Below is a paper I wrote for a doctoral seminar at Midwestern Baptist Theological Seminary. I have included some parenthetical explanations when I thought it may be helpful to a more general audience. The issue of transgenderism is an increasing concern in contemporary culture. The church, and pastors particularly, must not ignore this concern but must bring the light of God’s Word to bear so we can help others understand the nature of transgenderism and help transgender people come to Christ and live for Christ. My hope is that this paper will encourage my brother pastors in dealing with these concerns. I want to encourage the interested reader to browse the end notes of this paper as some helpful information is included regarding spiritual warfare, the nature of the pastoral office, and the risks of sex reassignment surgery which could not fit into the body of the essay.
An increasing awareness and social acceptance of transgenderism poses many questions for the church and pastoral care. Pastors will come to interact with transgender people with increasing frequency. They must be prepared to care for such individuals as God provides the opportunity. The nature of transgenderism, of pastoral care, and the right practice of pastoral care must be carefully considered. In order to provide spiritual care for transgender people, pastors must direct them to find a new identity in Christ in accordance with the Scriptures that will allow them to celebrate their biological gender as a gracious gift from God.
This essay will support the above thesis by showing the authority from which the pastor must understand transgenderism and from which he must derive his care. Further, it will provide an understanding of the salvific goal of pastoral care. Finally, this paper will explore Biblical passages which may be used to guide a transgender person in living out his identity in Christ.
The Pastor and Biblical Epistemology
(Epistemology is the study of the foundations of knowledge)
In the present bellicose atmosphere, a pastor who will provide care for transgender people must have confidence in the Bible as the source of truth. One’s epistemological foundation will affect his understanding of human nature, transgenderism, ethical direction, the nature of human flourishing, and the goal and manner of his work. Epistemologies opposed to the Bible will vie for dominance in the pastor’s work and the minds of the transgender people he hopes to help. Ethicist Daniel Heimbach warns, “Sexual norms upheld by the Church for centuries…are now treated as uncertain, contentious, or even unworthy, by a growing number of Christian scholars, denominational leaders and pastors.
A dominant authority for transgender care in the fields of psychology and medicine lies in the subjective feelings of the patient. In the preface of Harry Benjamin’s seminal work on the issue, he celebrates “the brave and true scientists, surgeons, and doctors who let the patient’s interest and their own conscience be their sole guides.” He later encourages doctors to perform sex reassignment surgeries for those who have “a deep and honest conviction gained after long and mature consideration.” A contemporary article to address the care of transgender adolescents published through the cooperation of the Substance Abuse and Mental Health Services Administration, the U.S. Department of Health and Human Services, and the American Psychological Association stated:
Approaches should be client-centered and developmentally-appropriate with the goal of treatment being the best possible level of psychological functioning, rather than any specific gender identity, gender expression, or sexual orientation. Appropriate therapeutic approaches with sexual and gender minority youth should…focus on identity development and exploration that allows the child or adolescent the freedom of self-discovery within a context of acceptance and support.
This self-derived authority has increased in influence and continues to persist among authorities in the field of psychology.
The subjective nature of this direction collides with the empirical worldview of many researchers and physicians who desire to support transgender lifestyles. Therefore, some have set out to find objective biological causes of transgenderism. One example is the work of Dick Swaab and Alicia Garcia-Falgueras who argue that natal “sexual differentiation of the genitals takes place much earlier in development…than sexual differentiation of the brain…In rare cases, this may result in transsexuality” due to atypical hormone levels in these developmental stages. Ethicist Alan Branch reveals that current studies attempting to claim a neurological basis for LGBT identities are often misleading because they have found no necessary and sufficient patterns of brain structure to support their claims, they over-exaggerate the differences of the male and female brain, and have confused causation with correlation in regard to brain plasticity.
The nature of the pastoral task, however, requires the foundation of God’s Word to provide true and lasting care for transgender people. One reason for a Biblical epistemology in pastoral care of transgender people is that the Bible is the necessary cause of the pastoral office. When a pastor ceases to derive the nature of his work from the Scriptures, he ceases to be a pastor and to provide pastoral care.
