Theology in the Raw - Transgender People and the Church, Pt. 1: Dr. Preston Sprinkle & Dr. Mark Yarhouse

Episode Date: May 12, 2025

This episode is a recording of the session titled "Transgender People and the Church" at the recent Exiles in Babylon conference in Minneapolis. In this session, I give a short theological overview of Transgender identities and Mark Yarhouse gives a psychological perspective. And then, we had three people share their testimonies: Remi Rathjen (a Christian who experiences Gender Dysphoria and who hasn't transitioned), Julia Mallott (a transitioned transwoman who does not identify as a Christian), and Chloe Cole (a Christian who transitioned at an early age and then detransitoned). To listen to these testimonies and our 45 minute dialogue, go to patreon.com/theologyintheraw and sign up for a free (or paid) account.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey friends, welcome back to another episode of Theology in the Raw. This episode is a recording of one of the sessions at the recent Exiles of Babylon conference in Minneapolis, Minnesota. And this session was titled Transgender People and the Church. Okay, here's how it's going to go. In this session, I introduce a session and then I give a theological overview of transgender identities. And then Dr. Mark Yarhouse comes on, he gives a psychological or an overview from a psychological perspective. And then we heard from three testimonies who are diverse in the trans, the broader kind of trans community. One is from Remy Rothgen, a Christian who experiences gender dysphoria and has chosen not to transition. The other testimony or another test, the second

testimony is from Julia Malat, who is a trans woman who has transitioned. And then the third testimony is from Chloe Cole, somebody who used to identify as trans, went through the surgical process, but then de-transitioned and no longer identifies as trans. And if you know anything about Chloe, she's very outspoken, an outspoken critic against minors transitioning in particular. So I wanted to get an array of different testimonies so that people could see that there are diversity of perspectives within the broader trans community or people who used to be part of that community. And then after, so then after the three testimonies,

then we all sit on the couch and we engaged in a really honest and forthright and I would say, extremely good faith dialogue around some differences of our viewpoints. Now, you're going to hear the public, what I'm going to release publicly is the first two talks from me and Dr. Mark Yawhouse. And then if you want to hear the testimonies and the dialogue, then you need to go over to patreon.com forward slash theology into raw and sign up for patron. Now here's the thing. You can create a free account. We're going to make this free for

anybody who signs up to patron. So you don't need to put your credit card in. You can just go, you put your email and that will give you access to watch the entire or listen to the entire session, which includes the testimonies and the dialogue. Okay. So please welcome to the show again, I guess, me and Dr. Mark Yourhouse. Okay. The final session is Transgender People and the Church. We could have worded this many different ways, that the wording is really intentional. I tried to be really specific with the titling

that I give to these sessions. We didn't title it Transgenderism. We didn't title it transgender-ism. We didn't title it transgender-issues. We didn't title it transgender-people and politics. And this morning, a lot of those things will come in, issues, some politics, some isms maybe, but we did want to focus on transgender people, people who identify as transgender or in other similar ways, non-binary, genderqueer,

and so on. And it's also a church-focused conversation. And since the Bible is a church's theological and ethical foundation, we will discuss what the Bible says about transgender identities. And the goal this morning, again, just a reminder is to think more deeply, love more widely. Everything you're gonna hear from the stage

belongs together. Thinking of is like one talk with several speakers. Each one of these individual talks or testimonies are incomplete by themselves. That's really important to keep in mind, okay? So if somebody just clipped like just my talk, said we wanna show this in church, I'm gonna say, do not do that.

But it's like taking part of a movie and saying, let's watch this clip of this movie, you know, like the last 20 minutes of No Country for Old Men or something, it's like, what? That doesn't make any sense. So that's really, really important. And I also want to acknowledge that there's going to be, well, first of all, there's gonna be different viewpoints

on the stage and that'll come out. And there's for sure different viewpoints in this audience. Can we be okay with, can I just, let's just, that's what is in this room, different viewpoints. Hopefully you're gonna hear different viewpoints maybe from the stage that are presented honestly, hopefully humbly, and each person's gonna maybe talk about their best understanding of the truth, hopefully humbly, and each person's gonna maybe talk

about their best understanding of the truth, whether it's their own story or their best understanding of what the scriptures say. So this, if you're here and you're like, I'm not sure if I'm gonna agree with everything's gonna be, what's gonna be said, you're not, first of all, because there's gonna be diversity on the stage. And that's okay, this is a safe place, okay, to be able to think deeply and love widely.

You don't need to agree with everything. You just need to be able to process and receive. All right, let's get started. A theology of transgender identities in 20 minutes or less, 18 minutes or less. Okay, let me start with a theological foundation. Genesis 1, 27, God created humankind in his image. And James castigates Christians who say,

who praise our Lord and Father with our tongues, and with the same tongue, we curse human beings who have been made in God's light as brothers and sisters. This should not be. Our theological foundation, our theological starting point is that all people, including people who identify as transgender are created in God's image, and it is profoundly un-Christian, un-biblical,

to mock, dehumanize, make fun of, not honor another person created in God's image. And this isn't a violation of like just secular kindness or Christian niceness. Oh Preston, you just wanna be nice to trans people, that's cute, whatever, grow a spine and speak the truth. No, if you are not honoring somebody as created in God's image, that is a theological problem.

