Is Transgenderism a Mental Disorder?

Denmark became the first country in Europe to allow transgender individuals to legally change their gender without medical records in 2014.[1] In 2016, Denmark became the first country in the world to announce that it will remove transgenderism from its list of mental diseases, effective January 1, 2017.[2] This despite the fact that the World Health Organization lists gender identity disorder—the term medically used to refer to transgender individuals—as a mental disorder in the World Health Organization’s International Classification of Diseases.[3][4] Likewise, given that transgender individuals perceive themselves differently than the testimony of objective reality, transgenderism meets the definition of a mental disorder according to the Diagnostic and Statistical Manual of Mental Disorders. The American College of Pediatricians explains:

A person’s belief that he or she is something they are not is, at best, a sign of confused thinking. When an otherwise healthy biological boy believes he is a girl, or an otherwise healthy biological girl believes she is a boy, an objective psychological problem exists that lies in the mind not the body, and it should be treated as such. These children suffer from gender dysphoria. Gender dysphoria (GD), formerly listed as Gender Identity Disorder (GID), is a recognized mental disorder in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V). The psychodynamic and social learning theories of GD/GID have never been disproved. (emphasis removed)[5]

Gender dysphoria is a recognized mental disorder in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association.

The classification of transgenderism as a mental disorder may not be politically correct, but with the absence of objective evidence disproving such a classification, the medical community is compelled to treat it as such. Failure to do so would be inconsistent with how psychiatry defines other recognized disorders of assumption. Former psychiatrist-in-chief at Johns Hopkins Hospital and University distinguished professor of psychiatry at Johns Hopkins School of Medicine Dr. Paul McHugh explains:

The transgendered suffer a disorder of “assumption” like those in other disorders familiar to psychiatrists. With the transgendered, the disordered assumption is that the individual differs from what seems given in nature—namely one’s maleness or femaleness. Other kinds of disordered assumptions are held by those who suffer from anorexia and bulimia nervosa, where the assumption that departs from physical reality is the belief by the dangerously thin that they are overweight.

With body dysmorphic disorder, an often socially crippling condition, the individual is consumed by the assumption “I’m ugly.” These disorders occur in subjects who have come to believe that some of their psycho-social conflicts or problems will be resolved if they can change the way that they appear to others. Such ideas work like ruling passions in their subjects’ minds and tend to be accompanied by a solipsistic argument. [This is the theory that only the self exists, or can be proved to exist, or an extreme pre-occupation with one’s feelings and desires.[6]]

For the transgendered, this argument holds that one’s feeling of “gender” is a conscious, subjective sense that, being in one’s mind, cannot be questioned by others. The individual often seeks not just society’s tolerance of this “personal truth” but affirmation of it.[7]

The transgendered suffer a disorder of “assumption” like those in other disorders familiar to psychiatrists.

Despite transgenderism’s similarities with other disorders of assumption, the mental health community has come under severe political pressure to declassify transgenderism as a mental disorder, and recent changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM) has provided the category of transgenderism with a degree of protective ambiguity. Transgenderism has been reclassified from gender identity disorder to gender dysphoria. According to CNN, “The new DSM refers to ‘gender dysphoria,’ which focuses the attention on only those who feel distressed by their gender identity.”[8] Additionally, the term “mental disorder” was redefined. According to the previous edition of the DSM, the DSM-IV:

A mental disorder is a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.[9]

However, the DSM-V redefined mental disorder to afford an exception for socially deviant behavior and conflicts that are primarily between the individual and society:

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.[10]

The American Psychological Association has endeavored to use these changes in the Diagnostic and Statistical Manual of Mental Disorders to deny that transgenderism is a mental disorder. On their website they answer the question “Is being transgender a mental disorder?” by saying:

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. … Many other obstacles may lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety, depression or related disorders at higher rates than nontransgender persons.[11]

In other words, because a transgender individual is not troubled by their perception of themselves, but only by the reaction of those around them, they cannot be said to have a mental disorder. However, this reasoning is not consistent with all mental disorders. For example, WebMD describes psychotic disorders as:

distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations – the experience of images or sounds that are not real, such as hearing voices – and delusions, which are false fixed beliefs that the ill person accepts as true, despite evidence to the contrary.[12]

Sometimes the individual is not troubled by these hallucinations and false fixed beliefs, but only by the reaction of others to their delusion. The fact that the individual is not troubled by the condition, but only by the reaction of others to the condition, does not disqualify it as a mental disorder.

Psychotic disorders include delusions, which are false fixed beliefs that the ill person accepts as true, despite evidence to the contrary.

