The Contested Nature Of Gender And Embodiment
Thoughts On How To Have A Meaningful Conversation
Andrew Sloane
I have been interested in gender and sex and identity in one form or another for some time. This is partly because of my previous training in medicine and my current work as a theologian; and this is an area where the two intersect. When I first started seriously exploring issues of gender, identity, transgender experience, and diverse embodiment a decade or so ago, it was something of a fringe interest. It was certainly not a matter of everyday conversation or heated political rhetoric. Nor was transitioning a common phenomenon—or at least, it was not a very visible one. Now it’s featured in the news, and in popular literature. [1] Ten years, it seems, is a very long time.
These are conversations we now need to have. But they are difficult conversations, and for many people they are deeply personal and potentially hurtful conversations. And so, if we are to proceed, we need to be clear about some ground rules.
The first is sensitivity. If we are to have a meaningful conversation and not a wounding one, we need to be sensitive to the hurts and fears that lie beneath people’s words. That’s something Christians like me need to be particularly alert to, given our lamentable history of wounding those we are called to love.
One sign of respect is to take someone else’s views seriously enough to seek to understand them.
The second is respect. Respect the other, and respect their integrity and respect their ideas. Respect, of course, does not mean agreement. Indeed, one sign of respect is to take someone else’s views seriously enough to seek to understand them and, where you do disagree, to say so and figure out why.
The third is related: listen. Listen well, and listen hard. Listen, not to store up ammunition to shoot back in debate, but empathetically, with a desire to understand, to try to think your way into their point of view. Listen responsively, and respectfully, but critically (yes, that is possible). If an argument you hear doesn’t seem to make sense, check to see if you’ve understood correctly (and, as much as is possible, from the ‘inside’). And, if it still doesn’t make sense, have the courtesy to say that you’re puzzled, and try to say what it is that puzzles you. And the fourth follows on from that: listen more than you speak, and listen before you speak, and, when you do speak, speak out of love and deep respect. The book of James puts it well: ‘Everyone should be quick to listen, slow to speak’ (James 1:19). Speak with a desire to grow in shared understanding of a friend, rather than to beat a conversational ‘enemy’.
I hope that’s the kind of conversation this piece might engender. But let me be clear about a few things from the outset, for conversations such as this are personal and particular, and arise out of particular perspectives. I am a heterosexual, late middle-aged, university educated, privileged white male. I am also an evangelical Christian of a more-or-less conservative kind, who finds a traditional view of sex and relationships compelling (mine is what is now called, somewhat disparagingly, a ‘heteronormative’ theology and ethic). While I have struggled long and hard against many aspects of stereotypical ‘masculinity’, especially its toxic expressions, I am quite comfortable in my body. Mine is not a ‘trans’ experience: I feel no disparity between my gendered sense of self and my bodily sex. I’ve never struggled with being male, whatever issues I’ve had with prevailing images of masculinity. I have been happily married to Alison for 36 years, and am the proud father of three adult daughters and father-in-law to their spouses. Whatever I say about the complex and painful experiences of not being ‘at home’ in the body I say from the ‘outside’, so to speak, not from lived experience. For some of you, perhaps that means you stop reading now. I think that would be a shame, but fair enough.
For those of you who decide to stay with me, I will begin by exploring some of the complex ways that sex and gender have become problematic in recent discussions, then move on to outline the basic theological and ethical stances that evangelical Christians have adopted in relation to gender and transitioning. I will go on to make some positive claims. Gender is mostly culturally constructed. Embodied sex is mostly a creational given. The distress of gender dysphoria is real; it is not a matter of ‘choice’, and it needs to be addressed. This raises some points of controversy in Christian circles that I will briefly address (including the use of hormone replacement therapy and sex reassignment surgery, and the pronouns and names we ought to use to refer to trans people). I will close with a few challenges addressed to people who, like me, adopt a ‘traditional heteronormative’ approach to sex and gender.
1. The contested nature of gender and embodiment in the ‘trans’ landscape
Both gender and embodiment are contested notions culturally and, to a certain extent, theologically.
