Transgender Care: Medical Caution And Wisdom

May 25th, 2024 | By | Category: Culture & Wordview, Featured Issues

The mission of Issues in Perspective is to provide thoughtful, historical and biblically-centered perspectives on current ethical and cultural issues.

A new medical phrase has entered our vocabulary—“transgender medicine.”  It refers to medical treatments for children who identify as transgender.  The treatments at issue include puberty blockers, cross-sex hormones and surgery, although this is relatively rare.  The Economist summarizes these treatments:  “Puberty blockers are drugs that delay the onset of puberty.  Cross-sex hormones stimulate the development of opposite-sex characteristics: estrogen causes males to grow larger breasts, testosterone gives females bigger muscles and deeper voices, among other things.”

In the West, approaches to transgender care fall into three broad categories:

  1. The laissez-faire approach:  If children identify as the opposite gender and desperately want to adjust their bodies to align with that feeling, they should be allowed to do so.  “If denied such ‘gender-affirming care,’ their lives will be blighted and they may consider sending them, proponents say.”  The American Academy of Pediatrics, a national body, supports the provision of puberty blockers and cross-sex hormones to minors.
  2. The draconian approach argues that such treatments should be banned.  Some states in America combine bans on treatment with harsh penalties for doctors who offer it.  “Florida threatens them with five years in prison; Idaho, ten.  Texas has tried to investigate whether parents who seek such care for their children are fit to be parents; thought this is now tied up in court.  In all, 22 American states have outlawed or restricted transgender care for adolescents, most of them recently.”
  3. The cautious approach, which obtains in Denmark, Finland, Norway, Sweden and England.  Each stresses that more evidence is needed.  “No one is sure why the number of children who identify as transgender has exploded in the past decade . . . Many trans-identifying children are on the autism spectrum.  Many suffer from depression, and should be offered counseling.”

The largest review ever undertaken in the field of transgender health care was released on 9 April 2024, under the leadership of Dr. Hillary Cass, a former president of the Royal College of Pediatrics in England.  It recommends a shift away from medical intervention for trans-identifying children, “an area of remarkably weak evidence,” to a model that prioritizes therapy and considers that other mental-health issues may be involved.  Her review was commissioned in 2020 amid growing concerns about the “affirmation model” of treatment for trans-identifying children being followed by England’s only youth-gender clinic, the Gender Identity Development Service (GIDS).  “On the basis of a single Dutch study in 2011, which suggested that puberty blockers may improve the psychological well-being of such children, GIDS began to give these medicines to young people.  Their long-term effects are not well-understood; children using them often ended up taking cross-sex hormones as well.”  Further, Cass found that compared with the general population, children referred to gender services had higher rates of parental loss, trauma and neglect, and she recommended that gender services should consider the high rates of concurrent mental-health problems, neurodiversity and “adverse childhood experiences.”

David Brooks observes that after more than three years of research the Cass report “is remarkable for its empathy for people on all sides of this issue, for its humility in the face of complex social trends we don’t understand and for its intellectual integrity as we try to figure out which treatments actually work to serve those patients who are in distress. With incredible courage, she shows that careful scholarship can cut through debates that have been marked by vituperation and intimidation and possibly reset them on more rational grounds . . . It is about what the health care approach should be, and how best to help the growing number of children and young people who are looking for support from the N.H.S. in relation to their gender identity.”

Brooks summarizes several other salient points from the Cass report:

