Last week the Church of Scotland published a report entitled Diverse Gender Identities and Pastoral Care which is intended help its pastoral teams ‘to support those in our communities who identify themselves as transgender.’
The report was produced on behalf of the Church of Scotland by the Scottish Trans Alliance which describes itself as a ‘project to improve gender identity and gender reassignment equality, rights and inclusion in Scotland.’  It consists of eleven stories about the experiences of seven transgender people, two mothers of transgender children, the wife of someone who is transgender and a Church of Scotland minister. The transgender people involved include those who would describe themselves as ‘androgyne’, ‘non-binary,’ and ‘demi-boy’ and those who have undergone transition from male to female and female to male.
This report is worth considering by those outside the Church of Scotland because it raises the question of what is the best way to care pastorally for those who identify as transgender. Is the approach advocated in the report the correct way forward, or would some other approach be preferable?
The approach taken by the report.
The approach to pastoral care advocated by the report can be summed up in the single word ‘acceptance.’ The message contained in all the stories in the report is that everyone should accept unconditionally and without question the identities claimed by transgender people and support them in living out those identities.
Three reasons are given for this.
First, these identities are who people really are. This can be see, for example, in the stories of Kaden and Judith which are designed to tell us that Kaden really is a demi-boy and that Judith really is woman.
In Kaden’s story we are told:
‘I am an 18-year-old demi-boy which basically means I mostly identify as a boy but thatthere is a bit of me, that could be a third gender, but isn’t: it is feminine, I suppose, but not in a girly way. I don’t really know, it is just a thing. I’m definitely non-binary which is under the umbrella term of trans.
My self-discovery that I’m non-binary happened almost overnight. One day suddenly I realised everything felt a bit wrong. Up until then, I hadn’t acknowledged puberty, I had ignored it and then on my 15th birthday I felt disconnected from what my body had become and, more importantly, I realised that I felt disconnected rather than just fumbling through life with a disconnection.
When I first came out I described myself as gender fluid but as time went on I tried out trans-guy and then found demi-boy and that really fitted what I felt so I carried on down that road. A lot of people talk about gender dysphoria but they don’t mention gender euphoria as much. For me when someone introduced me as Kaden or used male pronouns that felt really good, that felt right.
I suppose I am androgynous but mostly boy. I lean towards the masculine with a masculine outlook and feelings but I do have feminine in me. I try to describe it via life goals and my life goal would be to have a beard and lipstick.’ 
In Judith’s story we are told:
‘I’ve always known I was different. Even at school the other boys called me Mary because I was much happier playing with girls than running around with them. Growing up in an industrial town in the 1940s and 1950s was hard. Men were men and women were women and women were somewhere down there – lower. I’ve always known I was born into the wrong body.
But you go along with life. I got married at 24 to a lovely woman, and eventually had a family – as that was what was expected, but part of me was always unhappy. I had tofind time, to dress as Judith, privately. All the stress of pretending to be someone else –pretending to be a man – all that stress would fall away if I could just spend some time dressed in Judith’s clothes. Then I could relax and be who I knew I really was. Luckily my jobtook me away a lot and I stayed in hotels, so hidden in the boot of my car was all I needed to be Judith. Alone, I would lock myself up in the hotel room and watch TV in a nice dress It wasn’t anything sexual, it was just about being honest, being me – Judith.’ 
Underlying this acceptance of the identities that people claim for themselves is the further belief that our identities as sexual beings are not determined by our biology. As Jo puts it in the course of telling her story: ‘Some men have vaginas and some women have penises.’
Secondly, discovering their true identity helps people’s mental well-being whereas not acknowledging that identity is mentally damaging and can even lead to suicide. We can see this point about mental well -being in the stories of Kaden and Judith, and we can see the point about mental damage in the stories of Andrew and Dyan.
