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Gender: M or F or Other—Transgender Insights

Transgenderism is a hot topic in today’s culture. We feel it is important to respond appropriately in a Christian manner when faced with this topic of discussion, as well as when dealing with it in the healthcare profession.

By Karl Benzio, MD

Editor’s Note: Transgenderism is a hot topic in today’s culture. We feel it is important to respond appropriately in a Christian manner when faced with this topic of discussion, as well as when dealing with it in the healthcare profession. This is the first article on this subject, focusing specifically on the theological and psychological discussion points from a Christian perspective. A second article will be published in a future edition of Today’s Christian Doctor that deals with the practical side of the matter that will help you as you encounter transgender patients in your practice.

It used to be a straightforward prompt on any questionnaire or application: “Gender: Male or Female.” But that once simple question is now confused by the explosion of transgenderism within our culture. Who can use what bathroom? Do we need a third option in public changing rooms? Can you assume the person you’re meeting on a date is really the gender you are attracted to? What if my patient wants to change sex? Should I hire a transgender employee? And that’s just the beginning. Let me help sort out some transgender issues we face as Christians in healthcare so we can be better prepared to be witnesses for Christ in a dark world.

The Basics

To help clarify the numerous terms existing around this issue, let’s start with some basic concepts and definitions.

  • Sex or Birth Sex – A person’s physical reproductive anatomy and resultant secondary sex characteristics. Predominantly, but not always, dictated by genetics guiding uncorrupted fetal development.
    • Intersex – People who have anatomy that is not considered typically male or female or have anatomy not matching their genetic sex of XX or XY. Most come to medical attention because healthcare professionals or parents notice something unusual about their bodies or puberty or fertility isn't normal, but some are not known until death/autopsy.
    • Ambiguous genitalia – External genitalia not clearly and totally male or female.
  • Gender – Social roles and characteristics based on the sex of the individual. (Until more recently, gender and birth sex were understood and used interchangeably.)
  • Sexual Orientation – Refers to an individual’s enduring physical/sexual, romantic and/or emotional attraction to others.
    • Heterosexual (straight) is opposite-sex attraction (OSA).
    • Homosexual (gay, lesbian) is same-sex attraction (SSA).
    • Bisexual is attracted to both sexes.
  • Gender Identity – Defined as one’s internal sense of being a male or female, man or woman. Now the options include none, both or something totally different. Instead of believing gender is a binary system with only two options, either male or female, some believe gender falls on a more fluid spectrum. Some of those “newer” options include having no gender, having both genders or being even a third gender unique to that individual. Gender expression lies on a spectrum that includes the following:
    • Birth Sex Gender Conformity – People who are comfortable with their birth sex, identify themselves as that gender and present themselves fairly consistently as that gender.
    • Gender Nonconformity – People who identify with their birth sex but frequently behave in a manner usually associated with the opposite sex, such as males who are effeminate and females who are masculine. During pre-pubescent years, gender nonconformity is normal and common, more so in females than males. But when puberty starts and sexual hormones start to circulate, gender conformity or congruence, that is, behavior and psychological identify, begin to align and are congruent with birth sex.
    • Transgender (formerly Gender Identity Disorder) – An umbrella term for an ever-changing and evolving population and subculture of people who feel the gender they were assigned at birth (or in rare circumstances, shortly after birth) is a false or incomplete description of who they are psychologically.
    • Gender Ambiguity (GQ; alternatively non-binary) – A catch-all category for gender identities not exclusively masculine or feminine. Cross-dressing (transvestite) is a common subgroup.
    • Opposite Birth Sex Gender Conformity (transsexualism) – A person who thinks, feels and acts (if safe to do so) like a member of the opposite birth sex, especially psycho-sexually. If available and affordable, this group will often pursue hormonal and/or surgical sexual reassignment surgeries (formerly “sex change operations”).
God’s Plan

“So God created man in his own image, in the image of God he created him; male and female he created them” (Genesis 1:27, ESV).

