Bringing God into the heart of the situation is absolutely necessary because this is a spiritual issue too. Her gender distress has another element of struggle, beyond what she or others think about this issue. And it is this: that to go against God’s design and purpose (and reality itself) brings about increasing confusion and pain. Searching for healing is not necessarily wrong, but pursuing solutions that violate God’s intentional design and purpose is rebellion against him. Bringing God into the center is to move toward obeying him, even when it is difficult.

A pastor calls, wondering what he should do. A married woman in his church is beginning to look like a man. Over several months her changed appearance has made it increasingly clear that a slow but significant transformation is happening. But neither the woman nor her husband has asked for help. No one in the congregation has said anything publicly, though people are beginning to take notice. Hence his confusion. What should this pastor do?

For a church to help someone with gender confusion, they must first see a real person in distress. When we get down to the level of the individual, this becomes not a cultural battleground but a person who is struggling. Yes, our culture has made transgenderism the issue du jour, but the person in front of you is like a lamb without a shepherd. In everything you do, help her come to the true Shepherd who will gently guide her.

So, if someone in your church is struggling with gender confusion, we need to do more than proclaim adherence to Genesis 1 and 2 to resolve his or her dilemma. Yes, good biblical teaching on sexuality is necessary. We must not abandon the anchor position that Scripture gives us: God created humanity as male and female, and those two genders are who we are as unique, individual persons. Living out our given maleness and femaleness is an essential part of what it means to be human.

But we also live in a Genesis 3 world. Ours is a world that is broken, resembling God’s original design but increasingly showing deep cracks in how God’s image bearers reflect his image. Men and women have struggled with sexuality and gender for countless ages, so this isn’t anything new.

What is different now, however, is how the culture has turned reality upside-down, insisting that the individual decides what is real and true, rather than the individual conforming to reality. But those who wrestle with their gender identity don’t think they are trying to be rebellious. Rather, they are confused, desperate, and fearful, trying to make sense of their pain. The distress they feel is real. The world’s solution seems more hopeful, a better “fit” to their struggle, so they embrace the post-Christian script that gender is essentially pliable.

What is our advice on what this pastor could say to this woman? How might he speak a message that could give her hope—maybe enough hope to grasp why God has called her to live as a woman; maybe enough hope that she can begin to see herself living congruently with her femaleness; and maybe enough hope for a future that would help her choose to slow down and reverse the transition process she seems to be pursuing?

What do we say? Here are five broad principles this pastor and a church can pursue:

Affirm and recognize how hard this is

Affirm the likelihood that this struggle has been going on for some time. Recognize that this is not a superficial battle and that she and others are trying to make sense of what they experience. Ask good questions so that you can begin to grasp what her life is like and why she feels so strongly that she needs to transition to the opposite gender. When did you start feeling this way? When do you feel it most strongly? What makes you feel most desperate? Get to know her; listen to her stories that are shaping her. Listen carefully.

Understanding biblical truth, and then applying it to our hearts, is a journey, so expect this to take time.

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