Andrew, who is a female to male transgender states:
‘People presume I chose to be a trans man. Please believe me when I say that no one chooses to be transgender. Nothing about this journey is easy; who would choose to put themselves through this, all this pain and stress and medical procedures? It’s not about choosing to be transgender – it is about choosing to live as your real self and in the end that is a choice you don’t really have. You can’t go on any more – you have to live as yourself. That’s why suicide rates for the trans community are so high. You can’t carry on living a false life. ‘ 
Dyan tells the story of how her daughter Julie transitioned to her son James. She declares:
‘Things are good now but looking back Julie was a very unhappy teenager. There was self-harm and suicide attempts. Julie would have killed herself and it was killing me – I couldn’t watch her all the time. She was a nightmare teenager. She’d go into her room and I was terrified about what was going on, certainly some cutting. I’d hide every blade in the house. There were no sharp knives in my kitchen during that time. There had been no mental health problems until adolescence arrived because if you feel you are male and you start getting breasts and periods – well that is when he just flipped out – couldn’t cope with it. That’s where the self-harming came in because of disgust at the body – he had no self-esteem.
Julie was a desperately unhappy person who was trying to kill herself so if Julie said she wanted to be James then by golly I was going to support it. We knew we had to go down this route because eventually a suicide attempt was going to be successful. The provement in his mental health was huge and as he’s continued on his journey; it has all sorted itself out now. I have no worries on that score anymore.‘ 
Thirdly, God approves of people’s identity. Thus Jo, who identifies as non-binary, tells us:
‘I have had conservative traditional Christians call me an abomination, an affront to decency, a profound threat to the natural order but I don’t see that in the Bible. When I read the two creation stories in Genesis I see that ‘male and female created he them’. I know that these people read that as ‘male and separate to that female’ but the Hebrew is much more ambiguous than that. Perhaps it is ‘male together with female’. It might mean that the first being was androgyne. Indeed the work of Jung would suggest that we all have female and male energy in us. Trans people are part of God’s creation. It says in Isaiah that I named you in the womb. God’s word is full of texts that talk about the mercy and compassion of the creator.
I have no doubt that Jesus would love us. I was taught that Jesus came down to earth andembraced all human experience so, of course, that must include my experience too. We see that Jesus reached out to people that conventional society of the time would have hated and excluded and that he treated them all equally. We even have the passages in Matthew (19:12) where Jesus directly talks about eunuchs. That is me. He is talking about me. I am a eunuch. Look at the beautiful story of Phillip and the eunuch in Acts (8:26-40). Even the passages in the Old Testament refer to specific cultural contexts that aren’t around anymore. There isn’t a theological problem with trans people, there is just prejudice.’ 
Maxwell, who is a female to male transgender, likewise explains:
‘Thankfully, I never had any kind of fear that God would have any difficulty with my transition. I knew I was made, loved and affirmed by God. I knew that I was made in God’s image and that being transgender was truly a gift from God. My gut feeling was that it was all good and that God had finally got me to the place I needed to be.
I can link my transition experience to the resurrection story. Being resurrected in a different way, being transformed in a new way, you become who you were meant to be. I often hear transgender folks in a church context talk about having a resurrection experience and I feel like that is what God has allowed me to have.’ 
For these three reasons, the report says, whether you are a minister with transgender people in your congregation, a member of a congregation with transgender people in it, or the parent, spouse or other family member of a transgender person, you need to listen to them and accept who they say they are.
Responding to this approach.
The first thing that needs to be said in response to this report is that that anyone interested in the debate about transgender needs to read it. It is a very clear and accessible statement of the pro-transgender position. If you want to know why those arguing for the acceptance of transgender by the churches think as they do then this report will tell you.
Secondly, the report is right to highlight the importance of listening to the stories of transgender people and their families. All good pastoral care has to start from where people are, just as Jesus started from where the Samaritan woman at the well was in her life (John 4:7-26), and we will only discover where people are if we are prepared to listen to their stories in a non-judgemental fashion. The report’s prescription of ‘a hanky, a cup of tea and a hug’ may sound rather twee, but is in fact a good place to start.