The (newly) traditional distinction between sex (a bodily phenomenon) and gender (a social, psychological, behavioural phenomenon) is itself contested in gender theory and queer studies. [2] In the 1990s, sex—especially the traditional categories of male and female—came to be seen as ‘performative’ [3] — a matter of social scripts and the un/conscious adoption of them by individuals and those who shape their self-understanding. Bodily practices such as gait, posture, use of personal space, gestures and the like came to be seen as just as fundamental to being a man or a woman as what primary and secondary sex characteristics a person may have. Today, gender and sex are much more fluid categories (as well as having fluid expression) than had previously been thought. Gender—a set of attitudes, behaviours, and practices—leaks into bodily sex.
At the same time, and perhaps paradoxically, gender has come to be considered as a fundamental ontological category or, perhaps, a primary identity marker. And for a range of cultural and political reasons, a person’s (sense of) gender identity is held to be incontestable (and perhaps even immutable) including, oddly, being non-binary or gender fluid. [4] This is, I think, related to the radical subjectivity of identity in late modern capitalism, which sees personal identity as both a constructed project and as irreducibly internal, not open to others’ questioning. There are deep ironies at work here, of course, as much of what is internalised in the construction of this ‘privatised’ sense of self is the product of market forces that seek to shape malleable consumers and develop niche markets for commercial benefit.
For a range of cultural and political reasons, a person’s (sense of) gender identity is held to be incontestable.
We need to think about how we understand these phenomena and respond to them theologically—to ask what questions are raised for Christian people by these changes in society and people’s experience of their bodies in the cultural world. Do we need to re-think some of our assumptions about how we read the Bible (a Christian’s principal source of authority), and what it says? Has our tradition adequately come to grips with what it means to be human in the world as we find it? And, correspondingly, we need to ask what questions the Bible and our tradition might raise about these changes in culture. That, of course, is part of my task here.
But rather than try to cover all this complex terrain, I would like to focus on a specific issue, both because it provides a helpful sampling of the territory, and because of its importance in its own right: namely, gender dysphoria.
2. Gender dysphoria—a brief description, and a taxonomy of approaches
Any legitimate Christian response to gender dysphoria must be driven by love, and must also recognise the deep hurts trans people experience, and some that have been inflicted on them by Christians—at times even in the name of Christ. These criteria have not been met by all conservative Christian responses— to our shame—but they are true of the best of them. [5]
On the other hand, we need to recognise that for many LGBTQI+ people, anything other than unqualified acceptance of their experience and how they identify is seen (and experienced) as homophobic and transphobic—an illegitimate imposition of heteronormative bias. That, please note, is not an argument for a particular conclusion on these matters (my own view is clearly heteronormative, and I do not take that adjective as pejorative); it is a warning.
We also need to note that not all trans people experience gender dysphoria (and vice versa), nor does discussing gender dysphoria address all the important questions we could ask about gender and bodies and identity. If you’ve addressed one issue relating to gender, embodiment and identity… you’ve addressed one issue.
Finally, I recognise that there are particular, and particularly difficult, issues associated with the phenomenon of gender dysphoria in adolescents, and also that of childhood gender dysphoria. They not only add significant complexity to the discussion, but they also require addressing matters that are beyond my limited expertise. So, for the sake of both clarity and space, I will have to leave them to one side. What I am addressing in what follows is persistent gender dysphoria in adults.
So, what is gender dysphoria? Briefly, it is the experience some people have of being alienated from the sexed nature of their bodies. The painful alienation from their bodies, and the sense that the only way of alleviating that dysphoria (painful experience) is by adopting practices, and even the bodily form, that typically matches the gender they identify with.
What are we to make of this? How should we think about this theologically? The options fall broadly into three categories. [6]
i) The first view sees binary sex-and-gender as inextricably linked God-given features of what it means to be human creatures. While different cultures may express (binary) gender differently, every culture has gender norms that faithful Christians must not subvert by their behaviour or appearance (including dress and other adornment). They must not change their bodily form by means of hormones or surgical treatment. Trans-practices, in particular transitioning, are an unfaithful rejection of God-given sex and gender.
ii) Diametrically opposed to that view are those who see clear male and female bodily forms, and culturally typical masculinity and femininity, as the most statistically common expressions of sex and gender, but not normative in a restrictive sense. That is, people are not morally bound to adhere to these typical forms or expressions. Rather, there is a pluriformity, a rich diversity, of God-given sex and God-given gender. For some people, their embodiment and their experienced identity are aligned. For others, they are not. This is to be affirmed, even celebrated, where possible and, in cases where it causes a person distress, we are to do whatever we can to enable them to ‘inhabit’ the bodily form that they most identify with. Trans-practices, including transitioning, are a theologically and ethically appropriate expression of the diversity of Godgiven sex and gender.
iii) Finally, there are those who adopt a ‘middle road’. While recognising the goodness of the created body, and that God’s plan is that there be an alignment between a person’s sex and their gender, this is not always a person’s experience. That is not (in general) something they choose; it is a complex, and at times fraught, fact of their experience. For some people, this distress can only be alleviated by adopting practices that are typically associated in their culture with those of the other sex; indeed, hormonal or surgical intervention may be required. Trans-practices, including transitioning, are a theologically and ethically acceptable measure to deal with distress.
