Recently, a case has come before the Honourable Alastair Nicholson, Chief Justice of the
Family Court in Australia, in the judge authorized that a 13 year-old child with a
condition known as gender identity dysophoria (GID) receive treatment as part of a sex
Here, sexologist and CASE faculty member, Dr Patricia Weerakoon, comments on the
Alex is a classic case of “Gender Identity Dysphoria” (GID), also called
• is biologically female (with the female sex chromosomes of XX and female external
• takes on the gender role of a male (dresses and behaves as a boy and wishes to use
the boys toilets—even in primary school); and
• identifies as a male, suppressing feminine characteristics and expressing extreme
distress at having female characteristics and menstruation.
GID is an acknowledged phenomenon of gender identity that often has nothing to do with
psychological and social trauma. Some people exhibit a confused gender identity from a
young age, without any unusual trauma in their life.
However, in some cases it would seem that this confused gender identity may be
brought to the surface when a person is put under significant psycho-social trauma. Alex
has a history of being treated as a boy by his father, and grieves his father’s death. After
his father’s death, he was then rejected by his mother and step father. Current research is
not clear on whether these traumas may trigger an existing biological predisposition to
However, these traumas are not
unique to Alex. Many children are treated as if they
are of the opposite gender. Many children are rejected by their parents. These do not
So, Alex may just be going through the ordinary turmoil of being a teenager, but
compounded in his case by the trauma he has suffered. If this is the case, treatment to
change gender may cause more problems than it solves, because many of the changes are
This case is interesting because it involves a child – Alex is 13 years old. The court gave
permission for him to undergo continuous Oestrogen and Progesterone treatment. This
hormone treatment will suppress menstruation and decrease the development of female
secondary sex characteristics (like breasts and body shape). This treatment is reversible.
Permission has also been given, when Alex reaches age 16 years, for further hormone
treatment that continues to suppress female characteristics but also stimulates male
characteristics (Testosterone). Many of these alterations (muscle changes, body hair,
No judgement was given regarding gender reassignment surgery (GRS) at this point.
When he reaches age 18, he will be able, if he so chooses, to undergo this surgery. All
medical management is to be done under strict and ongoing medical psychological and
Given the ambiguity of Alex’s situation, the court order seems to be a reasonable
interim course. It permits treatment to deal with the symptoms that are causing him
immediate distress, but postpones the irreversible treatment for when he is older. If we
assume that GRS should not be withheld in toto
from people who have reached legal
adulthood, it is entirely reasonable that Alex should at that time be permitted to make his
own decision, guided by medical advice, just like any other sensible adult.
Is there anything specific that a Christian view of the world brings to the case of Alex? Is
there a ‘Christian position’ on Alex’s treatment?
Before trying to say anything particular about gender reassignment, we can make
some general theological statements about the state of the world.
When God made humanity male and female, all the characteristics of gender were in
perfect alignment. Eve would have had perfect female biology (whatever that may
mean), would have known she was a female and known how to behave as a female.
Gender was “good” in the Garden, just like everything else.
However, now that sin has entered the world, this perfect alignment of gender
characteristics has gone awry. Sin has both broad and specific impact on people’s lives,
broad because its effects accumulate throughout history, and specific in that the sins of
certain individuals (for example, an abusive father), affect the lives of certain other
individuals. Some people suffer from sin’s impact more than others. This does not mean
that each individual’s gender and sexuality questions are inevitably a result of their own
sin, but rather they are a result of living in a sin-riddled world full of sinful individuals.
Alex has been the victim of much sin—biologically in a confused gender identity or
psychologically and sociologically in his family trauma, perhaps both. Our aim should
be to assist him, with caution and compassion, to become the person God intended him to
be. Issues of gender are only a part of this: the broader issue of dealing with sin in Alex’s
life has to be addressed by the gospel of Christ, with its forgiveness, new life and hope
However, the specific issue of gender reassignment poses tricky theological questions.
I can’t pretend to solve them all here. It is worth saying, however, that I find it difficult to
see any absolute theological impediment to gender reassignment. It may not be wise or
godly or moral for all sorts of other reasons. Perhaps an individual is already married and
has made promises to another person which override his or her desire for gender
reassignment. Or perhaps the cost and complication of surgery will so disrupt a person’s
life (and the corrective benefit of the surgery remains unclear) such that it would be an
unwise step to take. But I am not at all sure it should be forbidden outright.
I certainly see confusion among practitioners and theorists in biology and gender
studies as to the moral basis of this kind of intervention. Some who would aggressively
discourage anyone who wanted to ‘correct’ their homosexual orientation are very
supportive of sex-change procedures based on the will of the patient. Clearly, there are
other political and moral issues involved.
While these issues are being wrestled with, the clear Christian position is to love
unreservedly those who are involved, to counsel them with the wisdom of the Scriptures
as we understand it, and to do everything to the glory of God. These words apply as much
to the biologist, judge and social worker as they do to anyone else.
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