Living in the Image of God

Transgender People in Pastoral and Spiritual Care

By Laura Thor, MSW, D.Min

The middle-aged clergyman seated across from me gazes at the candle between us. Then his eyes find a spot on the floor and his shoulders sag. “I no longer rage at God for making me this way. But I feel no blessing in it.” Silence. Then: “I will lose everything…well, not God maybe...” And finally, “How did God call me to this wonderful vocation, give me a loving family, and yet make me a transsexual?”

We sigh together, sending up prayers in the stillness, save for March rain spattering the window. I watch his face for signs of hope for a life worth living, despite radical change for his family, his marriage, and himself. I know despair can so easily take hold. He is a preacher well-read in spiritual literature and Biblical texts, and he knows his dark night of the soul from his clinical depression; over a few years of pastoral therapy with me, he realized he was neither deluded nor broken, only born with a female mind in a male body. Although not all transgender people suffer from the body-mind incongruence called gender variance, many develop severe gender dysphoria and suicidal feelings. My client’s dysphoria stemmed from trying to live two conflicting lives: the one fitting his male body, and the other expressing his true, inner female self. Our work helped him discern that there is no cure except to begin the process of medically supervised transition of his body into the right sex to fit “her” female gender.

We talk and pray together for strength to live the truth at the core of his being, which while terrifying, holds the chance for an authentic life. He senses God calling at the root of his soul, which held the truth hidden since childhood when he was punished for dressing in his sister’s clothes. Now he finds consolation in late-night walks on moonlit, rural roads, in women’s slacks, shoes, and sweaters that feel “right” and let his body move in natural, familiar ways. By day he is desperately afraid: How will God help as he becomes “her?” What will happen to his family? Will all the nurture he gave his congregants be lost in scandal?

He and his wife love each other dearly. They teeter on the brink of an amicable, but dreaded, divorce as they explore new boundaries for an abiding love. They have yet to tell their grown children and grandchildren. His church will fire him. But these are challenges with solutions. Here in this companionship hour, his worst fear is maybe there is no God who intended him to be two-gendered; maybe there is no purpose or meaning in it at all. Perhaps he is simply the victim of nature’s brutal forces: errant DNA, or an accident in the womb. How can God be behind this? What can God be up to? He gazes outside at apple-budded branches brushing the windows, tears dripping from his chin.

I mention the possibility of God’s love. Locating a slim book on my shelf and handing it to him, I smile gently, my own eyes tearing up a bit. Together we know how dreadful is the refining love that insists on ravishing our whole selves. The book is Rabbi Shefa Gold’s prayerful reflection on the Song of Songs, In the Fever of Love. She translates chapter two, verses 5-6:

Cover me with blossoms, Refresh me with apples, For I am in the fever of Love. His left hand beneath my head, His right arm embracing me.

Gold comments:

What looks like sickness is true health. What passes for brokenness is only the path to my wholeness, the place where passion burns like the burning bush, with flames that don’t consume, but give life with every spark. When I surrender to the “fever of love”; when I consent to the embrace of My Lover; when I stop resisting and instead rest, lean into those arms that support me…I am held in the contours of Life…This fever is the sun at the center of my heart, shining out, ripening the fruit that is me. (Gold, 23-24)

Our work is to sustain the seeker in knowing himself or herself and in drawing closer to God as the Ground of Reality; together we prepare the ego to surrender to the soul’s deeper, truer self-knowledge.

It is months later when my spiritual friend begins dismantling the false male self behind which she was imprisoned. She looks to God with less fear, more reliance. She admits the need for a new ministry, for her preaching has subtly changed and her congregation and denomination are no longer “home.” We encourage her heart to remain open to sacred callings toward some unknown landscape of God’s making, where she must become only herself.

Meanwhile, in a nearby congregation, a transgender lay minister made the bumpy journey while relying on her nerve and her God. “Linda” was born male and underwent therapy, hormone therapy, and surgery ten years ago. Still married to her wife of 35 years, and having raised their children in their church, she had long been a Eucharistic minister, but when she came out as a woman some congregants refused to receive Communion from her. Her priest, whom she had once trusted, failed to intervene. But a few years later, a new priest set a different tone. At his first Sunday Mass there, he observed that Linda’s line for Communion was shorter than the others as some people crossed over to his or the other lay minister’s line. A fiery, large man, he dramatically strode over to Linda’s station, took a host off her plate and solemnly carried it back to his station where a woman had just crossed over. Seeing the communicant’s mouth already agape, he popped it in, “The body of Christ!” She mumbled her “Amen.” And that was that: no more crossed lines. On that day, her priest was her spiritual director, and perhaps, she was also his.

“Made in God’s Image” and “Male and Female He Made Them”

What spiritual foundation allows these two people to trust their own unfolding? How do both Linda and her priest know who Linda is in God’s eyes, and that God continues to call to ministry a person who had a surgery that her own religion’s teachings do not condone? Spiritual presence with transgender clients focuses on the core issue of spiritual integration of all aspects of one’s identity. Our work knits together one’s essential biological, psychological, and spiritual identities as God-given; at our core selves, we are all Betzelem Elohim, Made in the image of our God (Bereshit/Genesis 1:27a). The full meaning of this claim provides profound affirmation for the transgendered; as Rabbi Margaret Moers Wenig writes, this sentence in Genesis concludes with “a challenging second half: ‘male and female [italics mine] God created them’ (Genesis, 1:27b).” She points out that the original text contains a linguistic merism, a “common Biblical figure of speech in which a whole is alluded to by some of its parts.” She explains:

