I want to strongly recommend Mark Yarhouse’s book called “Understanding Gender Dysphoria.” You can read about Dr. Yarhouse – here. He is an expert on matters of sexual identity, and is well respected by both Christians and non-Christians.

To be honest, I did not agree on every detail in the book, and I will explain my thoughts throughout this post. But overall, it is a very excellent book. It is a book that not only will help Christians to think thoughtfully and theologically about gender dysphoria and transgender issues, but it also a book that will give anyone a very helpful summary of what gender dysphoria is all about and a summary of the current state of research on the topic. Yarhouse does a terrific job explaining the basic issues and terms surrounding sex, gender, gender dysphoria, and transgender issues. It’s a good introductory book to give to a family member or friend who has just learned about your gender dysphoria.

Before I talk about the book, let me share a video speech of Mark Yarhouse I found on YouTube – Understanding Gender Dysphoria. If you don’t have the book, or don’t want to get it, this video covers most of the main points of the book. So you could watch this speech and then read my notes below.


Three Approaches or Frameworks

Yarhouse organized much of what he discussed by focusing on 3 “frameworks.” These are three different approaches to looking at the issue, three ways of framing the issue.

1. The Integrity Framework – This is about keeping the sanctity and distinction between male and female. This is the approach of most Christians, and the framework which makes Christians so uncomfortable with cross-gender behavior, and especially transgenderism. Quote from Yarhouse – “When extended to the discussion of transsexuality and cross-gender identification, the theological concerns rest in the ‘denial of the integrity of one’s own sex and an overt attempt at marring the sacred image of maleness or femaleness formed by God.”

2. The Disability Framework – This is about looking at gender dysphoria as a mental health problem. It exists because of the Fall, but is not immoral, not something a person should feel guilty about. Some people taking this approach might see gender dysphoria as a disorder to be healed from through counseling so a person can be at peace with his or her biological sex. Others might take this same approach but see gender dysphoria as a disorder that needs to be accommodated and treated by helping people to live as the sex that they feel they should be.

3. The Diversity Framework – This approach tends to look at gender dysphoria as something to be celebrated and honored, as something that makes a person unique and special. People who take this approach pay attention to issues such as finding identity and community. For example, many people within the LGBT community find a sense of identity by identifying as an LGBT person, and find a strong sense of belonging in the LGBT community.

This breakdown of the three general approaches to this issue is very helpful, especially for creating a way to more easily talk to those who are not experiencing these issues themselves nor knowledgeable about the issues. It certainly describes well the different ways that different people approach the issues. And in the Church today you can find Christians coming at the issue from all of these approaches.

I approach the issue mostly from the integrity framework. But I also think the other two are important. I do view gender dysphoria as a result of the Fall, a disorder, and I don’t blame people for having it. But I think proper treatment is helping people to accept who they really are as created by God, rather than accommodating the disorder through cross-gender living. In the same way, I personally have some OCD, but I don’t embrace it and give in to it, I resist it and try to live a normal life without giving in to the strange behaviors and compulsive thoughts. As far as the diversity framework, I think it is important to help people with gender dysphoria to be able to have meaningful identity and community. For me, my history with crossdressing and a bit of gender dysphoria is a large part of who I am, and it has shaped my life and my ministry. God has used my brokenness for good by using me to help others. And as far as community, I love God’s church, a place where broken people like me can live with and love other broken people like me. Furthermore, I have found a great sense of community in the prayer group I started through this blog, of people like me who have struggled with the same thing.

Yarhouse suggests an integrated framework which is to take the best from all three of the approaches. He wants to maintain integrity of sex differences, but compassionately help those with the disorder of gender dysphoria, and yet also help people to find true identity in Christ and true community in the Church, as people with gender dysphoria, not people who have to hide it. I very much like this integrated framework. If you only focus on one of the three, you are likely to have all truth and no love, or have a feeling of love that does not truly help people.


