Virginia pastor John Pouchot ministered in evangelical congregations for more than a decade before he first encountered a family dealing with transgenderism in 2013. After Pouchot led a man to faith in Christ, his extended family began attending church and Pouchot learned the man’s high school-aged niece wanted to be a boy. Despite counseling the girl’s parents to the contrary, she underwent hormone therapy and began presenting as a boy. The experience left Pouchot convinced pastors like him will encounter transgenderism—and its root condition of gender dysphoria—with increasing frequency in the years to come and must be prepared to respond.
Christians trained to counsel those struggling with gender confusion agree with Pouchot’s assessment and have offered suggestions for pastors and laypeople seeking to make a difference among those who do not feel at home with their God-given gender. In at least some cases, the following actions should be undertaken in conjunction with help from a trained, Christian mental health professional.
- Recognize the difference between struggling with gender dysphoria and identifying with the opposite gender. Gender dysphoria is the technical term for the condition of not feeling at home in one’s body in terms of gender. One response to gender dysphoria is to present as the opposite gender, but that is not the only response. As with same-sex attraction, gender dysphoria is often an unwanted feeling that is battled by those who experience it.
- Listen. Often, simply talking to those struggling with gender identity and listening to their stories will begin a restoration. As North Carolina professor and counseling pastor Brad Hambrick put it, “Not having an immediate next answer may feel a little frail and helpless to the pastor.” But “that is the kind of [response] that [can lead a struggling person to] say, ‘You get me.’”
- Help struggling people manage their dysphoria “in the least invasive way possible.” In many cases, this is as simple as compassionately befriending a teenager until he or she “outgrows” feelings of gender dysphoria—as 70-80% of children reporting “transgender feelings” do. In no case, is so-called gender reassignment surgery appropriate. Not only is such surgery a sinful rejection of God’s good gift of gender, secular researchers have concluded it tends not to alleviate mental distress. A Swedish study found that a decade following gender reassignment surgery, “the transgendered began to experience increasing mental difficulties,” including a twentyfold increase in suicide rate.
- Urge individuals who have identified as the opposite gender to admit their sin and ask God for forgiveness. While experiencing unwanted feelings is not a sin, responding to them by shunning the Lord’s providential gender assignment is (cf. Genesis 1:27; 1 Corinthians 6:9). Without a doubt, turning from transgenderism often involves dealing with past emotional wounds and complex medical realities. But such actions should come in addition to confession, not in lieu of it.
- Help those who have identified as the opposite gender transition back to their God-given gender as much as possible. At minimum, this will involve dressing as the appropriate gender and ceasing hormone therapy. For those who have undergone gender reassignment surgery, it likely will mean concealing surgical alterations as much as possible. When financial and medical conditions permit, some types of surgery may be reversed. The transition also will involve deciding whether marriage or chaste singleness is the most appropriate path forward.
This list is not exhaustive. And as with many struggles, the road to healing can be difficult, with sinful temptations from the past reemerging from time to time. Yet Christian therapists have reported “huge success” in battling gender dysphoria, including a success rate of nearly 80% for transgender people who want to change.
 David Roach, “Transgenderism Is Growing Ministry Focus,” Baptist Press, May 4, 2016, http://www.bpnews.net/46796/transgenderism-is-growing-ministry-focus (accessed August 1, 2016).
 Mark Yarhouse, “Understanding the Transgender Phenomenon,” Christianity Today, June 8, 2015, http://www.christianitytoday.com/ct/2015/july-august/understanding-transgender-gender-dysphoria.html?start=5 (accessed August 1, 2016).
 Paul McHugh, “Transgender Surgery Isn’t the Solution,” The Wall Street Journal, June 12, 2014, http://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120 (accessed August 1, 2016).
 Roach, “Transgenderism is Growing Ministry Focus.”
 Bob [last name omitted intentionally], “Steps for Healing,” Help for Families Website, n. d., http://help4families.com/steps-toward-healing (accessed August 1, 2016).