If you are a Theo bro, and I'm kind of a theobro, I don't know what that means. If you're a theobro and you are mocking a trans person, you are violating biblical truth. This is a fundamental theological starting point. I could spend 20 minutes on this point, okay? But this is where it's hard for me because usually when I go into churches

and I give, you know, usually it's like a three hours, hour and a half like talk or seminar on this topic, I linger here for about 40 minutes. But my slice is the theological piece. So I must move on. Let me just briefly explain some terms and maybe Mark was gonna hit on this or maybe he might not have to,

but there's just a couple of terminology things that we just, we have to understand before we even move into this conversation. Sex and gender. Sex and gender are often understood differently in this conversation, okay? I know a lot of you already know this, so I hope I won't spend a lot of time here,

but because we have to all understand this, the terms sex and gender are often used differently. They're not synonyms in this conversation. Now, some of you are like, no, gender is the same as sex, or no, you can't separate sex and gender, whatever that even means. Okay, I might even agree with that. I'm just saying in this conversation,

as we're trying to understand how this conversation is taking place, people in the conversation are using these terms differently. So if you have any ounce of like missionary spirit in you, and when you're trying to understand a certain culture, people group, we have to take notes. We have to listen. We have to understand how people are using terms. So sex and gender.

Sex, one basic definition that is pretty widely agreed upon. Sex verse two, an organism. An organism is either male or female if it is structured to perform one of the respective roles in reproduction. It doesn't need to succeed at reproduction, but it is structured to perform one of the respective roles

in reproduction. Gender refers to the psychological, social, and cultural aspects of being male or female. And so gender identity is one kind of subset of gender, and this refers to one's internal sense of being male, female, both, or neither. Again, I'm not endorsing whether these claims are accurate or true or whatever.

I'm just saying when people use these terms, these are generally what they are referring to. So even, you know, in Facebook or wherever, then they say like, yeah, 74 genders to choose from. And people were flipping out because they're thinking sex. They're like, oh, 74 sexes among humans. I'm like, well, that's true. But if somebody says, if somebody is defining gender

as one's internal sense of being male or female, then why stop at 74? You know, I mean, from that perspective, you can disagree with those definitions or whatever, but if they're using those terms that way, at least you can understand maybe a little bit about where they're coming from. Transgender is an identity term adopted by some who experience incongruence between their biological sex

and their gender, okay, bringing our definitions with us, in particular, their gender identity. And again, there's other terms, non-binary, genderqueer, I'm not gonna get into all the details. I'm kind of using transgender here as an umbrella term that covers kind of other similar identity terms. In terms of theology, here's a couple theological questions that we can ask.

I think it is important as we're saying, what does the Bible say about transgender? We're kind of like transgender-ism people. I don't even... We need a word that we need to come up with the right questions that we're even bringing to the text. Here's two, these aren't the only two,

but here's two that I think might be important. Does it matter whether a Christian identifies with their biological sex or their gender identity when they experience incongruence? Another question we could bring to the text is, if we experience incongruence between our sex and our gender, which one are we? If one differs, if one's internal sense of being male

or female, if their internal sense is different than their biological sex, then is there one that is more true to who they are as a human being? I think that's an interesting theological question we can raise. It's not the only, so we also have to raise lots of psychological questions. That's above my pay grade, okay?

That's what Mark's here. But theologically, here are some questions we can bring to the text. Here are, I'm gonna give four biblical observations that I think are relevant to wrestle with as we seek to address these questions. I don't think any one of these observations alone just slam dunk, maybe answers it,

but I think these are relevant biblical observations. And I just, let me just be, again, slam dunk maybe answers it, but I think these are relevant biblical observations. And I just, let me just be, again, I'm gonna be as honest as I can with how I understand the Bible. That's kind of a narrow lane. I'm one person interacting with other viewpoints and simply saying here, if you just take the,

if someone says, what do you think just the Bible says, not interactive with psychology and philosophy and all these, I'm like, okay, those are other things we need to consider, but I'm just gonna say, here's my most honest understanding of the scriptures. And again, you're free to disagree and offer another kind of way to read the Bible.