God created man in His image. Then, from man, God created woman, also in His image. God created man and woman with many similarities, but also with key, yet complementary, differences. These differences weren’t just anatomical, but also physiological, especially regarding our body development, reproductive hormones and particularly brain development and functioning. These physiological hormone and brain differences generate psychological differences, such as personality types and relating styles, allowing us to better execute the roles God designed for man and woman in certain non-individualistic systems such as marriage, family, parenting, government and church. In bearing God’s image, although with different design, each sex carries a different yet complementary image of God, but when brought together in heterosexual marriage, man united with woman forms the fullest human representation of God’s image in this world.

Ideally, when egg meets sperm, God’s unique and individual physical design for that person is encoded in their wondrous genetic blueprint. This would include sex, gender, gender identity and sexual orientation. This would be XY = male sex and gender, confidently identifying as a male and psycho-sexually attracted to females. Or XX = female sex and gender, confidently identifying as a female and psycho-sexually attracted to males. God infuses a spirit to complete this spirit-mind-body being.

The next ideal steps would be a pristine gestational period in utero, with no contaminants, traumas or issues, followed by approximately 25 years of living in physically, psychologically and spiritually healthy environments allowing development and maturation of all three spheres. You see, the genetic design is only the start of the process, or the first domino in a sequence of millions. The further execution of God’s design needs the participation of the individual and is based ultimately on the worldview (a God-centered perspective or a world-centered perspective) and emotion management skills of the individual, as these are the main determiners of the decisions the individual makes. Gender identity, sexual orientation and a variety of other life activities are later dominoes determined by the preceding dominoes. These preceding foundational dominoes following God’s initial creating-our-unique-life domino, are made up from our experiences, especially the processing and response to these experiences. To put it quite simply, our life decisions start with our first breath.

Satan Attacks

“…Your adversary the devil prowls around like a roaring lion, seeking someone to devour. Resist him, firm in your faith, knowing that the same kinds of suffering are being experienced by your brotherhood throughout the world” (1 Peter 5:8-9, ESV).

“The thief comes only to steal and kill and destroy. I came that they may have life and have it abundantly” (John 10:10, ESV).

Unfortunately, as we see throughout the Bible, when God has a plan, Satan is immediately on the prowl with disruptive intent, hoping for the exact opposite of what God intends. Satan, the Great Deceiver, attacks. Satan’s primary tactic is deceit, deception or lies. Satan’s goal is to keep us out of relationship with God, so he attacks all those elements pertaining to relationship. Not only does he want to disrupt our understanding of healthy relationship concepts, but he also wants to thwart our decision-making process as it pertains to self-identity, our needs and how to engage in healthy relationships. Satan’s spiritual warfare strategically exposes us to wounds, trauma and loss via relationships so we’ll feel incompetent in and afraid of relationships with the intent that we’ll reject the opportunity for the ultimate relationship with God.

So Satan attacks early and often. Even before we are born, Satan attacks our mothers with “normal” fears, doubts and worries about parenting tasks like being a good mother, living in the right neighborhood, teaching the right principles, getting to the pediatrician on time, etc. This worry causes the secretion of chemicals that cross the placental barrier and affect body, brain and receptor development, leading to pathological physiologic changes. This is accentuated when the unborn child is exposed to toxins such as alcohol, nicotine, heroin, lead, benzodiazepines, thalidomide and numerous others, as well as when trauma (domestic violence, accidents) or disease (diabetes, lack of nutrition) occur.

By far, Satan’s most significant attacks occur during our childhood years, as these years blend the highest degree of brain neuroplasticity with high gullibility and our poor ability to precisely interpret and process the situations around us. These attacks wound, hurt and traumatize all of us, leading us to commit a significant number of mistakes and sins. In response, we all develop defenses which become a set of beliefs about ourselves and the world, which then allows us to understand, manage and then self-heal the wounds to protect ourselves from further harm.

Ideally, these defense mechanisms or life management strategies are developed from biblical truths and principles. But Satan knows how to prick our fleshly desires and our sin nature to influence a corrupted repertoire of life management paradigms and decisions. Unfortunately, we all have some distorted information and interpretations producing misguided defense mechanisms. For some, same-sex attraction or gender identity disorder is the paradigm they develop to manage and make sense of the hurts, wounds, traumas, distresses and inaccurate data they have accumulated in their lives with the intent of minimizing any further harm to themselves. Most of these strategies are not intentionally or pragmatically determined but develop organically and unconsciously over several years or more, so the individual believes no overt or definitive conscious decision was ever made. Rather it feels like a reflex or even created design or wiring from as early as they can recall.

