Navigating a major resource on Gender Dysphoria

David Shaw reviews Mark Yarhouse’s book ‘Understanding Gender Dysphoria’.


David is the Editor of Primer. He is part-time Theological Adviser for FIEC and part-time Lecturer in New Testament and Greek at Oak Hill Theological College, London. He’s married to Jo and they have four children.


I can’t remember the last time a whole week went by without several news stories about transgenderism. Here are some sample headlines from the last week:

Top London girls school allows pupils to identify as male or gender neutral

Donald Trump revokes Barack Obama guidelines on transgender bathrooms

Transgender boy wins girls’ wrestling championship in Texas

It’s everywhere in the news, and not just in the news. Transgender storylines are woven through TV dramas and, closer to home, our eyes are being opened to the profound challenges many people experience navigating gender issues within our families and our churches.

Consequently, one of the pressing challenges of the day is to think how Scripture addresses a) the experience of gender confusion, b) a culture that promotes gender fluidity and c) Christians living in that culture, seeking to win it for Christ, and trying to navigate the complicated question of gender for themselves.

understanding gender dysphoriaFor help, many have turned to Mark Yarhouse’s Understanding Gender Dysphoria (Downers Grove, Ill.: IVP, 2015). Several of the commendations call it a “must read,” and it is that. Since it was published in 2015, for many pastors it has also been a “the-only-thing-out-there” read. So in this brief review I’d like to outline its basic shape and reflect on some issues it raises.

Describing his aims, Yarhouse rightly identifies a need for “a resource that is written from a Christian perspective and is also informed by the best research we have to date, as well as seasoned with compassion for the person who is navigating gender dysphoria” (10).

At one level that is quite a comprehensive aim, but there is a particular focus here. As a professor of psychology and licensed clinical psychologist, Yarhouse has significant experience of counselling those who are diagnosed with gender dysphoria, and a clear burden of this book is to open our eyes to the severe distress those people experience and to urge a more compassionate response.

This means the title Understanding Gender Dysphoria is probably a better guide to the content than the subtitle: Navigating Transgender Issues in a Changing Culture. There is relatively little here on the wider transgender movement and there is little reflection on the “Changing Culture” and what a Christian response might be to the various secular ideologies that are driving those changes. It would of course, be a much longer book if it attempted a full answer to those things, but this does mean Yarhouse’s book cannot be an “only read” book, nor does it claim to be.

The Book’s Shape

The structure of the book is shaped by that desire to share the best research and to construct a compassionate biblical response to individuals. Chapter 1 defines many of the key terms (biological sex, transgenderism, gender incongruence, gender identity concerns and gender dysphoria) and helpfully conveys the pastoral complexity.

This abundance of terms might seem unnecessary, but it highlights an important point: Some people identify as transgender without experiencing any anxiety, whereas those that do will live somewhere a spectrum from mild discomfort to profound distress. Pastorally, this is significant, because it means no two peoples’ experience will be the same.

Beyond that, Yarhouse also shows how people engage in cross-dressing, transvestism, and gender-bending behaviour for a multitude of reasons, relating to their sexual orientation, perceived gender identity, or an unwillingness to conform. Pastorally this too is significant, because it shows that behind similar appearances lie very different motives. Understanding someone’s specific circumstances is going to be crucial.

Having laid that foundation, the focus of the book narrows to the question of how best to understand life when a sense of incongruence with one’s biological sex causes (sometimes profound) distress. With that question in mind, Yarhouse sketches out three current approaches:

The integrity framework (generally embraced by conservative evangelicals) emphasises the created distinction between male and female and so is concerned to preserve the distinctions and apply them to questions about transgenderism and same-sex relationships, seeing both as a rebellious impulse against the Creator.

The disability framework approaches gender dysphoria “with reference to the mental health dimensions” and sees it as an aspect of life in a fallen world, sharing in a condition we did not choose and for which we are therefore not morally culpable.

By contrast with both of these, the diversity framework celebrates transgender experiences. Within this, Yarhouse describes a strong and weak form. The former “calls for the deconstruction of norms related to sex and gender,” the weak form “focuses primarily on identity and community” (50).

In the remainder of the book, Yarhouse does two main things.

  1. He surveys the best of what little research there has been into the causes, prevalence and treatment of gender dysphoria, helpfully highlighting the diverse ways in which the different frameworks interpret that data.
  2. He argues that the best approach to caring for people experiencing Gender Dysphoria will be to adopt an integrated framework, combining the strengths of the three existing frameworks.

This probably comes as a surprise, given how opposed the frameworks are at the level of presuppositions. One simply cannot uphold distinctions of sex and gender as created boundaries (the integrity model) and seek to deconstruct them at the same time (the hard form of the diversity model).

