Should Christians endorse Gender Reassignment Surgery (GRS) as an option for transsexuals?
I think it is best if we begin with a working definition of transsexuality. A transsexual person is someone who is uncomfortable with the behaviour required for his or her chromosomal gender. In other words, a transsexual is someone who rejects his or her biologically and genetically determined sex, and prefers to live as a member of the opposite sex. Studies conducted in the US show that the incidence of transsexuality is relatively low: about 1 in 30,000 males, and 1 in 100,000 females. In the UK, the incidence of transsexuality is less than 0.003% of the population.
There is no consensus on the cause and origin of transsexuality. Most studies maintain that feelings of discomfort, known as gender dysphoria, begin from childhood. Studies have also indicated that transsexuality could possibly be associated with clinical, behavoural and family factors, but none of these is conclusive. No clear reproducible sex hormone abnormalities are found in transsexuals. That is why those undergoing GRS must be treated with adequate sex hormones for the target sex. Studies conducted on identical twins seem to indicate that transsexuality has no genetic basis either.
Historically, transsexuality has been considered as a psychiatric condition. But since GRS became available in the 1970s, transsexuality has been relabeled as a medical condition.
Can the Bible provide guidance on transsexuality? We must begin with what the Bible has to say about human sexuality and reflect on the specific issue of transsexuality from that standpoint. Genesis 1 provides the clearest statement regarding gender, that human beings are created as male and female (v 27). This basic statement also means that a person’s sexual identity is biologically determined and part of who he or she is. Genesis 2:18-25 sets out God’s ideal for sexual relationships: they should be monogamous, heterosexual, and open to the possibility of procreation. This is the creational ideal with regard to human sexuality, and God’s people are expected to live according to this ideal even in this fallen world. That is why any breach of sexual differentiation, like cross-dressing, is an abomination to God (Deut 22:5).
This ideal, as we know, is disrupted by human rebellion which led to the Fall. Sin did not only alienate human beings from their Creator; it also brought about a perversion which touches human nature in every aspect. In the case of transsexuals who feel that their bodies and sexual identities are at variance, the distortion is more pronounced, making their struggle more intense. But the distortions, contradictions and ambiguities brought about by human rebellion touch every single human being.
Should transsexuals seek therapy for their condition? Of course they should, but much depends on what sort of therapy is sought.
Since the emergence of sex-change surgery in the early 1970s, many transsexuals have undergone this almost irreversible procedure, in which extensive plastic surgery is performed, and extensive preparation and follow-up required. In the past, the accepted medical wisdom is that GRS should be the absolute last resort. But more recently, ‘transgender’ activists, who are often allied with gay liberation movements, have argued that transsexuals are entitled to whatever surgery they want. GRS has also become more common because of medical centres in countries like Thailand, which would perform the surgery with ‘no questions asked’ for anyone who can pay for it.
GRS is not an option for transsexual Christians seeking therapy because it transgresses the divine creational ideal for human sexuality and sexual relationships. The Bible appears to favour the view that human sexual identity is determined biologically. Put in modern scientific terms, human sexual identity is built into our constitution mostly by the genes we inherit and the embryogenesis process we undergo. According to this view, transsexuality is not deterministically enforced genetically or biologically, but rather has a psychological origin. This means that transsexual operations will not correct the profound psychological disquiet experienced by transsexuals.
Psychiatrist and psychoanalyst Jon Meyer at Johns Hopkins found very little change in the psychological condition of post-surgical transsexuals, despite their claim of being happier and more fulfilled.
On the basis of such research, hospitals like Johns Hopkins have stopped performing gender reassignment procedures in adults with sexual dysphoria. Similarly experts in the field at the Portman Clinic in London no longer make such procedures available because they believe that offering GRS to transsexuals is preying on their delusional fantasies. For these doctors transsexuality is a form of psychiatric condition called ‘autogynephilia’, a kind of sexual misdirection which is manifested in cross-dressing, and which eventually leads to the surgical option. To provide surgical alteration of the body is therefore to collaborate with a mental disorder rather than to treat it.
Christians suffering from sexual dysphoria should seek psychiatric help. The Christian community should never agree that transsexual operations be allowable for Christians. But it should at the same time be willing to support the Christian transsexual who is willing to work patiently through the issue.
Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor of the Ethos Institute for Public Christianity. This article was originally published in the Methodist Message.