Recent far-right reaction to transgender persons—0.3%-0.6% of the population and often highly vulnerable—includes

  • calling them all mentally ill
  • deeming them non-Christians
  • declaring their family, friends, and doctors who affirm them to be non-Christian
  • writing open letters about them that avoid calling them by name, and
  • politicizing them

Fortunately, there is a substantial body of Christians who reject this treatment as contrary to the teachings and example of Jesus.

This post is the third in a series of three introducing issues associated with how transgender persons are sometimes mistreated based on misguided religious views, often ones based on fear and uncertainty.  There are plenty of people with religious views that are positive towards transgender persons and their families, but those are usually not the ones that receive attention.

The first post provides basic definitions and explains the difference between sex and gender in context of transgender persons.  The second asks the U.S. Conference of Catholic Bishops to withdraw a negligent and damaging letter regarding transgender persons.

This post addresses additional issues that arise frequently in discussions with Christians regarding transgender persons: mental disorders and “gender dysphoria.”  The post discusses current medical views and basic definitions derived from the authoritative Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Transgender is Not a Mental Disorder

Medical professionals throughout the world recognize that some people experience a persistent and significant incongruence between their gender identity (the gender they feel is appropriate for themselves) and their sex (as assigned at birth pursuant to their reproductive organs, for example).

The person’s reaction to this incongruence is deeply personal and varied.  For some, the incongruence does not last.  For others, the incongruence persists their entire life.  Some are deeply disturbed and tormented by it, and others do not suffer significant distress relative to the incongruence itself.

Medical professionals in the United States do not today consider a transgender person to have a mental disorder merely because the person is transgender.  That is, in and of itself, being transgender is not a mental disorder.

Of course, a transgender person can have a mental disorder just like a cisgender person can have a mental disorder.  A transgender person can appear sympathetic and take advantage of another person just like a cisgender person can, for example.  Indeed, a Psychology Today article reports that transgender persons experience drastically higher rates of mental-health issues than the general population and often have many significant needs in that area.  The point here is that the state of being transgender itself does not mean that the person has a mental disorder.

Gender Dysphoria = Gender Incongruence + Significant Distress 

If a transgender person suffers significant distress or impairment associated with incongruence between the person’s gender identity (or expression) and their sex, however, medical professionals can consider the transgender person to have a mental disorder referred to as “gender dysphoria.”  If the transgender person does not experience significant distress or impairment associated with such incongruence, then a diagnosis of gender dysphoria is improper, per the DSM-5.

Many transgender persons do not experience any distress or impairment inherent in their gender identity or expression.  Many are fine with their gender identity and expression.

You Might Be The Source of the Significant Distress

Many transgender persons, however, experience major distress or impairment emanating from other people—from society, from family members, from people holding themselves out as religious leaders, from politicians, from difficulties in obtaining medical care, ….

Many are ostracized, ridiculed, shunned, made into political fodder, made the subject of letters and statements by people holding themselves out as religious leaders, singled out for condemnation, told they cannot be Christians, and put under a microscope.  Such experience can lead to anxiety, depression, significant impairment, self-harm, suicide, and other effects.

In other words, it is often not the transgender person’s gender identification that is damaging to that person, but instead it is often *** society’s treatment of the transgender person *** that is damaging to that person and that can give rise to a mental disorder and other effects or that can additionally damage them.

Some Definitions

Here are some definitions derived from the DSM-5 that might help you parse what politicians, religious leaders, and others say about transgender persons:

1.  Gender Atypical …

a.  Is not a mental disorder.

b.  Is identifying or communicating as a gender other than that associated with the person’s birth sex.

c.  Does not—for a great many transgender persons—itself serve as a source of distress or impairment (just the opposite in many cases).

2.   Gender Dysphoria …

a.  Is a mental disorder defined by the DSM-5.

b.  Is not something all transgender persons have.

c.  Requires two criteria (associated with factors set out by the DSM-5):

                    (1)     A persistent and significant incongruence between a person’s

(a) gender identity or gender expression; and

(b) sex assigned at birth; and

(2)     The condition is associated with a clinically significant distress or impairment in social, school, occupational, or other important areas of functioning.

3.  The Source of Significant Distress or Impairment is sometimes …

a. the incongruence itself,

b.  the transgender person’s inability to obtain treatment, surgery, or other aid, or

c.  others’ treatment of the transgender person in reaction to their gender identity or gender expression.

4.  Functional Consequences of Gender Atypical or Gender Dysphoria relative to others’ treatment can include:

a.  Teasing, harassment, or pressure to conform to their assigned gender role may cause a refusal to attend school or work or to leave home.

b.  Relationship difficulties with family and friends

c.  Discrimination and victimization, leading to increased rates of anxiety, depression, school dropout, and economic marginalization, with attendant social and mental health risks.

