The church must do more than just point out the correct pathway forward on questions of sex and gender; it must also learn to minister effectively to those grappling with the effects of sin and the Fall on the sense of self and sexuality.

The Bible affirms the creation of humans in the image of God, which included the distinction of male and female (Genesis 1:27). Both sexes were essential to the full picture of the image of God, and both brought their special skills and gifts into the family, society, and the worship community. Jesus reaffirmed the binary sexual nature of creation by saying that “‘God made them male and female’” (Mark 10:6, NKJV).¹ Paul also valued male/female distinction, seeing it as a symbol of the relationship between Christ and the church (Ephesians 5:31, 32). The apostle acknowledged that differences between the sexes called for differing roles at times (Ephesians 5:22–29), but he also affirmed the fundamental equality of men and women before God in the community of faith (Galatians 3:28).

As the Christian Church developed, it unfortunately was impacted by both the dualism and the male-centered view of the Greco-Roman world. Plato’s identification of the material with evil influenced the church to develop a celibate clergy. Aristotle’s statement that a woman is an incomplete man led to a subjugation of women as both social and spiritual beings. The inferiority of both marriage and women was an implicit and explicit feature of the medieval West until the time of the Protestant Reformation.

In the 16th century, Luther and Calvin restored marriage as good both for the kingdom of God and for humankind. Both of them set examples by taking wives for themselves. Still, the notion of gender distinctiveness and separation, for purposes of modesty, chastity, and protection of the female, were upheld by Protestant teaching. Of course, notions of gender inferiority did not disappear overnight, and the Protestant world is still wrestling with the question of what it means to be both “equal” and “different.”

The central strands of Protestantism, whether Calvinist, Lutheran, Anglican, or Anabaptist, generally took the doctrine of total depravity seriously. They believed that sin had impacted all parts of human beings, including the physical and mental elements of sexuality and gender. Both Scripture and nature were perceived to teach that deviations from physical gender identity and an appropriate (opposite-sex) sexual orientation were results of the Fall that needed to be resisted, modified, and curbed.

MODERN DEVELOPMENTS: GENDER IDENTITY TODAY

In the post-Freudian, materialist, postmodern 20th century, the subjective sense of self and desire moved closer and closer to the center of society’s determination of reality and value. Nature, its design and its purpose, was largely abandoned as a guide to the normative and the good, at least in public life. Belief in a fallen human nature that possesses inappropriate desires also waned.²

This de-linking of the physical from the normative and moral, and the prioritizing of human desire, has caused many in the secular scientific and medical community to view deviations of sexual orientation and gender identity as minority experiences on a spectrum of normalcy, rather than a deviation into the abnormal. For example, the new phrase for gender confusion, “gender dysphoria,” implies that identification with the gender of the opposite sex is a “problem” only if it causes distress or suffering.³

However, many evangelical scholars and theologians, including Adventist ones, believe that this change represents much more of an ideological and philosophical shift, rather than the natural progress of scientific discovery. Revisions in philosophy and politics related to gender and sexuality, they point out, preceded by many decades these alterations in scientific and medical outlook. The release of sexual desires, behavior, and identity from traditional constraints, whether scriptural or natural, was part of an explicit political and legal agenda of certain 20thcentury advocacy groups, especially the American Civil Liberties Union, beginning in the 1920s.⁴

Christians surveying these developments have argued that allowing a person’s subjective sense of gender to override all objective physical evidence is a “surrender to a form of gnosticism” and a re-embrace of Greek material/spiritual dualism.⁵ In such an environment, Christians must make a special effort to stay true to biblical principles of reality. In applying these principles today, it is generally acknowledged, one needs to distinguish between issues of intersex and transgender. Intersex involves actual and apparent biological and genetic ambiguity in regard to sex. (There is no true hermaphrodism, however, and the medical community is moving away from use of the term intersex, with its implications of some kind of third or in-between sex, to disorders of sexual development.⁶) Transgenderism, on the other hand, involves a clear biological sex that is at odds with a person’s subjective sense of gender. The vast majority of those termed transgender are not intersex.⁷

