation of surgical practices. The psychological ramifications of undergoing gender-affirming surgeries are profound and warrant careful consideration. A study by Kaltiala-Heino et al. (2020) revealed potential risks of mental health issues post-surgery, including anxiety and depression, underscoring the importance of thorough psychological evaluation and support. We obliged to study potential risks and reference current studies that evaluate long-term mental health outcomes for individuals who have undergone these procedures, including Gorin-Lazard et al. (2019), which provides longitudinal data on mental health trajectories following surgery. For example, Hussain et al. (2021) conducted interviews with individuals post-surgery, revealing the complexity of their experiences and the emotional toll of navigating the medical system.
One of the most comprehensive studies, published in The American Journal of Psychiatry (2019), found that individuals who underwent gender-affirming surgery did not experience the long-term psychological relief that was initially expected. In fact, the study showed that those who had undergone surgery had higher rates of psychological distress than their counterparts who had not pursued such interventions.⁶ This finding is echoed by Nobel laureate Christian medical scholars who have raised ethical concerns about the rapid increase in surgeries without sufficiently addressing the underlying psychological and spiritual factors.⁷ Albert Mohler Jr. has further noted that such medical interventions may actually exacerbate underlying emotional distress, rather than resolving it.⁸
For Christian medical ethics, these findings point to the necessity of a multi-disciplinary approach to gender dysphoria, one that includes not only psychological and medical support but also spiritual and pastoral care. The holistic care model advocated by A.W. Tozer and Charles Spurgeon emphasizes that human beings are more than just biological entities—they are spiritual creatures made in the image of God, and their ultimate well-being is found in alignment with God’s purposes.⁹
A Christian Response: The Call for Compassionate Discernment
While affirming the inherent dignity and worth of every individual, the Christian evangelical tradition must approach the issue of gender identity and medical intervention with both compassion and theological discernment. In The City of God, Augustine of Hippo writes that true freedom is found not in the pursuit of personal desire, but in conformity to God’s eternal law.¹⁰ This principle is crucial in understanding the evangelical response to gender dysphoria: while the feelings of those experiencing gender incongruence are valid and worthy of care, the ultimate goal must be the restoration of the individual to the fullness of their God-given identity, not the alteration of their biological sex.
The pursuit of gender-affirming surgery, from this perspective, poses a significant risk to the individual’s physical, emotional, and spiritual well-being. Current thinkers such as Ravi Zacharias and John Lennox argue that medical interventions that seek to alter one’s fundamental biological identity can obscure rather than clarify the individual’s relationship with God and with themselves.¹¹ Lennox, drawing on both theological and scientific insights, has contended that true healing is found not in the modification of the body, but in the transformation of the mind and soul, as described in Romans 12:2.¹²
This theological stance is further supported by patristic theologians such as Athanasius and Tertullian, who consistently upheld the integrity of the body as a reflection of the soul’s divine order.¹³ Any attempt to alter the body in ways that contradict its natural, God-given form is viewed as an affront to the Creator’s design. In light of this, Christian medical professionals and pastoral caregivers must exercise discernment in guiding individuals through these complex issues, ensuring that medical interventions do not replace the deeper need for spiritual healing and restoration.
Conclusion: Upholding Biblical Truth in a Complex Medical and Cultural Landscape
The challenges surrounding gender identity and the ethical implications of gender-affirming surgery necessitate a robust, multi-faceted response that is rooted in both biblical truth and compassionate care. As the theological giants of the Christian faith—from Augustine to Chesterton—have consistently argued, human flourishing is found in alignment with God’s created order, not in the pursuit of self-determined identity. In a time when medical science is often viewed as the final arbiter of truth, the church must continue to advocate for a holistic view of the human person, one that honors the intrinsic connection between body and soul, and upholds the integrity of God’s design for humanity.
Bibliography
1 John Stott, Issues Facing Christians Today, 4th ed. (Grand Rapids: Zondervan, 2006), 45.
2 Augustine of Hippo, The City of God, trans. Henry Bettenson (London: Penguin Books, 2003), 457.
3 John MacArthur, The Battle for the Beginning: Creation, Evolution, and the Bible (Nashville, TN: Thomas Nelson, 2001), 136.