At the heart of this debate over how to classify transgenderism is the question, “What causes transgenderism?” Is transgenderism a perfectly natural and inborn condition; is it a consequence of social conditioning; is it a psychological disorder, or is it something else? Until recently, many of those who denied that transgenderism is rooted in a psychological disorder or a hormonal imbalance adhered to behaviorist psychological theories which assumed that an infant’s mind is a blank slate whose social conditioning produces all aspects of personality, including gender.[13] However, recent studies, combined with the discrediting of former studies, have given rise to neurological theories of transgenderism. Despite the fact that the human brain remains so complex that scientists are still trying to understand it, these studies have indicated that the brains of transgendered individuals may be constructed similarly to the gender with which they identify instead of their biological gender. These studies have garnered much media support, but none of these studies have been replicated, and within these studies, the authors often discuss the problems with their own research and the fact that their findings cannot prove anything until the findings are replicated.[14] Furthermore, a study from the Stockholm Brain Institute concludes that present data does not support the theory that male-to-female (MtF) transgender brains are feminized. Walt Heyer reports:

The scientists compared the sizes of various areas of brains belonging to MtF transsexuals to brains of heterosexual men and women. The findings: 1) all the males differed in the same ways from the females (no feminization of the transsexuals) and 2) the MtF transsexuals differed from both heterosexual men and women in the area of the brain that processes body perception.[15]

Additionally, neurological theories of transgenderism ignore the fact that the human brain is continually reorganizing itself according to our daily activities. Dr. Norman Doidge observes, “Now we know the brain is ‘neuroplastic’, and not only can it change, but that it works by changing its structure in response to repeated mental experience.”[16] Any similarities in brain structure between a transgender individual and the gender with which they associate does not preclude the possibility that the transgender individual’s brain was conditionally restructured based upon personal habits. Even so, brain structure does not determine reality. Carlos Flores writes:

For example, we may suppose that, through habitually behaving as a sixteen-year-old, the brain activity of the seventy-year-old mentioned above “resembles” that of a sixteen-year-old’s. Does it follow, then, that the seventy-year-old really is sixteen years old? Or that he is really a sixteen-year-old trapped inside a seventy-year-old’s body? Of course not. The most rational conclusion is that such an individual has some sort of cognitive or psychological defect associated with identity and self-perception. The same can be said for the transgender individual.[17]

Neurological theories of transgenderism ignore the fact that the human brain is continually reorganizing itself according to our daily activities.

Wisdom cautions against placing too much weight at this time upon any scientific study because there simply is an insufficient degree of reliable data. Popular as the neurological theories of transgenderism may be, it could be that they are premised upon a faulty assumption that there is such a thing as a typical male brain thinking pattern and a typical female brain thinking pattern. According to an NBC News article titled “Can You Tell Which Brains Are Male? Neither Can These Scientists:”

Scientists who tried very hard to find differences between male and female brains said they couldn’t do it — not with brain scans and not even by asking seemingly obvious questions such as whether someone likes boxing or worries about his or her mother.

They couldn’t find any single pattern that distinguishes between a male brain and a female brain, and say only a very small percentage of people fall under clear all-male or all female [sic] brain patterns.

“Our study demonstrates that although there are sex/gender differences in brain structure, brains do not fall into two classes, one typical of males and the other typical of females, nor are they aligned along a ‘male brain-female brain’ continuum,” Daphna Joel of Tel Aviv University and colleagues wrote. … “In other words, even when considering highly stereotypical gender behaviors, there are very few individuals who are consistently at the ‘female-end’ or at the ‘male-end’, but there are many individuals who have both ‘female-end’ and ‘male-end’ characteristics,” they wrote.[18]

Similarly, an article in The Scientist titled “Sex Differences in the Brain” notes:

[W]hile both the popular and scientific presses make reference to “male” and “female” brains, the brain is in reality not a unitary organ like the liver or the kidney. It is a compilation of multiple independent yet interacting groups of cells that are subject to both external and internal factors. This is abundantly true for hormonal modulation, with many and varied signal transduction pathways invoked. As a result, it is quite literally impossible for the brain to take on a uniform “maleness” or “femaleness.” Instead, the brain is a mix of relative degrees of masculinization in some areas and feminization in others.[19]

At this point we do not have enough objective data to conclusively determine a cause for transgenderism. This is the conclusion of Dr. Jack Drescher, a psychiatrist who was part of the American Psychiatric Association’s work group on gender identity. Dr. Drescher admits, “‘The truth is we actually don’t know what it is. Is it a mental disorder or does the cause of gender dysphoria lie somewhere else? We don’t know what causes it…’”[20] Theories abound, but we should continually keep in mind that these are merely theories. In the meantime, we are compelled to rely upon the only objective data that we have. As Jazz Shaw comments:

Falling back on the unfathomable intricacies of something as unbelievably complicated as the human brain isn’t going to make some scientific case that you were born in the wrong type of body. The fact is, we still only have a few obvious things to go on when determining your gender: an examination of your private parts and a chromosome analysis.[21]

We do not have enough objective data to conclusively determine a cause for transgenderism.