Number one, biological sex is a significant part of human identity, Genesis 1.27. God created humankind in his own image. He created them in the image of God. He created the male and female. According to like the Hebrew poetry, there's like a layered meaning here where each line sort of continues to expand

on the previous line. So there's like an overlap in meaning here. My best understanding of Genesis 1.27 is that our embodied nature is intrinsically related to bearing or being in the image of God. And not just our embodied nature, but our sexed embodied nature as humans

is inseparable from the fact that we are created in the image of God. And this isn't just like a verse. I don't wanna give the impression that I'm just like quoting that verse and quoting that verse and quoting that verse and taking all these verses and adding them up. Like, I mean, this isn't just, oh, that's okay,

that's one verse. This verse is one of the most revolutionary statements about human nature and all of religious history and it controls and shapes the entire biblical worldview about humanity. It's why slavery is wrong, it's why misogyny is a sin, and on and on and on it goes about how the Bible talks about human nature.

It flows out of this verse. So it's an important verse. It's not just one of several thousand. Another verse that I think taps into this biblical theme is 1 Corinthians 6, 19 to 20. Paul says, do you not know that your bodies are temples of the Holy Spirit who is in you, whom you have received from God?

You are not your own, you are at a price, therefore honor God with your bodies. What we do with our bodies is a moral issue for trans people, and guess what? a moral issue for trans people, and guess what? And non-trans people. For anybody who claims to be a follower of Jesus, they cannot say, I can do whatever I want with my body. It's just my body.

That's not a Christian category. Also notice how Paul interchanges personhood with body. You don't have like, here's you, and then here's your body that covers the real you. He conflates bodies with you, you and your body. We are not souls with bodies, we are embodied souls or in-souled bodies. There's an intrinsic unity between the immaterial

and material aspects of human personhood. Okay, second biblical observation. Maintaining sex distinctions is a biblical value. And, sorry, why are you laughing? I'll tell you why in a second. Deuteronomy 22, five, a woman must not wear a man's clothing nor a man wear a woman's clothing for the Lord your God detests anyone who does this.

Okay, I want to acknowledge that this verse, and it's very triggering for trans people. And so please let me explain a little bit here. It's triggering because, I don't think it's because the Bible intrinsically is triggering, it's because Christians can use verses inappropriately and that can be very triggering.

People could use verses on slavery as we have done for thousands of years and that can be very triggering. People could use verses on slavery as we have done for thousands of years and that can be triggering for people who have been on the other end of a misuse of a verse. So it would be lazy to simply quote this verse and say, all right, that's it. That's what the Bible says about transgenderism and we're done here.

There's no conversation. There's debates about this translation, the Hebrew phrase, keli geber, men's clothing. Actually, men's clothing probably isn't the best translation. It literally is things of a man could include weapons, helmets, external apparel that in that culture was associated with men, males. The context here is weird.

Have you read around the context? I mean, the first four verses talk about strain oxen. The next three verses talk about birds in their nests. And then this verse pops out of nowhere. It's like, what's going on? There's just nothing in the context, in the near context that makes any sense. There's also the problem of, hey,

this is the one verse that says this and it's in the Old Testament. Is this an Old Covenant thing? How do we know this is even a New Testament thing? So I just might put, I, we cannot unthoughtfully just quote this verse, which has been done many times, and think that this is,

settles the conversation about being transgender. It's still a verse, breathe out by God, that we have to ask the question, does this verse participate in broader themes that are also saying something similar? So I do, and again, I'm trying to be concise here, but once we do the work of working through a lot of extra-genetic questions here,

I do think it does represent a wider theme that maintaining sex distinctions is a biblical value. Here's another passage that I think also represents this theme, 1 Corinthians 11, 2 to 16, the head covering passage, okay? This is, okay, some of you know, I've been writing a lot, doing a lot of thinking about what the Bible says about women and this passage is the most difficult passage

in all of Paul's letters. Well, that's debated, other people said, no, this is the most difficult passage. It just is, okay? It's not an argument, it's an observation. There's even a debate about whether it's even talking about head coverings. You can almost translate some of these phrases,

long hair, not head coverings. Like your long hair is your head covering, I'm not gonna get into any of that. In the midst of the myriad of different ways people read this passage, the one thing, I think all, I'll just say, I'll just be safe and say, virtually all scholars agree, is that the underlying thing that Paul is drawing on

is that he wants men and women to express their differences and not blur those differences according to the cultural standards of the day. It's important, okay, this is really important. Paul reinforces expressions of male-female sex distinctions not because such cultural expressions are intrinsically moral, but because the underlying sex differences

are part of God's design of creation. Clothing differs from culture to culture. When I was 18, I preached in a dress, they call it a lava lava, in Samoa. Because men wear a lava, it's a wrap, it's not a dress, it's like a wrap around and real men go commando, which is, I didn't, because I didn't know how to tie the thing well.

That would have been the best sermon ever. And it's windy on that island. There are some cultures that have, where clothing, there's a black and white line between what is male clothing and what is female clothing. The ancient world was like that too. Clothing signified status and sex, biological sex. Other cultures, like Western culture,

it's a lot more blurry. So anyway, not getting into any of that, the underlying thing that Paul is drawing from in his cultural application is Genesis 1.27, basically, that God created us male and female. Number three, enforcing male-female stereotypical behavior is not a biblical value. While the Bible celebrates sex differences, stereotypical behavior is not a biblical value.