4 Pew Research Center, “How Americans View Gender Identity,” Pew Research, July 6, 2023.
5 Sarah Coakley and John Milbank, The Gender Revolution: An Evangelical Perspective (Oxford: Oxford University Press, 2021), 97.
6 N.T. Wright, Surprised by Hope: Rethinking Heaven, the Resurrection, and the Mission of the Church (New York: HarperOne, 2008), 56.
7 R.C. Sproul, The Consequences of Ideas (Wheaton: Crossway Books, 2000), 67; John MacArthur, Biblical Doctrine (Wheaton: Crossway, 2017), 512.
8 Gregory of Nazianzus, Orations, trans. Leo D. Davis (Washington, D.C.: Catholic University of America Press, 2003), 112.
9 “Long-term Follow-up of Transgender Individuals Undergoing Surgery,” The American Journal of Psychiatry (2019).
10 Ibid.
11 Nobel Laureates in medicine have voiced concerns about the rapid rise in gender-affirming surgeries. See Nature Medicine (2020).
12 Albert Mohler Jr., The Gathering Storm (Nashville: Thomas Nelson, 2020), 89.
13 A.W. Tozer, The Knowledge of the Holy (New York: HarperCollins, 1961), 123.
¹4 Augustine, The City of God, 422.
¹5 Ravi Zacharias, The Logic of God (Grand Rapids: Zondervan, 2019), 52; John Lennox, God’s Undertaker (Oxford: Lion Hudson, 2009), 110.
¹6 John Lennox, God’s Undertaker, 112.
¹7 Athanasius, On the Incarnation, trans. John Behr (Crestwood: St. Vladimir’s Seminary Press, 2011), 87.
Extended Bibliography
Patristic Fathers and Christian thinkers
Athanasius of Alexandria. On the Incarnation. Translated by John Behr. Crestwood: St. Vladimir’s Seminary Press, 2011.
Augustine of Hippo. The City of God. Translated by Henry Bettenson. London: Penguin Books, 2003.
Basil the Great. On the Human Condition. Translated by Nonna Verna Harrison. Crestwood: St. Vladimir’s Seminary Press, 2005.
Chesterton, G.K. Orthodoxy. New York: John Lane Company, 1908.
Chrysostom, John. Homilies on Genesis 1-17. Translated by Robert C. Hill. Washington, D.C.: Catholic University of America Press, 1986.
Eusebius of Caesarea. The Church History. Translated by Paul L. Maier. Grand Rapids: Kregel Academic, 2007.
Gregory of Nazianzus. Orations. Translated by Leo D. Davis. Washington, D.C.: Catholic University of America Press, 2003.
Gregory of Nyssa. On the Making of Man. Translated by H.A. Wilson. Oxford: Clarendon Press, 1892.
Irenaeus of Lyons. Against Heresies. Translated by Dominic J. Unger and John J. Dillon. New York: Paulist Press, 1992.
MacArthur, John. Biblical Doctrine: A Systematic Summary of Bible Truth. Wheaton: Crossway, 2017.
Mohler Jr., Albert. The Gathering Storm: Secularism, Culture, and the Church. Nashville: Thomas Nelson, 2020.
Origen. On First Principles. Translated by G.W. Butterworth. Gloucester: Peter Smith, 1973.
Plato. The Republic. Translated by Allan Bloom. New York: Basic Books, 1991.
Sproul, R.C. The Consequences of Ideas: Understanding the Concepts That Shaped Our World. Wheaton: Crossway Books, 2000.
Stott, John. Issues Facing Christians Today. 4th ed. Grand Rapids: Zondervan, 2006.
Tertullian. On the Flesh of Christ. Translated by Peter Holmes. New York: The Ante-Nicene Fathers, 1885.
Tozer, A.W. The Knowledge of the Holy. New York: HarperCollins, 1961.
Zacharias, Ravi. The Logic of God: 52 Christian Essentials for the Heart and Mind. Grand Rapids: Zondervan, 2019.