Thirdly, however, we should not simply take at face value what people say about their own identities. This is because one of the consequences of this being a fallen world is that people can be deceived about who they truly are. A classic example of this is the strange case of King Charles VI of France, who became convinced that he was made of glass and consequently would not allow people to touch him and had special reinforced clothes made to prevent himself from being broken.
Transgender people may find the suggestion that their position is in any way akin to that of Charles VI to be offensive. Nevertheless, his story is relevant because it reminds us that we cannot just accept the truth of what people say about themselves. We have to check what they say against other available evidence.
In the case of Charles VI and others suffering from what is known as a ‘glass delusion’ there is no reason to question the sincerity of their self-perception. They genuinely believe that they are made of glass. However, everything else we know about the composition of human bodies tells us that this belief is wrong. There can be no such thing as a glass human being. 
In the case of transgender people there is likewise no reason to question the sincerity of their self-perception. As the stories in the Church of Scotland report remind us, there are a small minority of people (some one in ten thousand men and one in thirty thousand women) who experience a disconnection between their sense of who they are and the sex of their bodies (what is technically known as ‘gender dysphoria’). Declaring that they are gender non-binary, or that they are a member of the opposite sex to that of their bodies, is a way of overcoming this sense of disconnection by adopting an identity which accords with their sense of who they are.
However their adoption of this identity does not prove that their sense of who they are is correct. As in the case of all other human beings, what they say about themselves has to be checked against the other available evidence.
If we do this, we find that the evidence provided by the use of our natural reason tells us that the human race, like other mammals, is a sexually dimorphic species. That is to say, the human race is a species of animal that is divided into males and females. As the American writer Christopher Tollefsen explains:
‘Our identity as animal organisms is the foundation of our existence as selves. But fundamental to our existence as this animal is our sex. We are male or female organisms in virtue of having a root capacity for reproductive function, even when that capacity is immature or damaged. In human beings, as well as in many other organisms, that function is one to be performed jointly with another human being; unlike the digestive function, no individual human being suffices for its performance.
Accordingly, reproductive function in human beings is distributed across the two sexes, which are identified by their having the root capacity for one or the other of the two general structural and behavioral patterns involved in human reproduction. In male humans, this capacity is constituted by the structures necessary for the production of male gametes and the performance of the male sex act, insemination. In females, the capacity is constituted by the structures necessary for the production of oocytes and the performance of the female sex act, the reception of semen in a manner disposed to conception.’ 
Of course, human beings are not simply mechanisms for producing sperm and eggs and bringing them together to produce offspring. However, everything else that is true of human beings is true of them as creatures who have bodies that are biologically designed for the performance of this basic function, even if through accident or design they never actually have children.
Furthermore, the distinction between the two types of human beings necessary for sexual reproduction begins from the moment of conception. To talk in the way that has now become fashionable about ‘sex assigned at birth,’ as if what makes someone a boy or a girl is what someone decides at that point, is a denial of reality. The development of medical technology means that we can detect that a foetus is male or female long before they are born.
The use of our natural reason also tells us that as well as having bodies we also have immaterial souls, or conscious selves, which is why we are capable of rational thought, and possess freedom of action and moral responsibility.
Our souls, however, do not exist in isolation from our material bodies. Each human being is a single person consisting of a unity of body and soul. We can see this, for example, if we consider a case where someone asks someone else ‘shall I give you a hug?’ A hug is a physical act by the body and yet it makes sense to ask ‘shall I give you a hug?’ rather than ‘shall my body give you a hug?’ because when my body acts it is my whole self, body and soul, that is involved. Conversely, if I have a thought it is ultimately my conscious soul that is doing the thinking, but it does so in unity with my body. That is why our thoughts can be affected by the state of our bodies to the extent that when our bodies become unconscious we cannot think at all.
