Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture (Christian Association for Psychological Studies Books) Paperback – May 22, 2015

Dr. Yarhouse’s book is a unique and extremely valuable contribution to the discussion on gender identity, gender dysphoria, and how a local church can engage with people who experience gender dysphoria. The book is targeted towards Christians who are seeking to understand what gender dysphoria is and how to respond to it in a biblical way. However, I expect any person who is interested in the topic will gain something from it.This book is unique because Dr. Yarhouse possesses a unique combination of several crucial characteristics: (1) formal Christian theological training; (2) formal psychological training; and (3) over a decade of clinical experience in treating people who experience gender dysphoria. This combination of characteristics sets him apart from almost every other Christian who has published something on this topic and makes him one of the most authoritative voices that the evangelical church has for summarizing the latest research and providing thoughts on a way ahead.I found this book to be incredibly valuable for a number of reasons that I will attempt to summarize briefly.First, the book’s tone is very gracious and respectful. While this kind of respect should be the standard, in my experience it is not uncommon for people to write about transgender issues with tones of disdain. Throughout the book, Dr. Yarhouse puts in reminders that people who experience gender dysphoria are not any less worthy of respect than the average person, even saying (p. 41) “I acknowledge that we are – all of us – disordered. We do not like to think of ourselves as disordered, and this too is a reflection of the fall…What will make it harder is if we treat gender dysphoria as disorder while those of us who do not experience gender dysphoria…relate to others as though we are not ourselves disordered.”Second, I found the book to be an incredibly fair and even-handed treatment of the available literature on gender dysphoria. Over the years I have read the majority of published books and articles on this topic. (In contrast with published works on homosexuality, the volume of research and theological attention devoted to gender dysphoria is just a trickle.) Most authors on this topic only promote their own views and cite works that support those views. In contrast, Dr. Yarhouse provides a comprehensive and fair representation of existing views and research. The average proponent of the brain sex theory or sex reassignment surgery does not, in my experience, highlight Blanchard’s theories (except, perhaps, to denigrate them). Nor does the average Christian who believes transitioning is morally wrong tend to highlight studies by Diamond or Mazur. The Notes section at the end represents what is perhaps an unparalleled bibliography for the average person who is new to this subject and wants to understand what books and articles have been published about it.Third, Dr. Yarhouse identifies three common frameworks, or lenses, with which people today tend to view gender dysphoria. This is valuable because it can help people to understand how others may approach the subject differently, potentially leading to actual discourse versus just talking past each other. He also proposes an integrated framework that combines the best aspects of the three. I believe this integrated framework is a valuable tool for the church to build upon. One observation that I found particularly insightful was that people are looking for a sense of meaning and community and thus tend to gravitate towards the diversity framework (which celebrates the transgender experience) because it offers these things. In contrast, the integrity (commonly held in evangelical circles) and disability frameworks do not inherently provide meaning-making structures or storylines (p. 124 - “Most people do not find, ‘I’m managing my dysphoria in the least invasive way’ as a particularly meaningful storyline for identity and community”). This observation leads to reflection on how the church can better integrate this aspect of the diversity framework together with the others.Though I could fill this entire review with superlatives (I am giving the book five stars after all), I do have a few relatively minor critiques and comments that may help someone know what to expect.First, at times the book tends to read like a seminary textbook or a peer-reviewed article in a clinical journal. (Not surprising, since Dr. Yarhouse is, after all, a university professor and director of a research institute.) Words like “telos,” “noetic,” and “etiology,” which are readily understandable to someone who has studied Greek or regularly reads medical journals, frequently appear with little explanation. This is particularly the case in chapters 3-5, in which he reviews the available research and treatments. It is less the case in the chapters where he discusses Christian responses. Regardless, I think the book is approachable to anyone who is really wanting to understand more about gender dysphoria.Second (and related to the first item), facts and excerpts from books or studies are sometimes presented without a lot of commentary to help a person understand the meaning of those facts. This is understandable given that if Dr. Yarhouse were to stop and thoroughly explain every fact presented, the book would probably be ten times longer. It is also fine if one is already familiar with the topic at hand. However, if one is reading about gender dysphoria for the first time, there may be times when a fact, while true, may cause someone to attach the wrong meaning to the fact. The most notable instance of this to me was on p. 119 where Dr. Yarhouse presented a study by Dhejne et al., which concluded that the mortality/suicide rate was higher in post-operative transsexuals than in the general population. The average person, not understanding how high the suicide rate is in the pre-operative transsexual population, could easily read this and think that surgical operations increase the likelihood of a transsexual person’s suicide. The study did not factor in the mortality rate of pre-operative transsexuals (in fact the study even says “no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment.”) However, this was not explained in the subsequent commentary.Third, Dr. Yarhouse seems to use pronouns that are consistent with a person’s outward gender presentation. That is, if referring to someone who experiences gender dysphoria but is not seeking sex reassignment, pronouns consistent with the person’s biological sex are used. However, if referring to someone who is transitioning, pronouns consistent with the target gender are used. This may be unexpected and jarring to people who insist on sticking with the name and pronouns consistent with a person’s biological sex. In his associated Christianity Today article, Dr. Yarhouse explains, “If Sara shares her name with me, as a clinician and Christian, I use it. I do not use this moment to shout ‘Integrity!’ by using her male name or pronoun, which clearly goes against that person’s wishes. It is an act of respect, even if we disagree, to let the person determine what they want to be called. If we can’t grant them that, it’s going to be next to impossible to establish any sort of relationship with them.” However I do not recall a similar explanation in the book.To conclude, I am extremely grateful that Dr. Yarhouse took the time to write this book. Gender dysphoria is currently a very misunderstood and polarizing topic, and Dr. Yarhouse writes with an authority, clarity, and humility that deserves much respect and gratitude, particularly from the Christian church. Although I know this book is not going to please everyone, I think Dr. Yarhouse makes many insightful points that are well worth considering, regardless of your take on gender dysphoria.