Given the biological basis of their condition, it would seem that intersex persons need room to work out their biological identity puzzle—involving chromosomes, gonads, other primary and secondary sexual characters, as well as self-perceived identity— in consultation with parents, physicians, counselors, and pastors. Once their biological sexual identity is understood, then they are able to take the next steps to live with a gender consistent with it.⁸

When relating to those struggling with a purely subjective sense of transgender, there must be Christian care, concern, and compassion. Some Christians with a dualistic anthropology, where the spirit/mind of the person is separate or distinct from the body, are showing some willingness to accept and accommodate the expression of transgender impulses.⁹ But those Christians with a more wholistic anthropology of mind, body, and spirit of gendered persons, it is difficult, if not impossible, to speak of a gender identity that is completely separate from or opposite to that of the body.¹⁰

Given the Adventist belief in the total impact of sin on the person—mind, body, and spirit—it is unsurprising, one can argue, that there is at times confusion regarding reality. Psychologists know that there are mental states and delusions that cause people to reject the reality of their bodies—such is the case of anorexics (whose body image is different from reality), the transabled (those who think they are or should be disabled, sometimes termed Bodily Integrity Identity Disorder), or those suffering from species dysphoria (the belief they are actually an animal).¹¹

EMBRACING THE REALITY OF BODY/MIND

Most experts agree that these conditions are treated best as psychiatric/psychological conditions, where the mind is helped to embrace the reality of the body. The alternative is to damage the body, by allowing for unhealthy thinness, the amputation or destruction of perfectly good body parts, or the artificial reshaping of the body into non-human forms. For many Christians, this would be to participate in the marring of the image of God.

This Christian concern is even more strongly implicated when it comes to that element of humanity, sexual identity, that the Bible teaches has a special connection to the image of God.¹² To vary this image is to ultimately distort the person created by God. As one Christian study team has put it:

“[T]o recommend gender reassignment surgery as ‘the solution’ may consequently be viewed as unhelpful encouragement to submit to the distorted image of self. It is a solution that allows the deep psychological confusion and hurt suffered by transsexual people to go untreated, thereby increasing the prospect of future emotional damage. Rather than allowing this to occur, the Church should be able to offer fuller hope. A Christian response that emphasizes both psychological and physical wholeness, rather than concentrating exclusively on artificial and cosmetic physical changes in the hope that they will of themselves produce the desire psychosomatic unity, more truly reflects a biblical view of holistic health.”¹³

Given a biblical and nature-affirming worldview, it appears that purely subjective notions of transgender fall into the category of psychological confusion and should be dealt with mentally and psychologically. This conclusion is supported by both historic and recent systematic studies of those who have undergone sex-reassignment surgery. An early study carried out in 1979 showed that while transsexual surgery patients reported some level of subjective satisfaction and happiness with their change, objective measures of underlying mental health, including depression, anxiety, and basic life-coping were unchanged. The results of this study caused Johns Hopkins University to discontinue sex-change surgery.¹⁴

More recent studies have had mixed results, but none has fundamentally altered the conclusion that sex-change is at best an ambiguous intervention, one that has its own costs and burdens. As some Johns Hopkins researchers recently put it, “the scientific evidence summarized suggests we take a skeptical view toward the claim that sex-reassignment procedures provide the hoped for benefits or resolve the underlying issues that contribute to elevated mental health risks among the transgender population.”¹⁵

Of course, there are always new studies coming out, and some of them unsurprisingly purport to support the new gender ideology line that transitioning produces positive outcomes for transgender persons. But it is very telling that the national organization that oversees Medicare/Medicare policy has refused to provide a national rule supporting funding for transition services. In 2016, under the Obama administration, after a review of literally dozens of studies, they concluded that the clinical evidence “is inconclusive for the Medicare population.”¹⁶

