3 questions to ask when considering transgender minors and medical transitioning

August 1, 2019

The Star Tribune ran an opinion piece drawing attention to the recent launch of a clinic for transgender and “gender diverse” young people at the flagship facility, Children’s Minnesota.[1] The opening of this gender clinic highlights the current trend within the country to normalize the experience of gender dysphoria. Social programs are presenting a transgender identity—where someone comes to the realization that their conscious gender does not match their birth sex—as another way of expressing personal identity along with the traditional binaries for gender and sexuality, “man” and “woman.” 

The Tribune’s article points to the fact that the present-day transgender push upon minors in medicine and psychology has not been without its protestors. The secular armor defending this new ideology has a few cracks and weak points. Rather than taking the offensive in debates with defenders of transgenderism and these medical practices, Christians can respond to those who are defending these practices by asking a few simple questions. 

Here are three questions that anyone considering transgender minors and medical transitioning should consider: 

1. Have these practices been tested and verified? 

Imagine if you were approached by a stranger on the street who said, “I’m looking for some people to participate in some experimental surgeries and hormone treatment, are you interested?” 

Are you ready to sign-up? 

Now that might sound like a crude analogy, but find someone who is proposing these practices, and ask them a simple question, “Do doctors know the long-term effects of hormone treatment and surgery on minors?” 

They don’t. 

Do some simple math. The first sex-reassignment surgery was performed in the 1930s. It started to pick up steam in the 1950s–1970s, meaning that we may have a few individuals who are in their 50s to 70s who have been living with these processes. So, we are only beginning to see the long-term effects of these practices on a relatively small pool. 

But we are talking about minors, who have only recently begun to receive these treatments. These minors are individuals who have not reached physiological maturity, whose bodies are having to process strong sex-hormones not natural to their endocrine systems, in addition to hormone blockers, a new treatment within the last decade used to freeze minors in pre-puberty development. 

What does a minor who receives hormone blockers, sex-hormones, and sex-reassignment surgery look like in 40, 50, 60, or 70 years? 

Simply put, we don’t know.[2]

2. Are these practices safe? 

Safe is a squishy term in this discussion. What is safer, a minor committing suicide or being put on drugs that will alter the course of their physiological development and removing healthy body parts? 

In this conversation, we need to be constantly reminded of the fact that we are talking about children, not adults. Let’s say that a 30-year-old transgender woman (biologically male) begins receiving hormone treatment. It is often overlooked that this individual has benefited from natural sex-hormones to reach this point of physical maturation for 30 years. For this individual, all the years of hormone fluxes and major developments have passed. Even if this individual completely transitions over with hormones and surgery, this person has benefited from his or her natural sex-hormones for 30 years. 

The process of hormone therapy is radically different for a developed adult than a minor facing the most important development years of his or her life. 

As the Tribune article referenced earlier reports, there is great cause for concern about the administration of hormone blockers and sex-hormones in healthy adults, not to mention in minors. These hormone blockers stop 95% of sex-hormones in minors, render the child infertile, and halt the maturation of the child, impacting areas such as bone growth and brain development.[3]

Are these practices safe? Three questions must be answered: (1) What are the long-term results of hormone blockers on physiological development? (2) How does a maturing body respond to hormone blockers and sex-hormones opposite of its birth sex and physiology in puberty? (3) How does a developed post-transitioned adult compare in health to his or her pre-transitioned adult form?

We do not have the luxury of watching someone naturally develop, then rewinding the clock and administering hormones and noting the differences. The reality of those pesky sex-chromones and natural development seems to place every man and woman on a track toward physiological maturity. While we may think that we can redirect sexual development through hormone blockers, doctors are unable to reverse natal sexual development and change our chromosomes. The body will attempt to revert to its birth sex if hormones treatment ceases. 

If we are freezing minors in pre-puberty and administering to them the other sex’s hormones, what are we really doing to these minors? 

Again, we don’t know. We do not know the long-term effects of a physiologically frozen pre-pubescent individual with cross-sex hormones. But do the proponents of these practices have confidence—based upon minimal long-term research—that this treatment is truly safe? 

3. Are these practices working?

It’s important to note that these treatments are attempting to alleviate feelings of gender dysphoria, where the body does not align with a self-perception of gender. There is a dissonance between body and consciousness that rings constantly in one’s experience of self. Hormones and surgery are trumpeted as the only viable option for these individuals, lest they pursue suicide.

But what happens on the other side? 

Studies are beginning to show that transgender minors are not completely “cured” from gender dysphoria by these practices, and the risk of suicide still exists.[4] Many people want to silence the voices of those who have deconversion stories, regretting surgery and previous choices.

