How do Protestant Christians explain gender dysphoria/transgenderism? The Scripture mentions homosexual practises a lot but Scripture seems silent about transsexualism. 

This question is asking answers from a Protestant perspective preferably those who uphold the doctrine of Sola Scriptura of the Reformation. 

How do Protestant Christians explain gender dysphoria/transgenderism?
I will answer from the perspective of Evangelical Christianity (Reformed).

We Evangelicals believe that transsexuals have a disordered gender identity and is suffering from an extreme form of mental illness:


  Anyone who really believes he is a woman when he is a man (or vice
  versa) is profoundly, dangerously ill. 
  
  (Evangelical: The Transgender
  Phenomenon: Esther O' Reilly, 2016).


Gender dysphoria (DSM-5, 2013) is the mental distress that comes from gender incongruence experienced by transgenders both transsexuals and some of the intersex. 

According to science, gender incongruence refers to the (normal) gender identity mismatching the genetic sex. Gender identity is one's gender according to one's sense of the self whilst the genetic sex refers to one's chromosomal sex (XX- female, XY- male) and its phenotype, its outward expression such as appearance of the body and the genitalia.


  "The researchers identified a region of the hypothalamus, known as the
  bed nucleus of the stria terminalis (BSTc), as being responsible for
  sexual behaviour. This area is always larger in men than women.
  However, in their study of six MTF GID sufferers, a female‐sized BSTc
  was present in all subjects. Additionally, the size of the BSTc was
  not influenced by taking sex hormones in adulthood. This implies that
  these individuals had a powerful biological force compelling them to
  be female, rather than just a psychological conviction" (Nicola Tugnet
  et al. 2007).


According to science, the most effective treatment for Gender Dysphoria is the combination of medical therapy (hormones and suyrgery) and psychiatry. 


  Gender reassignment (which includes psychotherapy, hormonal therapy
  and surgery) has been demonstrated as the most effective treatment for
  patients affected by gender dysphoria (or gender identity disorder),
  in which patients do not recognize their gender (sexual identity) as
  matching their genetic and sexual characteristics (Selvaggi G, 2011).


Intersex peoples equally blurred the lines of the gender binary and much more so than transsexials because their sex was more deviant than the transsexual whose only deviance is either psychiatric or brain physiology. 


  According to research conducted by Anne Fausto-Sterling of Brown University, one in 100 children are born with “bodies that differ from
  standard male or female” biology. This includes those children born
  with both a penis and a vagina, as well as those with vaginal
  agenesis, ovatestes, or genetic disorders such as Klinefelter
  syndrome. Apparently, God sometimes creates humans both male and
  female or neither fully male nor fully female. Intersex persons offer
  a critique of those who believe that gender is a static binary
  assigned from birth and divinely ordained. For example, what about a
  person who is a sexually “mosaic,” which means they have mixed gonadal
  dysgenesis such as the development of both ovaries and testes? It’s
  hard to say because Christian commentators almost never acknowledge
  the existence of these individuals


The Bible itself is sufficient to address our topic (2 Timothy 3:16-17).


Romans 1:20-26

Romans 1:20-26 contain inspired texts of Scripture. In it, Paul had taken steps to condemn the practises common to the roman world of his time but that which argument is so general that its applicability encompasses all generations including that of ours in the 21st century. Paul is alluding Genesis creation in his argument saying that homosexual practices is in the same standing as idolatry (worshiping of idols, image of creatures according to context) because they deviate from the original design. 


The teachings of Paul is as follows: 

The gender binary (male and female) is the only truth. Romans 1:18

The gender binary is evident, obvious and can be clearly seen. The outward phenotype of the gender binary. Romans 1:20

To believe  gender expression other than the gender binary is to fail in honoring and giving thanks to God. Accepting the other-gender expression is said to be unintelligent since knowing God is knowing his design which is the correct knowledge to uphold by all. There is no wisdom (practical application of knowledge) in such a way of thinking since wisdom is created* by God, that is, his design is all-wise (note Proverbs 8:22-25). Romans 1:21-22

They gave honour to the images of creatures instead of honouring God. Romans 1:23

In such state, God allows them to become  lustful, dishonouring their bodies (as it experience sexual intimacy against the original design per 26-27). Romans 1:24

(i). Because they deny that only the gender binary is the truth and (i).  because they worship idols of the roman pantheon. Romans 1:25

God allows these people both male and female to practise homosexuality which is (i). Degrading passions (ii). indecent acts. Romans 1:26-27

Those who practise these things are like the other people who do improper things. They deserve to die -- both the one who practises and the one who supports such practise Romans 1:28-32

For Paul, the very essence of gender is in the phenotype ("clearly seen") of the sex per Romans 1:18-27. This is understandable as the concept of genetic sex (chromosomes) is unknown in the first century A.D. and thus, the ancients can only refer to what is visible.  