Indeed, as described by the decision panel, much of the evidence was negative and deeply concerning. The largest and most robust study the panel reviewed was from Sweden, which has supported gender transitioning for many years. It identified increased mortality and psychiatric hospitalization compared to the matched controls. The mortality was primarily due to completed suicides (19.1-fold greater than in control Swedes). In addition, death due to neoplasm and cardiovascular disease has increased 2 to 2.5 times as well. The risk for psychiatric hospitalization was 2.8 times greater than in controls, even after adjustment for prior psychiatric disease.¹⁷

NATURE HAS THE LAST WORD

Ultimately, nature has the last word. No one can truly change his or her sex. A complete sex “change” operation consists of destroying usually functioning genitalia and reproductive systems and replacing them with mere facsimiles and physical representations that can no longer function reproductively. The underlying sex identity of the body does not change, the chromosomes, DNA, and web of other sex-related features are the same. This persistence of underlying sexual identity is evidenced by the body’s constant effort to return to its natural state. Thus, there is a need by “change” patients to receive hormone therapy for the rest of their lives to repulse these bodily efforts. Such lifelong drug regimens come with side effects and health risks of their own, such as thrombosis and cardiac arrest, which requires patients to be continuously monitored and supervised by medical professionals.¹⁸

Apart from the health concerns for the individual, there are also very disturbing public-policy and public-safety implications of allowing persons to decide their genders based entirely on subjective perceptions. Separating unmarried men and women, and boys and girls, when it comes to bathrooms, changing rooms, and housing quarters protects modesty and sexual purity, which are values for both church and society.

Just as importantly, and even more basically, it also protects girls and women from male predators, whose greater strength and aggressiveness make females particularly vulnerable if society and its institutions are degenderized. This concern is not based on a belief that transgender persons are somehow more violent or predatory than others. Rather, it is the fact that once the rules are changed, it will be next to impossible to police against heterosexual, non-transgender men who claim to be transgender to gain access to women’s toilets and changing rooms for their own nefarious purposes. Once gender identity is based purely on a subjective sense of self, authorities must generally accept one’s claim to be the opposite gender at face value, appearances notwithstanding.

It is well documented that one of the single best ways of keeping women and girls safe in refugee camps and centers is to provide well-secured, single-gender bathrooms.¹⁹ That society would consider reversing these common-sense bathroom rules, at a time when sexual assault in American public institutions, such as higher education and the military, is hitting new highs, is seen by some as a sign of the extreme nature of our modern philosophical confusion.²⁰

CONCLUSION

For Seventh-day Adventists, the connection of the sexes with the image of God has not only theological, but also prophetic significance. The seventh-day Sabbath is a pre-Fall institution from Eden, and it is at the heart of God’s moral law. Loyalty to the seventh-day Sabbath will become the final, end-time point of controversy. Like the Sabbath, the other institution from Eden, also identified at the heart of God’s law is the fifth commandment that speaks of the basic family unit of father and mother. As a church, Seventh-day Adventists would be fully mobilized if and when Sunday laws began to be passed in legislatures around the world. Would Adventists be as prepared to publicly speak just as well when marriage and sexuality are redefined in ways that confuse and undermine this institution whose significance to the stability and continuity of society is supported by both nature and revelation?

Surely marriage and Sabbath, with their roots in pre-Fall Eden, and their proximity and importance in God’s law, both deserve our attention and support. As Ellen White put it:

“Then [in Eden] marriage and the Sabbath had their origin, twin institutions for the glory of God in the benefit of humanity. Then, as the Creator joined the hands of the holy pair in wedlock, . . . He enunciated the law of marriage for all the children of Adam to the close of time.”²¹

The “law of marriage,” being given to “all the children of Adam” to the end of time points to its transcultural, enduring nature. Rather than just being a standard for the faithful, as the Sabbath might be characterized, it is a teaching of the natural law that can and should be understood by all humanity. This does not mean, of course, that there are easy answers to those struggling with questions of sexual and gender identity. The church must do more than just point out the correct pathway forward on these questions; it must learn to minister effectively to those grappling with the effects of sin and the Fall on the sense of self and sexuality.