As will become clear I take the third, ‘middle-road’. But let me hasten to add: in claiming a middle road, I am not thereby claiming the middle—and higher—ground. I think it is right not because it ‘avoids extremes’ (if extremes they are), but because I think it makes best sense of both the Bible and the world as we find it. [7]
3. Approaching the issues
Those of us in the Christian tradition seek to ensure that our thinking on these, as on all other matters, lines up with the witness of Scripture. There are important texts for us to come to grips with: Genesis 1–3 (of course), and 1 Corinthians 7, amongst others. But we need to recognise that it’s not a simple matter of ‘the Bible says’. Even in what might seem to be a clear and unambiguous passage, we need to ask important questions. How does each text relate to its cultural context? What theological matters are in view? More generally, how do we understand what the writer (and so God) was doing with the relevant texts? What theological motifs are in play (creation order; sexual practices; cultic aberration)? How are they in play, and to what ends? [8]
We need to consider other matters as well. How do we understand our own cultural context, and the broader philosophical questions in play? How do we approach Christian ethics? Is it a matter of rules? Of principles? What role do context, relationships, consequences play? What is our broader understanding of what it means to be a woman or a man, and how does that shape how we read culture and the Bible? These are all contested questions that deeply impact our conclusions on these matters. And we need to acknowledge that. Of course, this is not to say that the Scriptures should not inform our views on these complex matters. But it is to say, it’s not a simple matter of ‘the Bible says’. [9]
That is reflected, to a greater or lesser extent, by proponents of the views I noted earlier. Some, but not all, of those who see binary sex-and-gender as normative recognise the complexity of the interpretive issues. Even so, they are of the view that the creation of humans as male and female in Genesis 1 and 2, and Paul’s endorsement of cultural norms of gendered behaviour in 1 Corinthians 7 and elsewhere mandate the alignment of gendered behaviour with biological sex, and require that we learn to live with the bodily form given to us in creation.
Those who see gender and sex as more fluid, and believe that God accepts, even delights in, that diversity as part of the intricate goodness of creation, tend to clearly recognise the complexity of the interpretive task. Indeed, that is one key element of their argument for their view. Male and female are not presented in Genesis 1 and 2 as fixed categories to which we must conform, but as expressions of ‘otherness’ that we are called to embrace. Cultural norms are malleable and, in our changing cultural landscape, Paul’s instructions require responsiveness to them, not a slavish commitment to past expressions of sex-and-gender.
Those of us in the Christian tradition seek to ensure that our thinking...lines up with the witness of Scripture.
Space limits me to a brief summary of my own view—one that seeks to recognise the complexity of the interpretive and cultural issues, while seeking to understand the Bible and be faithful to it. As a result of my reading of Scripture and my understanding of the underlying issues, I see gender as mostly culturally constructed (and that Scripture does not endorse particular patterns of gendered behaviours, etc.); embodied sex as mostly a creational given (and basically dimorphic, but with a range of bodily forms); and the distress of gender dysphoria as real, non-volitional and needing to be addressed so as to minimise the distress of those who endure it and the harms that might follow, using the minimum of interventions needed to enable them to navigate the world and flourish in it (up to and including HRT and SRS). That brings us to a number of deeply contested issues.
4. Thoughts on contested matters—things that matter
Gender, sex and identity
A hallmark of recent discussions of gender, bodily sex, and sexuality is the way that they have become wedded to personal identity. That, it seems to me, is a fundamental mistake, one that’s almost too big for us to see. [10] True, sex, gender and sexuality are important, and inevitably shape our identity. In many ways that’s to be celebrated, for these aspects of our being in the world form the attitudes, values, experiences, affections, and relationships that, in turn, form who we are. But that’s not the same as these characteristics defining who we are. If I may speak from my own very traditional, heteronormative experience, I don’t identify as a heterosexual, cis-gendered man. But my identity is fundamentally determined by the relationships that form me: as son, and brother; as husband, father, and father-in-law; as friend and colleague. And, as a Christian, pre-eminently by my relationship with God.