Jesus spoke about people "who do not marry" and they are the eunuchs (Matthew 19:12) and Jesus classified them in great detail as (i). naturals eunuch, (ii). man-made eunuchs and (iii). voluntary eunuchism. The second type of eunuch is condemned in the Old Testament but is now blessed by Christ. The natural eunuchs might be those born with genital defects (i.e. transex/hermaphrodites ) and thus, Jesus was insisting on the design of God revealed in the genesis account in that marriage is only for those with the normal physique of the gender binary (Matthew 19:4-6). Why would Christ proscribe this for the natural eunuchs? Due to lack of capability of procreation and most manifestly, due to deformity (alien to the original design -- referring again to Romans 1). In this sense, Christians who strictly follow the Bible should deny marriage to the intersex. 

What if the intersex had reconstructive surgery making their genitalia appear "normal"?

Jesus and Paul refers to phenotypic sex in their anthropological  theology. This is all what Biblical data gives us.  We should arrive at our conclusions very carefully with Scripture about medicine for us to decide as we do have authority to judge these things (1 Corinthians 6:1-5). 

If the procedure is said to be safe and effective, then Scripture could support the intersex undergoing medical treatment and be eligible for marriage. 


1 Corinthians 6:9


Arsenokites - practising homosexuality (NETBible)

Malakoi - effeminate (KJV), catamites (NKJV)

Arsekoites alludes to Levitical Law of Homosexual practise as sinful. 

Malakoi - might historically refer to the passive man in homosexual act. Or effeminate behaviour of a man. 

Arsenokites should be interpreted in light of Romans 1:18-27 where homosexuals are not using their phenotypic sex in agreement with the original design. 

Malakoi is indeed referring to the outward expression of sex. Apparently, Scripture teaches that males should conform to society's standards and practises of masculinity (having authority over the wife, not having long hair, not wearing female clothing etc.). 


Other texts 1 Timothy and Jude reiterated these points. The Genesis
account of Sodomy (raping men anally) is obviously a sin for it is
not only homosexual acts but coercive. Two types of sins at that.




We have discovered from Scripture that (1) phenotypic sex is the only basis of determining true gender, and (2) phenotypic gender should match behaviour and it means behaviour should conform to one's phenotypic sex. If male outwardly, be male outwardly. If female outwardly, be a female outwardly. Homosexuality, Gender Dysphoria and Intersex are all deviating from the gender binary  design of God but only Homosexuality is sin per se. Gender Dysphoria is a mental disease and not a sin and it needs paychological treatment not physical mutilation. To follow the world in the hormone therapy and sex change operations for Gender Dysphoric is to be in sin. The Intersex is also not a sin as it is correctly identified as eunuchism. An intersex who enters marriage will be in sin per Matthew 19. 

   biblical exegesis      

    

Reformed Evangelicals encourage the gender dysphoric patient to seek counselling from Christian psychiatrists. There are reported gender dysphoric who de-transition albeit suppressing their innate gender identity. There are others who continue to transition whilst receiving (yet righteous) judgment from other Evangelical Christians that they have been in Apostasy. Still, other transgenders received love and compassion despite their transitioning due to gender dysphoria clearly a mental disease. Those Evangelical Christians are hoping and praying that God will change these people with gender dysphoria  in his own timing. And that at the resurrection, our bodies will be conformed to the image of His glorious body, free from carnal defects of any kind. 

The intersex (Hermaphrodite) in Christian fellowship 

The ancient Church had no understanding of genetic sex and it is a novelty that is available now to God's people. Such a wider understanding influences our modern day Reformed Evangelical churches. 

We see from two well-known Reformed Evangelical sites online: (i). Got questions.org and (ii).  CARM ,  about how Evangelicals  view the intersex:


  Transsexualism, also known as transgenderism, Gender Identity Disorder
  (GID), or gender dysphoria, is a feeling that your
  biological/genetic/physiological gender does not match the gender you
  identify with and/or perceive yourself to be.
  Transsexuals/transgenders often describe themselves as feeling
  “trapped” in a body that does not match their true gender. They often
  practice transvestism/transvestitism and may also seek hormone therapy
  and/or gender reassignment surgery to bring their bodies into
  conformity with their perceived gender.
  