Christians must also acknowledge the moral freedom and diversity that God allows all of humanity. Not all things that we morally disagree with can or should be outlawed by the state. Where practicable, Christians who value freedom should work through political processes to protect the rights and dignities of sexual and gender minorities, while assuring that the religious freedom and values of religious organizations and people of faith will be protected. We cannot compromise our underlying beliefs about human nature, sexuality, and marriage. But we must uphold these truths in a manner that shows respect for the image of God in all people, including those we may differ with in their views on sexuality and gender.

Nicholas P. Miller (JD, Columbia University Law School, New York, U.S.A.; PhD, University of Notre Dame, Indiana, U.S.A.) practices law in Maryland and is a Professor of Church History at the Seventh-day Adventist Theological Seminary at Andrews University in Berrien Springs, Michigan, U.S.A. E-mail: [email protected].

Recommended Citation

Nicholas P. Miller, "Sexuality and Gender: A Biblical Perspective," Dialogue 35:3 (2023): 5-9.

NOTES AND REFERENCES

1. Unless otherwise indicated, all Scripture references in this article are quoted from the New King James Version of the Bible. Scripture taken from the New King James Version®. Copyright © 1982 by Thomas Nelson. Used by permission. All rights reserved.
2. John Witte, Jr., “Sex and Marriage in the Protestant Tradition, 1500–1900,” in The Oxford Handbook of Theology, Sexuality, and Gender, Adrian Thatcher, ed. (New York: Oxford University Press, 2015), 318; Todd T. W. Daly, “Gender Dysphoria and the Ethics of Transsexual (i.e., Gender Reassignment) Surgery,” Ethics and Medicine: An International Journal of Bioethics 32:1 (Spring 2016): 41.
3. Mark A. Yarhouse, Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture (Downers Grove, Ill.: IVP Academic, 2015), 14, 15.
4. “Long before they founded the ACLU, [its leaders] and others who shaped the ACLU’s first policies on matters related to sexuality participated in the sexual experimentation that characterized Greenwich Village’s bohemian culture in the early twentieth century” (Leigh Ann Wheeler, How Sex Became a Civil Liberty [New York: Oxford University Press, 2013], 12).
5. Evangelical Alliance P. C., Transsexuality: A Report of the Evangelical Alliance Policy Commission (Carlisle, Cumbria, U.K.: Paternoster Publishing, 2000), 60, 61.
6. In 2005, an international gathering of gender experts proposed that the term intersex be replaced with the phrase “disorders of sex development (DSDs),” as this more accurately describes the condition, and does not imply that there is somehow a third gender between the genders (Peter A. Lee et al., “Consensus Statement on Management of Intersex Disorders. International Consensus Conference on Intersex,” Pediatrics 118:2 [August 2006]: e488–500). doi.org.10.1542/peds.20060738. The pediatric community has generally accepted this terminology, though they recognize that many in the community may prefer that the language of “disorder” should be replaced with “difference,” so as to avoid undue stigmatization.
7. Yarhouse, Understanding Gender Dysphoria, 16–22.
8. Interact: Advocates for Intersex Youth, a national advocacy group for intersex persons, also rejects the notion that there are true hermaphrodites, or third-sex persons. Their main burden is that that non-emergency gender-related surgeries should largely be postponed until developmental conditions can more clearly reveal the underlying gender of the child, whether male or female. See https://interactadvocates.org/faq.
9. Heather Looy and Hessel Bouma III, “The Nature of Gender: Gender Identity in Persons Who Are Intersexed or Transgendered,” Journal of Psychology and Theology 33:3 (September 2005): 174176. doi.10.1177/009164710503300302.