The New Testament uses three terms interchangeably of the pastoral office, ἐπισκόποις (bishop or overseer), ποιμένας (pastor or shepherd), and πρεσβυτέρους (elder or presbyter), which convey the provision of authoritative direction and instruction. Jesus commissioned twelve of his disciples to be Apostles sent out with His authority to teach His Word (Mt 10:1-15, Acts 6:4). As the church spread, the Apostles appointed pastors (also called elders) in every church (Acts 14:23) who would also teach God’s Word as they received it from the Apostles (Eph 4:11). The content of pastoral instruction is “the knowledge of the Son of God” (Eph 4:13) which contradicts falsehood (Eph 4:14) and encourages “speaking the truth in love” (Eph 4:15). The Apostle Peter informs the churches of Northern Asia Minor that this “knowledge of God and of Jesus our Lord” (2 Pt 1:2) comes from the Apostles as “eyewitnesses of His majesty” (2 Pt 1:16) and is the Holy Spirit-inspired Scripture from God (2 Pt 1:19-21).
Pastors must gain an understanding of their work from God’s Word and must direct transgender people (and all those for whom they wish to help) by God’s Word. John Calvin stated:
[E]very dignity of authority ascribed by Scripture to the prophets and priests of the old law, and also to the apostles and their successors, is not ascribed to them personally but to the ministry and functions to which they have been appointed—or to put it more clearly, to the word of God, to the stewardship of which they have been called. For if we consider them one by one, we will find that prophets and priests as well as apostles and disciples were never given power to command or to teach except in the Lord’s name and through his word.
Pastoral work requires directive care through the application of Scripture.
Another reason for a Biblical epistemology in the pastoral care of transgender people is the nature of truth which relies on an immutable, communicative source; namely, God. Gregory Thornbury writes, “The notion of truth is an inherently religious idea. Only an eternal, transcendent sovereign could create everything in such a way as to make the universe knowable, personal, and understandable.” Truth comes from God and the primary source is His Word.
Secular therapies for transgender people encourage the suppression of truth and the deception of others. Benjamin provides four motives for transgender people desiring a sex reassignment or “conversion” operation. Each motive (sexual, gender, legal, and social) comes from a desire to believe and act in a way that denies truth and hides it from others. Indeed, Benjamin even revels in a male to female post-operative transsexual deceiving and marrying a man without ever telling him that he was not born a woman.
Contrary to secular transgender therapies, pastors must guide transgender people to a certainty that is fully objective and powerful enough to contradict their thoughts and emotions about themselves which do not correspond to truth. While addressing the idea of church-officiated transgender weddings, Oliver O’Donovan warns that the church must guard against an accommodation theory, made for difficult pastoral situations, subverting Scripture and truth because “[t]he church’s practice, even if it was devised as an accommodation for the weak, soon becomes the source of its teaching.” Biblical authority, not pragmatism, must drive pastoral care.
Psalm 19:7-9 shows that the Bible, in its every aspect, is the authoritative, perfect, and sure self-revelation of God which is necessary and sufficient for doctrine, counsel, and practice in the life of churches and individuals. The Pastor’s direction for transgender people is stable and certain because it comes from an eternal and unchanging God who revealed Himself in Scripture.
Salvation for Transgender People
In order to provide help for transgender people, pastors must first understand the situation of transgenderism. Transgender refers to “the broad spectrum of individuals who transiently or persistently identify with the gender different from their natural gender.” Transgenderism is not an issue which only affects the contemporary world. One can find examples of transgenderism in some cultures throughout history because it is a condition, like many other conditions, of the sin-fallen human heart. The Ancient Mesopotamian deity Inanna-Ishtar is described as both a woman and a man. She was said to have the ability to curse her enemies to change them from male to female. Consistently, her priests sought to represent her by dressing like a woman on their right side and a man on their left. In Egypt, the female Pharaoh Hatsheput represented herself as both male and female and has been pictured with male genitalia. She would often wear male clothing and the royal beard of the Pharaohs and is referred to as both a son and a daughter.
Ancient Israel was not silent concerning transgender-related issues either. Transvestitc activity was strongly prohibited as תֹועֲבַת יְהוָה “an abomination to the LORD” (Dt 22:5). Acts denounced in this way “were sure to bring God’s wrath on those who perpetrated them.” This prohibition likely reveals that the nations which would surround Israel in the Promised Land celebrated such practices. Duane Christensen points out that this law fits into the broader literary context dealing with other sexual sins, specifically, adultery while Craigie explains men’s clothing includes “not only clothing, but ornaments, weapons, etc., normally associated with men.” This law not only denounced cross-dressing but also intentionally behaving and taking on the role of the opposite sex.