My Main Criticism

Yarhouse comes at the transgender issue from a Christian perspective, and he is extremely pastoral, sensitive and compassionate. My main criticism is that he is maybe “too” compassionate, and I would like to see him come down more firmly regarding ethical boundaries on this issue. I think he is so loving and compassionate, and has counseled so many hurting people, that it is difficult for him to proclaim clearly what he thinks is or is not acceptable for Christians with gender dysphoria to do. I completely agree with him that people with gender dysphoria are not culpable for the feelings that they did not choose to have. But I would say much more strongly than he does, that people with gender dysphoria are culpable for how they respond to and act on those feelings. While we should not chase after or celebrate suffering, suffering is a part of the Christian life. Those of us, like myself, with feelings or desires we did not choose, will have a difficult and hard life in certain ways. We need to live the right way even when it is hard, and even when it seems to cause us anguish. Christian counselors need to call people to do the right thing. That is really the loving thing to do. And I believe that when we obey God and do his will, ultimately that will make us more satisfied and joyful. His plans are better than ours.

I would have liked Yarhouse to state clearly that from a Christian perspective it is wrong to change our bodies in order to appear as the opposite sex, and it is wrong to take an identity as the opposite sex. Instead, he suggests that some cross-gender living and treatments could be seen as pastoral accommodations instead of affirmation. Here is a quote – “Towards that end, I see the value in encouraging individuals who experience gender dysphoria to resolve dysphoria in keeping with their birth sex. Where those strategies have been unsuccessful, there is potential value in managing dysphoria through the least invasive expressions (recognizing surgery as the most invasive step toward expression of one’s internal sense of identity).”

What I’ve said in the two paragraphs above constitutes my main criticism of the book and his views. But I still find it an extremely helpful book and would recommend it to both Christians and non-Christians.


Other Miscellaneous Comments

Yarhouse uses the preferred pronouns for transgendered people. As I’ve written about before, this is a really tough issue, and I’ve gone both ways on it in the past. On the one hand, I see the need for not lying, and not giving in to the confusion people are feeling which does not do them any good. (I wouldn’t call someone black if they were white for example, nor would I agree with an anorexic person that they are fat). On the other hand, I don’t think it’s helpful to anyone to constantly be calling attention to the fact that you disagree with a man’s decisions by constantly using “he” or “him” when he doesn’t want to be hearing those words. I understand why Yarhouse wants to accommodate for the sake of grace and love. When I’ve talked to transsexuals in the past in person, I have used their preferred pronouns and on this blog I use the female names that crossdressers identify themselves with, though to be honest it makes me uncomfortable to do so. Going forward, my plan is to avoid using the pronouns that only reinforce their confusion. I will not call a man a woman. But at the same time, I will try to avoid using any pronouns when possible so as to not make it a constant issue of strife when I’m trying to care and counsel such people. I like John Piper’s approach to this issue better than Yarhouse’s. You can read Piper’s view and my more detailed thoughts here – Transgender Friends – Which Pronouns Should We Use?

I appreciated his analysis of the issue in light of the biblical story of Creation, Fall, Redemption, and Consummation. All of us are disordered because of the Fall, though in different ways. As Christians I would say that we need to try to live out who we are supposed to be, rather than embracing our fallenness, and fight against the Fall in every area of life.

I took note that Yarhouse agrees with me on gender stereotypes. He says that when we emphasize rigid gender stereotypes too much this can actually help to cause gender dysphoria. We should not abandon the idea that males and females are different. But if we put too much emphasis on the cultural applications of those differences, it can make people feel like they don’t fit in with what is expected and exacerbate their dysphoria and pain.

I appreciated that Yarhouse pointed out that most transgender people are not the ones who want to totally deconstruct the gender binary and have a genderless society. They like gender and don’t want it gone, but they want the gender that they feel is right for them. Unfortunately, society has not seemed to notice this (as well as some in the LGBT community) and they are arguing for the goodness of transgenderism by arguing against the gender binary.

