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Luke’s Journal July 2026  |  Vol.31  No.2  |  Sexuality

Part 1: Understanding the Transgender Phenomenon

The transgender revolution challenges the Christian health professional at multiple levels.

It introduces a radically ‘liquid’¹ sense of self that stands against both the biblical and scientific understandings of humanity’s binary sexed nature. It introduces a framework of diagnosis that reinterprets childhood discomfort with the body, adolescent developmental distress, and adult sexual desires through the single lens of transgender identity.² And it channels all people of any age, even very young children, into what is known as the ‘affirmation’ model of therapy, which has been shown to usher people towards medicalisation and surgery.³ Some jurisdictions now mandate that kind of unequivocal affirmation and criminalise any deviation from it.⁴

The transgender revolution has also introduced a plethora of new and confusing words, phrases and treatment modalities into health professional practice. Those of you who are fresh out of medical school may be familiar with the gender terms such as non-binary, pangender, omnigender, agender, xenogender, eunuch, and combinations such as ‘agender demiboy.’⁵ Others may find this all new and difficult to comprehend. You may even struggle to understand that a ‘transwoman’ is a biological male who self-identifies as a female and that a ‘transman’ is a biological female who self-identifies as a male. You may find it incomprehensible that your licensing body, the Australian Health Practitioner Regulation Agency (AHPRA), registers a biological male as being ‘female’ simply because he identifies as one.⁶

When it comes to sexual orientation, the terminology of lesbian, gay, bisexual is familiar. But here too the transgender revolution has introduced new terms like asexual, aromantic, allosexual and polyamorous.⁷ Some of you may have teenage patients who identify across gender and sexual orientation labels and call themselves an ‘asexual demigirl’⁸ or a ‘lesbian transwoman.’⁹

When it comes to management, those of you who are not fresh out of medical school may struggle to understand treatments such as gender affirmation therapy, top surgery, and bottom surgery.

You probably have been asked to state your preferred pronouns. Some of you may consider this a harmless practice. Others may be uncomfortable with it.

This article aims to help you understand the transgender phenomenon by demonstrating how it contradicts the biblical and scientific understandings of human beings and human health.¹⁰

Our next article will explore current research on why some people identify as something other than their biological sex and the current management options.

The biblical view of sex and gender

The Christian view of humanity is that we are created by the personal, relational, Triune God as two sexes, male and female. The main purpose of that binary sexed creation was that the two sexes would love each other, including (but not only) sexually. Both binary sex and heterosexual monogamy are demonstrable from the creation accounts in Gen 1:26-28 and 2:18-25, and especially from the way Jesus himself brings Genesis 1 and 2 together in Matt 19:4-6 and Mark 10:6-9. Christian orthodoxy therefore requires affirming that binary sex and heterosexual monogamy are both God’s intention for human beings, and that any declension from them is sub-optimal – it is the effect of ‘sin.’

“Christian orthodoxy therefore requires affirming that binary sex and heterosexual monogamy are both God’s intention for human beings…”

The same Jesus who affirmed binary sex and heterosexuality also said, e.g. in Luke 13:1-5 and John 9:1-3, that people are not always directly responsible for the effects of sin. We can recognise the effects of sin upon people’s bodies and sexual inclinations without burdening them with guilt. Disorders of sex development (DSDs), identity confusion, negative responses to adolescent bodily changes, non-heterosexual attractions, and heterosexual attraction to someone other than one’s spouse (adulterous lust!) are some of the various effects of sin upon our bodies and souls. We can recognise them to be wrong without burdening ourselves or others for experiencing them.

However, since Christian orthodoxy includes affirming the goodness and rightness of both binary sex and heterosexuality, no Christian should encourage anyone to identify other than their biological sex,¹¹ or to act on their sexual impulses outside of heterosexual marriage. Anyone who does so loses their right to represent the Christian faith.

Scientific, medical knowledge of human health

Medicine is scientific knowledge. It is founded upon the belief in the objective reality and stability of the human body through time and place. Scientific medical experimental results conducted in Argentina fifty years ago can be used to improve medical care in Zimbabwe today. The generalisability of medical knowledge – the fact that those carefully conducted experiments can be replicated in different places at different times – demonstrates that they are telling us something about human nature in general, not just one specific human being. Centuries of careful medical research have created a reliable body of knowledge about the healthy functioning of the human body – including, importantly for our purposes, the differences between males and females.

Science and medicine are predicated upon what is called a realist ontology and consequently depend upon at least a critical realist epistemology.¹² For the history of human civilisation, people have understood that the physical world – including our body, our physiology – possesses a concrete reality which, in its material tangibility, exercises authority over us. We may not like that material reality. We may prefer or imagine a better one. But we have understood that it is best to live in harmony with, not against, those physical realities.^{13 14 15}

“We may prefer or imagine a better one. But we have understood that it is best to live in harmony with, not against, those physical realities.”

This body of scientifically discerned knowledge about the human body possesses authority over both medical practitioners and patients. Medical practitioners spend years, often decades, learning it. This knowledge gives medical practitioners authority to inform their patients about their health. But it also places the responsibility upon medical practitioners to diagnose in accordance with that knowledge. A doctor who ignores a cancer marker on a test just because the patient says they feel fine would be guilty of professional misconduct. The patient may, under the principle of patient autonomy, ignore that cancer marker, but they would be acting AMA: against medical advice.