Transgender occurs when a person with a psychospiritual issue is looking for a physical solution. It’s the boy who is abandoned by his father, so he yearns for a father’s love and seeks the love of a man. It’s the boy whose father is absent, so he is raised predominantly by his mother. He is very connected to and deeply identifies with his mother, has a sensitive disposition and doesn’t want to be lumped in the male category, so he develops a transgender paradigm. It’s the young girl molested by a male who believes her womanhood was the culprit, so she denies her femininity in an effort not to attract males, and then she seeks sexual connection with safer females instead of males. All these are examples of people faced with overwhelming circumstances and hurt who don’t have caretakers to help them process, and they had to come up with some paradigm on their own to adapt to these confusing life experiences in the spiritual war that is our world. Situations like these, as well as variables we do not know, can shape how we view our gender.

Is transgender sinful?

“For those who live according to the flesh set their minds on the things of the flesh, but those who live according to the Spirit set their minds on the things of the Spirit” (Romans 8:5, ESV).

Homosexuality is a sin, but transgender isn’t as clear cut, although Deuteronomy 22:5 and 1 Corinthians 11:14 discuss gender expression with some prohibitions. God has selected and given to each person, even before conception, a unique identity and design. A significant component is our gender. To deny this gift and be someone different would be denying God’s will, and that would be a sin. God designed male and female differently, and these unique and intentional distinctions should be maintained while guarding against the blurring or fusion of gender roles.

With this said, we should recognize the attacks of sin on mankind (genetic mutations), as well as Satan’s attacks during gestation on the unborn child’s development. Although rare, genetic sex and physical development can be mismatched or unclear, and we want to make sure we are not judging a person’s situation with wrong assumptions or incomplete data. If their transgender pursuits are not from these biological/physiological in-utero attacks and actually come from post birth attacks, we need to recognize that the transgender individual is, like all of us, a wounded person needing to find their true identity in Christ.


Transgenderism is a complex issue. Those struggling with it are wounded and in pain, and they are looking for soothing and healing. In our efforts to soothe them, falling into the trap of acquiescing to their needs and wishes seems the loving course and the path of least resistance. But to really understand transgenderism, offer hope and provide a cure, we need to unpack all three spheres of spirit, mind and body, as all three are involved in the evolution of this struggle. The biological is where we have significant training, but we need to understand and use accurate biblical principles to address the psychological struggles and implement the psychospiritual remedy. Above all else, as Christian healthcare professionals, we must be the relationally-prioritizing and compassionate ambassadors for God as He divinely appoints and inserts us into the life journey of someone needing an encounter with God through us.

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  1. Idk on January 19, 2020 at 8:52 am

    Ok then I don’t understand why I’ve always “wanted” to be a boy. I had a happy childhood. Never molested. Trans male.

    • Julia Stevenson on January 6, 2021 at 4:00 pm

      If this is God’s plan, why do intersex people even exist. I’m sorry, but this never fully explained the universe and is based on at best a medieval understanding of science.

      • Sheep Lover on January 15, 2021 at 8:25 pm

        Intersex people exist because Satan loves to corrupt the things of God. The Bible also tells us we are born flawed because of the original sin (sex acts) that took place in the garden of Eden, putting a curse on the entirety of humanity.
        Also, God allows it because He has given Satan control over the earth. (Though ultimately God has full power and control). He allows it because it’s all part of His plan which we will never fully understand until we meet Him and tells us all the mysteries.

        • Angela on April 1, 2021 at 11:09 am

          I understand God allows it, but how do I explain this to my 28 year old son who was gifted with all the looks that would make a young man successful in every area of this world? Which he has to live his entire life in? At 6ft 4inches with entirely male physical traits, he is dying more and more every day from not being able to present to the world as a woman and the worst pain seems to be that he will never be able to give his partner a child. Exactly what is God teaching us when he allows this situation where someone is authentic in every way with great integrity but is 100% convinced he is a woman inside?