Transsexual “denotes an individual who seeks, or has undergone, a social transition from male to female or female to male, which in many, but not all, cases also involves a somatic transition by cross-sex hormone treatment and genital surgery (sex reassignment surgery).” Transsexualism may seem to many a merely contemporary issue, yet, like transgenderism, similar practices are found in antiquity. Deuteronomy 23:1 prohibits anyone who has been emasculated from entering the assembly of the LORD. Craigie argues that this prohibition is not of those who are accidentally emasculated but those who have intentionally emasculated themselves in worship of a foreign god whereas Merrill contends that it includes both accidental and intentional emasculation. Merrill is likely correct given the emphasis on ritual purity and wholeness in the worship of Ancient Israel. Regardless, those who emasculated themselves were excluded.
Likewise, descendants of Aaron who were to act as priests were prohibited from doing so if they had crushed testicles (Lev 21:20). This passage does not discriminate between accidental, forced, or willful harm to the sexual organs. The early church, at the Council of Nicaea (AD 325), also prohibited anyone from serving in the ministry who had intentionally emasculated themselves. Ancient Rome endorsed something similar to transsexualism. On the cultic festival of the goddess Cybele, any man who wished to become her priest would beat and castrate himself. Then, he would dress like a woman from that day forward. A grave of one of Cybele’s priests was found as far as Britain. Issues resembling transsexualism are not new, nor have they gone unaddressed by the Bible or the church.
Gender dysphoria speaks of “the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.” The secular view contends the cause of this distress to be the negative reaction of others, specifically, the “stresses of prejudice, discrimination, rejections, harassment, and violence…[from] multiple social systems, including family, school, and religious networks” which cause an increased risk for “suicidal ideation, suicide attempts, and suicides” as well as “negative self-concept, increased rates of mental disorder comorbidity, school dropout, and economic marginalization, including unemployment with attendant social and mental health risks.” To its proponents, transgenderism does not cause suffering.
Pastors must realize that there is real suffering in the individual with gender dysphoria and some of it may be due to victimization. However, there is certain suffering in transgenderism and transsexuality that comes from spiritual causes related to the beliefs and behaviors of transgenderism. Pastors must address transgender people with compassion and direction; as sheep without a shepherd (Mt 9:36); as those who are willing to bring them healing through the gospel of Jesus and the direction of the Word of God.
The mental distress and physical harm that come upon those who practice transgenderism do not primarily come from outside of them, but from their own souls. The Bible reveals the initial cause of suffering in the world was disobedience to God (Gen 2:17) which caused a spiritually deadness in all of mankind (Rom 5:19). This deadness results in a state of life contrary to God’s will and under God’s wrath (Eph 2:1-3). Paul states that because of this rejection, God “gave them over in the lusts of their hearts to impurity, so that their bodies would be dishonored among them. For they exchanged the truth of God for a lie” (Rom 1:24).
Transgender people reject the truth of God (as does every person manifest in some way), which is the gender God provided them at birth. It is the lie coming from the lusts of their hearts. This ἐπιθυμίαις (lust) is a desire of something forbidden. A transgender person’s strong feeling of being assigned the wrong sex at birth and his desire to dress, act, and exist as a member of the opposite sex is consistent with the Bible’s teaching regarding the state of the human heart. Sin separates man from God (Is 59:2) and results in insensitivity to and opposition of God’s will. Therefore, Jeremiah states, “The heart is more deceitful than all else And is desperately sick” (Jer 17:9).
The secular gospel for transgender people is to pursue the lust of their heart. Benjamin primes his argument by setting up a cognitive dissonance for his readers and promising a solution. Explaining one may have a psychological sex opposed to his biological sex, he writes, “Great problems arise for those unfortunate persons in whom this occurs. Their lives are often tragic and the bulk of all the following pages will be filled with the nature of their misfortunes, their symptoms, their fate, and possible salvation.” Later, he explains to his readers that sex reassignment surgeries are the source of hope for transsexuals. While the secular world encourages transgender people to go deeper into the lie of their hearts’ desires, pastors must lovingly guide them to see their desire as deceitful and requiring correction and healing. The pursuit of their desires is the cause of their distress.
