Dialogue between an evangelical Christian leader and a person who has transitioned
These notes arose out of an extended dialogue between two people of Christian faith, with in some ways different theological convictions, and a genuine desire on the part of the Christian minister to understand better how a local church could welcome and support people who suffered from acute gender dysphoria who may be going through gender transition. We also discussed the needs of families of trans people.
PASTORAL CARE OF TRANS PEOPLE
AND THEIR FAMILIES
Twenty Six Issues:
1. The term 'trans' covers a range of people from those who physically transition with surgery, to those for whom it is a matter of feeling free to express gender without stereotypes, to gay guys in the whole (often camp) 'drag' culture, as well as people who don't particularly identify as one or other in a gender binary.
I write from the category of those known as 'transsexual' because their gender dysphoria and distress grows so great that they alter their genitalia. Their internal gender stays the same but they alter their bodies with hormones and surgery to make their bodies congruent with how they feel internally and who they experience themselves to be. So the first thing is to understand that not all trans people are the same. This extends to 'identification'. A trans person may show up at your church and 'self-identify' that they are female or male. Another trans person may have had that established by medical authorities and may have a Gender Recognition Certificate. Some trans people may have altered bodies. Some may not.
2. Gender identity is not the same as sexual orientation. For many trans people it's not about sex, and the huge issue is just their sense of identity in their brains. It's not primarily a sex thing, though like anyone else they may or may not have a sex life. But that's not the thing.
3. For a transsexual person, transition is not some hedonistic lifestyle choice: it is a profound psychological distress, that needs help and mercy. How can a church community offer help?
4. The best way to understand trans people better is to actually meet them, and live alongside them, and talk with them - but beware asking lots of intrusive questions about their genitals... because how would you feel if someone started asking intrusive questions about yours?
5. When a person transitions they may well experience abuse on the street, or worse still violence. Some friends will abandon them. They may feel loneliness and vulnerability, at least to begin with. For this reason, a church should go out of its way to make sure - regardless of doctrine - that they offer 'safe space' and welcome. Better still is a church community who gets alongside a transitioner and says, we don't understand everything, but we will make this journey with you, and you matter, and we care. In the loneliness and isolation that sometimes characterises early transition, that compassion and belonging can be huge.
6. Trans people may well have families, and that may involve family conflict, or sadness, or anger. A partner may feel humiliated, and may feel their own identity and sexuality challenged and subverted. It can be dreadfully raw. Children of a trans person deserve counselling and good youth leaders can be invaluable. It is not just a matter of the trans person thinking it's about 'me-me-me'. There are very hard decisions for a local church to make, but as with other marital crises it is important to try not to 'take sides' but to simply be pastoral. However, given doctrinal beliefs that church members may have, they may need to guard about not solely siding with the non-trans partner, and vilifying the trans partner. A hard decision may have to be made to suggest the transitioning person moves to a different church, because of the sense of shame and embarrassment their partner or children may feel. That said, some families do stay together, but none of it will be easy.
7. Another growing issue is when teenagers choose to transition and their parents don't agree with it. This can be an issue at school. In a church situation there is an obvious case for leaders to call in the parents and confer. If a teenage trans boy or girl is not allowed self-expression at church, bear in mind that they may walk away, and might not come back again. Having said that (and I say this with my experience as a school nurse), be aware that a growing number of teenagers are exploring their gender identity at school, and for some that's where it ends - just part of growing up and working out who they are - so I advise: don't encourage them, just give them space, give them time, and give them respect. My experience is that 3 out of 4 will explore and then resume life in the gender they grew up with. I don't deny some teens cross-dress, or go non-binary, as a 'fad' or 'copycat' thing. Given time, those teens may well give it up. But there are some people who are deeply distressed by gender dysphoria, such that it needs to be treated as a crisis condition, and medical/psychological support may be vital. Please bear in mind, particularly with that category, that they can be subject to suicidal ideation. A church needs to handle all these young people with great care, consultation, prayer, and compassion.
8. One of the most hurtful things that can happen in church is distancing, and cold stares. I say that from experience. But... some of that is understandable, If a trans person attends a church, the church community needs help and care as well. For some people this is quite a new thing. They may well feel anxious of not 'getting things right'. What pronouns should they use? etc etc. So it's fair to point out that people may mean well, and not want to exclude, but may feel very uncertain, and maybe insecure, and use avoidance out of fear of getting things wrong. For this reason...
9. In some cases, if a person transitions, the trans person could be invited to talk and explain to people about the situation, and answer some questions. However, again, there may be family issues in doing that. But it is a possibility. Another possibility is to get in a speaker who can talk more objectively to try to inform and explain.