Although the cause of transgenderism may be in doubt, as Christians we understand that the Bible defines transgender behavior as sinful behavior regardless of its cause. A person’s biology and mental health cannot be our basis for determining the morality of any behavior. Scientists have discovered possible biological predispositions to such things as adultery, rape, pedophilia, violence, and many other sinful behaviors.[22][23] Just because something is natural does not make it acceptable behavior. Instead, our morality is determined by our Creator.

Those behaviors and actions that are immoral or sinful are so because they fail to align themselves with the character and behavior of God. Our standard for all behavior is determined by our Creator. In Leviticus 11:44, God commanded His people, Israel, “For I am the LORD your God. Consecrate yourselves therefore, and be holy, for I am holy.” Also, in verse 45 He said, “For I am the LORD who brought you up out of the land of Egypt to be your God. You shall therefore be holy, for I am holy.” Still again, in Leviticus 19:2, God commanded His people, “Speak to all the congregation of the people of Israel and say to them, You shall be holy, for I the LORD your God am holy.” These commands are then repeated to God’s people, the Church, in 1 Peter 1:14–16, “As obedient children, do not be conformed to the passions of your former ignorance, but as he who called you is holy, you also be holy in all your conduct, since it is written, ‘You shall be holy, for I am holy.’”

A person’s biology and mental health cannot be our basis for determining the morality of any behavior.

God originally created mankind as holy creatures. Adam and Eve were without sin until they chose to rebel against God and place their will above God’s will. At that point, their nature was broken. No longer did their nature tend towards God. Now it was bent away from God, and this sinful nature was passed along to their offspring. This is the teaching of Romans 5:12, which says, “[S]in came into the world through one man, and death through sin, and so death spread to all men.” Nevertheless, despite the fact that mankind was now born with a pre-disposition to sin, God continued to demand holiness. Never does God condone sinful behavior on the basis of biology. Instead, He calls mankind to overcome their temptations and to align their behavior with God’s will. God’s standard has never changed. When mankind possessed a sinless nature, God’s standard was holiness, and when mankind rebelled and received a sinful nature, God’s standard remained holiness.

With such a lofty standard, no person can succeed on his own. James 2:10 teaches, “[W]hoever keeps the whole law but fails in one point has become accountable for all of it.” There is no room for error. A single sin permanently prevents a person from being holy through his own deeds, and Romans 3:23 teaches that every person has sinned, “[F]or all have sinned and fall short of the glory of God.” Moreover, failure to be holy results in death. Romans 6:23 says, “For the wages of sin is death.” Not only will we die physically, but we will die spiritually. Revelation 20:12–15 describes this death as a second death in which a person is eternally separated from having a right relationship with God and from fulfilling their purpose for existing:

And I saw the dead, great and small, standing before the throne, and books were opened. Then another book was opened, which is the book of life. And the dead were judged by what was written in the books, according to what they had done. And the sea gave up the dead who were in it, Death and Hades gave up the dead who were in them, and they were judged, each one of them, according to what they had done. Then Death and Hades were thrown into the lake of fire. This is the second death, the lake of fire. And if anyone’s name was not found written in the book of life, he was thrown into the lake of fire.

Never does God condone sinful behavior on the basis of biology.

Fortunately, Romans 6:23 doesn’t conclude with the statement, “For the wages of sin is death.” If it did, we could have no hope but only despair because every one of us has sinned. But there is hope. Romans 6:23 says, “For the wages of sin is death, but the free gift of God is eternal life in Christ Jesus our Lord.” (emphasis added) This free gift is forgiveness from our sins, and it is made possible through the ministry of Jesus Christ who, having lived a sinless life, paid the penalty of our sin with His own life. John 3:16–18 says:

For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life. For God did not send his Son into the world to condemn the world, but in order that the world might be saved through him. Whoever believes in him is not condemned, but whoever does not believe is condemned already, because he has not believed in the name of the only Son of God.

Jesus is God’s means of fixing our broken relationship with Him and forgiving our sin. Because Jesus lived a sinless life, He did not have to die. Yet, His love for man was so great that He chose to die a horrific death on a cross for any who would accept His sacrifice. However, being God, death could not hold Him, and He rose from the dead three days later. As such, He stands before God as an advocate for any who are willing to repent—which is a turning away from sinful behavior—and accept God’s charge to live holy lives. Of course, until God redeems His creation and removes the curse of sin, we will struggle with our sinful natures, but God promises to give us the strength to overcome any and every temptation. And He promises to continue to forgive our failures if we seek His forgiveness.