Is hormone therapy and surgery really the silver bullet to gender dysphoria? 

Or do we stop and ask another question: Don’t we all experience some level of dysphoria? 

Christians recognize something that the world wants to ignore: that the world is broken and subject to futility (Rom. 8:19-22). Our desires are constantly at war with ourselves and each other, and it all stems back to our disobedient parents who wanted to become something that they were not, God. 

Have you ever noticed what happened right after Adam and Eve ate the fruit of the tree? “Then the eyes of both were opened, and they knew that they were naked” (Gen. 3:8).

Nakedness, the introduction of experiencing alienation and discomfort about one’s body. Adam and Eve no longer had perfect pre-fallen bodies, but ones that were exposed, open to abuse and harm in a broken world. Since then, the body has become a liability to us. Adam, Eve, and every individual to come from them experiences some level of suffering in our sexuality, in either warped desires, scars of abuse, or self-hatred. Many of us would rather not have bodies that remind us of hurt, mistakes, and regrets. All of us are prone to desire what we do not have or what appears to be better, the allure of transgenderism. 

But instead of a gospel that promises to fix us from the outside-in through surgeries and hormones, the gospel transforms us from the inside-out. The hope of the gospel is that the pierced body of man, born of a woman, restores our brokenness. Christ not only saves us from our sins—those committed in the body—but Christ redeems our bodies and will one day give all of us glorified bodies. This is available to all who repent of their rebellion against God and his design for human flourishing and submit to the lordship of Jesus by faith. 

The sexually broken can hope in the truth that God can restore what sin has destroyed (Joel 2:25), in this life and the life to come. The promise of a life to come, marked by renewal and resurrection, halts the fury of those scrambling to make this short, futile life meet all their hopes and dreams. 

Christian, do not feel pressured by the culture to be silent on these issues. The flourishing of many minors and future adults depends upon how we respond in this cultural moment. You may find out that you have more in common with those pursuing these practices. You may even gain something, a brother or sister who will share eternity with you—with glorified, resurrected, dysphoria-free bodies. 


  1. ^ As a quick medical summary, sex-reassignment treatment for minors involves a three-step process. Step 1, minors on the verge of puberty (ages 10-12) will receive hormone blockers to stop the natural development of their sex hormones which would naturally develop secondary-sex characteristics (i.e., breasts, hair, deep voice). Step 2, the minor (age 16) receives hormones of the opposite-sex to develop desired secondary-sex characteristics. Step 3, the minor (age 16-18) receives surgeries to finish up the sex-reassigning, surgery on the top and bottom. We can refer to the sex-reassignment process in two stages: the hormone treatment stage (steps 1-2) and the surgery stage (step 3). For more information, see E. Coleman et al., Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 (World Professional Association for Transgender Health (WPATH), 2012), https://www.wpath.org/publications/soc.
  2. ^ The use of PBT (puberty-blocking treatment) in transgender children has increased dramatically; however, it is a relatively new treatment in this population, and outcomes specifically related to the social and biological implications of treatment remains largely unknown.” Harris et al., “Decision Making and the Long-Term Impact of Puberty Blockade in Transgender Children,” 67. They also caution within this article: “While transgender patients are often counseled on the benefits and reversibility of PBT, many impacts are largely unknown. These issues are highlighted in guidelines recently published by the Endocrine Society, which state that ‘endocrine treatment protocols for gender dysphoria/gender incongruence should include careful assessment of the following: effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain.’” Harris et al., 67; “There are limited data on the consequences of puberty suppression for bone mineral density and executive brain function but much remains unknown about the long-term effects of [puberty suppression].” Lieke Vrouenraets et al., “Perceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth,” Archives of Sexual Behavior 45, no. 7 (October 2016): 1700. “The strongest argument against cross-sex therapy lies in the lack of knowledge of its long-term effects, which means that more studies and follow-up information are necessary.” Bizic et al., “Gender Dysphoria,” 3.
  3. ^  “Sex-steroid hormones are involved in sexual differentiation, development and behaviour and play a pivotal role in the development and function of the central nervous system. They exert varied effects on the brain and the body and are thought to alter several processes related to cognition and emotion.” Rene Seiger et al., “Subcortical Gray Matter Changes in Transgender Subjects after Long-Term Cross-Sex Hormone Administration,” Psychoneuroendocrinology 74 (December 2016): 371. “PBT halts exposure to endogenous sex hormones during a critical window of bone accrual; therefore, PBT may negatively impact adult bone density.” Rebecca M. Harris et al., “Decision Making and the Long-Term Impact of Puberty Blockade in Transgender Children,” American Journal of Bioethics 19, no. 2 (2019): 67.
  4. ^ See American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Arlington, VA: American Psychiatric Association, 2013), 454.