10. Faith may be really important for trans people, just as it is for other people. God may be the deepest support for trans people. Try to see past the transition stuff, to the person. Their faith can still be real and authentic. It's easy to fall into the trap of judging. Having said that, there may be issues over roles for a fairly 'conservative' church to consider. Would it be acceptable for a trans adult to help lead a youth group? Or preach? Or lead prayers? Or read the lesson? And so on. Obviously as a trans person myself, I would argue 'just include'. It would be great if church leaders said, "Okay, you're trans, I see that, but how would you like to help us? What skills do you have?" But I do understand that if transition goes contrary to what a church teaches, then it may not be the same for all churches. One big lesson I've learned in my transition journey (to daily life in a gender I now take for granted) is how important it is that people show me respect not abuse, but also, that if I want respect then I should try to show respect to other people if they don't agree with me. My own view is that if some Christians just don't believe (after study and prayer) that transition is right, then their conscience on that should be respected (and protected) but the minute they also abuse or are unkind, they cross a line. Respect for conscience works both ways. And compassion is always a component.
11. I appeal for Christians not to succumb to the most visceral 'hate' shown to trans people in some media outlets, which can descend to vicious prejudice, often weaponising trans lives for political and populist reasons. The vast majority of trans people are not a threat to anyone. They are just living their lives (I'll come to that in point 12). There are as many dangerous people who are not trans, but that doesn't make any of you dangerous. Yet the media tries to paint trans women as a threat on a woman's hospital ward or in lady's toilets. No, they are just sick and in bed. Or just needing a pee, like anyone else. Just being a human being.
12. The so-called 'Trans Lifestyle.' For most people transitioning they just want to lead normal lives (at last, set free from gender dysphoria). It's not something kinky, it's not fetish, or pornographic. It's waking up, making breakfast, washing up, going to work, shopping at lunch, doing more work, avoiding the rain, getting home, turning on the oven, doing the ironing, taking the washing out of the washing machine, maybe phoning a friend. I trust you get the point being made. It's just normal life. And that's the whole point. That's what a transsexual person wants. That's the whole point about transition. To make life easier to live. Happier. More at ease.
13. People say that if you transition you will regret it. Most people don't. At least, not the transition itself. You may deeply, deeply regret that it had to come to this, because of impact on people you love, but over 90% of people who go the whole way through surgery (according to one European study) are happier than before, and don't regret having surgery. Of the remaining people, some are disappointed with the cosmetic appearance at the end, some have other life issues that make things desperate, and a very small number wish they hadn't gone through with the surgery. Speaking for myself, I cannot tell you how it transformed my well-being psychologically. After years of terrible self-harm, and the hard-to-describe pain of gender dysphoria, like an elephant in the room whatever I was doing... within weeks of dealing with it, the self-harm ended, and though there was bitter emotional sadness about the effect on others, in the past 14 years I have found happiness and peace at last. And grown as a person, I hope, and re-trained as a nurse, and at last it's not all about gender, gender, gender... it's just living and feeling congruent, and hopefully leading a productive life.
So please, in getting alongside someone at church thinking about transition, by all means help them think through the relationship consequences of such a decision, but don't try to say they will be 'mutilated', or 'broken', or that they will inevitably regret it. In most cases they won't. And in a sense, adults all have to take responsibility for their choices medically - they always do... you might choose to have an op on your knee, but the outcome may not always be better. So I don't think 'You may regret it' is sufficient to argue against it, when so many people actually get set free to find such happiness and an end of the psychological torment.
14. A gift to the Church? We read in the Bible that sometimes God is found in the people who need our help and kindness. People who may seem marginal or 'other' than us, remain incredibly precious to God, may help the church community grow in faith, may be loved in community, may bring gift to community. 'Who is my neighbour'? Whatever the doctrinal position you hold, be aware that God may be found in people it's easy to write off. So there may be gain for a church in welcome and care, not just a problem.
15. Pronouns. I've heard it said that 'we should be allowed to call a trans woman "he"... if that's what we believe'. That will almost certainly be pastorally disastrous. I would urge people always to show respect (and toleration if needed) to use the pronouns that the person identifies with. To refuse, and deliberately go against that, risks frankly being a bit of an ass. It's a self-indulgent action that may knowingly cause distress and may alienate a person from church altogether. I wouldn't stay in a church if people were allowed to do that. It would be impossible. Just please be aware how sensitive pronouns can be. Having said that, if it's just an honest accidental slip up - that's different. Same with accidentally calling someone by a name in another gender you used to know them as. My own brothers slipped up like that for a year or two. It's habit. But at least try to show sensitivity.