While the Bible celebrates sex differences, it does not impose cultural stereotypes about how men and women should behave. David was a pretty manly man, killed Goliath. Didn't even, didn't he kill a lion? Or is that David Crockett? No, he killed a bar when he was only three. Davy killed a lion, right? Yeah.

That's pretty masculine. Lion? Without a gun? He also played a harp, wrote emotional poetry and cried more than anybody else in the Bible. And when his best friend died, he said, your love to me was better than the love of women. And he had a lot of women.

Jonathan, your love to me was better than the love. Try that with your best friend. Guys, bring them close. And then give them a holy kiss. And then give them a holy kiss. Deborah and Yael were females, godly women. At least Deborah was, Yael just was good with the tent peg. Deborah we know was a prophetess and she, we don't know too much about Yael,

but yeah, they did not fit the stereotype about how women should behave. Jesus wasn't, okay, in the first century, Jewish and Greco-Roman context, it was very manly to be married, father children, and in the Greco-Roman context, to have sex with whoever you wanted, okay? And especially in the Greco-Roman context

to not serve people of a lower social status than you. And you would never, if you're a real man, you would never turn the other cheek when your enemy is beating you. Enter the manliest man to walk the face of the earth. An unmarried man who fathered no children of marital age, who washed the feet of those of a lower socials, took the form of a slave.

Jesus blew apart cultural stereotypes around masculinity. So I think it's unbiblical. When we define what it means to be a man in terms of masculine behavior, and we define what it means to be a woman in terms of feminine behavior. And there's fewer people who fit into those boxes. And if you don't fit into those boxes,

then you're not actually a man or a woman. You're something in between. I think that that's not just unbiblical. I think it's very damaging for people. And this exists outside and inside the church. If you are a man and you would rather watch the halftime show than the Super Bowl or a rom-com than an action movie.

And if you're not good at basketball or pick up sports, whatever, And if you're not good at basketball or pickup sports, whatever, and you go to a men's retreat at church, and for unintentional reasons, you're made to feel like you're less of a man, like you just don't fit in, and you can question your manhood, that is unbiblical.

And same for women. I'm not gonna get into the stereotypes. I get myself in trouble when I start talking about female stereotypes because it looks like I'm like endorsing them. Like, you know, I don't know. I stopped doing that. I stopped doing that.

The Bible, okay, these little stereotypical characters with the dress and the, you know, that represents biological sex. The circles represent what people define as gender, psychological, social, and cultural aspects of being male and female. These general, I mean, masculine and feminine behavior are general stereotypes that are true for the most part.

Most men, males, like naturally resonate with stereotypical masculine behavior and interests, don't feel ashamed if you resonate with that. I resonate with a lot of them, not all of them. Like I grew up and I hated seeing animals die. And I forced myself with my pellet gun in my backyard to kill innocent birds, to desensitize myself from this female virtue or stereotype. It didn't work, cause I still don't like to see animals.

I eat them, but I don't like to, I want somebody else to kill them. So maintaining sex distinctions, and yet the Bible is very generous with how whatever we're interested in, how we behave, it doesn't say be masculine, be feminine, it says be godly, be tenderhearted women and men, be courageous men and women. Even that command, some of you were like, what about 1 Corinthians 16, whatever it was, 16, 16, I think,

where Paul says, act like men. Andridzomai, I think. That just simply means be courageous. But he's still in a mixed congregation that. You guys know, nobody even gets that far in 1 Corinthians, right? You kind of lose steam after 14, call the day at 15. But the commands in the New Testament are almost all,

there's some like women tell a woman do this, men tell men, you know, but even those lists oftentimes are like, be holy, be sober, be, you know, don't get drunk. And you know, all these things are like, well, he tells men that elsewhere. Okay, lastly, I need to speed up. Welcoming the other is a biblical value.

And relevant to our conversation is the eunuch, where Jesus says there are eunuchs who are born that way and other eunuchs who have been made eunuchs by others. There are those who choose to live like eunuchs for the sake of the kingdom of God. Okay, choose to live like eunuchs who have been made eunuchs by others, there are those who choose to live like eunuchs for the sake of the kingdom of God. Okay, choose to live like eunuchs. Most people say that's kind of like a metaphor for taking a vow of celibacy, like choosing to be single.

Cause in the context, a eunuch is a symbol of singleness, right? Jesus just got done talking about marriage and how he kind of comes down pretty hard against divorce. And then the disciples are like, well, who can get married then if we can't just be, you know, divorcing our wives right and left? And he's like, well, it's really hard.