You might say, that’s all very well and good given our culture’s almost unquestioning acceptance of your heteronormative experience. And of course, that’s true. Nonetheless, I think there are good reasons to de-couple sex, sexuality and identity (with apologies for the pun). Identity is not, primarily, a project we undertake, but a gift we explore and express. Theologically, it is gifted to us in creation (including embodiment), providence (including family and culture), redemption (being united to Christ by the Spirit, members of the Father’s household), and ultimately awaits its full experience and unveiling in the new creation.
This is also true phenomenologically. We find ourselves in the world in families and cultures and places in history we do not choose and that we need to navigate as well as we can. Yes, our choices contribute to the paths our lives take, but they do not determine those paths. Too much of who we are and where we find ourselves in the world is beyond our control. To see our ‘life project’ as subject to our unfettered will is the result of ignorance or self-deception. And, for many of us, dooms us to frustration and a deep sense of failure when the vicissitudes of life overtake us. We need to recognise those constraints; but also to receive with gratitude the possibilities that our location in time and space open up for us. That allows us, I would suggest, to explore what it means to live faithfully with the desires, orientation, bodily form and limitations we find ourselves with, without having to reify them as being who we are.
Of course, that doesn’t in itself close off the possibility that non-conforming gender behaviour is one such faithful expression. Indeed, there are some cultural norms of gendered behaviour that we ought to contest (‘alpha male’ stereotypes, for instance). And, as I’ve already noted, there are faithful Christians who reject heteronormativity and embrace gender fluidity (although, as I also noted earlier, that is not my own view). But that is better articulated as a way of inviting people to explore what it means for them to live out their identity as creatures under God and followers of Christ (for those who identify as Christian), rather than seeing their gendered-experience or sexual orientation as who they are.
Experience and theology
This relates to another thorny matter: the nature of experience and its authority. What force does experience have, and what ought it have, in shaping our understanding of ourselves and the world? The experience of trans people is important in its own right, and is a key factor in a number of evangelical respondents. For DeFranza and Sabia-Tanis, for instance, trans experience needs to shape the theological and ethical conclusions we draw about trans phenomena. [11] However, things are not so simple, for experience is itself a complex phenomenon. Indeed, there is no ‘pure experience’, there is only experience of something as something. [12] ‘Worldview-type’ issues deeply inform how we interpret our experience. This raises important questions for LGBTQI+ people that need to be handled with (great) care—I would certainly not want to dictate to someone what their experience really is, or what it means. But it is also important to explore it theologically: for if experience is more complex than we might think, then so is our theological response to it. We need first to seek to critically understand the experience of others in light of their background, assumptions, and the like, and then to figure out how we are to make sense of that theologically and respond to it ethically. That is more complicated than we might (like to) think, and is best handled, I should think, in an open, exploratory conversation.
Language and names
The matter of language and names is also controversial, particularly, perhaps, in relation to pronouns. Should we use the names and pronouns that a person chooses to identify with, or the ones assigned to them by birth or cultural practice?
Practices of ‘misgendering’ and/or ‘dead-naming’ someone (that is, not using their preferred pronouns or name) can be deeply offensive to trans people. We may not only offend, but also fail to communicate effectively if we stick to our gendered pronominal guns. As Christians who seek to love our neighbours, then, we would need strong reasons to not comply.
Are there such reasons? My own view is that there are not. Pronouns, like linguistic gender in general, are language-specific, and evolve over time as patterns of use change (we no longer use ‘thou’—except ironically, or as a deliberate anachronism). I see no reason to reject a person’s preferred usage (and it raises unnecessary barriers and causes unnecessary hurt).
However some Christians believe that using pronouns that fail to correspond to a person’s ‘objective’ sex is a faithless rejection of God’s creational order. [13] While I believe this view is based on a mistaken philosophy of language, those who do not feel that they can in good conscience use what they consider ‘wrong’ pronouns still have the option of using the now generic ‘they, them, their’. In this way they may show their concern for vulnerable people and minimise offence. These terms are also useful in contexts where we are uncertain of a person’s preference, and suspect that it might matter deeply to them. [14] Fruitful conversation requires it, and I don’t believe that anything in a (theologically informed) understanding of language use prohibits it.