Of course he’s alert to that. Instead, what Yarhouse wants to do is to learn something from each framework: preserving a commitment to the view that “God had a purpose in creating humankind male and female” (integrity) while recognising that the person navigating gender confusion “has not chosen to experience dysphoria” (disability) and is in need of a community that will support them and provide them with a secure sense of identity within a plausible narrative (emphases that characterise the weak form of the diversity model).

Does it Succeed?

Overall I think the book’s significance merits at least two cheers. Greater clarity on a few of the details would clear my throat for that third cheer:

1. The way the three frameworks are described seems to imply that the disability framework alone allows me to see someone suffering gender confusion “with empathy and compassion” and only the diversity framework is capable of offering community and identity. While it’s surely and sadly true that some evangelicals have adopted a very combative stance towards LGBT issues, I don’t see why an integrity model can’t also involve those things (indeed it must!). But the way it is set up implies I somehow need to trade in or soften my commitment to a created gender binary to have them.

2. It is also somewhat simplistic to present a choice between the integrity framework emphasising human choice (and so condemning violations of the created order) and the disability model which sees gender dysphoria as a “nonmoral reality” (122). When Yarhouse comes to present his integrated framework, it’s clear that he’s closest to the disability framework, and so is willing to countenance quite a few ways of “managing” dysphoria, albeit in the least invasive ways. But the Bible’s account of the human moral situation is more complex than this kind of analysis allows. Inherited predispositions to sin generate temptations and sinful desires, and there can be either sinful or godly responses to those things. That a condition was not chosen does not make all subsequent decisions morally neutral. A more nuanced answer is needed here.

It is also worth noting a common but troubling assumption here. Essentially the expectation is that compassion and empathy will only be extended where it’s thought that people bear no blame for their situation (hence the connection between compassion and the disability model). And yet the very heart of the gospel is a God who has compassion on sinners. The gospel is for all, not just the victims or the afflicted. Thus, our challenge is to hold to a created reality of two sexes, a complex fallen reality, and to ensure that our compassion is equal in scope to the Lord’s.

3. When Yarhouse turns to the Bible he eschews the usual proof-texts (1 Cor 6:9-10, Deut 23:1, 22:5, Matt 19:12) and offers a brief Bible overview around the headings creation, fall, redemption and glorification (35-45). I’m convinced this is a helpful approach, but there are some weaknesses here. There is, for one thing, very little Bible.

a. Regarding creation, Yarhouse rightly observes that humanity are created male and female, but this point is rather muted. Some more attention to the text of Gen 1-2 and those ‘proof-texts’ would help establish a clearer pattern from creation. Indeed there are significant resources here to help someone embrace the ways in which our embodied selves do not need to establish or generate an identity for themselves (an exhausting and unsustainable project!). Rather, we can rest in the given-ness of male and female. In addition, we also can see that although the Bible upholds that binary, it is actually less rigid than our culture about the ways in which masculinity or femininity finds expression through any one personality.

b. As to the fall, there is the same lack of engagement with biblical material and a foregrounding of a medical perspective: the fall affects our biological and psychological health; we are “broken, incomplete and disordered.” (46); examples of fallen reality are depression, schizophrenia, anxiety. The only mention of sin comes in a quote from Oliver O’Donovan.

c. The discussion of redemption also feels like a missed opportunity. The final chapters of the book very helpfully urge the church to reckon with the power of identity, community and narrative. To be ‘in Christ’ offers all three but this is not really developed under the redemption heading. It is, to be fair, not often developed in much evangelical spirituality either. The New Testament frequently points to a participation in Christ’s narrative of self-giving and the service of others. It is a compelling vision for a Christian community and for the life God calls us to, in which we are turned outwards and oriented towards meaningful relationships with others.


Yarhouse’s book is a vital eye-opener on the distress people can experience navigating issues of gender today. A culture that simultaneously elevates and destabilises gender categories is bound to produce more confusion in the short and medium term. So we will do well to heed Yarhouse’s call to distinguish the cultural campaigners from their casualties, and to seek to offer the latter both compassion and a more compelling vision for what life will look like, lived God’s way. For that, however, I suspect we need several more tools:

  • a more robust biblical theology of gender.
  • a grasp of where the cultural movement has come from and where its persuasive power lies.
  • a model for casting that compelling vision.

We have tried to do some of that work in Primer issue 03. More help is at hand in Glynn Harrison’s A Better Story (Nottingham: IVP, 2017), and look out for the forthcoming Heirs Together: A Theology of the Sexes by Alastair Roberts (Grand Rapids: Crossway, 2018). Those are probably your next ‘must-reads.’

A shorter version of this review appeared in Oak Hill College’s Commentary magazine (Winter 2016-17), available online here: