A medical perspective on Transgender

This piece is written in response to Eternity’s first article on transgender, written by our staff writer Tess Holgate, titled ‘Gender bending? Transgender not as black and white as you might think’.  You can read it here.

I appreciated the recent reminder that Christ’s followers ought always to treat broken people with sensitivity. Even while it urges people away from self-destructive choices, the church must not neglect to show empathy. The broken people the author, Tess Holgate, wrote about here on this site are transgender. I agree with Holgate that our engagement with the complex issue of transgenderism must be a careful, educated one; not blunt or dismissive.

That leads me to the first point I want to make, which is that we must have an adequate grasp of the concepts and terminology, and in particular, the distinction between “transgender” and “transsexual”. Bruce Jenner is, apparently, a transsexual.

A transsexual is a person who seeks to leave behind the physical aspects of their birth sex and become embodied as a member of the opposite sex. The transsexual pursuit involves a number of “treatments” (eg. hormones, surgery, speech therapy) in an effort to modify the body, so that a man can come to physically resemble a woman or vice versa. Importantly, the “transsexual experience” (if we can call it that) typically assumes the binary nature of sex (male and female) to which the Bible and biology testify.

If Bruce Jenner’s hair or saliva were found at a crime scene and sent for DNA testing, the result would come back male—every time.

Of note: transsexualism is extremely rare. One out of several thousand people is a transsexual. By comparison, about 2-3 percent of the population identifies as gay or lesbian.

Transgenderism on the other hand is a much broader category that includes any person who does not “identify with” their gender—that is, the cultural expectations and roles associated with their sex. Besides transsexuals, transgenderism also encompasses many other kinds of gender non-conformist behaviours and lifestyles: cross-dressing, identification with both genders or neither, “being queer”, and so on. Many of Facebook’s (in)famous 50 gender options would fit in the transgender basket.

So, the “girl trapped in a boy’s body” stereotype which is the subject of media focus is but one corner of the transgender playing field. Many, or most people who might label themselves “transgender” will not in fact pursue sex reassignment the way Bruce Jenner has. Much of the transgender movement would regard Jenner’s desire to be female and feminine as itself a validation of traditional, binary ideas about gender—something which many would reject.

I have pressed this distinction because while I acknowledge that many or even most transsexuals suffer from the disordered but overwhelming and deep-seated belief that they truly belong to the opposite sex and are trapped in the wrong body, my impression is that this is not the case for the bulk of those in the wider transgender movement. It seems to me that for a great many who are transgender (but not transsexual), their identities and lifestyles are determined by voluntary choices and cultural winds (such as those which prevail on liberal western university campuses) to a significantly greater extent than by irresistible, internal impulses.

Having laid this crucial groundwork, I can move to my central point: transsexuals can never succeed. Holgate asserts that “Doctors today can remodel a male body into a female body and vice versa… We have the technology to do it, people are doing it, and it’s not going to stop any time soon.” But this is factually, biologically, medically false.

I am a doctor; I have been educated about the human body, I prescribe powerful drugs (including hormones) on a daily basis and I see the results of all kinds of surgery. “Sex reassignment therapy” is a sophisticated and cruel myth.

At a fundamental level, our maleness and femaleness goes all the way down to the level of our individual cells. Each of the trillions of cells that make up our bodies—skin, bones, glands, nerves, organs—are genetically male or female. The crude hormonal and surgical “therapies” that transsexuals undergo do not even scratch the surface of their biological sex.

If Bruce Jenner’s hair or saliva were found at a crime scene and sent for DNA testing, the result would come back male—every time.

Even at a more superficial level, no amount of hormonal or surgical “therapy” can give a woman functioning male genitals. It cannot give a man ovaries, enable him to menstruate or to conceive a child. “Sex reassignment therapy” cannot recreate the elaborate physiological and hormonal mix that comes naturally with maleness and femaleness.

Nor can it reproduce the faults and frailties of maleness and femaleness. Bruce Jenner can never be diagnosed with cervical cancer or suffer the travails of menopause. A woman who “transitions” to a “man” will never develop prostate disease or seek a doctor’s help for premature ejaculation.

Even if it could be morally condoned, the technology does not exist, and can never exist, to change a man into a woman and vice versa. All that “sex change treatment” achieves is to create demeaning caricatures of manhood and womanhood.

If we call Jenner a “woman”—even after he has availed himself of the very best plastic surgery that money can buy—we are proclaiming untruth to him. We are sustaining him in a pathological, delusional belief. Doctors would never countenance affirming a depressed, anorexic teenager’s belief that she is, in fact, fat, ugly and worthless. We would never agree with an OCD sufferer that she is surrounded by deadly germs, or with a paranoid patient that he is being monitored by spies.

Instead, when somebody has incorrect beliefs about the world or themselves, our duty as professionals, care-givers and friends is to gently but firmly challenge those beliefs so that the patient might heal. To take any other course is unkind, and unchristian.

The church will need much wisdom when dealing with those who suffer gender identity confusion. For those looking for somewhere to begin, I commend the guidance of Pastor John Piper:


The benefits of “sex reassignment treatment” are far from proven, and the dangers are real. The following two articles provide more information.



Jereth Kok is a Melbourne general practitioner.