10. See Biblical Research Institute Ethics Committee statements on transgenderism, released in October of 2014 and found at https://www.adventistbiblicalresearch.org/wp-content/uploads/BRI_ Ethics_Committee_Releases_Statements_on_Transgenderism.pdf.
11. Daly, “Gender Dysphoria and the Ethics of Transsexual (i.e., Gender Reassignment) Surgery,” 41, 42.
12. Ibid., 46–48.
13. Transsexuality: A Report of the Evangelical Alliance Policy Commission, 26, 27.
14. This study and its impact are discussed in Lawrence S. Mayer and Paul R. McHugh, “Special Report: Sexuality and Gender—Findings From the Biological, Psychological, and Social Sciences,” The New Atlantis: A Journal of Technology and Science 50 (Fall 2016): 10–143; see especially section starting on page 110. From the Johns Hopkins Medicine, Center for Transgender and Gender Expansive Health Website: “Through a collaborative relationship with endocrinology and psychiatry, we work to provide comprehensive services for all youth. Clinical services are available for children, adolescents and young adults 5–25 years old and include education, family and individual support, pubertal blockade, cross-hormonal therapy and mental health support and treatment. The clinic additionally provides referrals for gender affirmation surgery for adolescents and young adults, 18 years and older, according to the Johns Hopkins Center for Transgender and Gender Expansive Health guidelines” (https://www.hopkinsmedicine.org/center-transgenderhealth/services-appointments#services-young).
15. Cited in Mayer and McHugh, “Special Report: Sexuality and Gender,” 112.
16. National Coverage Analysis (NCA) Decision Memo, “Gender Dysphoria and Gender Reassignment Surgery,” CAG00446N (August 30, 2016), 1, 2: https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo. aspx?proposed=N&NCAId=282.
17. Cecelia Dhejne et al., “Long-term follow-up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden,” PLOS One (February 22, 2011), 6(2): e16885: doi.10.1371/journal.pone.0016885.
18. Jamie D. Weinand and Joshua D. Safer, “Hormone Therapy in Transgender Adults Is Safe With Provider Supervision: A Review of Hormone Therapy Sequelae for Transgender Individuals,” Journal of Clinical and Translational Endocrinology 2:2 (June 2015): 58, 59.
19. See Amnesty International Report, “Female Refugees Face Physical Assault, Exploitation and Sexual Harassment on Their Journey Through Europe” (January 18, 2018): http://www.amnesty.org/en/latest/news/2016/01/female-refugees-facephysical-assault-exploitation-and-sexual-harassment-on-theirjourney-through-europe/.
20. The U.S. National Center for Education Statistics reports that despite an overall decrease in campus crime between 2009 to 2019, “the number of reported forcible sex offenses on campus increased by 363 percent, from 2,500 in 2009 to 11,800 in 2019. Readers should take note that reporting guidelines for forcible sex offenses changed in 2014, which likely contributed to the largest single-year percent increase in that year (36 percent, from 5,000 to 6,800). However, the number of reported forcible sex offenses on campus continued to increase steadily between 2014 and 2018, from 6,800 to 12,400 (an 83 percent increase, or an average increase of about 16 percent per year): https://nces.ed.gov/programs/coe/indicator/a21#fn1. The U.S. military reports rather sharp increases in sexual assault against both men and women members of the armed forces in the past two decades—see Heather Mongilio, “Latest Military Sexual Assault Report Shows ‘Tragic’ Rise in Cases, Pentagon Officials Say,” USNI News (September 1, 2022): https://news.usni.org/2022/09/01/latest-military-sexual-assault-report-shows-tragic-rise-in-casespentagon-officials-say#:~:text=Sexual%20assault%20rates%20 are%20up,sexual%20contact%2C%20with%2013.4%20percent).
21. Ellen G. White, Thoughts From the Mount of Blessing (Mountain View, Calif.: Pacific Press, 1896), 63, 64.