Theological responses to gender variance that object to gender transition sometimes do so, as we have seen, for distinct moral or doctrinal reasons. Often, however, objections are more ethical and pragmatic, prompted, at least ostensibly, by concerns about health. Sometimes objectors suspect – in defiance of the World Professional Association for Transgender Health (WPATH), the World Health Organization, and various mainstream therapeutic bodies – that gender dysphoria and/or a desire to transition gender are themselves pathological, pointing to underlying mental illness. Sometimes there are concerns that apparent gender dysphoria masks deeper underlying problems such that people who believe that they want to transition will actually be no better off afterwards than they were before. And there has been particular anxiety in recent years about an apparent mental health crisis amongst young people, which has coincided with higher numbers of young people (especially those assigned girls at birth) seeking transition. In this situation, it may be unclear whether gender dysphoria is something with its own independent reality or a side effect of mental health problems whose most appropriate treatments may not include support for transition. In this chapter and Chapter 9 I discuss health-related questions prompted by the existence and experiences of trans people, again in the context of reflection on limits. I ask whether support for transition is indeed always the most appropriate response to gender-variant identity; I deal, too, with some ethical questions such as whether it is justifiable to undergo interventions that will compromise fertility and whether transition-related interventions may justly be prioritized when finances and resourcing for healthcare are scarce.

Questions about the removal and preservation of fertility and how far this should be a concern when judging the rights and wrongs of gender confirmation surgeries in particular might seem more ethical than theological per se. Questions about the ethics of removing ‘healthy’ body parts, as in the case of gender confirmation surgery but examined here through the lens of discussions of other elective surgeries that tend to baffle observers, are also often cast more as moral dilemmas than as ways into broader theological anthropologies. However, these concerns are, of course, also deeply theological, as I will show particularly in the latter part of this chapter: they speak into how we understand our vocation as persons and animals and prompt re-examinations of procreation’s centrality in Christian theology, an expansion of the one I attempted in Cornwall (2017).

The creation was made through Christ (John 1:3, Colossians 1:16). It was and is remade in him. He is the firstborn of creation (Colossians 1:15); in him all things are made anew (2 Corinthians 5:17). In Christ, all things hold together (Colossians 1:17). Yet where there is renewal there is shattering: where there is birth there is pain, blood, rupture. The new coming-into-being that Christ enabled occurred not as a bloodless, sterile event, but as something visceral, even foetid. There is nothing clean or immaculate about creation: it is messy and often wasteful; it has many casualties (Southgate 2008). It is, above all, profoundly material and, from the point of view of humans, profoundly animal.

In Part IV of this book, entitled Transformative Creatures, I develop a constructive theology of gender variance. It encompasses accounts of theological anthropology: the truths gender tells us about ourselves, individually and collectively; our sexuate and animal statuses (Chapter 10); the hints that as humans we tend to embrace order and give a high place to social and psychological systems that allow us to manage our expectations and minimize danger; and the concomitant fact that we often create and cling to arbitrary and over-solidified delimitations in order to exercise power. It dwells on creation, with particular reference to the question of the licit limits of human technologies given God’s creative control over creatures (Chapter 11). It notes that Christ signifies a way but not the sole way to be a human, much less a creature, and does not tell the full story of what it means to be a sexed and gendered person (Chapter 11). It is eschatological, but it shows that our creaturely ends may include those accessible here and now, not just those ‘ahead’ of us (Chapter 12).

In 2004, the Gender Recognition Act (GRA) was passed into law in England and Wales. It enabled trans people who had been diagnosed with gender dysphoria by a medical professional and had lived in their gender of affirmation for two years to be legally recognized as members of this gender. Once the Gender Recognition Panel (a judicial body comprising judges experienced in tribunals and medical experts, to which appointments are made by the Lord Chancellor) was satisfied by the evidence provided,1 and after payment of a processing fee, trans individuals could be issued with a Gender Recognition Certificate (GRC). This meant that anyone who applied for a birth certificate based on the Gender Recognition Register would be given a certified copy that did not disclose the individual’s gender at birth, or their name at birth where this differed from that on the GRC.