Neither ontological realism nor the priority that science and medicine place on embodied biology discount the reality of people’s invisible, internal life – our psyche, our ‘soul.’ The Bible is full of emotional language, e.g. the book of Lamentations; Psalm 88. Psychology and its associated disciplines seek to discern, in ways akin to the natural sciences, the patterns of thought which demonstrably lead to healthy, sustainable ways of life. In the realms of art and literature, we can use our imagination to visualise ‘fantastic’ worlds where the natural laws of our real universe don’t hold, which are entered by a magic portal and are full of strange creatures like talking animals and white witches.

But psychological health, artistic creativity, and right enjoyment of fiction and fantasy all depend on recognising the difference between the immaterial and the material, between our emotions or imagination and concrete reality. People who constantly walk into wardrobes looking for Narnia are going to be disappointed because Narnia doesn’t ‘really’ exist. Their inability to distinguish fantasy from reality may eventually even adversely affect their mental health.

People may be uncomfortable with their physical bodies. They may prefer something different, especially during puberty, which is an intense confluence of bodily changes, youthful immaturity, and social pressure. Transgender ideology misleads people – especially vulnerable young people – into distrusting, perhaps even despising, the physical realities of their body, and into believing that they can enforce their preferences upon that body in a sustainable way.

Transgender ideology tries to redefine reality

Transgender ideology contradicts both the Christian and scientific understanding of what it means to be human by setting up a new, completely subjective basis for defining not just ourselves but all reality. Transgender ideology claims that each person has an internal, innate, and immutable sense of who and what they are – their gender identity – which may or may not match their biological sex. People whose gender identity does not match their biological sex are said to be transgender.¹⁶ Those who feel significantly distressed at this disjunction between their inner feeling and their biological sex are said to have gender dysphoria.

According to trans ideology, a person’s gender identity is their core, ‘authentic’ self. That gender identity consists of a more or less settled bundle of self-referential emotions. It’s how the person feels about themselves. Because that set of feelings resides within them, it is completely private to them. No one ‘outside’ that person can know it – not their parents, their friends, their teachers, nor health professionals. It is therefore untestable. It cannot be examined by medical instruments. It therefore cannot be assessed scientifically. It can only be declared by the person themselves. Everyone else, including medical professionals, must accept the person’s declaration. And since that internal, invisible, unexaminable being – not the person’s physical, visible, examinable body – is taken to be their real, ‘authentic’ self, their physical body should be changed to fit their internal feelings, not the other way around.

Trans ideology thereby affects nothing less than a redefinition of reality. As discussed above, while Christianity and other religions recognise the reality of the supernatural, human civilisations have accepted the reality of physical matter, including the reality of our physical bodies, and have sought to live well in light of those physical realities. In contrast, trans ideology locates ultimate reality within, not outside, the individual, and defines people as being primarily emoting, not thinking, beings.¹⁷ It then encourages the trans-identifying person to impose this internally emoted ‘reality’ upon everyone around them by demanding that everyone submit to the trans-identifying person’s ‘reality.’

“It then encourages the trans-identifying person to impose this internally emoted ‘reality’ upon everyone around them…”

At this point, trans ideology’s internal inconsistency becomes clear. On the one hand, it focuses on what is completely private: a person’s internal sense of themselves. But it inconsistently uses those private convictions to make public demands upon the trans-identifying person’s family, friends, workmates, and, significantly for the purposes of this article, upon medical professionals.

Trans ideology disempowers medical professionals from being able to use their hard-earned knowledge to advise the patient. It discredits the entire medical profession because the patient’s embodied biology ceases to be the primary reference for the patient’s health.

It then debases the medical profession by demanding that medical professionals affirm what medical science knows to be false – that people can ‘become’ the opposite sex – and worse, by requiring medical professionals to contradict their primary Hippocratic oath of non-harm by participating in medical procedures which demonstrably cause harm.

Indeed, trans ideology discredits the entire scientific endeavour because it refuses to accept that objective reality possesses authority over a person’s internal subjective preferences. It is therefore similar to the kind of science denialism that underpinned the anti-vaccination movements, which caused such social trauma during the COVID pandemic.