    • Sheep Lover on January 15, 2021 at 8:44 pm

      That is the demonic spirit causing you to believe the lie that makes you want to be something you were never meant to be.
      Get it cast out of you in the name of Jesus Christ, because that is the ONLY freedom from that spirit. Turning transgender will never give you that freedom.
      Turning transgender does not change gender, it only butchers, mutates, and corrupts what used to be a beautiful natural body. It’s all a great big man-made, make-believe pile of garbage lies. Let your body do what it is meant to do naturally, not what you want to. It does not want to be filled with false unnatural hormones. Hormones need to be naturally produced and balanced. When you take those unnatural hormones, you are just begging for health problems. Is that seriously what you want?!
      Wake up humanity, you are being deceived by strong demonic powers! Transgenderism is nothing but evil filth filled with lies.
      I feel so sorry for those who have been blinded from the truth and reality of the evil that is behind it all.

      • Kaitlyn on February 23, 2021 at 4:57 am

        Everyone here is do quick to say that being transgender occurs because of a demon twisting ones view and distorting who they are. They claim that a transgender person is blind to the truth and that changing is the answer. Let’s look at this from all sides. Birth defects can and do happen. Some are more obvious, such as down syndrome or other handicaps; however, they don’t have to be obvious and they are always recognized as a physical defect. Who would have stronger faith, the person born male that has always had female behavioral traits, who has always felt female and prays to have their thinking changed, or the one identical to what I listed above that prays and believes that God could make them whole as a female. Perhaps Satan did cause a birth defect, but what if the defect he caused was for an intended female to be born male? Would be be above that? Wouldn’t it be more likely to turn a person away from God to change them in that way and then have them persecuted by people who honestly have no idea what Gods view on this is? For everyone who is quick to pass judgement, imagine for a second that the devil had caused you to be born genetically the opposite gender, but mentally you still felt exactly as you do now? Imagine that and imagine that you were expected to push those feelings aside because that wasn’t acceptable to others who claimed to be Christian. The bible says, “judge not lest ye be judged,” it says, “let her who is without sin cast the first stone.” Think about the many people who have committed suicide because they were told they were unnatural and evil by people who couldn’t follow those two simple verses. You can believe what you want. It is not your place; however, to interpret Gods will for others. Bring people to God, let his word guide them, not your lack of understanding and hate.

        • DR on August 27, 2021 at 9:23 pm

          There is a scripture in the Bible that says If a man lays with a man he can’t inherit the Kingdom of Heaven.We are recognized by God for the Gender we are born with at birth. You can change your gender but the question is he going to accept you that way. By changing into someone we were not meant to be we risk losing the chance of being in Paradise with Jesus.

  2. JL on January 29, 2020 at 1:01 am

    Thanks for taking the time to write this clear & concise article. I thought it was very helpful in terms of clearing up some confusion with regards to gender identity (specifically transgender), while also encouraging Christian healthcare professionals to lead with not just truth, but love and grace as well. One question I have, though, is, how can you practically walk with someone who struggles with their gender identity, even if their background or environment was not marred by a tragic incident(s)?

  3. Amanda on June 29, 2020 at 2:42 pm

    Christian here: this is disgraceful. Shame on this article and the twisted ideas that make it up. IDK, you’ve always wanted to be a boy because that’s your gender expression, and you were created in God’s image. That’s wonderful and worth celebrating. Trauma is a separate issue from gender expression–and there is danger for trans humans when we imply that they’re intertwined. This article is not Christlike in its take.

    • Mike on October 31, 2020 at 3:35 pm

      There is nothing disgraceful for the way one is born nor to whom one identifies or who is attracted to. The individual’s body, affection, and affiliation does not pertain nor affect you nor me. So back off and let others live their lives . Who are you to judge – do you think you are born with more privilege than others who are not like you ? You should look within yourself and be thankful and appreciate ALL of God’s children.

    • LB on December 16, 2020 at 5:39 pm

      Although correlation is not causation, there are multiple studies regarding the effect of childhood mistreatment and mental health disorders including gender dysphoria. That is not to say that all gender dysphoria persons have been exposed to maltreatment.

      I myself don’t know yet what I believe as a Christian. I can see both sides. I do wonder if there is some difference in neurobiology and if that’s the case, how do we differentiate gender dysphoria from depression and anxiety or any other mental illness. We provide medications and therapy. Perhaps developing therapies to improve self image, while not denying this very real experience is what is warranted.

      Just some thoughts from a psychiatrist.