In fact, some people don't get married. For example, the eunuch. This was an example of singleness. So the born eunuch, the made eunuch is probably somebody who was castrated. Somebody else made them a eunuch. The born eunuch is probably somebody who was castrated, somebody else made them a eunuch. The born eunuch is probably somebody born with some, what we would call today a disorder of sex development,

DSD, or the identity term is intersex. Somebody with some kind of atypical feature in their male or female sexual anatomy or chromosomes. Notice I just said in their male or female sex, being intersex isn't like a third, fourth, other kind of sex. It is some kind of atypical feature that we can see medically how we got here

in someone's male or female sex anatomy. In the ancient world, a eunuch was a male who for some reason was infertile. And the born eunuch, there was probably some atypical feature in their sexual anatomy that was probably visible why they were unable to have kids. A few observations about the eunuch.

The acceptance or praise of the eunuch here does not challenge the sex binary. Just a few verses earlier, Matthew 19, four to six, Jesus says, have you not read? God created the male and female. And he goes on to build his theology of marriage out of that reality. The eunuch isn't challenging that.

Again, the eunuch was not a, neither male or female, was a male with some kind of atypical feature in his sexual anatomy. Number two, and this could take longer to really unpack, I'm just gonna make an observation. I don't think there's evidence that the ancient, that the eunuch in the first century was kind of, was like an ancient, what we would call,

person who identifies as transgender. I think it does parallel somebody who is intersex with a typical feature in their biological sexual anatomy, but there's no evidence that the eunuchs back then had like, were experiencing like gender dysphoria or had some sort of experience like incongruence that the eunuchs back then had like, were experiencing like gender dysphoria or had some sort of experience like incongruence between their biological sex and their gender, what we would call gender identity.

It's possible that they did, but that's just not what the category eunuch conveyed according to what we know in the first century. However, another observation, most eunuchs were socially ostracized because their culture viewed them as unmanly. So they did feel that ostracism, that otherness, because they didn't fit the culture's understanding

of what a real man is and what a real woman is. So they did feel that and they were pushed to the margins because of that. And the gospel holds up the eunuch as a faithful, praiseworthy, exemplary follower of Jesus. So in summary, I hope I didn't get too long. That's my conference, I can go as long as I want, right? Ha ha ha.

Okay, in summary, I believe the Bible teaches that God identifies us as male or female based on our biological sex and that followers of Jesus should embrace this divine identity. And I also have dear friends in my life who identify as transgender. Some have transitioned, some have de-transitioned,

some have not transitioned. I have several dear friends who have transitioned who two, at least two, three, four, would be committed followers of Jesus. When they describe to me what it's like to experience crippling gender dysphoria, I don't have, all I can do is listen and learn. When they say on some days I couldn't go outside of my room

because my body just, I could not physically move my legs to go out into a socialized world where men were these categories of male and female or just where I was swimming in those categories. Two of my friends tried to commit suicide on several occasions and were upset that it didn't go through. They said, I would rather kill myself than to live with this gender dysphoria.

I have the two friends who did transition and they no longer live with that pain for years. Other friends who live with more pain after transitioning. or friends who live with more pain after transitioning. I don't determine my theology from people's experiences. You can't, even if you think you do, you can't because which experience are you gonna use to determine it? If you've met one transgender person,

you've met one transgender person. But I do think listening deeply to experiences should shape how we think theologically, how we hold on to our theology. So I am in an ongoing way, I'm putting my best understanding of the Bible in conversation with real people. Did you know that only 3% of Christians who serve overseas actually go to unreached places?

That means the other 97% are going to areas where the good news is readily available. ELIC wants to change this and that's why they're sending and supporting hundreds of Christians every year as English teachers in Asia, the Middle East, and North Africa. So ELIC or the English Language Institute in China has been doing amazing work for several years, over 40 years in several countries, and they've helped thousands of people live a purposeful life by teaching English and bringing hope to communities that don't have access to the gospel. Now you might be wondering why English. Okay, so English education empowers students to pursue better career opportunities while giving ELIC teachers long-term access to restricted countries and a platform to build relationships with locals.

And the best part is they're doing it all within a supportive Christian community because ELIC believes no one should go alone. So applications for 2026, the 2026 teaching placements has just opened. So if you want to maximize your time to prepare, fundraise, then don't wait to take the next step. Head to ELIC.org forward slash TITR. Okay, that's ELIC.org forward slash TITR to learn more about how you can be a part of the 3% who are reaching the unreached. All right, let's welcome Dr. Mark Yarhouse to the stage. One of the first studies that I ever conducted

on Christians who are navigating gender identity questions, I asked the person, what is it like to experience gender dysphoria? And they said it's like puzzle pieces that don't fit together. And I look around and I wonder how it fits together for everybody else. You know, when I started my career in 1998, I mostly worked with Christians who were navigating same-sex sexuality and faith, but I had always seen people who were navigating gender discordance.