Paul says that these desires dishonor the bodies of those who have rejected God’s truth (Rom 1:24-25). The term ἀτιμάζεσθαι (dishonor) carries the connotation of shame. This shame is likely the cause of most of the negative psychological issues associated with transgenderism. It cannot be cast off or shifted to others as the secular proponents contend. Rather, repentance for transgender beliefs and behaviors combined with faith in Jesus Christ will remedy the psychological problems and distress in time. Describing the power of the gospel of Jesus Christ, Paul shows that the gospel moves one from insensitivity toward God’s Word to receptivity, from slavery in sin to freedom, from shame to glory, from deception to truth, and from spiritual blindness to enlightenment (2 Cor 3:12-4:6).
In the Bible, refusal to acknowledge and confess sin results in intense psychological turmoil that leads to psychosomatic problems. David writes, “When I kept silent about my sin, my body wasted away…My vitality was drained away as with the fever heat of summer” (Ps 32:3-4). Confession of sin to God results in forgiveness of guilt (Ps 32:2, 5) and אַשְֽׁרֵי (perfect happiness: Ps 32:1-2). Adams agrees, “God’s remedy for man’s problem is confession. The concealing of transgressions brings misery, defeat and ruin, but the confession and forsaking of sin will bring merciful pardon and relief.”
However, direction to confess transgender beliefs and actions alone will not be sufficient care for transgender people. Pastors must instruct them that such confession must spring out of a life-surrendering faith in Jesus. This faith receives God’s grace in that the sinner is imputed with Jesus’ righteousness so he is justified from sin (Rom 4:22-25) and transformed to live consistently with God’s will (Eph 2:8-10). Matthew Stanford explains,
When we come to faith in him, that dead, separated spirit is nailed to the cross with Christ, never to return (Galatians 2:20). In its place, the Spirit of Christ takes up residence in us (Galatians 4:6; Colossians 3:1-3). We are alive for the first time—in spiritual union with God! The believer is complete in Christ; we have everything we need for life and godliness in him (2 Peter 1:3).
Salvation acquired through faith in Jesus, not only restores transgender people to God and frees them to live consistently with truth, but also imparts to them the hope of eternal life. By trusting in Jesus, they are removed from God’s condemnation (Rom 8:1) and ensured eternal life with Him (Jn 3:16; 14:1-6).
Pastors should provide Biblical guidance to transgender people who have trusted in Jesus as Savior and Lord. Transgender people who have become Christians will first need help centering their identity in Christ instead of their desire to be a member of the opposite sex. In Colossians, Paul argues against Judaizes who advocated for the necessity of following Old Testament cultic laws in addition to faith in Jesus for salvation. Paul assures the Colossians that they are “made complete” in Christ (Col 2:10). πεπληρωμένοι (made complete) is a perfect participle directing the reader’s attention to the time in the past when he trusted in Jesus and received salvation that resulted in a continual state of completeness. The idea is that the Christian has been fully supplied with everything he needs to be accepted into God’s favor and restored to a position of wholeness. He is complete in and through Christ.
Paul further warns the Colossians not to seek further fullness through circumcision which he describes as “self-made religion and self-abasement and severe treatment of the body” and instructs that these actions “are of no value against fleshly indulgence” (Col 2:23). For transgender people, pastors can direct them to realize that they are whole in Christ, without changing their bodies. Kline and Schrock point out the application of spiritual circumcision that happens in Christ allowing one to be set apart for God through faith alone (Col 2:8-15) in counseling transgender people. They claim, “despite the sincerest intentions of transsexuals, the surgery they desire to perform on the body needs to be performed on their heart…what they need is not a new body, but a new heart.”
Paul encourages the Colossians under temptation toward seeking completeness apart from Christ to remember their union with Christ. They died with Christ to a life at odds with God (Col 2:20), have been raised up with Christ so they can pursue God’s will (Col 3:1-2) and when Christ returns, their bodies will be perfected in glory (Col 3:4). Now those who saw themselves as transgender people pursuing the lifestyle and thinking of the opposite sex are now encouraged to “consider the members of your earthly body as dead to immorality, impurity, passion, evil desire, and greed, which amounts to idolatry” (Col 3:5). By their new union with Christ, they may pursue life in accordance with God’s will for them, including living out the gender in which He gave them.