The fact that ‘I’ am a unity of body and soul means that it makes no sense to suggest, as we have seen Judith does in the Church of Scotland report, that ‘I was born in the wrong body.’ There is no ‘I’ separable from the body we possess. What ‘I’ means is the person who exists in this particular combination of body and soul. The suggestion that I should have been born in a different body really means that I should have been a different person, but in that case I would not exist, so the suggestion is asking for the impossible.
What is also impossible is for someone to change their body from male to female or vice versa. It is possible through the use of hormones and plastic surgery to change to a certain extent the way our bodies function and their outward appearance, but we cannot change the fundamental character of our bodies as male or female. We can produce what Paul McHugh calls ‘feminized men or masculinized women, ‘  but we cannot make a man into a woman or a woman into a man.
The evidence of Scripture agrees that human beings are bodily creatures that are male and female and are able to reproduce as such, but it supplements the witness of natural reason in this regard in two key ways.
First, it teaches in the creation narratives in Genesis 1 and 2 and also in the words of Jesus in the Gospels (Matthew 19:4, Mark 10:6) that we are not a dimorphic species by accident, but because God in his goodness and wisdom created us as such so that men and women together can rule over and care for the world on God’s behalf and together can produce offspring who can continue this vocation in their turn. Scripture as a whole further teaches that the dimorphic structure of the human species is also the basis for marriage (Genesis 2:23-24) through which human beings are called to bear witness to the marital relationship between God and his people, which has begun in this world, but will be finally consummated in the world to come (see Ephesians 5: 21-33 and Revelation 19:6-9, 21:2-4).
Secondly, it teaches that our bodies are an eternal part of who we are. In the life of the world to come we shall have the same physical bodies that we have now, only animated by the Spirit and thereby made imperishable and immortal (1 Corinthians 15:52-54). This means that if because of our form of embodiment we are men in this life we shall be men in the world to come and if we are women we shall be women in the world to come. We can see the truth of this in the case of Jesus, who is in his humanity the ‘first fruits’ (1 Corinthians 15:23) of the new form of human existence created by his death and resurrection. In his humanity Jesus was a male human being with a male body and it was this same body that was resurrected (Luke 24:36-42), which subsequently ascended into heaven and which will return to earth when Jesus comes in glory (Acts 1:9-11). Being embodied as male or female is thus literally an inescapable part of our existence. Who we are as sexed being will be who we are for eternity.
Maxwell’s appeal to resurrection in support of gender transition thus backfires. Biblically understood, belief in resurrection tells against any idea of a genuine move from one sex to another.
It is true, as Jo notes in her contribution to the report, that the Bible makes reference to eunuchs. However, in the Bible eunuchs do not form an exception to the binary distinction between men and women. This is because the term eunuch refers to men who for some reason lack sexual capacity (and are therefore incapable of entering into marriage). Thus the standard dictionary of New Testament Greek offers three possibilities for the word eunouchos. The first is ‘a castrated male person’ (Matthew 19:12, Esther 2:14, Acts 8:27ff). The second is ‘a human male who, without a physical operation, is by nature incapable of begetting children’ (Wisdom 3:14, Matthew 19:12) and the third is ‘a human male who abstains from marriage without being impotent, a celibate’ (Matthew 19:12).
This being the case, the welcome extended to eunuchs in Isaiah 56:1-5, Matthew 19:10-12 and Acts 8:26-40 cannot be understood as biblical support for those who are transgendered because the eunuchs referred to in the Bible were not transgendered. They were, as we have said, men who lacked sexual capacity. It is true that this made them ‘gender variant’ in the sense of being outside the norm for men of their culture, but this does not mean they were transgender.