I read this book as part of PSYC 345 offered at a Christian Liberal Arts University and WOW! What a great read that grappled with a topic that is so seemingly difficult to understand! I was thoroughly impressed with the way Mark Yarhouse tackled this subject; approaching it with sensitivity, authority, and truth. Before reading this book, I was a little naive about the severity and complexity of the issue of gender dysphoria, but after careful study of this book, my eyes have been opened in a new way! I am very grateful to have its truths behind my back now, and really appreciated how Yarhouse was so clear on bringing everything back to the Christian response to this rapidly popularizing issue. I was highly impressed with the way this book brought about a new perspective to this issue; and especially how applicable it is to the realities of today's culture. I believe in the message of this book so much, that I gave it to a (Christian) friend of mine to read so that she could better understand how to help her friend who is struggling with gender dysphoria. Yarhouse presented this material in an extremely mature and concise way that I fully believe in its credibility and am given hope for our future; hope that there are people now who are really able to extend grace and love to individuals struggling with gender dysphoria.

While searching for resources to assist my parents in understanding transsexuality, I stumbled across this book and decided to give it a read. It's written from a Christian perspective, and my mother specifically raised concerns about being able to incorporate an understanding of transsexuality into her faith framework. So, I've been on the lookout for such resources.While I don't exactly hold the same beliefs as my parents when it comes to Christianity, I'm reasonably well educated in Christian doctrines. So, from that perspective - I found that for the most part, this book is fair and compassionate in its exploration of gender dysphoria. I also think it does a decent job of exploring the spiritual and religious ramifications of what it means to be transgender, particularly in the way it presents many different ideas on how these two concepts could be meshed together, and the pro's and con's of each. It also gives a good overview of some of the scientific theories behind the etiology of transgenderism in general.That Said. I have some issues with the book, from what I've read so far. If you're trans and are looking to give this book to someone as a resource, there are some things you need to be aware of.1. This book makes certain assumptions that I don't agree with, that I find quite arbitrary, and that I think contradict reality. The most glaring of these is the author's framing of the idea of "deconstructing sex/gender" - basically, the idea that biological sex is a spectrum rather than a strict dichotomy - as radical, subversive, and "bad". In my mind, the very existence of trans and intersex people seems to demonstrate that there can be gradations in between the poles of male and female. As fair is he is to other ideas, I don't really see his motivation for being so prejudiced against this particular idea, except perhaps to shore up his teleological argument in the first chapter about the god-ordained nature of the two dichotomous sexes.2. Ray Blanchard's "autogynephilia" theory is not only mentioned in this book, but it is given somewhat-serious consideration. To me this is a BIG RED FLAG. To be fair, the author treats AGP fairly dismissively, and alludes to the fact that it is unscientific, untestable, and has been thoroughly debunked. However, the mere fact that it was given any attention AT ALL in such a recently-published book is a bit disturbing. Which brings me to my third point:3. The author gives a number of different points of view on the whole subject, which in and of itself isn't necessarily bad, in my opinion. The problem is that he gives approximately equal weight to all of them, regardless of the amount of evidence for or against any one theory. He casts the shadow of "well, we don't /really/ know /for sure/" across the entire text, which, sure. We don't 100% know what causes people to experience gender dysphoria. But there is a huge body of evidence for biological/neurological causes, and in general, there is a consensus among researchers that it is highly likely to be a physiological phenomenon at its core. But he seems to gloss over this, and presents a false sense of competition among these different ideas as if they are all on equal footing. As if to say "we may never truly know 100% for sure, so it could just as likely be any of these." Which I find to be misleading and unnecessarily obfuscating.Those caveats aside, this book may well be of use as a resource for Christians to better understand trans people. My advice, though, is to supplement it with other materials, or at least some explanation, which give a more accurate view of modern scientific studies on transgenderism, ESPECIALLY material that more thoroughly debunks Blanchard's non-science.