One further idea needs addressed here. The current culture has sought to persuade those tempted toward transgender behaviors that their discordant feelings must define their identity. However, in First Corinthians 6:9-11, directing the Corinthian church toward holy living, Paul lists several sins which will disqualify a person from salvation. Three of these sins included together deal with sexual immorality. One term, μαλακοὶ (effeminate) is a term used often to mean “soft” but was applied to a male who becomes the receptive partner in a same-sex intercourse. Indeed, it speaks of a man who is taking on the sexual role of a woman. However, Paul reminds them of a powerful truth that should change the way they think and live. He says, “Such were some of you; but you were washed, but you were sanctified, but you were justified in the name of the Lord Jesus Christ and in the Spirit of our God” (1 Corinthians 6:11). Branch explains, “Many people who have been born again previously practiced such things prior to knowing Christ, yet the gospel empowered them to put these evil actions in the past. This…does mean they have a new desire to serve God and a new power to say no to what God forbids.”
Second, transgender people who have trusted in Christ will need Scriptural guidance in understanding and accepting their biological gender. Throughout the creation account of Genesis 1, the refrain “and God saw that it was good” is repeated after each creative act. At the end of the account, Moses recorded, “God saw all that He had made, and behold, it was very good” (Gen 1:31).
Included in this account is God’s creation of mankind. Moses wrote, “God created man in His own image, in the image of God He created him; male and female He created them” (Gen 1:27). God’s good creation of mankind was divided into two groups: male and female. God has provided only two genders which, once given, are unchanging. Kenneth Matthews states, “There is no place in God’s good order for unisexuality or for any diminishing or confusion of sexual identity…The proper role of the sexes therefore is crucial to God’s designs for human life and prosperity.” These genders are equal in value because they each have and express the imago Dei (image of God) in different but significant ways. They have different roles in the family (Eph 5:22-33) and in the church (1 Tim 2-3).
The complimentary nature of the two sexes within marriage is intended to bring glory to God by reflecting the character of God and the relationship of Jesus and the church in the gospel (Eph 5:22-33). Masculinity and Femininity each reflect God’s glory and character through differences in strength and beauty, sacrificial leadership and humble submission, protection and nurture. Gordon Wenham emphasizes that the distinctions of male and female focuses on the sexual distinctions that foreshadow the blessing of fertility. Transgenderism, when carried out, disables fertility and severs God-directed roles from biological sex.
Finally, a pastor must provide hope and direction for a life lived in God’s will, even in cases where sex reassignment surgery has occurred. As mentioned earlier, those whose genitals had been damages, through accident, force, or personal volition, were not allowed to enter the assembly of God’s people or serve as priests. Yet, Isaiah 56:3-5 promises great hope of salvation for the eunuch who enters into a covenant relationship with God by God’s terms. While the image of a eunuch as a “dry tree” may mean that he can have no children, which would certainly be true, Gary Smith offers another possibility, “maybe the point goes even beyond this issue, for a dry tree is usually considered worthless, useless, and is consequently burnt up in a fire.” But the promise for the eunuch, who cannot reverse what has already happened to his body, can now choose to live a life that honors God within His covenant, and can receive honor and eternal blessings.
Jesus provides great hope for transgender people who turn to Him. While, if they have undergone sex reassignment surgery which cannot be reversed and should not marry, they can still find joy in serving God in singleness. Jesus speaks of three types of eunuchs when he talked about the usefulness of singleness for the Lord. Some were those “who made themselves eunuchs for the sake of the kingdom of heaven” (Mt. 19:12).
If someone had carried out their transgenderism to the point of becoming like a eunuch, now in Christ, he may live a life fully dedicated to God. This idea of singleness is upheld and encourage by the Apostle Paul also. He states, “One who is unmarried is concerned about the things of the Lord, how he may please the Lord” (1 Cor 7:32). John Chrysostom highlights the blessings of this kind of singleness. He writes, “Thank God therefore now, for that with rewards and crowns thou undergoes this.” The transgender person who turns to Christ, will find a place to belong and a fruitful and fulfilling life serving Christ’s Kingdom.
This paper has sought to show that pastoral care for transgender individuals will direct them to find a new identity in Christ according to the Scriptures which will enable them to celebrate their God-given gender. An argument for the authority of the Bible over subjective feelings or empirical efforts was made. An understanding of life-giving salvation by turning to Jesus Christ was explained. Finally, Biblical passages relevant to counseling those individuals who have turned to Christ out of transgenderism were discussed. There is true and lasting hope and healing in the gospel, not only for transgender people, but for all who will surrender to Jesus in faith.