It is also true that there are a very tiny number of people (referred to as ‘intersex’)  whose sex is genuinely ambiguous in the sense that they have a mixture of male and female chromosomes, or a body that has a mixture of male and female characteristics. These people are not evidence against the idea that the human race is dimorphic because their condition is a result of a developmental disorder that has no good biological purpose of its own and that both by its extreme rarity and by its character points us to the truth that the human norm intended by God is to be either male or female. In the words of Oliver O’Donovan, what we find in the bodies of people with intersex conditions is, ‘an ambiguity which has arisen by a malfunction in a dimorphic human sexual pattern.’
However, even though the development of their male or female identity has become disordered, people with intersex conditions bear witness to their creation as human beings in God’s image and likeness through the male and female elements that exist in their bodies. They are therefore to be treated with same dignity and respect as all other human beings and pastoral care for them has be about helping them to discern the specific vocation that they have before God, in the light of their condition, as people created by God and redeemed by Jesus Christ, and summoned to have faith in the Gospel and love God and neighbour.
What the evidence that we have looked at thus far indicates is that it makes no sense to say that people have a true self that is at variance with the sex of their bodies. It also shows us that it would be wrong to say that God wills people to live as if this were the case. God has made us permanently the male or female creatures that we are and he calls us to live accordingly. To quote O’Donovan again:
‘The dimorphic structure, with its orientation towards permanent heterosexual union, is the generically given foundation for our individual sexual vocations. The first obligation of every human being is to hail that created givenness as a created good and to thank God for it, even though he or she may then have to acknowledge that for him or her in particular this created good has taken on the aspect of a problem.’
This means that the first two reasons given in the Church of Scotland report for accepting transgender people’s claimed identities do not work. This leaves us with the third reason, which is that adopting new identities is necessary for the mental well-being of the people concerned.
The evidence that we have challenges this argument as well. This is because although the stories in the report all suggest that gender transition produces a happy outcome, this view of the matter is challenged both by academic research studies and by the testimony of those who have ‘de-transitioned’ (i.e. returned to live according to their original sex).
If we look at the research studies first of all, we find they suggest that measures to achieve relief from mental anguish by embracing a transgender identity are of very limited effectiveness overall.
The available evidence shows that being transgender is linked to serious issues of both mental and physical health. For example, the biggest ever survey of transgender people in the United States indicates that there is a far higher prevalence of mental and physical health issues among transgender people than among the population as whole. The survey, undertaken by the National Center for Transgender Equality, surveyed 27,715 self-described transgender people in 2015. The key findings were that
- 39% of transgender people had suffered serious recent psychological stress (as compared to 5% among Americans generally);
- 40% of transgender people had attempted suicide (as compared to 4.6% among Americans in general);
- 7% of transgender people had attempted suicide in the last year (as compared to 0.6 among Americans in general);
- 1.4% of transgender people were infected with HIV (as compared to 0.3% among Americans in general. In particular, 3.4% of male to female transsexuals and 19% of black male to female transsexuals had HIV.
Furthermore, the research suggests that that gender transition will not necessarily be effective in resolving these issues.
Thus Dr Chris Hyde of the University of Birmingham notes that a study of the issue by the university’s Aggressive Research Intelligence Facility in 2004 showed that ‘there’s still a large number of people who have the surgery but remain traumatized – often to the point of committing suicide.’ Likewise, a major Swedish study in 2011 looking at the long term outcomes for people who had undergone sex-reassignment surgery found ‘substantially higher rates of overall mortality, death from cardiovascular disease and suicide, suicide attempts, and psychiatric hospitalisations in sex-reassigned transsexual individuals compared to a healthy control population.’
In 2014 the highly respected American medical research company Hayes Inc. undertook a review of the evidence for the long-term benefits of gender transition. It gave the studies supporting transition its lowest rating for quality and concluded that ‘Statistically significant improvements have not been consistently demonstrated by multiple studies for most outcomes.’ In 2016, on the basis of their survey of the evidence, Lawrence Meyer and Paul McHugh likewise found that it ‘suggests we take a skeptical view toward the claim that sex-reassignment procedures provide the hoped for benefits or resolve the underlying issues that contribute to elevated mental health risks among the transgender population.’