It was just kind of a rare phenomenon, and you would mostly be referred early onset cases, cases where the gender concern was present before puberty. And so normally the ratio, the research was showing the ratio was about a four to one or five to one ratio of natal males to natal females. And the thinking at the time was that there's a narrower box

for a young boy to be in, and if he expresses anything atypical, there's gonna be a referral to see someone about what's going on. But that wasn't the case for a natal female. There was a more expansive box for the natal female. We even have a positive word for it in English. She could be a tomboy. But there is no a positive word for it in English. She could be a tomboy.

But there is no corresponding positive word in English for a boy. So sometimes we refer to that as gender atypicality, being different in terms of how you experience your gender or express it. But one of the most consistent findings in research of adults who identify as gay and adults who identify as gay and adults who identify

as trans is that they felt different from their peers for gender-related reasons. Now what does that even mean? It means when all the boys were interested in these types of things, this boy felt different from those boys and attributed to differences around gender, okay? Gender, that's what we sometimes call gender atypicality.

Same with girls, looking at girls doing different things, they felt different. So both gay adults and trans adults look back on their childhood and felt different from their peers for gender-related reasons. Now fast forward to about 2011. I was doing workshops for youth ministers on Christians, teens navigating same-sex sexuality and faith.

But about 2011, all of the Q&A shifted to gender. Questions about trans youth, non-binary youth. And the youth ministers, unbeknownst to them, were signaling a cultural shift that would be captured in the Time Magazine cover featuring Laverne Cox that said the transgender tipping point. There was a shift happening. The thing that I had experienced as really rare

throughout the beginning of my career was now becoming more of a central part of the cultural discourse. Now, in 2013, the diagnostic manual that people like me as psychologists, psychiatrists use to make diagnoses would reconceptualize what was gender identity disorder to gender dysphoria. So it would be a different way to think about it.

What we're saying now is it's not fundamentally a question of identity, it's a question of distress. So dysphoria is a negative emotional state, euphoria, positive emotional state, right? So if you experience gender discordance, it's not the identity that's the focus of treatment, it is the distress. And even in DSM-5, this is the manual I'm talking about, diagnostic manual I'm talking

about, it even suggested that transitioning could be curative, that you could cure gender dysphoria if you transition sufficiently. It's an interesting, fascinating reconceptualization of this phenomenon. You might be wondering, well, what causes something like that? How do people come to experience this? In my early writing about this, I introduced three lenses through which people see this topic. The first lens I called integrity,

and it was people who said there's an integrity to male-female differences. And when you adopt a cross-gender or other gender identity, you're going against the integrity of what God intended. And that group often did frame it as a kind of willful disobedience, so there's a sin in that. And their interest was in restoring creational intent.

The second lens I described as more of a disability, something's not functioning properly. That's a second lens you could see this through. Kind of like when you think of someone with hearing loss, like something's not lining up the way it's meant to line up. And so it's a non-moral reality you would respond to with compassion. So I called it disability.

I was always using the language of the proponents. I didn't come up with these words. But then in the hearing loss community, you know that there's a debate there, a pretty heated debate between those who see it as a condition, a disability, and those who see it as a culture. And that's where the third lens would go, that they would see gender dysphoria signaling

a kind of person that should be celebrated as part of a transgender culture, a community. So these three lenses I just observed coexist in society and in families and in churches, and we often speak past one another in those spaces. So when you get to the question of causation, some people are saying, well, it's just willful disobedience.

I can remember sitting down with a mother and her 16-year-old daughter, and they had come for a consultation, came from the deep South, and had gone to three pastors. All three of them had said it was willful disobedience, that your daughter experiences herself this way. And I was the first person in the room in their life to say, I don't think your daughter chose

to have this experience. I think she went through puberty and she's found her, no, she had this from an early age, and she's found herself with this experience and she's been unable to talk with you about what that is like for her as a child, but now she's telling you. And the mother just broke down into tears

because she'd never heard a Christian with any kind of authority in her life say anything like that. Her only framework was willful disobedience. But to have this sort of experience her daughter had and she's trying to communicate it to you was hard to understand. Most of the research on etiology

is between nature and nurture, kind of like with sexual orientation. We actually study some of the same regions of the brain. The short answer for our time together is we don't know what causes gender dysphoria, what causes the discordance that exists there. I think there are correlational studies on like lack of connection with the same gender parent,

emotional abuse and neglect and trauma growing up, things like that. But these are correlational studies. By definition, they were not designed to show you a causal pathway. There's just associations. So really want to be careful with that. I would say most people in my field,

they would land more on the nature side. They would say there's something going on in the brain. There's some way in which, they would land more on the nature side. They would say there's something going on in the brain. There's some way in which there's something that's not, well, not always a concern. It might just be that there's a phenotypically distinct transgender brain. That's one theory. It's called the intersex condition of the brain.

So that if you have intersex experiences where in some cases there's shared reproductive tissue and it's difficult to identify, maybe at birth a child is clearly male or female, you might have something like that in the brain. That maybe there's phenotypically distinct aspects of male brains and female brains and a transgender brain would be distinct in this way. I'm saying it like it's, I want to very clear, that's a theory, and you always have to be disciplined to separate out theory from research to support theory.