16. Toilets. Let's try to be grown up about this. All people need them for is to pee. Trans people have been allowed to use the toilets of the gender they identify as for many years, and legally since 2010. My advice is to respect a person's gender and just let them get on and pee. I suppose if your church has disabled toilets you could invite a trans person to use those. That would be quite a statement of mistrust but personally I'd shrug and comply, because is having a pee such a big issue? But what a church should never do is tell a transwoman to use the male toilets. That's pretty much out of the question for a trans person, and you may as well show them the door. That trans person is unlikely to return. I wouldn't. A person just needs to pee because they are a human being. Treat them like one. As a nurse, I've been catheterising women, caring for them, washing them for years. And I can't go into a cubicle and pee?
17. Clothes. Being transsexual is not all about clothes. In fact, like almost all women, I just wake up each day and put them on. Now you may have watched RuPaul Drag Race. I never have. It's not my thing. But to be clear, for drag artists, clothes are a camp 'performance'. For a transsexual woman, they are just part of going about your everyday life. Asking a trans woman not to wear female clothes (whatever that is, women wear trousers etc) is closing down welcome. It would be dominating and it would lack kindness. If you want to help a new transitioner, given that in early days a trans woman may have little experience or fashion sense, a kinder thing as a woman in church would be to befriend, and offer polite ideas.
18. Following on from getting alongside a trans woman on fashion etc, there is a wider opportunity to befriend and make welcome. Trans people can often feel isolated of excluded, so if there's a woman's group in church why not invite a trans woman to join in? That can really make that person feel respected and included. Under no circumstances direct a trans woman to men's groups or activities. Generally, most church activities aren't segregated by gender anyway, but trans women may very well value friendship with sympathetic women. Why not consider inviting a trans person for a coffee, a meal, or a chat?
19. Critical need at the start of transition. Please be aware that when transition kicks off, some trans people are in need of critical pastoral support and care. When hormones start to be used, they take time to stabilise, and this can lead to hormonal swings and emotions. In addition, there are huge decisions and changes. There may be hostility from family, friends, or strangers on the street. And yet surgery may still not take place for three years or more. So the gender dysphoria is now particularly acute, because you've opened yourself even more, but that accentuates the distress over the body you still have. There may be pressure at work, or over housing, and lacking experience an early transitioner may attract more street violence and abuse. This may lead to very dark thoughts or self-harm. It gets so much better. But at the start, a church should be very aware of the vulnerability some will have, and try to be watchful and protective of the transitioner.
20. Young people transitioning - in school. This is a particularly sensitive issue. Firstly, people worry that being taught about gender diversity at school, this may give young people ideas. Secondly, there is concern that a school might allow a student to identify in a way their parents do not know about. Personally I believe parents ought to be involved up to the age of 16. But a school still has to decide how they handle their students. Thirdly, what about other students? Is it fair to let a trans girl do girls' activities? At the very least, I would say it is kind. Having worked as a school nurse, with 1200 teenagers, some of them trans, I have to say that the vast majority of students support them, involve them, defend them. It's the same with gay and lesbian students. They are defended. Though there's a political debate on these issues, the culture among young people is prevailingly tolerant. So I argue for trans students to be given: respect, space, and time, to work through and explore who they are. I'd advise the same approach with church youth groups.
21. Young people transitioning - concerns about dangers. This aspect of teen transition is the most acute and deserves really serious thought. But it is not really about pastoral care at church, because the decisions are getting made elsewhere. But you may certainly want to reflect on them, because you may have very worried parents of trans youth in your church fellowship. The worry is that if a trans person proceeds through hormones and surgery, they may end up making decisions that are pretty much irreversible. But we need to stop there and be clear of the facts. To be prescribed hormones, a GP will first need to refer the young person to gender specialists. There is a huge waiting list for appointments, of at least 3 years. There will then be a further period of 12-18 months for the specialists to hold further appointments, and hormones are not prescribed right off. Following that, the young person may get referred to have gender surgery one day, if that decision is made. But 'one day' means another waiting list of years PLUS the surgery can't happen until the youth is 18. So there's nothing rushed about the process.
All that said, there is an understandable concern that the very act of starting the hormones may block puberty from happening, so the youth can't test whether they would have been alright in their birth gender in the end. Churches need to be aware of these concerns, because parents of trans children and teens have pastoral needs too. My intuition is that only 20-25% of teens who transition at school will end up fully transitioning and end up exploring surgery with a specialist.