The growing body of testimony from people who have ‘de-transitioned’ also points in the same direction. Two examples, one from a Christian and one from a secular writer, illustrates this point.
First, the American Christian writer Walt Heyer, who underwent male to female transition, reports in his article ‘I was a trangender woman’:
‘I knew I wasn’t a real woman, no matter what my identification documents said. I had taken extreme steps to resolve my gender conflict, but changing genders hadn’t worked. It was obviously a masquerade. I felt I had been lied to. How in the world had I reached this point? How did I become a fake woman? I went to another gender psychologist, and she assured me that I would be fine; I just needed to give my new identity as Laura more time. I had a past, a battered and broken life that living as Laura did nothing to dismiss or resolve. Feeling lost and depressed, I drank heavily and considered suicide.’
Secondly, Cari Stella, another American, who underwent female to male transition, declares:
‘I will say, from my own experience and from my conversations with other detransitioned and reidentified women: transition is not the only way, or even necessarily the best way, to treat gender dysphoria. I felt a strong desire, what I would have called a ‘need’ at the time, to transition….And it wasn’t weeks, or months, that I stayed on hormones, before I realized that I needed to stop. I was on them for over three years, cumulatively. I know women who were on testosterone, three, for, five, even ten years before they were able to recognize that it was f***ing them over. It can be dam hard to figure out that the treatment you’re being told is to help you is actually making your mental health worse. Testosterone made me even more dissociated than I already was.’ 
What all this suggests is that purely from a mental health perspective we need to find a better approach to helping transgender people that enables them to understand and address the underlying issues that cause them to feel disconnected from the sex of their bodies so that these do not continue to haunt them in the future.  The selection of happy stories in the Church of Scotland report is a piece of propaganda by the Scottish Trans Alliance which obscures the darker reality pointed to by the sort of evidence that we have just considered.
What should pastoral care look like?
As we have already noted, Christian ministry to transgender people, as to all people, has to begin by meeting them where they are, getting to know them and understanding their stories. Beyond that starting point, we need to be a people who exhibit both truth and love. As Andrew Walker writes in his book God and the Transgender Debate:
‘If Christians have anything to offer in this contentious age it is truth, and we should not shy away from the truth. But equally, if we use truth as blunt force trauma against those who are coming to grips with what discipleship means, woe to us. Woe to us if we demand conformity from those who are struggling more than we are willing to walk alongside them while they are struggling.
It is only loving to hold to biblical truth if that truth comes wrapped in love. We are only firmly anchored, able to grow and to share the gospel without being tossed about by every idea and argument from both the conservative and progressive ends of the spectrum, if we are ‘speaking the truth in love’ (Ephesians 4 v 15). Neither love nor truth is an optional bolt on to our Christianity.’
As people of truth we have to continue to uphold a number of key truths that we have already identified in the course of this paper:
- Reason and Scripture tell us that people’s sex is defined by their biology;
- Reason and Scripture tell us that there are two sexes, male and female;
- Reason and Scripture tell us that a person’s sexual identity cannot be changed or eradicated;
- Reason and Scripture tell us that the path of wisdom and godliness lies in accepting the truth of our sexual identity and living accordingly;
- A growing body of evidence indicates that seeking to change one’s sexual identity will not bring lasting relief from the distress caused by gender dysphoria and reason therefore suggests that encouragement should be given to alternative forms of treatment that address the underlying mental health issues that lead to gender dysphoria.
As people of love, who value the God given dignity of transgender people as those whom God has created and for whom Christ died, we should be proactive in ensuring that transgender people are not subject to harassment or violence, or discriminated against in the provision of goods, services, or opportunity for appropriate employment.