Practices of ‘misgendering’ and / or ‘deadnaming’ someone...can be deeply offensive to trans people.
Transitioning, hormones, and surgery
As we think more specifically about gender dysphoria, we need to consider the complex question of hormone treatments and sex reassignment surgery as harm-minimization strategies. The evidence of benefit seems to be unclear and/or ambivalent. [15] At the risk of simply copping out, I do not think I am in a position to form an independent conclusion on the scientific and sociological data. For me, the primary question, and the one I am best qualified to judge, is whether HRT and SRS are theologically and ethically appropriate. And I think they are—or at least, can be in some circumstances.
One concern Christians may have is that altering one’s God-given body is a rejection of a created good. Of course, in a fallen world we often think it’s fine to alter our God-given bodies in many ways—from correcting a tongue-tied infant to removing cataracts to implanting a pacemaker. But is changing the gender we present as such an intervention, and how do we decide?
Particular intersex conditions demonstrate that bodily form and DNA may not match in ‘nature’ (fallen though that may be). [16] This suggests to me that a change in bodily form need not be taken as a denial of our nature as creatures (of course, it may be; it is just not necessarily so). So, if a person chooses to transition, not as a rejection of the givenness of their created embodiment, but as a strategy for dealing with painful complexity in this interim period (a penultimate, and not ultimate solution to these struggles), and in hopeful openness to whatever embodiment might be for them in the new creation, it seems to me to be theologically acceptable.
One gift we might be able to offer people who struggle with gender...is to provide places where those stereotypes do not reign.
The question of whether it is the best decision for them needs to be determined on a case by-case basis, and depends on an assessment of the relative risks and benefits of the procedures. And that, it seems to me, is best determined not by a theologian, but by an ethically informed clinician in dialogue with a well-informed patient.
5. And a last word to us as leaders in God’s church
Let me end with a challenge to conservative Christians like me. How do our practices and language unhelpfully reinforce damaging gender stereotypes? I am often concerned at the way that particular constructions of gender have been imposed on biblical texts and theological motifs, covered in a tissue-thin veneer of biblical and theological authority, and then inflicted on people and communities. We must be circumspect—much more than we often have been—before imposing particular constructions of gender on biblical texts and theological motifs, and then on people and communities with the force of biblical and theological authority. There is, unfortunately, growing evidence that some of these stereotypical gender roles contribute to the demeaning of women and the incidence of intimate partner violence. I am suspicious that they also contribute to both gender dysphoria and problems of gender identity. If someone is presented with a rigid view of what it means to be a ‘real man’ or a ‘real woman’ and they do not relate to that, this may lead them to feel deeply uncomfortable with their assigned gender, or question whether they’re a man or woman at all.
What can we do as evangelical Christians to counter that? That, it seems to me, is an urgent question that needs more creative and sensitive exploration in our churches. Perhaps one gift we might be able to offer people who struggle with gender stereotypes (and even the community at large) is to provide places where those stereotypes do not reign. Places where women and men can explore the rich diversity of what it means to be created by a loving God and called to a future of freedom. And, indeed, where we speak and live a freedom that isn’t imprisoned in the myth of the self-made self but accepts God’s invitation to true freedom in Christ.
But the questions we need to address are not just negative. If we truly want to speak and demonstrate the gospel of the love of God in Christ in a way that is faithful to Scripture and makes sense in our context, what positive strategies should we put in place? If we really are welcoming as well as not-affirming, what does that look like? And how can we ensure that it feels like that to those for whom it matters the most? Perhaps we might even come to recognise the ways that our fixation on the suburban households of the late modern nuclear family excludes not only people who wrestle with issues of gender and sex, but single adults, childless couples, the divorced and widowed and… And put in place forms of speech—and life-in-community—that more faithfully express the New Testament’s picture of life in the household of God.
Big issues, prompting lots of questions. But exploring them is, I suppose, the point of conversation, is it not?
ENDNOTES
[1] See, for instance, Torrey Peters, Detransition, Baby (Serpent’s Tail, 2020). And in the world of young adult literature, Akwaeke Emezi, Pet (Faber & Faber, 2019).
