When talking about a personal and emotive subject like transgender, tone and posture are important. Yarhouse and Sadusky’s chapter provides a good example of the tone and posture that I believe we should seek to adopt when engaging in this conversation. They write with a deep understanding of the reality of gender incongruence and the distress which it can cause, expressing compassion and concern for those experiencing this distress.  In addition, they exhibit a desire to submit to the Bible’s teaching even when it might not fit with our natural instincts in a situation; they offer a balanced evaluation of scientific research into the effectiveness of medical transitioning and put a strong focus on thinking through how Christians can best support those experiencing gender dysphoria. All of these are strengths in this chapter.

The three interpretive lenses offered in the chapter, and previously explained in Yarhouse’s Understanding Gender Dysphoria, provide a useful way of understanding different perspectives on gender identity. (So much so that other contributors make use of them in their responses elsewhere in the book, see DeFranza’s response to Sabia-Tanis.) I particularly value the way that Yarhouse and Sadusky highlight the strengths and weaknesses of each lens and seek to bring each under the authority of the Bible as they attempt to integrate them together. The imaginative exercise of applying each lens to the pastoral response of a local church in the last section is particularly helpful (pp.125-128).

Yarhouse and Sadusky do well in acknowledging the diversity of experiences and expressions of gender which now fall under the terminology of transgender. This is important to note as it is a complicating factor in the conversation which is not always acknowledged. Their discussion of emerging gender identities is helpful (pp.108-111). They explain how the early 20th century saw the separation of observable biological traits, gender identity, and sexual orientation, and how this has made the way for the multiplication of different gender identities.

In their application of the interpretive lenses to the possibility of gender transition, Yarhouse and Sadusky give a useful discussion of the nature of healing in this life (pp.113-115). I agree with their observation that, while able, God often does not act to remove sources of suffering from our life in this age and that a ‘robust theodicy’ (p.114) is therefore necessary. This is akin to my suggestion that we should respond to gender dysphoria as an experience of suffering rather than identity. I agree with Yarhouse and Sadusky that gender dysphoria can be an opportunity to glorify God in suffering while eagerly awaiting the redemption to be experienced in the resurrection.

While I find many areas of agreement with Yarhouse and Sadusky’s chapter, I believe there are also several weaknesses in their contribution to this conversation. One which struck me most was their suggestion that gender dysphoria may be caused by an intersex brain, that is, that a biological male might have a female brain or vice versa. Citing a review of studies into the brain structures of transgender people, they conclude that in light of recent research ‘the intersex [brain] hypothesis seems more plausible’ (p.107). This conclusion is slightly surprising coming immediately after an acknowledgment of the limitations in the methodologies applied in these studies. It is also a misleading way of talking about brain differences.

Brains are not distinctly male or female in the same way chromosomes, gonads and genitals are in non-intersex people. There are parts of the brain which differ between males and females, but they differ on a continuum and so the identification of a brain structure as male or female is based on what is commonly found for males and females, not on what is always found. In this way, the sexed differences in the brain are fundamentally different from the sexed differences elsewhere in the body which are used to determine biological sex. In non-intersex people (i.e. the vast majority of people), there are two distinct forms that chromosomes, gonads, and genitals can take. There are not two comparable distinct forms of brain. Thus, while some males may have brains which in some ways more closely reflect what is more commonly found in a female brain, and these differences could potentially be the cause of gender incongruence, this is not comparable to an intersex condition where there is a clear variation upon the two standard patterns. The brain, therefore, cannot be a clear indication of sexed identity. In light of this, it is surprising that Yarhouse and Sadusky use the language of an ‘intersex brain’ approvingly and even suggest that if further evidence supports the idea, Christians may need to consider whether gender identity could in some cases be indicative of creational intent (p.112). Brain differences are not sufficiently dimorphic to carry this weight.¹

Another weakness of the chapter is the paucity of references to Scripture. Yarhouse and Sadusky mention Genesis 1-2 in relation to the integrity lens and Genesis 3 when explaining the disability lens but otherwise make little use of Scripture. In part, this may be because they write more as psychologists than theologians, and indeed it is this specialism which makes their contribution to the Christian conversation, including outside of this book, particularly useful. However, I’m not sure their perspective fully wrestles with Scripture as much as is necessary. This most concerns me where they seem to take the position that transitioning is not God’s intention for us but may sometimes be permissible in exceptional cases. This is a view for which they do not give a biblical defense and is one, I think, for which they would struggle to do so.

The complex topic of the morality of gender incongruence comes to the fore in discussions of the disability lens. These discussions suffer from the same sort of lack of nuance I have identified in Strachan’s chapter, although with rather different conclusions. Yarhouse and Sadusky note that the disability lens sees gender incongruence as an involuntary result of the Fall and therefore a non-moral issue comparable to other conditions such as depression or anxiety (pp.104, 126). This is probably a fair presentation of the perspective of many who would view transgender through the disability lens, but it suffers from a lack of nuance in distinguishing between the involuntary experience of incongruence and the desires and actions which can flow from that experience. To take up the comparison made in the chapter in relation to depression, the experience of depression is a non-moral issue, but how that depression is then handled is a moral issue. For any of us who experience or have experienced depression, there are choices to be made about what we do – and what we desire to do – in response. Some of these desires and actions could be holy and wise, others sinful and unwise. So while it is true that the involuntary experience is non-moral, the voluntary response in cherished desire and in action is moral. This nuance would, I feel, give the disability lens a more thoroughly biblical perspective.  

I found Yarhouse and Sadusky’s chapter a particularly helpful contribution to this discussion. While there are some areas I feel could be improved, in general, their approach to transgender and their analysis of Christian responses to the topic is one which I think can help Christians to think and act carefully, compassionately, and wisely towards those for whom transgender is a real-life experience.