As people of love, who recognize and value as a work of God the sex into which transgender people were born, we should encourage transgender people not to engage in cross-dressing or to go down the path of gender transition. If they have gone down this path, love means helping them to accept and live out their original, God given, sexual identity, whilst acknowledging the acute challenges doing this will raise, particularly for those who have undergone gender re-assignment surgery or formed families in their assumed identity.
Finally, as people of love we should give transgender people an unconditional welcome into our churches and provide them with appropriate pastoral care. As a Lutheran Church – Missouri Synod report helpfully explains, the starting point for such pastoral care is the truth that:
‘…. the deepest need of such a man or woman—as it is for every person—is to know that he or she is beloved by God. Christ’s love and forgiveness are in this case, as always, one’s greatest needs. Sorrow, confusion, frustration, shame, and despair are likely present in any individual dealing with gender dysphoria or struggling with questions about his or her identity as male or female. If such an individual has not already sought psychotherapeutic care, the pastor should seek to encourage and, to whatever degree possible, facilitate the individual in securing competent therapy that is not hostile to the Christian faith.’
Such pastoral care also needs to be based on:
‘…. the development of genuine Christian friendship modelled after the One whose friendship knows no boundaries (Luke 7:34). Loving pastoral care for the individual seeks to provide a spiritually nurturing, encouraging, and accepting ‘safe place’ to someone who may well have suffered from actual or perceived ostracism, mockery, and animosity. He or she may view the church with suspicion or share the common assumption that Christianity is more concerned with moral judgments, cultural battles, or political victories than about broken and suffering people. In accepting the struggling individual, a relationship of interpersonal trust develops. Within that relationship there will be natural opportunities to make Christ known, to call the person to trust in his promises and love, and to show that the purposes and commands of God for our lives are for our good.’
Since ‘the pathway of growth, sanctification and change can be expected to be slow and painful’ and ‘struggle and relapse can be anticipated’ our pastoral care needs to involve patience and a long term commitment to praying for, loving, listening to, and assisting the person concerned in any way necessary. It will also mean continuing to love and support them even if progress is slow or relapses occur, trusting that God is in the process and has the capacity to bring about the result that he desires, even if this takes years. As Walt Heyer reminds us in A Transgender’s Faith: ‘we must never give up on people, no matter how many times they fail or how long recovery takes. We must never underestimate the healing power of prayer and love in the hands of the Lord. We must never give up hope.’
The reason we must never give up hope is because God can and does change people’s hearts and lives. We noted earlier that there are a growing number of testimonies from people who have de-transitioned following gender reassignment. Among these are Christians who testify how God has enabled them to accept their biological sex as a gift from him and live accordingly. A good example, with which we shall conclude this response to Diverse Gender Identities, is the following testimony from Robert John bearing witness to what God has done for him:
‘I had irreversible gender reassignment surgery in 1997 absolutely convinced I was a woman in a man’s body. I anticipated living happily ever after, however I had persistent difficulties and fell into deep depression. I began reading the Bible, unsatisfied with superficial proclamations of diversity, inclusiveness, and tolerance. I happened upon King David’s famous repentance Psalm 51 and discovered, like David, I could be forgiven for all my sins. I also learned God chastens those whom He loves and I was being guided to seek repentance, and faith in the finished work of Jesus Christ. I knew identifying as a woman was not living in truth, and returned to my given names and birth gender without further surgery. My victory has come by allowing the Lord in my heart, becoming God-focused instead of self-centered, and am thankful for my birth sex and many blessings. Despite the consequences and challenges. God has led me to witness His truth and love, and I can testify: indeed, God’s grace, mercy and truth do set one free.’ 
M B Davie 15.3.18
 Church of Scotland, Diverse Gender Identities and Pastoral Care at: http://www.churchofscotland.org.uk/resources/learn/publications/diverse_gender_identities_and_pastoral_care
 Scottish Trans Alliance at https://www.scottishtrans.org/
 Diverse Gender Identities, p.11.