Jared Poulton

Jared Poulton (M.Div.) is a graduate of Columbia International University and The Southern Baptist Theological Seminary. He is currently pursuing his Ph.D. in Biblical Counseling and Christian Ethics at The Southern Baptist Theological Seminary. He resides in South Carolina with his wife and two children and serves in the local … Read More

Article 12: The Future of AI

We affirm that AI will continue to be developed in ways that we cannot currently imagine or understand, including AI that will far surpass many human abilities. God alone has the power to create life, and no future advancements in AI will usurp Him as the Creator of life. The church has a unique role in proclaiming human dignity for all and calling for the humane use of AI in all aspects of society.

We deny that AI will make us more or less human, or that AI will ever obtain a coequal level of worth, dignity, or value to image-bearers. Future advancements in AI will not ultimately fulfill our longings for a perfect world. While we are not able to comprehend or know the future, we do not fear what is to come because we know that God is omniscient and that nothing we create will be able to thwart His redemptive plan for creation or to supplant humanity as His image-bearers.

Genesis 1; Isaiah 42:8; Romans 1:20-21; 5:2; Ephesians 1:4-6; 2 Timothy 1:7-9; Revelation 5:9-10

Article 11: Public Policy

We affirm that the fundamental purposes of government are to protect human beings from harm, punish those who do evil, uphold civil liberties, and to commend those who do good. The public has a role in shaping and crafting policies concerning the use of AI in society, and these decisions should not be left to those who develop these technologies or to governments to set norms.

We deny that AI should be used by governments, corporations, or any entity to infringe upon God-given human rights. AI, even in a highly advanced state, should never be delegated the governing authority that has been granted by an all-sovereign God to human beings alone. 

Romans 13:1-7; Acts 10:35; 1 Peter 2:13-14

Article 10: War

We affirm that the use of AI in warfare should be governed by love of neighbor and the principles of just war. The use of AI may mitigate the loss of human life, provide greater protection of non-combatants, and inform better policymaking. Any lethal action conducted or substantially enabled by AI must employ 5 human oversight or review. All defense-related AI applications, such as underlying data and decision-making processes, must be subject to continual review by legitimate authorities. When these systems are deployed, human agents bear full moral responsibility for any actions taken by the system.

We deny that human agency or moral culpability in war can be delegated to AI. No nation or group has the right to use AI to carry out genocide, terrorism, torture, or other war crimes.

Genesis 4:10; Isaiah 1:16-17; Psalm 37:28; Matthew 5:44; 22:37-39; Romans 13:4

Article 9: Security

We affirm that AI has legitimate applications in policing, intelligence, surveillance, investigation, and other uses supporting the government’s responsibility to respect human rights, to protect and preserve human life, and to pursue justice in a flourishing society.

We deny that AI should be employed for safety and security applications in ways that seek to dehumanize, depersonalize, or harm our fellow human beings. We condemn the use of AI to suppress free expression or other basic human rights granted by God to all human beings.

Romans 13:1-7; 1 Peter 2:13-14

Article 8: Data & Privacy

We affirm that privacy and personal property are intertwined individual rights and choices that should not be violated by governments, corporations, nation-states, and other groups, even in the pursuit of the common good. While God knows all things, it is neither wise nor obligatory to have every detail of one’s life open to society.

We deny the manipulative and coercive uses of data and AI in ways that are inconsistent with the love of God and love of neighbor. Data collection practices should conform to ethical guidelines that uphold the dignity of all people. We further deny that consent, even informed consent, although requisite, is the only necessary ethical standard for the collection, manipulation, or exploitation of personal data—individually or in the aggregate. AI should not be employed in ways that distort truth through the use of generative applications. Data should not be mishandled, misused, or abused for sinful purposes to reinforce bias, strengthen the powerful, or demean the weak.

Exodus 20:15, Psalm 147:5; Isaiah 40:13-14; Matthew 10:16 Galatians 6:2; Hebrews 4:12-13; 1 John 1:7 

Article 7: Work

We affirm that work is part of God’s plan for human beings participating in the cultivation and stewardship of creation. The divine pattern is one of labor and rest in healthy proportion to each other. Our view of work should not be confined to commercial activity; it must also include the many ways that human beings serve each other through their efforts. AI can be used in ways that aid our work or allow us to make fuller use of our gifts. The church has a Spirit-empowered responsibility to help care for those who lose jobs and to encourage individuals, communities, employers, and governments to find ways to invest in the development of human beings and continue making vocational contributions to our lives together.