  The Bible nowhere explicitly mentions transgenderism or describes
  anyone as having transgender feelings. However, the Bible has plenty
  to say about human sexuality. Most basic to our understanding of
  gender is that God created two (and only two) genders: “male and
  female He created them” (Genesis 1:27). All the modern-day speculation
  about numerous genders or gender fluidity—or even a gender “continuum”
  with unlimited genders—is foreign to the Bible.
  
  The closest the Bible comes to mentioning transgenderism is in its
  condemnations of homosexuality (Romans 1:18–32; 1 Corinthians 6:9–10)
  and transvestitism (Deuteronomy 22:5). The Greek word often translated
  “homosexual offenders” or “male prostitutes” in 1 Corinthians 6:9
  literally means “effeminate men.” So, while the Bible does not
  directly mention transgenderism, when it mentions other instances of
  gender “confusion,” it clearly and explicitly identifies them as sin.
  
  What about the possibility that those suffering with transgenderism
  have a brain that functions as one gender while the rest of the body
  is biologically the other gender? The Bible does not even hint at such
  a possibility. However, neither does the Bible mention hermaphroditism
  (a condition in which a person has both male and female sexual
  organs), which undeniably occurs (although extremely rarely). Further,
  people can be born with or develop all kinds of different brain
  defects or malfunctions. How can it be said that it is impossible for
  a female brain to be in a male body (or vice versa)?
  
  With hermaphroditism as evidence, it cannot be said that if the Bible
  does not mention something it does not occur. So, it might be possible
  for a person to be born with a brain wired in such a way that it
  contributes to gender dysphoria. This could also be an explanation for
  some instances of homosexuality. However, just because something might
  have a biological cause does not mean embracing the effects is the
  right thing to do. Some people are wired with a sexuality on
  hyper-drive. That does not make it right for them to engage in sexual
  immorality. It is scientifically proven than some
  psychopaths/sociopaths have brains with severely weakened
  impulse-control mechanisms. That does not make it right for them to
  engage in every deviant behavior that crosses their minds.
  
  No matter if the gender distortion has a genetic, hormonal,
  physiological, psychological, or spiritual cause, it can be overcome
  and healed through faith in Christ and continued reliance on the power
  of the Holy Spirit. Healing can be received, sin can be overcome, and
  lives can be changed through the salvation that Jesus provides, even
  if there are biological/physiological factors. The Corinthian
  believers are an example of such a change: “And that is what some of
  you were. But you were washed, you were sanctified, you were justified
  in the name of the Lord Jesus Christ and by the Spirit of our God” (1
  Corinthians 6:11). There is hope for everyone, transsexuals,
  transgenders, those with gender identity disorder, and transvestites
  included, because of God’s forgiveness available in Jesus Christ.


(What does the Bible say about the various forms of gender dysphoria? Got.questions.org) (source: https://www.google.com/amp/s/www.gotquestions.org/amp/transsexualism-gender-identity-disorder.html)


  The Bible does not address this issue because it was not around at the
  time.  But, No, sex change operations are not okay.  God created
  people as male and female (Gen. 1:27).  People are ordained by God to
  be male or female because it is He who forms them in the womb:
  
  Isaiah 44:2, "Thus says the Lord who made you and formed you from the
  womb, who will help you, Do not fear, O Jacob My servant; and you
  Jeshurun whom I have chosen." Isaiah 44:24, "Thus says the Lord, your
  Redeemer, and the one who formed you from the womb, 'I, the Lord, am
  the maker of all things...'" Therefore, to change the gender of a
  person through an operation is a violation of the natural birth gender
  that God has ordained for the person.  It also violates the
  distinction of those attributes which designate a male from a female. 
  Furthermore, if, for example, a male becomes a woman and has relations
  with a male, then this would be homosexuality another sin clearly
  forbidden by scripture.
  
  If anything, this sexual identity dysfunction is due to sin in the
  world.  Transsexuals (those who have changed sexes) and claim to be
  Christian cannot appeal to the problem of a "biological goof" due to
  sin in the world.  It is due to sin, and its effects that such an
  issue of transsexualism even exists and an appeal to a sinful state
  should never excuse further sin.
  
