Transgender Solution Comparison: Surgery vs. the Gospel

For example, a 2019 study published in The American Journal of Psychiatry noted that, compared with the general population, those suffering from “gender incongruence” were “six times as likely to have had a mood and anxiety disorder health-care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt.”

This same study, the largest study done to date, sought to determine if hormone treatment (a very common “solution” to gender dysphoria) or so-called “gender-affirming” surgery positively impacted the mental health of those struggling with gender dysphoria. While the study was positive towards hormone therapy and surgery, the study authors noted that good evidence for the effectiveness of such treatment is lacking,

Despite professional recommendations to consider gender-affirming medical interventions for transgender individuals who experience gender incongruence, the effect of such interventions on long-term mental health is largely unknown.

In other words, we could say this is a medical experiment, and the long-term outcome is basically unknown. In an attempt to help shed light on this unknown, this comprehensive study used health and prescription databases in Sweden, a country where hormone and surgical “treatments” are free, to study the mental health outcomes of transgender individuals years after taking hormones and having surgery.

After looking at patient records for over 2,000 transgender individuals, the study authors determined,

Among those with a gender incongruence diagnosis receiving hormone treatment, years since initiation of hormone treatment was not significantly related to likelihood of mental health treatment . . . However, among those receiving gender-affirming surgical treatment, the risk of mental health treatment was significantly reduced with increased time since last surgical treatment.

In other words, hormones did not appear to help the long-term mental health of these individuals, but, as time went on, surgery did. This finding regarding so-called gender-affirming surgery was much celebrated in the media, and the study authors were quoted saying that their results give "strong support for providing gender-affirming care to transgender individuals who seek them." News outlets provided summaries such as “essentially, if we want to reduce the high rates of suicidal ideation among trans people, one of the most effective ways to do so is to give them access to gender-affirming care.” According to these articles it is case closed—if we want to help people, we need to increase the availability and affordability of these surgeries and decrease the stigma surrounding them. But is it really case closed?

Surgery Is of “No Advantage”

In August of 2020 headlines (largely of conservative news outlets) reported an important update to this landmark 2019 study, “Prestigious Psychiatry Journal Retracts Findings, Admits Sex-Reassignment Surgery Didn’t Fix Mental Health.”

While the study itself has not been retracted, the data was reanalyzed, and the study is now prefaced with a link to a “correction.” This correction reveals that the study’s conclusions were “too strong” when the data set was compared alongside those with gender incongruence who did not receive so-called gender-affirmation surgery. The correction states, “the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison.” Did you get that? Surgery is of no advantage, and according to the same study, neither are hormones. (Interestingly, this confirms the findings of a Swedish study from 2003 mentioned in the 2019 study.)

Our culture’s answer of ignoring biological and biblical reality in favor of affirming mixed-up feelings and sinful desires is not working! Pushing people towards cross-sex hormones, body mutilating surgery, and more is not “fixing” gender dysphoria.

So What’s the Answer?

If trying to force the body to match perceived gender identity through hormones and surgery isn’t the answer, what is? While this issue can be quite complex with past abuses and other issues often playing a role, the ultimate solution is simple and is something every single Christian should be ready to share—the gospel of Jesus Christ.

At the heart of gender dysphoria is an identity problem. A person struggling with gender dysphoria is putting their identity in something so much less than Christ and his design for them.

As an analogy, consider the young woman or man struggling with anorexia, “an emotional disorder characterized by an obsessive desire to lose weight by refusing to eat.” Such a woman or man has an identity issue—their identity is in their physical appearance, specifically their weight. This so consumes them that they will forgo food and necessary nutrients, and/or compulsively exercise, to lose weight. This is unhealthy and, generally, the woman or man’s perception of themselves as obese or overweight is a wrong perception—and everyone else can see it but them.

Such a person is not helped by their friends or family saying, “well, if you feel you are overweight, you must be. Make sure to skip meals and workout for hours. If it makes you feel better, it’s right for you.” Such advice would be tantamount to abuse!

Now, the reasons someone may struggle with anorexia may be complex (e.g., as in gender dysphoria, past or ongoing abuse may play a role), but the solution is the same—this person needs an identity rooted in Christ and his design for them.

We are designed as male and female (Genesis 1:27), but that is not the “be all and end all” of who we are. Surely it is an important part of who we are, but who we are in Christ is infinitely more important. When someone struggles with God’s design of them as a male or female, they don’t need a fan club telling them to live however they feel. They need true friends who will point them away from their destructive feelings about themselves and to the only One who is truly and ultimately our identity—Jesus Christ, who created our physical bodies, whether male or female, “fearfully and wonderfully” (Psalm 139:14)—not as canvases to take shape according to our own desires or under a surgeon’s knife.

