How do we counsel those considering gender-affirming surgery from a gospel perspective?
Introduction
Counseling someone who is considering gender-affirming surgery is one of the most sensitive and crucial tasks in modern ministry. This conversation requires the highest level of Christian maturity, blending the unyielding truth of Scripture with the unconditional love and grace of the Gospel.
A Gospel-centered response does three things simultaneously: it affirms the person's dignity, acknowledges their deep suffering, and offers a solution rooted in Christ's work, not a physical procedure. Our approach must mimic Jesus' model: full of grace and truth (John 1:14).
Three Pillars of Gospel-Centered Counseling
Counseling in this area must proceed through three key phases, each rooted in the Gospel’s teaching about God, humanity, and identity.
1. Affirmation of Personhood and Acknowledgment of Suffering (Grace)
The first step is to establish trust by leading with empathy and compassion, separating the person from the conflict.
Affirm Image-Bearer Status: Start by affirming the person's infinite worth and dignity. They are created “in the image of God” (Genesis 1:27) and are loved by Him regardless of their struggles or decisions. This establishes that they are not a project to be fixed, but a precious soul to be loved.
Acknowledge the Pain: Counselors must recognize that gender dysphoria—the distress over a mismatch between biological sex and psychological identity—is real and profoundly painful. It is a result of living in a fallen world where our physical bodies and inner feelings are in conflict (Romans 8:22). Do not dismiss their experience or suggest they are merely confused.
Weep with Them: The Christian response is to weep with those who weep (Romans 12:15) and patiently enter into their grief, building the credibility needed to speak truth later.
2. Upholding God's Design (Truth)
Once a foundation of trust is established, the counseling moves to the biblical truth about the human person, gender, and the body.
The Body is a Gift, Not a Problem: The Gospel affirms that God’s creation is good. “Male and female he created them” (Genesis 1:27). A person’s biological sex is not a mistake to be corrected, but a gift to be received and stewarded. The body of a Christian is the “temple of the Holy Spirit” (1 Corinthians 6:19) and does not belong to the individual for self-reconstruction.
The Body-Soul Unity: The biblical view of personhood is integrated: body and soul are gloriously connected. Counselors must gently suggest that to attempt to resolve a psychological, internal tension (gender identity) by permanently altering the physical body (surgery) is to treat the symptom, not the source. The body is a part of the created self that will one day be redeemed and glorified (Romans 8:23).
The Principle of Non-Harm: From a Gospel perspective, medical interventions should promote genuine, holistic health. Counselors point to the high rates of regret and the fact that surgery does not ultimately resolve the underlying psychological distress. True care, therefore, is rooted in helping the mind align with the body, not vice versa (Romans 12:2).
3. Anchoring Identity in Christ (The Gospel Solution)
The ultimate solution is the Gospel's promise of a new, secure identity found not in personal feelings or external appearance, but solely in the finished work of Christ.
The New Identity: Counseling shifts the focus from the search for identity in gender (or anything else created) to the identity found in the Creator. The person is no longer defined by their deepest struggle or internal conflict, but by their adoption as a child of God: “Therefore, if anyone is in Christ, he is a new creation” (2 Corinthians 5:17). This is the only identity that is secure and eternal.
Suffering as Sanctification: The deep pain of gender dysphoria can be reframed as a cross to bear—a form of suffering that God can use to deepen dependence on Him. “Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness” (James 1:2-3). The goal is not the removal of the feeling, but the spiritual maturity achieved through the trial.
Discipling the Mind: The call is to “be transformed by the renewal of your mind” (Romans 12:2), presenting the body as a living sacrifice (Romans 12:1). The path forward is discipleship: walking with the individual as they commit the hard, daily work of trusting God's design for their body and allowing His Spirit to transform their internal life.
Conclusion
Counseling someone considering gender-affirming surgery is a long road requiring patience, prayer, and deep theological grounding. The counselor must never lose sight of two things: the deep, Christ-like love due to the image-bearer, and the firm, kind truth of God's Word.
The Gospel’s hope is not a quick fix but a slow, lifelong transformation where the individual discovers that their ultimate purpose, meaning, and wholeness is found when they surrender all of their identity—body, mind, and spirit—to the gracious authority of Jesus Christ.
