Understanding Gender Dysphoria


Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture
By Mark Yarhouse
161 pages

Issues of gender dysphoria are becoming more and more prevalent in our culture. As a pastor, this was a topic I knew I had to investigate. I want to have a solid biblical understanding of gender, possess a working knowledge of how our culture is viewing gender changes, and be competent at helping a local church navigate the tension between being too rigid and too welcoming on matters of gender dysphoria.


Yarhouse wrote this book for the average Christian who has a steadfast faith in Christ and commitment to the church, but is unsure how to engage the transgender community. Thankfully he has a long list of key terms, including the difference between biological sex (birth sex), gender identity (one’s psychological and emotional sense of their sex), and gender role (cultural expectations for maleness and femaleness). (17-20)

The Bible and Gender

Yarhouse does not give a very thorough theology of gender in this book. But he does, however, show us the key verses in the Bible that relate to gender dysphoria. Here are the verses he lists:

1 Corinthians 6:9–10 Or do you not know that the unrighteous will not inherit the kingdom of God? Do not be deceived: neither the sexually immoral, nor idolaters, nor adulterers, nor men who practice homosexuality, nor thieves, nor the greedy, nor drunkards, nor revilers, nor swindlers will inherit the kingdom of God.

Deuteronomy 23:1 No one whose testicles are crushed or whose male organ is cut off shall enter the assembly of the Lord.

Deuteronomy 22:5 A woman shall not wear a man’s garment, nor shall a man put on a woman’s cloak, for whoever does these things is an abomination to the Lord your God.

Matthew 19:12 For there are eunuchs who have been so from birth, and there are eunuchs who have been made eunuchs by men, and there are eunuchs who have made themselves eunuchs for the sake of the kingdom of heaven. Let the one who is able to receive this receive it. 

Acts 8:26–40 Now an angel of the Lord said to Philip, “Rise and go toward the south to the road that goes down from Jerusalem to Gaza.” This is a desert place. And he rose and went. And there was an Ethiopian, a eunuch, a court official of Candace, queen of the Ethiopians, who was in charge of all her treasure.… Then Philip opened his mouth, and beginning with this Scripture he told him the good news about Jesus….

The author admits that the Bible does not give us black-and-white answers to today’s questions about gender. But we know that gender is a good part of human nature and Israel (in the Old Testament) and Christians (New Testament) are warned against practicing sexuality as the pagans do. (34-35)


Yarhouse uses four frameworks, or paradigms, for thinking about gender dysphoria throughout the book. They are as follows:

Integrity Framework - there is a sacred integrity of maleness and femaleness stamped in the human body. Denying one’s God given sex is “an overt attempt as marring the sacred image” of God. (46)

Disability Framework - gender dysphoria is a mental health issues, not a moral issue. Disabilities are not sinful, but our attitudes and choices in response to a disability may be good or bad. Rather than following through with embracing a different gender, treatment is needed. (48-49)

Diversity Framework - gender-fluidity should be celebrated, honored, and respected. All people are diverse and unique, and this is a very good thing for humanity. We should call for a deconstruction of gender norms. (50)

Integrated Framework - this is Yarhouse’s framework; seeing strengths in each framework and shepherding people through gender dysphoria. We can validate someone’s incongruities without shaming them or blaming them. (53-54)

Causation, Prevalence, and Treatment

We aren’t sure what causes gender dysphoria, but there are two primary theories: nature and nurture (my words, not Yarhouse).

Brain-Sex Theory (or my term "nature") - testosterone in the brain during pregnancy affects our hormones and brains structure. There are serious limitations to this theory. Most compelling is the fact that our self concept or feelings of identity don’t show up on an MRI. (73)

Psychosocial Factors (or my term "nurture") - our environment, like culture or our home life, cause us to question our birth gender. He notes emotionally distant fathers, parental wishes for a girl, parents who push against gender norms, and abuse as factors that may influence gender dysphoria. (76-77)

In the end, Yarhouse admits “We don’t know what causes gender dysphoria.” (79) And even as we look at the research, we have to remember “equifinality” (there are multiple pathways to the same outcome) and “multifinality” (a group of people may share the same history, but arrive at different outcomes).

Yarhouse defines gender dysphoria as “unhappiness with one’s given gender.” (85) Research estimates that one in every 10,000 males and one in every 20,000 females experience this. Much more common are those who identify as transgender (an umbrella term for a broad range or gender incongruencies), close to one in every 300 people. (92-93)

Most children grow out of their gender issues (101), yet most later identify as homosexual or bisexual (105). There are four kinds of treatments for children: (102ff)
  1. Behavior therapy or psychotherapy.
  2. Watching waiting (to see if the gender incongruence goes away over time).
  3. Psychosocial facilitation (allowing children to grow out their hair or wear clothes of the opposite sex as they see fit).
  4. Puberty suppression (delaying hormones to set in until the child decides on their gender).
In teenagers and adults, there are three treatment options: (109f)
  1. Reversible Steps - new clothes, using a new name, etc.
  2. Partially Reversible Steps - hormone therapy.
  3. Irreversible Steps - surgery.

Adults manage gender dysphoria in three primary ways. (111ff) Some live with it and take not change. Many cross dress to manage gender dysphoria. A few go through with surgery.

A Christian Response

We all have scripts, or narratives we use to explain how we see the world. (126, 131f) The author suggests some language that a Christian experiencing gender dysphoria can use. (135) I found the distinction between “this is who I am” versus “this is how I am” very helpful. (139)

Within the church, we should steer clear of the stereotypical “Behave - Believe - Become” expectation. A missional church expects “Belong - Believe - Become” as the order of engaging Christ and his church. (147) We need to be careful, too, that we don’t mix up cultural masculinity and femininity with biblical gender. (158) And remember, “redemption frequently takes the form of making meaning out of suffering.” (154)

He gives several examples of good pastoral care throughout the book:
  • Know your terms. (17020)
  • Don’t make this a culture war. (42)
  • Don’t blame or accuse. Validate while retaining biblical integrity. (54-55, 58)
  • Discourage surgery for practical reasons. (120f)
  • Remind parents that most kids will grow out of their gender concerns. (123, 101)
  • Listen to peoples’ stories. (126)
  • Avoid simple answers. Feelings of gender dysphoria are far too complex for simplistic answers. Help them discern God’s will for managing their dysphoria. (142)
  • Give them language to use as they reveal their struggle to others. (135)
  • Remember, gender dysphoric people do not choose this for themselves! (61, 81)