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1. Following Zygmunt Bauman’s characterisation of postmodernity as the denial of all ‘concrete’ order in favour of a chaotic, ‘liquid’ view of ultimate reality: Bauman, Zygmunt, Liquid Modernity, Cambridge, UK / Malden, Mass.: Polity; Blackwell, 2000.
2. This is known as ‘diagnostic overshadowing,’ where a person’s distress and symptoms are all attributed to one specific diagnosis while other mental health or medical issues are overlooked.
3. The four steps of gender affirmation therapy consist of (1) social transitioning; (2) use of puberty blockers (GnRH analogues); (3) use of cross sex hormones; and (4) surgery.
4. This is known as ‘ideological capture.’ It happens when an organisation set up to advance the public good permits a specific set of beliefs, values, or convictions to determine their operations, so that instead of using their public status to serve the common good, they end up imposing those particular beliefs etc. upon the public. In the process, the public agency covertly and illegitimately becomes an activist organisation for private interests.
5. ‘68 Terms That Describe Gender Identity and Expression,’ Healthline website: https://www.healthline.com/health/different-genders.
6. Rachel Baxendale, ‘Trans doctor Beth Upton at centre of UK dispute now working in Australia’ The Australian 21 April 2026, archived online at https://archive.md/v80vU.
7. ‘47 Terms That Describe Sexual Attraction, Behavior, and Orientation’ Healthline website: https://www.healthline.com/health/different-types-of-sexuality.
8. A person who partially identifies as a girl and feels no sexual attraction to anyone.
9. A male who identifies as a female and feels sexually attracted to other females (hence lesbian).
10. For a more in-depth analysis please refer to our book (co-authored with Robert Smith) The Gender Revolution, Sydney: Matthias, 2023.
11. Please note that we are here talking only of one’s biology. There are many ways to behave as a man or woman. We shall discuss more below.
12. Epistemology is the (meta)science of knowledge—how we know anything at all. Naïve realism is the attitude that all reality is immediately obvious to everyone and that everyone should, because we all experience the same reality, therefore interpret all reality the same way. It therefore interprets all disagreements as at core culpable folly. Everyone knows the truth; anyone who disagrees with me is being stubborn. Critical realism acknowledges that even if we experience the same objective reality, we interpret it through various culturally-influenced ways. It is therefore much more patient with disagreement. Disagreement is an opportunity to discover, understand, appreciate, and improve people’s different interpretative assumptions (the technical term is ‘hermeneutics’). That act of understanding and, through that understanding, seeking to improve each other’s hermeneutics expresses the ‘critical’ aspect of critical realism. Its optimism of our ability, through this critique, to spiral in closer to ultimate truth—even if the approach is asymptotic and therefore never ultimately arrives at final truth—expresses its realism. Final reality exists, even if we may never 100% arrive at it.
13. Disabilities may be part of the reality of certain people’s bodies and/or psyche. But they are known as dis-abilities because science is able to investigate and determine normal abilities. Disabilities are demonstrably sub-optimal for human health. We should definitely be compassionate towards people who suffer from them and seek to include those people within society. But part of that compassion is seeking to heal people from those disabilities so they no longer suffer from them.
14. Knowing and accepting concrete realities does not exclude working in harmony with them to create improved conditions which are sustainable because they work with, not against, the underlying patterns of those concrete realities. That is the difference between, e.g., sustainable development and relentless deforestation and urbanisation. Transgender ideology is similar to ripping up of the natural environment, replacing it with concrete, and wondering why the climate has changed, plants break through the concrete, etc.
15. The authority of physical realities does not contradict the existence and authority of invisible spiritual realities. The Christian doctrine of creation holds that the Triune God alone is uncreated invisible eternal spirit. Other invisible spiritual creatures exist: angels and demons. Other religions similarly accept that an invisible realm exists above and beyond—‘super’—physical nature: ‘the supernatural.’ All religions accept that nature possesses ordered patterns—known in Christianity as ‘natural laws’—which science can discover. Christian monotheism does not undermine, but actually underpins, an expectation of an ordered world which humans can discover. God is ordered; he created an ordered universe (Gen 1); and created humans in his image to rule that ordered universe. The (ironically this case) binary opposition of belief in nature and the supernatural is a recent fabrication invented by secularists which has (again ironically, with overtones of divine judgment) actually contributed to the recent decline in popular confidence in science and medicine, of which transgender ideology is a part. Without confidence in a divine cosmic lawgiver, we lose trust in natural laws, and thereby lose trust in human ability to discover and live by those natural laws.
16. The older term ‘transsexual’ was more accurate.
17. Trans ideology therefore differs even from (ancient) Platonic and (early-modern) Cartesian idealism. Idealism considers the physical world to be less than, and an imperfect expression of, invisible, immaterial ideals. Those ideals are considered to be perfectly ordered, and to be the source of the patterned, predictable forms of life which we observe in nature and which give nature, including our natural body, its health. Disorders within nature—disease, decline, disasters and death—are considered evidence of nature’s imperfection therefore its suboptimality compared to the immaterial ideals. Transgender ideology differs from idealism in two ways. First, while idealism prioritises the internal acts of thinking and reasoning over the more palpable acts of the body—eating, drinking, having sex—it still locates the ideals outside the thinking, reasoning individual. The person’s internal, invisible acts of cogitation are considered to connect them to those external, invisible ideals. Trans ideology in contrast terminates within the individual, who is (inconsistently) considered to be self-sufficient (but only if they are permitted to express themselves; and if they are not so permitted, they are considered to be extremely vulnerable and fragile—which means they are entirely dependent upon external affirmation). Secondly, idealism values the concrete orders of the material world as true, if imperfect, reflections of ideal order. Transgender ideology in contrast focuses on immediate, unstable, changeable emotions. Transgender’s internal emotivity inverts idealism. Transgender ideology is neither realism nor idealism. It really belongs by itself in a unique category of confusion.