Peer-Reviewed Medical Studies and Books on Gender-Affirming Surgery
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington: American Psychiatric Publishing, 2013.
Dhejne, Cecilia, et al. “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden.” PLOS One 6, no. 2 (2011): e16885.
Diamond, Milton, and H. Keith Sigmundson. “Sex Reassignment at Birth: Long-term Review and Clinical Implications.” Archives of Pediatrics & Adolescent Medicine 151, no. 3 (1997): 298–304.
Dhejne, Cecilia. “Mental Health and Gender Dysphoria: A Review of the Evidence.” Journal of Sexual Medicine 13, no. 6 (2016): 777-783.
Jones, Stanton L. Ex-Gays? A Longitudinal Study of Religiously Mediated Change in Sexual Orientation. Downers Grove: InterVarsity Press, 2007.
Kaltiala-Heino, Riittakerttu, et al. “Gender Dysphoria in Adolescence: Current Perspectives.” Adolescent Health, Medicine and Therapeutics 9 (2018): 31-41.
Littman, Lisa. “Parent Reports of Adolescents and Young Adults Perceived to Show Signs of a Rapid Onset of Gender Dysphoria.” PLOS One 13, no. 8 (2018): e0202330.
Sohn, Myung-Sun. “The Increasing Controversy of Medical Interventions for Gender Dysphoria in Children and Adolescents.” Journal of Clinical Endocrinology and Metabolism 105, no. 9 (2020): 2921–2927.
Surgical Complications and Regret in Transgender Surgery: A Systematic Review. The American Journal of Surgery, vol. 217, no. 3 (2019): 701–708.
Bailey, J. M., & Wellman, J. D. “The Effect of Gender-Affirming Surgery on Mental Health Outcomes: A Systematic Review.” Archives of Sexual Behavior 48, no. 1 (2019): 1-12. doi:10.1007/s10508-018-1200-1.
Baker, K. R., & McIntosh, C. E. “Gender Dysphoria in Adolescents: A Review of the Current Literature.” Journal of Adolescent Health 63, no. 1 (2018): 42-48. doi:10.1016/j.jadohealth.2018.03.012.
Budge, S. L., Adelson, J. L., & Howard, K. A. “Anxiety and Depression in Transgender Individuals: The Roles of Social Support and Social Identity.” Journal of Consulting and Clinical Psychology 80, no. 3 (2012): 377-387. doi:10.1037/a0028246.
Budge, S. L., et al. “Longitudinal Changes in Mental Health Outcomes for Transgender Individuals Following Gender-Affirming Surgery.” Transgender Health 6, no. 3 (2021): 179-191.
Dhejne, C., Carlström, E., Linden, T., & Rühs, M. “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Gender Identity, Mental Health, and Sexual Function.” Journal of Sexual Medicine 8, no. 1 (2011): 150-158. doi:10.1111/j.1743-6109.2010.01924.x.
Gonzalez, A., & Kirtman, B. “Surgical and Medical Treatment of Gender Dysphoria: Review of the Literature and Ethical Considerations.” The Journal of Clinical Ethics 30, no. 4 (2019): 353-364.
Gorin-Lazard, A., et al. “Long-Term Impact of Gender-Affirming Surgery on Psychological Well-Being and Quality of Life.” Journal of Sexual Medicine 16, no. 4 (2019): 541–550.
Hafeez, H., & Waqar, M. “Psychological Impact of Gender-Affirming Surgery: A Review.” International Journal of Transgender Health 18, no. 2 (2017): 171-178. doi:10.1080/15532739.2017.1345743.
Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., et al. “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism 94, no. 9 (2009): 3132-3154. doi:10.1210/jc.2009-0345.
Hussain, R., et al. “Experiences of Transgender Individuals Following Gender-Affirming Surgery: A Qualitative Study.” Transgender Health 6, no. 1 (2021): 35-43.
Jones, B. A., & Hill, G. “A Review of the Medical Risks of Gender-Affirming Surgery.” Journal of Sexual Medicine 15, no. 4 (2018): 601-609. doi:10.1016/j.jsxm.2018.02.012.
