In the quiet of a clinic, a Christian physician faces a challenging ethical question. A patient sits across the desk, requesting referral for gender reassignment surgery. The doctor’s heart is moved by genuine compassion for someone in stress, yet a deeper question haunts the moment: What does faithfulness to Christ look like in this situation?

The scenario confronts Christian medical professionals with increasing frequency, forcing them to navigate between cultural pressures and biblical convictions. The stakes are high—not just professionally, but spiritually. How we answer reveals what we truly believe about God’s design, human nature, and our calling as healers.

 

THE FOUNDATION: GOD’S DESIGN FOR HUMAN NATURE

Scripture speaks with remarkable clarity about human sexual identity. Genesis 1:27 declares God “created mankind in his own image, in the image of God he created them; male and female he created them.” This isn’t merely a biological description—it’s an emphatic theological declaration. The binary nature of human sexuality is woven into the very fabric of what it means to bear God’s image.

The design isn’t arbitrary or culturally imposed. When God surveyed all His creative work, including the male-female distinction, He declared it “very good” (Genesis 1:31). The Psalmist echoes this truth: “I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well” (Psalm 139:14). Our bodies aren’t cosmic accidents requiring correction, but divine masterpieces deserving reverence.

Reformed theology also emphasises the unity of body and soul. We aren’t spirits trapped in material shells, but integrated beings where physical and spiritual reality intertwine. This means our biological sex isn’t mere external packaging, but integral to our identity as image-bearers. To surgically alter this design treats the body as fundamentally flawed rather than fundamentally good.

The apostle Paul reinforces this perspective: “Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honour God with your bodies” (1 Corinthians 6:19-20). Medical intervention to heal disease honours this principle. Fundamental alteration of healthy reproductive organs, however, does not.

 

THE PROBLEM: SIN’S EFFECT ON UNDERSTANDING

Why do we struggle with these truths? Romans 1:21-25 provides the answer. Sin doesn’t just corrupt our actions—it corrupts our thinking. When we “suppress the truth,” our foolish hearts become darkened, and we exchange the truth of God for lies. This includes lies about our own nature and identity.

The Reformed tradition has long recognised sin’s noetic effects—how fallen thinking clouds our understanding of reality. What feels true to us may not align with what is actually true according to God’s design. This is why Scripture, not subjective experience, must serve as our ultimate authority.

The Westminster Confession reminds us Scripture is “the rule of faith and life.” In ethical matters like this, we cannot rely on autonomous human reason or cultural consensus. We need divine revelation to correct our fallen perspectives and guide our decisions.

This doesn’t diminish our compassion for those experiencing gender dysphoria. Rather, it helps us understand the solution isn’t found in conforming reality to disordered desires, but in aligning our understanding with God’s perfect design through His grace.

 

THE CALLING: CHRISTIAN MEDICAL ETHICS

Christian physicians face unique challenges in this cultural moment. The medical establishment increasingly treats gender reassignment surgeries as standard care, creating professional pressure to comply. Yet our primary calling transcends professional expectations.

Paul instructs us: “Whatever you do, whether in word or deed, do it all in the name of the Lord Jesus” (Colossians 3:17). This means every medical decision must pass through the filter of Christ’s lordship. Can we honestly perform procedures that contradict God’s design “in the name of the Lord Jesus”?

The historic Hippocratic principle of “first, do no harm” supports this position. Growing evidence suggests significant long-term psychological and physical complications from gender reassignment procedures. The distinction between therapeutic intervention (healing disease) and non-therapeutic alteration (changing healthy function) is crucial for maintaining medical integrity.

Christian physicians can demonstrate genuine compassion without compromising conviction. This includes providing mental health support, addressing underlying psychological distress, offering spiritual care, and making appropriate referrals to counsellors who can help patients process their struggles within a biblical framework.

 

THE HOPE: GOSPEL TRANSFORMATION

The gospel offers what surgery cannot: true identity transformation. Paul declares, “If anyone is in Christ, the new creation has come: The old has gone, the new is here!” (2 Corinthians 5:17). Our deepest identity isn’t found in subjective feelings about gender, but in our relationship with Christ.

This doesn’t promise instant resolution of all struggles. Sanctification is a process where we gradually align our thinking and living with God’s truth. But it does offer genuine hope that transcends surgical solutions—hope rooted in God’s power to transform hearts and minds.

 

MOVING FORWARD IN FAITHFULNESS

Christian physicians must courageously maintain this position despite cultural pressure. Love requires truth-telling (Ephesians 4:15), even when truth is unwelcome. Professional licensing boards and colleagues may object, but our ultimate accountability is to Christ.