We deny that human worth and dignity is reducible to an individual’s economic contributions to society alone. Humanity should not use AI and other technological innovations as a reason to move toward lives of pure leisure even if greater social wealth creates such possibilities.

Genesis 1:27; 2:5; 2:15; Isaiah 65:21-24; Romans 12:6-8; Ephesians 4:11-16

Article 6: Sexuality

We affirm the goodness of God’s design for human sexuality which prescribes the sexual union to be an exclusive relationship between a man and a woman in the lifelong covenant of marriage.

We deny that the pursuit of sexual pleasure is a justification for the development or use of AI, and we condemn the objectification of humans that results from employing AI for sexual purposes. AI should not intrude upon or substitute for the biblical expression of sexuality between a husband and wife according to God’s design for human marriage.

Genesis 1:26-29; 2:18-25; Matthew 5:27-30; 1 Thess 4:3-4

Article 5: Bias

We affirm that, as a tool created by humans, AI will be inherently subject to bias and that these biases must be accounted for, minimized, or removed through continual human oversight and discretion. AI should be designed and used in such ways that treat all human beings as having equal worth and dignity. AI should be utilized as a tool to identify and eliminate bias inherent in human decision-making.

We deny that AI should be designed or used in ways that violate the fundamental principle of human dignity for all people. Neither should AI be used in ways that reinforce or further any ideology or agenda, seeking to subjugate human autonomy under the power of the state.

Micah 6:8; John 13:34; Galatians 3:28-29; 5:13-14; Philippians 2:3-4; Romans 12:10

Article 4: Medicine

We affirm that AI-related advances in medical technologies are expressions of God’s common grace through and for people created in His image and that these advances will increase our capacity to provide enhanced medical diagnostics and therapeutic interventions as we seek to care for all people. These advances should be guided by basic principles of medical ethics, including beneficence, non-maleficence, autonomy, and justice, which are all consistent with the biblical principle of loving our neighbor.

We deny that death and disease—effects of the Fall—can ultimately be eradicated apart from Jesus Christ. Utilitarian applications regarding healthcare distribution should not override the dignity of human life. Fur- 3 thermore, we reject the materialist and consequentialist worldview that understands medical applications of AI as a means of improving, changing, or completing human beings.

Matthew 5:45; John 11:25-26; 1 Corinthians 15:55-57; Galatians 6:2; Philippians 2:4

Article 3: Relationship of AI & Humanity

We affirm the use of AI to inform and aid human reasoning and moral decision-making because it is a tool that excels at processing data and making determinations, which often mimics or exceeds human ability. While AI excels in data-based computation, technology is incapable of possessing the capacity for moral agency or responsibility.

We deny that humans can or should cede our moral accountability or responsibilities to any form of AI that will ever be created. Only humanity will be judged by God on the basis of our actions and that of the tools we create. While technology can be created with a moral use in view, it is not a moral agent. Humans alone bear the responsibility for moral decision making.

Romans 2:6-8; Galatians 5:19-21; 2 Peter 1:5-8; 1 John 2:1

Article 2: AI as Technology

We affirm that the development of AI is a demonstration of the unique creative abilities of human beings. When AI is employed in accordance with God’s moral will, it is an example of man’s obedience to the divine command to steward creation and to honor Him. We believe in innovation for the glory of God, the sake of human flourishing, and the love of neighbor. While we acknowledge the reality of the Fall and its consequences on human nature and human innovation, technology can be used in society to uphold human dignity. As a part of our God-given creative nature, human beings should develop and harness technology in ways that lead to greater flourishing and the alleviation of human suffering.

We deny that the use of AI is morally neutral. It is not worthy of man’s hope, worship, or love. Since the Lord Jesus alone can atone for sin and reconcile humanity to its Creator, technology such as AI cannot fulfill humanity’s ultimate needs. We further deny the goodness and benefit of any application of AI that devalues or degrades the dignity and worth of another human being. 

Genesis 2:25; Exodus 20:3; 31:1-11; Proverbs 16:4; Matthew 22:37-40; Romans 3:23

Article 1: Image of God

We affirm that God created each human being in His image with intrinsic and equal worth, dignity, and moral agency, distinct from all creation, and that humanity’s creativity is intended to reflect God’s creative pattern.

We deny that any part of creation, including any form of technology, should ever be used to usurp or subvert the dominion and stewardship which has been entrusted solely to humanity by God; nor should technology be assigned a level of human identity, worth, dignity, or moral agency.

Genesis 1:26-28; 5:1-2; Isaiah 43:6-7; Jeremiah 1:5; John 13:34; Colossians 1:16; 3:10; Ephesians 4:24