[2] See, for instance, Ketil Slagstad, ‘The Political Nature of Sex— Transgender in the History of Medicine’. New England Journal of Medicine, 2021. https://doi.org/10.1056/NEJMms2029814. I was interested to note, on the other hand, that the recent ABC guide to LGBTQIA+ terminology seems to accept the distinction without qualification (see www.abc.net.au/ everyday/lgbtqia-glossary/100839282)
[3] Judith Butler is a pioneer of this line of thought. See her now classical treatment in Judith Butler, Gender Trouble: Feminism and the Subversion of Identity (Routledge, 1990).
[4] One key marker of this is the banning of ‘conversion therapy’, including any course of action that might prompt questions about a person’s gender self-identification, which is seen as inherently abusive and denying a fundamental aspect of a (young) person’s identity. See, for instance, the recent Victorian legislation: https://content.legislation.vic.gov.au/ sites/default/files/bills/591143bi1.pdf (Sections 5 and 9 are especially pertinent).
[5] See, for instance, Preston Sprinkle, Embodied: Transgender Identities, the Church, and What the Bible Has to Say (David C Cook, 2021); and the essays in James K. Beilby and Paul Rhodes Eddy, eds. Understanding Transgender Identities: Four Views (Baker Academic, 2019).
[6] These views are nicely represented in Beilby and Eddy, op. cit.
[7] I have written on that elsewhere, and won’t rehearse the arguments in detail here. If you’re interested, see Andrew Sloane, ‘“Male and Female He Created Them?” Theological Reflections on Gender, Biology, and Identity’. Marriage, Family and Relationships: Biblical, doctrinal and contemporary perspectives, edited by T.A. Noble, S.K. Whittle and P.S. Johnston (Apollos, 2017), pp223–236.
[8] For instance, Deuteronomy 22:5 is often seen as an unambiguous prohibition of ‘cross-dressing’, and so as the basis for rejecting strategies for dealing with dysphoria. This is problematic due to issues relating to the specific language used in the passage, and questions about precisely what practices it refers to. See Peter C. Craigie, The Book of Deuteronomy (Eerdmans, 1976); Michael A. Grisanti, Deuteronomy (Zondervan, 2017); Edward Woods, Deuteronomy (IVP, 2011).
[9] I discuss a number of these issues in relation to Christian use of the Hebrew Bible in Andrew Sloane, At Home in a Strange Land: Using the Old Testament in Christian Ethics (Baker Academic, 2014).
[10] It is interesting to note that Judith Butler, who is very far from being traditionally heteronormative in her views on sex, sexuality and gender, also argues that gender is not a fixed state of being that defines who someone is. For this, see Ch4 ‘Undiagnosing Gender’ in Judith Butler, Undoing Gender (Routledge, 2004). I should note that her argument depends on (and seeks to foster) a particular notion of autonomy that I think is philosophically problematic; moreover, she is sceptical of the category of gender identity disorder (the term used for gender dysphoria at the time she wrote her piece: the term gender identity disorder in DSM-IV was removed from DSM-V and replaced with gender incongruence and gender dysphoria). But exploring those issues is well beyond the scope of this short piece.
[11] See the pieces by DeFranza and by Sabia-Tanis in Beilby and Eddy, op. cit. [12] For an excellent discussion of the philosophy of experience (with a particular focus on experiences of God), see Kaiman Kwan, ‘Religious Experience’ Ch29 in The Routledge Companion to Theism, edited by Charles Taliaferro, Victoria S. Harrison and Stewart Goetz (Routledge, 2012).
[13] John Piper, for instance. He argues that while names are arbitrary, pronouns refer to an unambiguous created phenomenon (biological sex which, in his view, always corresponds to created sex [or at least, it ought to, with the exception of intersex conditions]). See www.desiringgod.org/ interviews/he-or-she-how-should-i-refer-to-transgender-friends
[14] This is a fairly standard practice, and is argued for effectively in the editors’ introduction in Beilby and Eddy, op. cit.
[15] That is, some studies seem to show correlation with improved outcomes; others do not—so, the evidence is unclear. And some studies show that it helps some people and exacerbates distress for others—so that evidence is ambivalent. A good introduction to gender dysphoria and related research can be found in Mark A. Yarhouse, Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture (IVP, 2015). For more recent research and its findings, see his piece and that of Sabia-Tanis in Beilby and Eddy, op. cit .
[16] For a brief discussion of this, see my piece, ‘Male and Female He Created Them?’, op. cit.
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