 Ibid, p.15.
 Ibid, p.7.
 Ibid, p.22.
 Ibid, p. 25,
 Ibid, p.7.
 Ibid, p.28.
 Ibid, p.18.
 For more on the glass delusion see ‘The people who think they are made of glass, ‘ BBC News Magazine, 8 May 2015, at http://www.bbc.co.uk/news/magazine-32625632
 Christopher Tollefsen, ‘Sex Identity,’ Public Discourse, 12 July 2015, at http://www.thepublicdiscourse.com/2015/07/15306/
 Paul McHugh, ‘Transgenderism: A Pathogenic Meme’ in Public Discourse, 10 June 2015 at http://www.thepublicdiscourse.com/2015/06/15145/
 Contrary to what Jo argues there is no suggestion in the creation narratives that human beings were originally androgynous. See Richard Davidson, Flame of Yahweh – Sexuality in the Old Testament, Peabody: Hendrickson, 2007, pp.20-21.
 W. Arndt, F. W Danker, F. Wilbur Gingrich and Walter Bauer, A Greek-English Lexicon of the New Testament and Other Early Christian Literature, Chicago: University of Chicago Press, 2000, p.409.
 Around 0.018% of live births.
 O’Donovan, Transsexualism: Issues and Argument, Cambridge: Grove Books, 2007, p. 8.
 Ibid pp.19-20.
 James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M, The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality, 2016.
 David Batty, ‘Mistaken identity,’ The Guardian, July 30, 2004, http://www.theguardian.com/society/2004/jul/31/health.socialcare.
 Cecilia Djehne et al, ‘ Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,’ PLoS One, 6 (No.2), 2011.
 Hayes, Inc ‘Hormone therapy for the treatment of gender dysphoria’ and ‘Sex reassignment surgery for the treatment of gender dysphoria,’ in Hayes Medical Technology Directory, Lansdale Pa: Winifred Hayes, 2014.
 Lawrence Meyer and Paul McHugh, ‘Gender Identity,’ in New Atlantis, Fall 2016, p.113.
 Walt Heyer, ‘I was a Transgender Woman,’ Public Discourse, 1 April, 2015, article at http://www.thepublicdiscourse.com/2015/04/14688/.
 Cari Stella, ‘Response to Julia Serano: Detransition, Desistance and Disinformation’ posted on You Tube9 August, 2016 at https://www.youtube.com/watch?v=9L2jyEDwpEw. For further testimonies pointing in the same direction see Ryan Anderson, When Harry Became Sally, New York: Encounter Books, 2018, Ch.3.
 A particular area of concern is the way in which children and young people who exhibit confusion or distress about their sexual identity are now being encouraged to identify themselves as members of the opposite sex and are given powerful drugs to prevent the onset of puberty. Since we do not know what the long term psychological and physiological consequences will be, this amounts to dangerous experimentation on the nation’s children and is something the Church needs to challenge. For an introduction to the issues involved see Anderson, op.cit. ch.6.
 Andrew T Walker, God and The Transgender Debate, Epsom: The Good Book Company, 2017, p.128.
 The Lutheran Church -Missouri Synod, ‘Gender Identity Disorder or Gender Dysphoria in Christian Perspective,’ 2014.
 The Evangelical Alliance, Transsexuality, Carlisle: Paternoster Press, 2000. p.82.
 Heyer, op.cit. p.141.
 Text from the website Sex Change Regret http://www.sexchangeregret.com/examples. For other such testimonies see Heyer, A Transgenders Faith and the documentary film Tranzformed which containsthe witness of fifteen ‘ex-transgender’ Christians, https://tranzformed.org/.
Thank you so much for a balanced, researched, well written and loving approach to the question of transgender pastoral care. Weaving hard truth into loving acceptance is a difficult and delicate endeavor, and I think the author has done so admirably.
Fr. Robert Rieger (Catholic Priest)