And the research has been lacking. It's really not very convincing, at least to me as I read it right now. I'm not against it, I just don't wanna mislead you to think that's what it is. We just don't know that that's what it is. It's an open question. But I think the idea of willful disobedience,

I wanna take that part off the table. I've never met someone who chose to experience the kind of dysphoria that person shared in that interview, that the puzzle pieces aren't fitting together. Or another person who came for a consultation said it was like dissonance in music. It's like gender dysphoria is like a tonal combination that is seeking resolution, but it never resolves.

And to live with that every day, very painful, right? Then we would begin in the last 10, 12 years to see a rise in late onset cases. Remember I said early onset was prior to puberty, you'd have a young child with this experience of their gender without the language to communicate it to their parents, but they would be sort of gender atypical

in ways that parents would flag, they would remember things that would be said. But a late onset case is from puberty on, does the person experience this for the first time? It's what's called late onset. And what was really fascinating about the last 10 to 12 years is that there would be a gender ratio flip. You would see a four to one or five to one ratio

of natal females to natal males presenting at gender clinics with late onset gender dysphoria. Now remember, I just told you that early onset, most of my career was natal males to natal females, four or five to one ratio natal males. So now, not only do we have an increase, a dramatic increase at every gender clinic that keeps records of this in the UK,

in the Netherlands, in the US, but now we were seeing a gender ratio flip. And for some people it was like, going back to the question of etiology, it almost felt like a different phenomenon. Like what is this? And how do we account for, and what theory of etiology

that we don't understand for early onset would apply to late onset? Like it just was really, I mean, it continues to be a very challenging question. Then you would have a debate that was kind of going on the same time that ensued about whether some of those early onset cases would resolve on their own. It was called desistance, we called it. So there's a desistance versus persistence debate.

And there's literally like 12 studies that have documented desistance from anywhere from 60 something to percent to over 90%. And I would say roughly about 75% of the cases resolve on their own. If you don't do anything, early onset cases often appear to resolve on their own. That's the desistance claim.

Now, critics would say those are not trans kids. Remember, gender atypicality common between trans adults and what? Gay adults. Maybe you're seeing kids who really are going to be gay and you're misdiagnosing them as trans, and then they go through puberty, and lo and behold, the dysphoria abates, and they're gay.

In fact, of those cases that I just told you about, 75% of the time resolves on its own. Guess what adults identify as when it resolves on its own? In 75%, again, of those types of cases, they identify as gay, lesbian, bisexual. So it's interesting. Maybe it is apples and oranges. Maybe we're not sufficiently assessing people correctly

at a young age, or maybe it does desist. Like that's an open debate in our field. That's a conversation that we're still having. Okay. So we have that discussion going on, and then into that conversations comes medically affirmative care, which had been present for adults for some years,

which is cross-sex hormones and possible surgical procedures. And a lot of times when you saw a child with this experience of gender dysphoria, you would just support the child and help the parents not be punitive and give them coping resources and help kind of get them to adulthood

where they could be referred to an adult gender clinic. Well, now what's been happening is the desire to bring some of the medical advances to minors, make that more accessible to younger and younger people. So this would be developed in the late 1989, early 1990s in Utrecht and Amsterdam in the Netherlands. And it would be brought to the US in 2007 at the Boston Children's Hospital. And it was called the Dutch model, the Dutch approach.

And it would be to block a child from going into puberty at about what's called the Tanner two stage of sexual development. You would block them from going, we already knew we could do this, could be done, because it's been done for precocious puberty where a child's going into puberty early, you could stop them from going into puberty,

let them kind of let their cohort catch up and then they could release and go through puberty. So it's kind of the model that had been now applied to children with gender dysphoria. So we could block puberty and then maybe let them explore gender for another year or two and then decide to either take them off the blockers, they'd go through puberty as they would anyway,

or you could begin cross-sex hormones. So that model was brought to the US, as I mentioned, in 2007. And most gender clinics in the US, I think, who do that kind of work would say that they're kind of following that model, the Dutch approach, the Dutch model. Now, I have to tell you, I've been to the clinic there, and they're very comprehensive in their assessments, their testing, their psychological evaluations. They actually have a three-year waiting list right now. So when someone gets to the point where they're being considered, they're probably a pretty, you know, they're a

different kind of candidate at that point of waiting for three years and being complete, you know, psychological evaluations, so on and so forth. I don't think that model is being applied in very many gender clinics in the U.S. and that has led to a lot of criticism of that model, just criticism in and of itself, should you even offer that kind of intervention to a minor? So some states in the US are legislating to ban that access. Others are arguing to protect that access. That's its own debate.