  Nevertheless, we are not to abandon the transsexual.  Even though the
  person is in sin, the transsexual is still a person in need of full
  redemption, love, grace, and kindness.  We do not convince someone to
  repent by condemning and accusing.  Rather, they need to see the love
  of Christ in us so that His presence might convict and convince them
  of their sin.


(Are Sex Change Operarions Okay? CARM, Matt Slick) (Source: https://carm.org/sex-change-operations)

The new perspective of the 21st century church is genetic sex as the main identifyer of one's real gender. Such a shift in understanding is an influence of modern biological science in which the DNA sequence contains genetic instructions on how we should look like, what gender we are going to be and even to a limited extent on how we would behave. All of these in light of the concept of free will. And so affirming the dualism of body and soul. 

Therefore, the Intersex is allowed the sex change operation provided that the Intersex suffers (i).  gender dysphoria, (ii). Has genetic incongruence. 

On the other hand, the Transsex is not allowed the sex change operation because of (i). gender dysphoria without genetic incongruence. 

The judgment made by our bishops and pastors in Evangelical churches about the transex is a novelty at best. It is a product of wisdom given by the Holy Spirit. 

      

Based on the Evangelical ethics on the Intersex and Transex, The transsex who suffers gender dysphoria must have chromosomal tests to determine if genetic incongruence exists. 

If it is proven to be the case, 

(i). Sex change operation is warranted

If not,

(i). Christian psychiatrist must be consulted. 

This is the current standard of Evangelical churches nowadays. 

        ?

Based on Evangelical Tradition, the following should be followed by the Christian patient with gender dysphoria.

(i). Discouraging from Transitioning to the opposite sex. Citing Scripture that phenotypic sex is the end and citing tradition that genetic sex supports this phenotypic sex. 

(ii).Counselling by a Christian Psychiatrist

(iii). Antidepressant drugs to off-set the depressive symptoms of Gender Dysphoria

(ix). Practise of Celibacy 

(v). In most cases, suicidal gender dysphoric patients will end up dying. Within Evangelical point of view, this is similar to the concept laid out in Scripture: "the destruction of the flesh, so that his spirit may be saved in the day of the Lord" (1 Corinthians 5:5). And thus, their death prevented them from further sin and pleases the Lord (Psalm 116:15). 

    . 

Should the transex also be given medical treatment of gender transition since they have genetic sex (female brain) that is not matching their phenotype (male)?  

Intersex (e.g. XX male intersex)
Gender identity - female
Genetic sex - female
Phenotypic sex - male

Transex (e.g. transgender woman)
Gender identity - female Genetic sex - chromosome XY (brain, female per 2009 study)
Phenotypic sex - male

In my analysis of current Evangelical consesus, they should allow gender dysphoric Christian patients to transition medically to the opposite sex since the argument on genetic chromosomal  sex encapsulates the genetic brain physiology too as both arguments have their basis in the biological gender binary expressed in the DNA. 

Strictly following Scripture, sex change operation to both transex and intersex shall not occur since Scripture honours phenotypic sex as final teaching on gender without regards to DNA analysis. And that celibacy is mandatory to these people. Their gender dysphoria should be dealt with by prayer and mere oral or intravenous anti-depressant medications. Suicides in this patients (as high as 50% among the population)  are inevitable and does not reduce the glory of God. 

  

Gender dysphoria is a complex issue. Evangelical Christians ,people themselves, will be torn with such a painful problem if experienced first hand or felt through closest loved ones. Naturally, we do not want to compromise our faith but we also do not want our transsex/intersex fellows to suffer pain and to die because of gender dysphoria. Current medical science offers medical transition for gender dysphoric patients as the most effective treatment. Scripture does not seem to accept this concept of medicine based on the Mosaic Law on gender being upheld by the Apostle Paul and our God,  Jesus Christ. The insight of certain Evangelical bishops, pastors and doctors that transition is appropriately allowed by God to those with "genetic gender incongruence" is secondary to Scripture but it does hold authority since it is based on careful analysis of the Scripture appealing to the ancient Chist-centric concept of "  " , such an instance occurred when Jesus heals a man on the Sabbath day. The reservations to gender dysphoric with minor elements of genetic gender (brain physiology versus chromosomal) needs to be addressed by Evangelicals in their churches.Some evangelicals already accepts sex change surgery as a last resort:


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