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 Daniel Heimbach, Pagan Sexuality: At the Center of the Contemporary Moral Crisis (Wake Forest, NC: Southeastern Baptist Theological Seminary, 2001), 6.
 Harry Benjamin, The Transsexual Phenomenon (New York: The Julian Press, 1966), ix.
 Ibid., 105.
 Substance Abuse and Mental Health Services Administration, “Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth,” HHS Publication SMA 15-4928 (2015): 3.
 Dick F. Swaab and Alicia Garcia-Falgueras, “Sexual Differentiation of the Human Brain in Relation to Gender Identity and Sexual Orientation,” Functional Neurology 24 Vol. 1 (2009): 18.
 J. Alan Branch, Born this Way? Homosexuality, Science, and the Scriptures (Wooster, OH: Weaver Books Company, 2016), 82-83.
 πρεσβυτέρους denotes spiritual maturity and an ability to set a faithful example of life in submission to God. ἐπισκόποις communicates leadership. ποιμένας is only used once in its nounal form (Eph 4:11) but accompanies the two previous terms in its verbal form (Acts 20:17, 28 and 1 Peter 5:1-5). Further, it conveys the task of spiritual provision and guidance through instruction and care.
 John Calvin, Institutes of the Christian Religion, trans. Robert White (Edinburgh: The Banner of Truth Trust, 2014), 723.
 Gregory Alan Thornbury, “Prolegomena: Introduction to the Task of Theology” in A Theology for the Church, Daniel L. Akin, ed. (Nashville, B&H Academic, 2007), 5.
 Benjamin, The Transsexual Phenomenon, 114.
 Benjamin, The Transsexual Phenomenon, 126.
 Oliver O’Donovan, “Transsexualism and Christian Marriage” The Journal of Religious Ethics 11.1 (Spring 1983): 157-158.
 The comprehensive nature of the inspiration of God’s Word is seen in David’s use of terms with overlapping meaning (מִֽשְׁפְּטֵי, מִצְוַת, פִּקּוּדֵי, עֵדוּת, תֹּורַת) to describe the Word of God.
 Also see John 17:17, 2 Timothy 3:14-17 and 2 Peter 1:2-3, 20-21.
 American Psychiatric Association, DSM V/American Psychiatric Association: Diagnostic and Statistical Manual of Mental Health Disorder, 5th ed. (Arlington, VA: American Psychiatric Association, 2013), 451.
 Nili Sacher Fox, “Gender Transformation and Transgression: Contextualizing the Prohibition of Cross Dressing in Deuteronomy 22:5” in Mishneb Todah: Studies in Deuteronomy and Its Cultural Context in Honor of Jeffrey H. Tigay, Nili Sacher Fox, D.A. Glat-Gilad, and M.J. Williams, eds. (Winona Lake, IN: Eisenbrauns, 2009), 53-55.
 Fox, “Gender Transformation and Transgression: Contextualizing the Prohibition of Cross Dressing in Deuteronomy 22:5,” 59-61.
 R. Laird Harris, Gleason L. Archer, Jr., Bruce K. Waltke, Theological Wordbook of the Old Testament (Chicago: Moody Publishers, 1980), 977.
 Duane L. Christensen, Deuteronomy 21:10-34:12, Volume 6B, Word Biblical Commentary (Grand Rapids: Zondervan, 1997), 492.
 Peter C. Craigie, The Book of Deuteronomy, The New International Commentary on the Old Testament (Grand Rapids: William B. Eerdmans Publishing Company, 1976), 287.
 American Psychiatric Association, DSM V, 451.
 Either by having crushed testicles (פְצֽוּעַ־דַּכָּא), done intentionally at times by the use of stones for castration, or the removal of the penis (וּכְרוּת שָׁפְכָה).
 Craigie, The Book of Deuteronomy, 297.
 Eugene H. Merrill, Deuteronomy, New American Commentary (Nashville: Broadman & Holman Publishers, 1994), 307.
 Philip Schaff and Henry Wace, eds., NPNF: The Seven Ecumenical Councils 2.14 (Peabody, MA: Hendrickson Publishers, 1999), 8.
 Alan Branch, lecture notes for DR 31280 The Bible and Pastor Care, Midwestern Baptist Theological Seminary, August 2, 2018.
 American Psychiatric Association, DSM V, 451.
 American Psychiatric Association, DSM V, 458; and Substance Abuse and Mental Health Services Administration, “Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth,” 1, 11, 13, 14.