It's a huge, huge issue in the US. This would also, okay, I shouldn't just say that. So if you block and you use cross-sex hormones, the greatest risk of that practice with minors is the risk to their fertility. Huge issue, very difficult to be in a room with a 14 or 15-year-old and asking them, were you hoping to have children of your own one day? Right, it's a very difficult conversation. And so that has to be said in this conversation

about where care has been moving. And then, okay, so at the same time, now you're hearing claims that this late onset is really rapid onset gender dysphoria. That would be a phrase used by some reporters and some concerned parents. It's actually not a phrase that's in our diagnostic manual, so I don't tend to use it

because it makes it sound like it's an official designation. So it's not an official designation. And I'm not even sure how you distinguish rapid onset from late onset because late onset does feel kind of compressed and there's not a history of it. And parents whose teenager comes to them and says, I am this, they feel kind of blindsided by it.

Whereas when it's early onset, parents don't feel blindsided. They feel like kind of a light bulb's going off. Like, okay, this explains what we've been seeing for all these years. But when you get late onset, you do feel blindsided as a parent. Like, where does this come from?

This is, that's not been your experience or our experience of you for your whole life. Okay, so you'd have these claims of kind of rapid onset. And then the other thing that kind of went with that was the idea that this is the result of social contagion. So social contagion is the idea that kind of like a virus, transgender identities can kind of be passed along through their peer groups and through social media and things like that.

And so what they're doing, people who make that statement are drawing on this concept that's well established in the eating disorder literature. So in the eating disorder, eating disorders are one of the most culturally bound mental conditions we have in our country, meaning they're tied to cultural messages about ideal body weight, shape and size and physical appearance and standards of beauty that are designated by your culture.

And so those messages through entertainment, media, peer group, your friends, adolescent females have historically been more susceptible to those messages than adolescent males. And so it has led to and maintained eating disorders for some in that who have eating disorders. Okay, so social contagion there has been researched for many, many years. I could show you dozens of studies.

There's whole systematic reviews. There's multiple systematic reviews of existing research showing social contagion. So what some people have done in this space is they've copied and pasted the concept of social contagion and applied it here and said, that's what's going on here. So I'm not saying it's not happening, I'm just saying it doesn't have the robust research evidence that you have in the eating disorder literature. So I don't tend to use it, that phrase right now,

I think it would be a little antagonistic if it came from me, I think, to kind of reduce it to that. But clearly there is an increase, and clearly there's a higher rate of females than males. And those things are real things. So how do we describe that is an open question. I'm just saying one group says it's social contagion. The other group would say it's just self-awareness.

I think that's a naive view. Self-awareness is a naive view and it doesn't explain the gender ratio flip. So I offer a different account in a book called Emerging Gender Identities, but I won't be able to unpack it here. Last year, because of the complaints that happened in the UK,

there was commissioned an independent review called the Independent Cast Review, it was published last year, to look at the research basis for the services that are being offered to minors. And the conclusions from that review is there is not a robust research support for the things that are being offered.

That the services that are being offered to young people, both medical, cross-sex hormones, possible surgical, and even some of the social transition, even the use of pronouns, don't have the most robust evidence that you would normally have from the medical community when you're doing these interventions. So that's led the recommendations there was let's stop, let's not have one clinic called Tavistock in the UK, let's have regional clinics, more holistic approach. Let a number of other countries, Norway, Finland, Sweden, to just stop at this point from making it the first approach to care.

And let's limit that to institutional review board studies of that experience. We're not going to give up on that. We're going to study that. But we're going to not make that the first line of research in the local clinic, which is what it had been. Now that has not gotten a lot of traction in the US. We're kind of more legislating across states, and we're not as, I would say my field is not as interested

in the CAS report as other countries have been. And I think that's unfortunate. There's some things there that are wise that would help us to kind of slow down. I think there's some wisdom in some of what's present there. So where does that leave us? I think that's my summary of where we are with psychological research at this point, and I've probably named five or six robust debates

that are just current right now in my field. When I meet with teenagers and their parents, I feel like I'm in an airplane at 30,000 feet, and that airplane needs maintenance. And there's not even time to land it and to get into a maintenance hanger and look at it and work on it, because everything's moving so rapidly,

and the needs are so significant at that moment. So if you feel like that in this space, if you're a parent or if you're a young adult who's navigating these issues, that's exactly what it feels like. It is very difficult space to be in to not have all the answers and not have the robust research evidence we'd like to have when we're serving families. Thank you. Thank you, Mark. That guy's like a walking Google when it comes to this conversation. I don't do, we have notes where you'd like,

oh, you did have some. Okay, if you would like to hear the three testimonies from Remy, Julia and Chloe and the ensuing dialogue that we had, all five of us, me, Mark and Remy, Julia and Chloe, then please go to patreon.com forward slash the Elgin raw. Again, you don't need to pay for an account to view the rest of this podcast. You can just sign up by your email. You don't need to enter a credit card and you can get access to the rest of this session. This show is part of the Converge Podcast Network.