  4. Cindy on November 4, 2020 at 8:58 am

    Please let us know when the second article is published. Pray for all families who are trying to understand and best help those we love.

  5. Anna on November 24, 2020 at 11:17 pm

    Also a Christian here: It’s sad to read material like this. Assertions such that being transgender is due to trauma earlier in life, can be quite damaging, both for the transgender person directly (causing lower self esteem and feeding self-hate and confusion), and indirectly by feeding a highly negative stigma against them.
    Trauma can happen, of course, to anybody, but it is silly to blame it for all transgender people’s gender identities. To my knowledge, there is no significant data to uphold this assertion.
    We are Christians, yes, but we shouldn’t for that reason leave our thinking hats at the door.
    Sad to read this in a periodical for medical professionals. :/

  6. Jayden on December 29, 2020 at 9:46 pm

    I thought this article was decent until it started linking trauma to transgenderism. I am a trans Christian and would say I had a very happy childhood. Apparently the author forgot to mention the part where NOBODY knows what causes it. Spreading false information like this is just as bad as harming someone with it.

    • Sheep Lover on January 21, 2021 at 2:57 am

      Oh my friend, you can’t be both Christian and transgender at the same time.
      The Bible makes it very clear that our body is sacred and that we should never defile it. This includes the surgery people with gender dysphoria get, and the unnatural hormones being pumped into the body.
      Leviticus 19:28.
      1st Corinthians 6:19 and 20.
      1st Corinthians 3:17.
      The Bible says in Mark 16:18 to lay hands on the sick and they shall recover. You won’t need to take those hormones after doing this. Throw them away, never look back, and claim your healing/deliverance in the name of Jesus Christ!

      Gender dysphoria is caused by a demon spirit which blinds those who it holds hostage, causing them to believe all manner of obvious lies.
      I can see it’s strong power because the Bible speaks of a strong delusion. Read: 2nd Thessalonians 2:9, 10, and 11, and 1 Timothy 4:1 and 2.
      I’ve spoken to several transgender people, and I can see the blindness covering them, and have noticed they immediately turn to hatred and anger when anyone tries to help them.

      • G on January 23, 2021 at 12:57 am

        Who are you to tell someone that they either are or aren’t a christian?

        God knows the heart, not you.

        I would also urge you to really study the verses you are pulling and who they were written to and why. For example, Corinthians is Paul speaking of someone who would destroy the church altogether, perhaps with false teaching or by dividing the people instead of uniting them.

        • John on February 9, 2021 at 5:28 pm

          I don’t think “Sheep Lover” was trying to tell someone whether they are a Christian or not, but the fact that the two just can’t go together. It’s a fact that there are a lot of nominal Christians in this world. So many claim to be Christians, but yet have the slightest clue as to what it really means to be a “follower of Christ.”

          Can you be a transgender and still be a TRUE follower of Christ? That would be paradoxical. A true follower of Christ should be able to discern the sins one is struggling with, and in prayer, seek for forgiveness and Christ’s power to free them from their struggles. Though the Bible never directly states that “transgender is a sin,” sin by definition is anything that diverts from the truth of what God had originally intended and designed.

          What’s being implied is that if you’re a true follower of Christ, you can’t hold onto being transgender and still claim that you’re Christian, because transgender isn’t what God had originally designed. You are either one, or the other.

          Jayden, this isn’t to denigrate you in any way whatsoever. What Christ taught was to love one another, never to discriminate. But Christ also gave us the Holy Spirit with the power to discern in truth. You are right in that no one truthfully knows what causes transgender but God alone. But I pray that you will seek the truth in Christ, and that He will set you free. God bless!

  7. Kellie Walton on April 14, 2021 at 1:44 pm

    I am a Christian who just happens to be trans. Coming to this conclusion took many years of deep reflection and many years of psychological counseling. I have since transitioned and feel much freer than when I was fighting against my true identity. I am no longer depressed and have a better outlook on life. I have a great job (as a RN) and an understanding spouse.

    While I find life better, I mourn the loss of any ability to worship God with other believers. Odd how a simple difference in understanding makes one a pariah to a group who won’t even sit down to discuss our differences. Sad, really. But, God knows that I have not abandoned him even though most of his followers have turned their backs on me.

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