  • “This issue begins with a mystery. For reasons that are not clear, the number of adolescents who have sought to medically change their sex has been skyrocketing in recent years, though the overall number remains very small. For reasons that are also not clear, adolescents who were assigned female at birth are driving this trend, whereas before the late 2000s, it was mostly adolescents who were assigned male at birth who sought these treatments.  Doctors and researchers have proposed various theories to try to explain these trends. One is that greater social acceptance of trans people has enabled people to seek these therapies. Another is that teenagers are being influenced by the popularity of searching and experimenting around identity. A third is that the rise of teen mental health issues may be contributing to gender dysphoria. In her report, Cass is skeptical of broad generalizations in the absence of clear evidence; these are individual children and adolescents who take their own routes to who they are.”
  • “Some activists and medical practitioners on the left have come to see the surge in requests for medical transitioning as a piece of the new civil rights issue of our time— offering recognition to people of all gender identities. Transition through medical interventions was embraced by providers in the United States and Europe after a pair of small Dutch studies showed that such treatment improved patients’ well-being. But a 2022 Reuters investigation found that some American clinics were quite aggressive with treatment: None of the 18 U.S. clinics that Reuters looked at performed long assessments on their patients, and some prescribed puberty blockers on the first visit.”
  • “Unfortunately, some researchers who questioned the Dutch approach were viciously attacked . . . As Cass writes in her report, ‘The toxicity of the debate is exceptional.” She continues, ‘There are few other areas of health care where professionals are so afraid to openly discuss their views, where people are vilified on social media and where name-calling echoes the worst bullying behavior.’”
  • “Cass’s report does not contain even a hint of rancor, just a generous open-mindedness and empathy for all involved . . . The report’s greatest strength is its epistemic humility. Cass is continually asking, ‘What do we really know?’ She is carefully examining the various studies—which are high quality, which are not. She is down in the academic weeds.  She notes that the quality of the research in this field is poor. The current treatments are ‘built on shaky foundations,’ she writes in The BMJ.  Practitioners have raced ahead with therapies when we don’t know what the effects will be. As Cass tells The BMJ, ‘I can’t think of another area of pediatric care where we give young people a potentially irreversible treatment and have no idea what happens to them in adulthood’ . . . her core conclusion is this: ‘For most young people, a medical pathway will not be the best way to manage their gender-related distress.’ She realizes that this conclusion will not please many of the young people she has come to know, but this is where the evidence has taken her.”

In America, we are developing the habit of not consulting the evidence, which has become an underlying crisis in so many realms. “People segregate into intellectually cohesive teams, which are always dumber than intellectually diverse teams. Issues are settled by intimidation, not evidence.” Our natural human tendency is to be too confident in our knowledge, too quick to ignore contrary evidence.

Because the transgender issue focuses on real people who have real struggles, this is a sensitive and very personal issue.  However, I believe what follows accurately summarizes what the Bible teaches:

  1. Maleness and femaleness are God’s choice, determined at conception.  But growing into one’s masculinity or femininity and embracing it can be thwarted by cultural and family developments.  It seems reasonable to conclude that gender identity is a developmental issue.
  2. It is certainly true that God desires that every male grow to masculinity and every female to femininity.  When that does not occur, the culture has developed labels such as transgendered and transsexual.  Regardless of the labels, God sees each individual as of worth and value because they bear His image, but as broken individuals.  As with every human being, the salvation offered in Jesus Christ heals the brokenness.
  3. As with every individual human being, our fundamental identity is in Jesus Christ.  Much of the postmodern world has focused on sex or gender as the primary aspect of personal identity.  But the Bible calls on us to identity with Jesus—He is our core identity, regardless of whether we are male, female, transgender, etc.  Identity in Christ is a profound, transformative concept that results from placing our faith in Christ.
  4. It is certainly true that God intends for males to manifest masculine characteristics and females to manifest female characteristics.  The fact that some people are born with evidence of mutations in sex-determining genes does not impact their value and worth to God.  But the Bible is clear that men are to appear as men and women as women (e.g., Deuteronomy 22:5).
  5. Focus on the Family has published a helpful position paper of the transgender movement.  I quote several points from that paper:
  • We must remember that those who struggle with their gender identity have lived lives of great pain, confusion and rejection . . . We must humbly share [God’s] love embodied in the Gospel, to lift them up in prayer and to allow the Holy Spirit to bring about conviction, healing and transformation.
  • We affirm the Christian view that to be human is to be holistically united as body and spirit.  Often, transgender advocates hold to the pagan view that the body is a container that the spirit is poured into.  As such, they erroneously conclude that God has mistakenly put an opposite-gendered spirit into the wrong body or that the body is not the real person—that only the spirit is real.
  • We call upon parents to take a positive role in their children’s development by providing them with a strong, Christian example of what it means to be male and female.
  • We believe we are called to proclaim the truth and beauty of God’s design and the redemption from sexual brokenness in our lives and culture can only come through Jesus Christ.  Like everyone else, “transgendered” individuals are desperately in need of God’s truth and deserve to know the love and compassion of Christ as shown through His people.

May God, in His grace, empower the church to see transgendered people as they are to see every human being:  A broken sinner desperately in need of the salvation that Jesus offers.  As with all human beings, only in Christ is there healing, wholeness and the promise of a resurrected body after which the struggle with brokenness and sin will end.  In eternity there will be no struggle with identity or life’s meaning.  Both will be fulfilled in Christ.

See The Economist (13 April 2024), pp. 9-10, 46; David Brooks in the New York Times (18 April 2024); Focus on the Family Position Paper on Transgenderism at; and “What is a Biblical View of Transgendered People” at

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