Yarhouse gave an excellent summary of the current biological and social research on the issue. Honestly, it makes me feel like I don’t need to go out and read hundreds of books and articles about all the research, because this very intelligent man has read all of those already. He is extremely well-read from what I can tell in the footnotes. I am very grateful for his extensive work and research. He makes clear that even with all of the research, the causes for gender dysphoria are still unknown. There are problems or holes with every theory. Much more research needs to be done. I especially appreciated his critiques of the brain-sex theory, but I won’t get into all of that detail here. You can read the book.

He also talked about Blanchard’s controversial view. I wish he would have talked more about the differences between those who have strong gender dysphoria as children and become transsexuals, and those that, like me, are sexually aroused by crossdressing but later consider becoming transsexuals. To me, from all my study and interactions with people, these two groups of people are very clear (but I’m not saying that everyone fits into these groups neatly). See my blog post on Blanchard’s view – here. I really appreciated him calling out the attacks people have made against Blanchard. He said – “I am also impressed by the amount of hostility directed at adherents of specific theories. There is a need not only for good research in this area, but a kind of open discussion that is not reduced to personal, ad hominem attacks.”

He sees gender dysphoria on a continuum which I appreciated. He notices how many different and various people there are out there, from those who crossdress for stress relief, to those who crossdress for sexual pleasure, to those with strong gender dysphoria. Interestingly he noted that 68% of all crossdressers only wear underwear and only one in 300 would make a sex reassignment transition.

I was disappointed by his analysis of some of the key Scripture passages on this issue. I don’t think he takes Deuteronomy 22:5 strongly enough, and maybe does not see how important 1 Corinthians 11 is to this issue. See my posts here – Deuteronomy 22:5 and 1 Corinthians 11:2-16 Prohibits Crossdressing.

Yarhouse discusses the transgender cultural script, that is, the mainstream ideas about being transgender. One of these mainstream ideas is that gender incongruence forms the core of a person’s identity. But gender is not all of who we are; there are many aspects to our identity. Even if our sense of gender feels broken or out of place, it does not mean that our lives are over or that we cannot live without change. I like the alternative Christian script Yarhouse mentions – “Perhaps being transgender is part of my identity; however, I am a complex person and am more than gender dysphoric.”

Yarhouse poses a question people sometimes ask – “Does my gender dysphoria mean I am going to hell?” Yarhouse responds, “No, gender dysphoria does not separate you from God; it does not consign you to hell.” While I absolutely agree with him, I think our answer needs much more nuance. First of all, there is a difference between having gender dysphoria and having gender dysphoria but acting on it in sinful rebellion. Sin does send us to Hell. We need forgiveness in Christ in order for our sin not to send us to Hell. Furthermore, a true Christian, (according to hundreds of biblical passages), is not someone who lives in sin, but confesses sin, repents of sin, and fights against sin. I would use an analogy. Committing adultery does not mean for sure you are destined for Hell, but willful repeated adultery without repentance is a sure sign that you are not a true follower of Jesus, and you still need to be born again.

Last, Yarhouse had some very helpful comments about the Church, and how local churches can care for those with gender dysphoria. Unfortunately, he noted that many of our churches have made people with gender dysphoria feel more shame, making them feel flawed, and that the flaw is their fault, and that if others in the church knew, they would be rejected. He also said a lot of evangelical churches look like – Behave, then believe, then belong. This means that churches expect people to behave rightly and then believe in Christ and then join the church community. This is to act like the Pharisees. Instead, Yarhouse suggests what I passionately agree with. Churches should operate rather with – belong, believe, become. Jesus spent time fellowshipping with sinners before they changed their lives around. We are given God’s grace and love first. We experience the love of God’s people first. Then we come to belief in Christ. And then slowly, through the process of sanctification, the Holy Spirit makes us into who we are supposed to be, making us more holy and more Christ-like. It is only grace and God’s work that can change us to be who we are supposed to be, only grace that can help us to obey God. To expect people to behave first, and then believe and belong, is foolishness. Our churches must be churches that welcome transgendered people, love them, listen to them, help them grow in Christ, and be patient as they work through tough decisions.