Conclusion

Much is at stake for real people in this discussion.

The health and well-being of transgender persons, as people created in God’s image, is indisputably worthy of our time.

An article in the New England Journal of Medicine explains that “[g]ender affirmation — having one’s gender identity acknowledged and accepted in social, legal, and other settings — can greatly enhance overall psychological health.”

So, we have a choice.  We can declare something to be “clearly” against God’s word when the Bible does not make such a statement and is ambiguous on it at best.  We can call transgender people and those who affirm and help them non-Christian.  We can write Nashville Statements and hold conferences to condemn these vulnerable people.

Or we can come to grips with the fact that every last one of us is created in God’s image, we are all traveling together for a very short time on this tiny planet, and we ought to follow Christ’s command to love one another and to follow his example in the meantime.

And we can humbly approach God’s word and “[b]ear one another’s burdens, and in this way … fulfill the law of Christ.”

Perhaps these definitions and descriptions can help us focus on where those burdens can be found.

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Sources & Notes

0.3-0.6%:  https://www.nytimes.com/2016/07/01/health/transgender-population.html

“Substantial body …”: See, e.g.,

For more in-depth discussion on religious and related matters relative to transgender persons, see (I have not read all of these):

  • Julia Serano, Whipping Girl
  • David Weekley, Retreating Forward: A Spiritual Practice with Transgender Persons
  • Virginia Mollenkott, Omnigender
  • Kate Bornstein, My Gender Workbook
  • Megan More, “The Transgendered Christ”
  • Justin Tanis, Trans-Gendered: Theology, Ministry, and Communities of Faith (Center for Lesbian and Gay Studies in Religion and Ministry)
  • Linda Herzer, The Bible and the Transgender Experience: How Scripture Supports Gender Variance
  • James V. Brownson, Bible, Gender, Sexuality: Reframing the Church’s Debate on Same-Sex Relationships

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (pay):

https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 (“Gender dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.” For adults and adolescents (besides children), the incongruence must be marked, between (a) one’s experienced/expressed gender and (b) assigned gender, as such for at least 6 months, and manifested by at least 2 of the following 6 conditions:  (1) such incongruence is between (a) and primary and/or secondary sex characteristics (or, in young adolescents, anticipated secondary sex characteristics) or (2) a strong desire (i) to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics),(ii) for the primary and/or secondary sex characteristics of the other gender, (iii) to be of the other gender (or some alternative gender different from (b)), (iv) to be treated as the other gender (or some alternative gender …), or (v) that one has the typical feelings and reactions of the other gender (or some alternative gender…).”  Appendix defines “gender dysphoria” as “Distress that accompanies the incongruence between one’s experienced and expressed gender and one’s assigned or natal gender.”)

http://www.chicagotribune.com/news/nationworld/ct-transgender-mental-illness-classification-20160729-story.html

New England Journal of Medicine article: Mark A. Schuster, M.D., Ph.D., Sari L. Reisner, Sc.D., and Sarah E. Onorato, B.A., “Beyond Bathrooms — Meeting the Health Needs of Transgender People” N Engl J Med (July 14, 2016) 

“USA Today’s report“: Laura Ungar,”Transgender people face alarmingly high risk of suicide,” USA Today (August 16, 2015)

Also see Harvard study:  https://www.hsph.harvard.edu/news/hsph-in-the-news/transgender-youth-at-risk-for-depression-suicide/

“bear one another’s burdens …” is Galatians 6:2.

An earlier post I wrote begins to describe the absence of scriptural support for those condemning transgender persons.

Psychology Today:  https://www.psychologytoday.com/blog/the-truth-about-exercise-addiction/201612/why-transgender-people-experience-more-mental-health

Update:  edited to add the sentence with Psychology Today post-publication. Also, note that the diagnosis of mental disorder or not can impact insurance coverage or hormonal, surgical, and other treatments.  Such procedures can be very expensive.  Revised the introduction to make it more inviting.

DSM-5 addresses diagnosis only, not treatment.  Treatment:  https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/symptoms-causes/syc-20475255

https://www.childrenshospital.org/conditions-and-treatments/conditions/g/gender-dysphoria/diagnosis-and-treatment

https://www.webmd.com/sex/gender-dysphoria

Not everyone who has gender dysphoria identifies as transgender.

Not everyone who identifies as transgender has gender dysphoria.

When writing about transgender people, I now try to follow the guidelines from the cites listed below.  If you notice a departure, please alert me to it, as I am trying to learn.

https://sandystone.com/hale.rules.html

https://radicalcopyeditor.com/2017/08/31/transgender-style-guide/