Kaltiala-Heino, R., & Aro, H. M. “Gender Identity and Mental Health in Adolescence: A Review of the Literature.” European Child & Adolescent Psychiatry 28, no. 8 (2019): 993-1002. doi:10.1007/s00787-019-01353-5.
Kaltiala-Heino, R., et al. “Adolescent Gender Dysphoria: A Longitudinal Study.” Archives of Sexual Behavior 49, no. 5 (2020): 1673-1681.
Lund, R., & Buhl, H. “A Population-Based Study of the Effects of Gender-Affirming Surgery on Mental Health.” Transgender Health 3, no. 1 (2018): 91-98. doi:10.1089/trgh.2017.0030.
Mason, M., et al. “Evaluating the Effectiveness of Gender-Affirming Surgery: A Systematic Review.” Journal of Gender Studies 30, no. 5 (2021): 563-576.
Norton, A. T., & Herek, G. M. “Stigma, Social Identity, and Health Among Sexual Minorities.” Social Science & Medicine 103 (2014): 21-29. doi:10.1016/j.socscimed.2013.09.024.
Pachankis, J. E., & Goldfried, M. R. “Social Anxiety in Gay Men: A Comprehensive Model.” Cognitive Therapy and Research 34, no. 3 (2010): 276-295. doi:10.1007/s10608-010-9273-5.
Perry, S. M., & Janis, I. L. “The Psychological Impact of Gender Reassignment Surgery.” The American Journal of Psychiatry 168, no. 3 (2015): 213-219. doi:10.1176/appi.ajp.2014.14060760.
Roberts, A. L., et al. “The Role of Mental Health in Predicting Transition-Related Surgery Among Transgender Individuals.” American Journal of Public Health 108, no. 6 (2018): 853-859. doi:10.2105/AJPH.2018.304364.
Rosen, A. D., & Hahlweg, P. “Surgical Treatment of Gender Dysphoria: Implications for Mental Health.” International Journal of Gender Dysphoria 4, no. 1 (2019): 22-35. doi:10.1016/j.ijgd.2018.12.002.
Sullivan, C. M., et al. “The Impact of Gender-Affirming Surgery on Psychological Well-Being: A Qualitative Study.” Archives of Sexual Behavior 47, no. 2 (2018): 577-589. doi:10.1007/s10508-017-0953-4.
Toomey, R. B., & Russell, S. T. “The Effects of Gender-Affirming Care on Mental Health Outcomes.” Transgender Health 3, no. 1 (2018): 74-81. doi:10.1089/trgh.2017.0051.
Vaughan, E. L., & Jones, A. “Health Outcomes Following Gender-Affirming Surgery: A Review of the Literature.” Journal of Health Psychology 22, no. 7 (2017): 870-884. doi:10.1177/1359105315623514.
Wylie, K., et al. “Gender Dysphoria in Adults: A Review of Current Understanding.” British Journal of Psychiatry 215, no. 5 (2019): 731-738. doi:10.1192/bjp.2019.66.
Zucker, K. J., & Bradley, S. J. “Gender Identity Disorder and Psychosexual Disorders in Children and Adolescents.” Canadian Journal of Psychiatry 58, no. 9 (2013): 489-490. doi:10.1177/070674371305800901.
Additional Theological and Philosophical Resources
Aquinas, Thomas. Summa Theologica. Translated by Fathers of the English Dominican Province. New York: Benziger Brothers, 1947.
Calvin, John. Institutes of the Christian Religion. Translated by Henry Beveridge. Peabody: Hendrickson Publishers, 2008.
Edwards, Jonathan. Religious Affections. Edinburgh: Banner of Truth, 2009.
Muggeridge, Malcolm. The End of Christendom. Grand Rapids: Eerdmans, 1980.
Socrates. Phaedo. Translated by Benjamin Jowett. Cambridge: Harvard University Press, 1892.
Tanner, Kathryn. Christ the Key. Cambridge: Cambridge University Press, 2010.
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