22. Do churches actually accept trans people and support their transition? For some churches, in conscience they believe they cannot. There are a growing number of churches that are more affirmative about transition, but I'll be honest and say that you can be welcoming and pastorally caring, without believing what a trans person does is right. 'Conservative' churches can still care. For other churches, transition is affirmed - as it is in the military, in the NHS, in Law, in the GMC, in the Royal College of Psychiatrists, along with countless businesses and universities. Some churches can therefore go further than others in positively embracing a trans person's journey. My own priest/minister put it this way: "You are welcome because you bring gift to our church, and help us understand better, and open our lives more to diversity." Some churches will openly affirm a transitioner, by their new name, in a public church service, calling on the congregation to pray, love, and share in the person's journey. That is a huge thing for someone marginalised, or abused, or in vulnerable state.
23. Disagreements in the Church community. One of the challenges for leaders of a church is that there may not be uniform views about issues like transition. One reason why the leadership need to really inform themselves is that - the trans person aside - they may need to sensitively navigate the issue in the wider church setting. So church policy needs to be firmed up, with clarity over what happens (for example) if someone tells a trans person "You're just a bloke in a frock" or if they deliberately use pronouns that they know will cause distress. A church should above all avoid becoming a 'hostile environment' for trans people. It is to the great credit of the leaders of a large conservative and evangelical church that they are trying to inform themselves so they can work out how they believe God leads them on this issue of... truth, pastoral care, welcome, inclusion. They have resolved to use the pronouns an individual identifies with, to allow access to toilets that align with a person's gender identity, to refer trans people for counselling to diocesan specialists outside their own church, to involve trans women with women's groups, to befriend and involve trans people. To welcome them.
24. Prayer, Counselling, and so-called Conversion Therapy. This is an incredibly finely-balanced area. It's obvious that prayer should be encouraged, and that may extend to praying with a trans person. But prayer is not dictating dogma. It is being still before God and listening. It is seeking the One who loves and cares for us all. Counselling a person on their gender is frankly a delicate and specialist skill. The transitioner may be in danger of serious self-harm or worse. There are people who are trained and skilled in this field. There may be such people in your diocese. But there is also a danger that arises from 'amateurism'. I would just like to flag up that done wrongly, it can be incredibly dangerous and harmful. Prayer that focuses on God is always right, but that should not be weaponised to 'convert' someone out of being trans. I think that's what I feel. Ask God to love, to enfold, instead. The 'conservative church' I have engaged with, wisely in my view, has chosen a policy of restricting prayer for trans people to asking God to bless them, but avoiding any mention or suggestion in prayer or counselling of reversal of gender decisions. That is something to be explored professionally, but they have wisely recognised that it is complex and dangerous to go anywhere near what some people term 'conversion therapy'.
25. Confidentiality. A strong word of warning. Church fellowships can be a bit leaky when it comes to things being shared, if they get spread around as prayer requests. When a person is thinking about transition, that is a huge decision. It affects home. It affects relatives. It affects work. It affects their own emotional stability. Life is on the edge at that point, sometimes, tragically, literally. Before transition the struggles are incredibly private and sensitive. If shared, they need maximum confidentiality. Who really 'needs to know'? It's vital a trans person controls the time they come out about it all. Timing may be vital, because once the bridges are burnt, there can be chaos if not done carefully. It's all too easy to pass on information in the guise of asking for prayer. Be very very protective over this.
26. And lastly - when transition helps a person to flourish. A lot of what I've written touches on problems and sensitivities, but actually transition can open up who a person is, helping them find congruence and psychological ease. It can end self-harm that may have gone on for years. In the experience of many people who transition, it works. Their lives become more productive, their identity can open up and flourish, and they grow. They may grow in faith as well. I was enfolded by God in the crisis. God did not abandon me - absolutely the opposite. My prayer life came alive, and I grew with the love of Christian communities. They journeyed with me. I am so grateful.
I found myself able to just live a life without the decades-long conflict with my private body. I was no longer at odds with myself. And that helped me open up more to the Love of God. Before, the gender dysphoria was this huge thing, whatever I did, casting a giant shadow, painful, life-diminishing. But after, it just wasn't there. In its place, ordinary life, and fuller 'aliveness' and 'givenness' in God. As things got worse and worse with the dysphoria, my life grew more and more hemmed in and diminished. But as Anais Nin put it: "And the time came when the risk to remain tight in a bud was more painful that the risk it took to blossom." So I transitioned. And though it was hard, and I will never be completely jubilant because of the impact on others, I am more alive now, and alive in Christ.
The other quote: "Life shrinks or expands in proportion to one's courage." My life had shrunk with the gender dysphoria until I was a shadow of myself. I made a journey with God, and what's expanded is awareness of God's grace, God's love, God's compassion. I re-trained as a nurse. It focussed my life outside myself, it forced me to love practically, it opened me to the flow and giving of God's compassion and care. And for the rest, it's nothing special at all. It's just ordinary day to day life, and that's what transition is really about - not sex, not lifestyle, just ordinary life. I can live that now.