The church must support these faithful physicians through prayer, encouragement, and advocacy for conscience protections. We must also provide robust pastoral care for those struggling with gender dysphoria, offering hope and healing that are found only in the gospel.

Our calling is clear: trust God’s wisdom over human wisdom, Scripture’s authority over cultural accommodation, and Christ’s design over personal desire. In doing so, we honour both the Creator and those created in His image, pointing toward ultimate restoration in Christ.

 

GENDER REASSIGNMENT SURGERIES: RELATED FAQs

What do Reformed scholars say about gender reassignment surgeries? Carl Trueman, in The Rise and Triumph of the Modern Self, argues transgender ideology represents the culmination of expressive individualism that prioritises psychological self-perception over biological reality. He contends this undermines the Christian understanding of embodied identity and God’s created order. Rosaria Butterfield emphasises the church must distinguish between experiencing unwanted feelings and acting on them, advocating for pastoral care that affirms biblical anthropology while showing Christ-like compassion. Both scholars stress the gospel offers better hope than surgical intervention.

• How should Christian doctors handle insurance coverage questions for these procedures? Ethicists generally argue Christian physicians should not facilitate insurance claims for procedures they believe are harmful and contrary to God’s design. This includes declining to provide diagnostic codes or referral letters that would enable coverage for gender reassignment surgeries. However, they can assist with coverage for legitimate mental health counselling and pastoral care. Some suggest physicians should transparently communicate their position to patients upfront to avoid later conflicts over insurance matters.
• What about intersex conditions—don’t these prove gender isn’t binary? Scholars distinguish between disorders of sexual development (intersex conditions) and transgender identity claims. Intersex conditions are medical anomalies affecting approximately 0.018% of births, representing deviations from the male-female norm due to the fall, not evidence against God’s binary design. These rare conditions require medical intervention to restore proper function toward the intended male or female design. In contrast, transgender surgery alters healthy, properly functioning reproductive systems based on psychological distress rather than physical abnormality.

Can a Christian doctor refer patients to colleagues who will perform these surgeries? Reformed ethicists would argue referral for procedures you believe are harmful constitutes formal cooperation with evil, making the referring physician morally complicit. Albert Mohler and others contend Christian doctors should instead refer to biblical counsellors or psychiatrists who won’t immediately affirm transition but will address underlying psychological and spiritual needs. However, they can provide general mental health resources and maintain caring relationships while clearly explaining their ethical boundaries.

• How are we to view hormone therapy versus surgical procedures? Reformed scholars generally oppose both, but recognise degrees of intervention. Cross-sex hormones, while less invasive than surgery, still attempt to override God’s biological design and can cause significant health complications including sterility, cardiovascular issues, and bone density problems. Some argue hormone therapy may be even more concerning because it’s often the gateway to surgical intervention and is increasingly given to minors. The underlying theological problem—rejecting God’s design for embodied identity—remains the same regardless of the intervention’s invasiveness.
• How do we address the argument that these surgeries help prevent suicide? Scholars like Kevin DeYoung challenge the suicide prevention argument as both empirically questionable and ethically flawed. They point to studies showing continued elevated suicide rates post-transition and argue that other psychiatric conditions with suicidal ideation aren’t treated by affirming the patient’s distorted self-perception. Biblical counsellors emphasise lasting hope comes through gospel transformation, not body alteration. They advocate for comprehensive mental health care that addresses underlying trauma, depression, and spiritual needs rather than immediately affirming transition as the solution.

What guidance do Reformed ethics offer for Christian medical students facing this in training? Reformed educators encourage medical students to research programs’ positions on these issues before applying, seeking institutions that respect conscience rights. During training, students should clearly communicate their convictions to supervisors while demonstrating competence and compassion in patient care. Organisations like the Christian Medical and Dental Associations provide resources and mentorship for navigating these challenges. Some Reformed advisors suggest students consider specialties less likely to encounter these situations regularly, though they emphasise that faithful Christians are needed throughout medicine to be salt and light.

 

GENDER REASSIGNMENT SURGERIES: OUR RELATED POSTS

• Gender-Affirming Care: Is It Really Good For Our Children?
• Preferred Gender Pronouns: Do We Give In to Culture’s Demands?
• What’s Wrong with Transgender Ideology: A Christian Perspective
• My Body My Choice’? What Does Scripture Actually Teach?
• Can God Condemn Homosexuality Even If Some Are Born Gay?
• Gender in Heaven: Will We Keep Our Identity in the Afterlife?