We have received in our office an increasing number of concerns related to the ethical implications of sex-change surgery. The church has not taken an official position on this specific issue, but its silence does not necessarily imply indifference to the ethical and spiritual dimensions raised by it. It is our purpose to provide some guidance on this difficult topic. In doing that we also want to remind the reader that this is not simply an impersonal ethical issue about which we can only argue. This is about human beings who are experiencing deep pain as they try to deal with their personal gender identity. They need our prayers, our love, and all the guidance we can provide for them. As a community of believers, we should always be open to sustain and support those who in their existential and spiritual journey face serious personal challenges, but who nevertheless are searching for God.

Gender identification is usually quite easy, but sometimes situations of genetic, chromosomal, hormonal, and intrauterine influences may result in ambiguity of anatomical sexual differentiation. In these situations anatomical development of genitalia can result in a spectrum of disorders spanning the gamut from definitely female to overly male. Those born with ambiguous genitalia may well benefit from surgical realignment with their correct gender identity. It is not my purpose, and neither am I qualified, to discuss the surgical correction of physical anomalies.

There is another group of patients whose anatomical gender identity is clearly male or female but who claim to be of the opposite gender trapped within an anatomical anomaly. Such individuals often request surgical intervention to change their genitalia into that approximating the opposite sex. True and complete transformation is not possible. It is the psychological, theological, and ethical implications of such sex-change surgery that I want to explore.

As already indicated, when dealing with this complex topic we should not become insensitive to the struggles of such an individual, but show them the respect they deserve as children of God. We also need to be aware of the limitations of our knowledge as well as the biblical principles that should be applied in evaluating this ethical issue. Concerning the limitations of knowledge, the phenomenon of persons claiming that their psychological and emotional gender does not correspond with their physical sexual organs is one about which psychologists, scientists, and physicians struggle to comprehend. But even if we grant the possibility of prenatal influences, the question is whether the best way to bring psychological healing to individuals struggling with their gender identity is to have a sex-change surgery.

At the present time it is not known whether the psychological effects of sex-change surgery are beneficial or permanently damaging. We do know that any type of alteration to our human body impacts our emotional well-being in one way or another. Sexual identity is not independent of the body, or to be restricted to human anatomy, but goes deep into the human psyche. In fact, our identity is to a significant extent determined by our gender. We are meant to be an undivided sexual entity. When it is claimed that some individuals do not have an integrated sexual identity because the inner identity differs from the sexual identity provided by their sexual organs, we face a serious type of psychological dichotomy. This deep psychological disturbance or brokenness reveals one of the damaging effects of sin on humans. No one can confirm that the psychological anomaly is overcome through sex-surgery. This is a case in which the treatment could psychologically disturb the patient even more.

There is insufficient data to define the extent of the damaging effects that constant hormone therapy could have on the physical well-being of the person. In fact, it could be argued that since the person who undergoes a sex-change surgery has to use hormones for the rest of his/her life, an integrated sexual identity is not achieved through the surgery. The individual lives and struggles with the psychological condition the rest of his/her life. Hence, the surgery never totally solves the problem. What aggravates this situation is the fact that surgery is irreversible but people may change psychologically with growth and maturity. Since the gospel proclaims freedom from the enslaving power of sin and its effects in our lives, we feel that the church should not advocate that specific type of radical and irreversible physical sexual change. At the same time, the church should demonstrate care and regard toward those who struggle with this most disturbing issue.

It would appear that in some cases of sex-change surgery, we may be dealing with a more sophisticated case of homosexual behavior. According to Scripture, the satisfaction of sexual drives is to take place within certain parameters, that is between a man and a woman who have been united in sacred matrimony. Undergoing sex-change surgery in order to satisfy a homosexual urge to have sex with a person of the same gender would not resolve the ethical and moral biblical perspective on homosexuality.

Finally, the Scriptures call humans to control their emotions and passions by bringing them under the Lordship of Christ. Sexual drives are not to be simply satisfied on the ground that since they are considered to be normal or natural we should let nature run its course. Sin and evil have corrupted human sexuality. Therefore self-discipline is indispensable in bringing it under subjection to biblical values and principles. This would require, even from those who may want to have a sex-change surgery to heal their brokenness and not because of homosexual concerns, to learn living with the condition of a perceived or real dichotomy in their sexual identity. Self-control on sexually related matters applies to all those who want to live a holy life before the Lord. So, for instance in the case of single individuals, it would mean abstention from premarital sexual intercourse, and in the case of a married person abstention from extramarital sexual affairs. Should humans seek to find in sex-change surgery a way of circumventing the biblical principles dealing with human sexuality and the proper way to satisfy it, they would be acting against God’s revealed will. The church must remain loyal to its commitment to the will of the risen Lord as revealed in the Scripture, while displaying love and understanding to all.

*This position paper was discussed with a number of Adventist theologians and benefited from input given by medical practitioners. Nevertheless the author is responsible for its content.