 Substance Abuse and Mental Health Services Administration, “Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth,” 20.
 American Psychiatric Association, DSM V, 454.
 Ibid., 458.
 In addition to the causes of the heart which will be discussed below, the Western world easily forgets about spiritual causes from demonic forces. In the Scriptures, those who serve demonic deities or who are demoniacs are often seen harming their own bodies. John Chrysostom writes about those who remove their genital organs, “For to cut off our members hath been from the beginning a work of demoniacal agency, and satanic device, that they may bring up a bad report upon the work of God, that they may mar this living creature” in NPNF: Chrysostom: Homilies on the Gospel of Saint Matthew 1.10, Philip Schaff, ed., (Peabody, MA: Hendrickson Publishers, 1999), 384.
 Extensive and common complications arise from sex reassignment surgeries such as a fifty percent wound infection rate, massive bleeding, urinary problems, incontinence, problems with the urethra, infertility, an inability to orgasm, leaking of seminal fluid, hypoactive sex drives, etc. See Craig Kline and David Schrock, “What Is Gender Reassignment Surgery? A Medical Assessment with a Biblical Appraisal,” Journal for Biblical Manhood & Womanhood 20.1 (Spring 2015): 35-47 and especially 40-41. For a discussion on the dangers of puberty suppressing medications now in vogue see Paul W. Hruz, Lawrence S. Mayer, and Paul R. McHugh, “Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria” The New Atlantis: A Journal of Technology & Society 52 (June 2017), 3-36.
 Jay Adams, speaking of many mental problems of which he would likely apply transgenderism, says, “Their problem is autogenic; it is in themselves. The fundamental bent of fallen human nature is away from God. Man is born in sin, goes astray…and will therefore naturally (by nature) attempt various sinful dodges in an attempt to avoid facing up to his sin.” In Competent to Counsel, (Grand Rapids: Baker Book House, 1970), 29.
 William F. Arndt and F. Wilbur Gingrich, A Greek-English Lexicon of the New Testament and Other Early Christian Literature: A Translation and Adaptation of Walter Bauer’s Griechisch-Deutsches Worterbuch zu den Schriften des Neuen Testaments und der ubrigen urchristlichen Literatur 4th ed. (Chicago: The University of Chicago Press, 1957), 293.
 For a discussion concerning the feelings and behaviors of transgender people, see P.D. Young, “Gender Identity Disorder” in Baker Encyclopedia of Psychology & Counseling, 2nd ed., David G. Benner and Peter C. Hill, eds. (Grand Rapids: BakerBooks, 1999), 491.
 Benjamin, The Transsexual Phenomenon, 9.
 Ibid., 126.
 William F. Arndt and F. Wilbur Gingrich, 119.
 Harris, Archer, and Waltke prefer the translation “bliss” over happiness. In Theological Wordbook of the Old Testament, 80.
 Adams, Competent to Counsel, 105.
 Matthew S. Standford, The Biology of Sin: Grace, Hope, and Healing for Those Who Feel Trapped, (Downers Grove, IL: InterVarsity Press, 2010), 22.
 Kline and Schrock, “What is Gender Reassignment Surgery? A Medical Assessment with a Biblical Appraisal,” 45.
 Alan Branch warns of the modern propensity to turn sexual issues into identity issues in Born this Way? Homosexuality, Science, and the Scriptures, 135.
 Fredrick William Danker, ed. A Greek-English Lexicon of the New Testament and other Early Christian Literature, 3rd ed. (Chicago: The University of Chicago Press, 2000), 613. Also, see Gordon Fee’s excellent discussion on this term in The First Epistle to the Corinthians, The New International Commentary on the New Testament (Grand Rapids: William B. Eerdmans Publishing Company, 1987), 243-245.
 Branch, Born this Way? Homosexuality, Science, and the Scriptures, 135-136.
 Kenneth A. Matthews, Genesis 1-11:26, The New American Commentary, (Nashville: Broadman & Holman Publishers, 1996), 173-174.
 Gordon J. Wenham, Word Bible Commentary: Genesis 1-15, (Waco, TX: Word, 1987), 33.
 Gary V. Smith, Isaiah 40-66, The New American Commentary, (Nashville: B&H Publishing Group, 2009), 533.
 John Chrysostom, NPNF: Chrysostom: Homilies on the Gospel of Saint Matthew 1.10 (Peabody, MA: Hendrickson Publishers, 1999), 384.