In my earlier book Un/familiar Theology (Cornwall 2017) I held that Christians should be circumspect about originism and particularly about appeals to origins that conceal the way in which origins themselves have been constructed and redacted in the transmission. I held that giving too high a place to origins in this way might be figured as a form of original sin – the sin of over-maximizing the importance of origins.

In Chapter 5 we saw that appeals to truth in discussions of bodies and identities have sometimes undermined trans people’s right to tell their own truths as they see fit. We saw that truth has sometimes not been problematized appropriately, nor the category sufficiently interrogated. I concluded that trans and cis people alike need to be granted the autonomy to self-narrate and that there needs to be a widespread acceptance that no identity signifies monolithically and that the truth of identity will therefore always be multiple and contested.

Reservations about the licit limits of technological transformation for trans people’s bodies are frequently grounded in convictions about created givenness and the desire to ensure that the body is a truthful and authentic expression of God-given identity. In this account, whilst the ostensible argument might be that bodies are irreducible and that spirit/mind/identity must supervene on them (such that where there is dysphoria minds must change to fit bodies), in fact there is a hidden appeal to a spirit and body which are mutually ‘fitting’ and coexist. Thus, in some conservative evangelical and conservative Roman Catholic accounts, commitment to the stability and reality of feminine and masculine gender means female and male bodies must not be altered. Bodily dimorphism is, in this account, significant because it points to broader truths about dimorphism that somehow precede actual concrete bodies (such that where an anomaly such as intersex arises it may or even must be corrected to ensure no physical variation from the binary lines; Hollinger 2009, p. 84; Congregation for Catholic Education 2019, pp. 13–14). Many trans people have appealed to the amelioration of distress that became possible for them when, post-transition, it no longer felt as though their body and spirit were in opposition.

Before turning to some theological accounts in Chapter 3, we take an excursus here into the phenomenon of so-called detransition, significant because its existence is a catalyst for much ethical concern about the enormity and permanence of the decisions that those who go through medical and surgical transition are making. It also sets up some questions about permanence, regret, and reality that will remain significant across the book.

There is some very fine recent work on trans studies and religious studies: Kelly (2018) is a masterful summary of the development of trans studies in religion, categorized according to genre and method and situated in the context of the germinal work in trans critical theory by Susan Stryker and Sandy Stone. In this volume, however, my focus and methodological concentration is Christian constructive theology and theological ethics. As Max Strassfeld and Robyn Henderson-Espinoza (2019, pp. 285–288) remark, tension between trans studies and religious studies has come about because of the perspectives on trans held by foundational feminist scholars of religion. The most notable example is Mary Daly, whose notoriously trans-suspicious perspective (Daly 1978; NB Daly also supervised Janice Raymond’s writing of The Transsexual Empire; Raymond 1979) has heightened observers’ assumption that the fields are necessarily in opposition. That means, however, that ‘if the trouble … lies originally in the field of theology, then its redress must come from within theology specifically’ (Strassfeld and Henderson-Espinoza 2019, p. 287). This is important particularly in contexts where not-so-secretly Christian theological glosses of maleness and femaleness, masculinity and femininity make it into legal and political texts that seek to define and regulate bodies, trans bodies among them (Strassfeld and Henderson-Espinoza 2019).

In Chapter 7 I will turn more explicitly to the doctrine of creation, but here we begin that journey through the lens of theological anthropology. We will consider, in particular, how far our bodies communicate truths about us, and, concomitantly, what our attachment to gender as well as to sex tells us about ourselves as humans. I suggest, for example, that our frequent theological appeals to truth, and particularly our desire that our bodies communicate what we perceive to be truths about us accurately, point to a concern and regard for our animality. Our desire that our bodies communicate honestly also gives a hint that as humans we tend to embrace order and give a high place to social and psychological systems that allow us to manage our expectations and minimize danger. This latter tendency has a more sinister flip side: the concomitant fact that we often create and cling to arbitrary and over-solidified delimitations to exercise power, and that therefore no appeal to monolithic repositories of truth is likely to be innocent, especially where it means policing others’ self-projections.