Understanding this, Romans 10:9–13 teaches us how to accept this free gift of God:

[I]f you confess with your mouth that Jesus is Lord and believe in your heart that God raised him from the dead, you will be saved. For with the heart one believes and is justified, and with the mouth one confesses and is saved. For the Scripture says, “Everyone who believes in him will not be put to shame.” For there is no distinction between Jew and Greek; for the same Lord is Lord of all, bestowing his riches on all who call on him. For “everyone who calls on the name of the Lord will be saved.”

Anyone who believes that Jesus is God, that He died as a substitute for our sins, and that He rose again from the dead can ask God for forgiveness and commit to living a life that aligns itself with God’s holy character and behavior. And anyone who does this will receive God’s forgiveness and salvation from sin. As Romans 3:23–25 says, “[F]or all have sinned and fall short of the glory of God, and are justified by his grace as a gift, through the redemption that is in Christ Jesus, whom God put forward as a propitiation by his blood, to be received by faith.”

Having received the free gift of God, the Christian is empowered by the Holy Spirit to overcome all temptations—regardless of whether or not he may have a genetic pre-disposition toward it. First Corinthians 10:13 says:

No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it.

This is God’s promise to every Christian. Whether it be gender confusion, homosexual inclinations, heterosexual temptations, anger, pride, gossip, bitterness, worry, or any other temptation, we are promised enough strength to overcome it if we so choose, and if we will stand strong. As James 4:7 says, “Submit yourselves therefore to God. Resist the devil, and he will flee from you.”

The Christian is empowered by the Holy Spirit to overcome all temptations.

From the very beginning, mankind has sought to absolve itself of responsibility for its actions, but the brutal truth is that we alone are responsible for our behavior. Regardless whether gender dysphoria is something that a person is born with, gender dysphoric behavior is sin. Every person is responsible to submit their passions and natural inclinations to the will of God. Therefore, we would do well to follow the Apostle Paul's exhortation in 1 Timothy 6:11–15:

But as for you, O man of God, flee these things. Pursue righteousness, godliness, faith, love, steadfastness, gentleness. Fight the good fight of the faith. Take hold of the eternal life to which you were called and about which you made the good confession in the presence of many witnesses. I charge you in the presence of God, who gives life to all things, and of Christ Jesus, who in his testimony before Pontius Pilate made the good confession, to keep the commandment unstained and free from reproach until the appearing of our Lord Jesus Christ, which he will display at the proper time.

  1. Lyengar, “Denmark Will Remove Being Transgender from its List of Mental Diseases.”

  2. Ibid.

  3. Duffy, “Denmark Will No Longer Treat ‘Transgenderism’ as a Mental Illness.

  4. World Health Organization, International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Chapter V, F64.

  5. American College of Pediatricians, “Gender Ideology Harms Children.”

  6., “Solipsism.”

  7. Paul McHugh, “Transgender Surgery Isn’t the Solution,” The Wall Street Journal, June 12, 2014, Source: “Paul McHugh: Transgender Surgery Isn’t the Solution – WSJ.”

  8. Basu, “Being Transgender No Longer a Mental ‘Disorder’ in Diagnostic Manual.”

  9. Maisel, “The New Definition of a Mental Disorder.”

  10. Ibid.

  11. American Psychological Association, “What Does Transgender Mean?”

  12. WebMD, “Types of Mental Illness.”

  13. Conway “What Causes Transsexualism?”

  14. Family Research Council, “The Scientific Objectivity and Universality of Gender Difference.”

  15. Heyer, “Data Shows Male to Female Transgender Brains Are Not Feminized.”

  16. Doidge, “Brain Scans of Porn Addicts: What’s Wrong with This Picture?”

  17. Flores, “The Absurdity of Transgenderism: A Stern but Necessary Critique.”

  18. Fox, “Can You Tell Which Brains Are Male? Neither Can These Scientists.”

  19. McCarthy, “Sex Differences in the Brain.”

  20. Jayson, “What ‘Transgender’ Means, and How Society Views It.”

  21. Shaw, “Don’t Expect a Brain Scan to Tell You if You’re ‘Transgender’ or Not.”

  22. Brown, A Queer Thing Happened to America, 211–214.

  23. Rosenfeld, “Are Some Men Born Pedophiles? New Science Says Yes, But Sexologists Say Not So Fast.”

Transitioning by Timothy Zebell is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.


“Timothy Zebell has carefully studied the Scriptures and discerned the culture to provide a foundational understanding of transgenderism and its implications. Although not openly discussed in many Christian circles, if we are not informed on this issue, we will give this generation over to transgenderism, just like the last generation was given over to homosexuality. To help young people embrace how God has created them, this book is a must read!”

Dave Warn

Director, Forerunners of America