Therefore, if anyone is in Christ, he is a new creation. The old has passed away; behold, the new has come. (2 Corinthians 5:17)

Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body. (1 Corinthians 6:19–20)

“You Will be Free Indeed”

Ultimately what the person struggling with gender dysphoria needs is the life-changing, freedom-giving message of the gospel of Jesus Christ. They need a new identity rooted in Christ and his completed work on the cross for them. First and foremost, they need to repent of their sin and trust in Christ alone for salvation.

If you desire to help someone struggling with gender dysphoria, love them, listen to them, cry with them, and, above all, share the gospel with them. Don’t minimize their struggle, don’t ignore it, don’t demean them—understand we all struggle in different ways. And love them well: well enough to put aside the cultural clamor of “do what feels right!” and point them to the gospel of Jesus Christ that brings true and lasting freedom and peace.

Jesus answered them, “Truly, truly, I say to you, everyone who practices sin is a slave to sin…So if the Son sets you free, you will be free indeed. (John 8:34, 36)

You keep him in perfect peace whose mind is stayed on you, because he trusts in you. (Isaiah 26:3)

I have said these things to you, that in me you may have peace. In the world you will have tribulation. But take heart; I have overcome the world. (John 16:33)

Fighting with a New Power

When a person comes to Christ, they may immediately be freed from a previous temptation or sin struggle, or they may not be. They may need to fight that sin with the new power they now have in the gospel, the person of the Holy Spirit who is within them, and the truth of God’s Word. Scripture is replete with commands to fight sin and temptation by the power of the Spirit:

[A]nd he died for all, that those who live might no longer live from themselves but for him who for their sake died and was raised. (2 Corinthians 5:15)

Let not sin therefore reign in your mortal body, to make you obey its passions. (Romans 6:12)

But I say, walk by the Spirit, and you will not gratify the desires of the flesh. (Galatians 5:16)

Don’t Let the Temporary Eclipse the Eternal

Many churches and Christians are falling into the temptation of elevating the temporary above the eternal. In a desire to relieve temporary suffering, they look to the world for answers on this issue and point those with gender dysphoria to the world’s answers. This is unhelpful because (a) those answers aren’t working; and (b) the temporary should never eclipse the eternal.

Those who are actively fighting sin would likely admit that it’s hard and that it involves denying the flesh. There’s a reason Scripture uses metaphors such as fighting in a battle, running in a race, or training for a sport when describing how we’re to live the Christian life and fight the sin that fights for the throne of our hearts—it’s hard! And it will be hard to “put to death what is earthly in you” (Colossians 3:5) until we are fully glorified before Christ. But we should never let the temporary eclipse the eternal.

Just because something is hard doesn’t mean it’s not the right thing to do. Romans says that the glories of what is coming will make the struggles of our day pale in comparison.

For I consider that the sufferings of this present time are not worth comparing with the glory that is to be revealed to us. (Romans 8:18)

As you “bear one another’s burdens,” (Galatians 6:2) never let the temporary struggles of today eclipse the eternal reward of being faithful to serve and obey the Lord in the days he has allotted us on this earth. Keep your gaze fixed on the promises of God, including the restoration of creation to what it once was and the ending of our earthly struggles and trials.

And remember that even as we fight sin here on earth, there is great joy in obedience and following after our Savior and what he’s called us to do. Obeying Christ isn’t drudgery—it’s life abundant.

The thief comes only to steal and kill and destroy. I came that they may have life and have it abundantly. (John 10:10)

Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing. (James 1:2–4)

You make known to me the path of life; in your presence there is fullness of joy; at your right hand are pleasures forevermore. (Psalm 16:11)

The Gospel—Our Hope in Life and Death

The gospel is not a “get out of hell free” card. Yes, repenting and believing the gospel saves us from eternal punishment. But it’s so much more than that! The truth of the gospel and the truth of God’s Word are what the Holy Spirit uses to help us fight sin and live for him in the freedom Christ alone can give. As we seek to help those dealing with gender dysphoria, we must point them to the age-old truth of God’s Word and the completed work of Christ on the cross that gives us a new identity that’s grounded, not in how we feel or how we struggle, but grounded in Christ, his never-changing love for his children, and his design for us as male and female, both made in his image and justified by his grace. Praise the Lord that we as believers have the message that will help all those struggling with identity and who are being tempted and encouraged down a sinful path. As always, the answer is the gospel.