When the Biblical text says, “There was evening, there was morning, the first day,” it means, of course, that there was evening, there was dawn, there was morning, there was noon time, there was afternoon, there was dusk in the first day. “Evening and morning” are used to encompass all the times of day, all the qualities of light that would be found over the course of one day. So, too, in the case of Genesis 1.27b, the whole diverse panoply of genders and gender identities is encompassed by only two words, “male” and “female.” Read not, therefore, “God created every human being as either male or female” but rather, “God created human kind zachar u’nikevah male and female and every combination in between.” (Moers Wenig, 16)

Indeed, studies of transgender persons demonstrate that gender (one’s “felt,” or psychic or mental identity) and sexual identity (as determined by reproductive organs, both inner and outer), exist on a spectrum between “male and female.” (Note: This short article cannot address “gender fluidity” and the non-binary transgender person.) Because not all transgender people have gender dysphoria, and therefore do not present themselves to medical clinics, prevalence studies can count only those who seek medical attention and transition; these are the only transgender people properly called transsexuals, like the two clients above. Ten studies in eight countries suggest a prevalence of male-to-female transsexual individuals ranging from 1:11,900 to 1:45,000. Prevalence of female-to-male transsexual individuals ranges from 1:30,000 to 1:200,000 individuals (WPATH, 7).

Therefore, a strict binary, “either/or” categorization of gender is inadequate in that it excludes a great many people. (Even in the animal world, a binary view of biological sex is inadequate, if sex is defined in simple biological terms as how an animal reproduces.) Theories of causation range from uterine changes during pregnancy’s precarious early trimesters, to chromosomal anomalies that occur at conception.

On the other hand, perhaps there is no “birth defect” in being born transgender. The study of biodiversity attests to apparently naturally occurring variations in gender among several animal species, including humans (Roughgarden). In any case, Moers Wenig correctly interprets the Genesis narrative as purposely inclusive and accounting for the fact of more than two opposite sexes in Creation; the text does not say “male or female He created them.”

I ask clients to listen contemplatively to the creation narrative of the first day, to hear the range from darkest night to brightest day, and to imagine the finest increments between the two extremes: midnight, pre-dawn, dawn, noon, late afternoon, dusk, twilight, evening, night. Then we read the narrative of the sixth day, when God made human beings, and list biological traits of males or females, and then of intersex people. Sometimes I offer humor: I spread my arms between the two poles of male and female, I might say, “Name every kind of gender expression you can think of between a G.I. Joe doll here” h(waving my left arm) “and Barbie, over here,” waving my right. And they do, giggling at the silliness of two dolls that signify, but falsely, the difference between men and women and leave out all that’s between. (I have yet to introduce my daughter’s childhood doll from her Waldorf kindergarten, which doesn’t have a face and is therefore gender-secretive, perhaps ambiguous.)

Coming out to God; Coming Out to the World

“Coming out” as a transsexual is both an internal, private process of self-recognition and experimentation, and a public process of transition into a social expression of being male or female. This process of self-discovery can begin in early childhood, but sometimes does not occur until the onset of puberty. According to a guideline published by the American Academy of Pediatrics, gender identity is not a given.

Gender identity, however, is a gradual process that is based on an internal conviction of belonging to either the male or female gender. Gender identity is distinct from gender role, which refers to a set of behaviors through which individuals convey to the larger society that they are male or female. Children usually develop a fixed gender identity by 2½ to 3 years of age, after which they emphatically perceive themselves as being

A child’s emerging gender identity does not seem to depend on birth order, or whether or not there is mix of sisters and brothers, or healthy adult role models. Identity does not depend on whether a little girl’s family kept strictly gender-separate role expectations or encouraged gender-neutral toys, activities, or friends. Most transgender people recalled discovering a peaceful comfort when playing dress-up in a mother’s or a brother’s clothes that correlated with a sense of “rightness.” Children stifle their gender expression when shamed for it, or worse. One client recalled regaining consciousness in her bed with a throbbing head and a black eye hours after telling her step-father she is a girl, not a boy. Children may “forget” about gender during their ensuing elementary school years, but always experience great emotional discomfort as puberty begins.

I always ask my clients how they thought about or talked to God about their dawning childhood awareness of being gender variant. Some hoped God wouldn’t “find out,” Some knew that God knew; they fell asleep at night praying to wake up in the right body. In the morning, when God had not changed them, some figured God was busy, or maybe God didn’t like them. A very few expressed the belief that God not only knew, but made them this way, and therefore God would take care of everything pertaining to it in time. Of course, the response many people receive from clergy or family is to refrain from changing their bodies because God doesn’t make mistakes. But God “makes” some people diabetic, and few would advise diabetics to refrain from taking insulin. A response that expresses dignity and accepts God’s mysterious and unclarified-as-of-yet creation is to help our spiritual friend contemplate the reality that God made me a transsexual person; God means for me to carry out the task of transition in promise to my identity.

In Jewish homes on Friday nights, after candle lighting marks the beginning of the Sabbath, the words of blessing that parents make over their children include these: “May you be blessed in who you are, and in all that you are.” Rabbi Shawn Zevit paraphrases in his song, May You Have Peace: “May you grow into the blessing that you’re born and meant to be in this life.”

Information that Pastoral Counselors and Directors can provide Clients

A great body of scientific research has established that transgender people experience discordance between their physical sex identity as male or female, and their psychological, social, and emotional gender identity that can be the opposite of their physical, embodied sex, or somewhere in between. The World Professional Association for Transgender Health (WPATH), whose members are physicians, surgeons, mental health therapists, and medical researchers, publishes studies and formulates theories of causation as well as new approaches in surgery and outcome studies over the lifespan. Healthcare protocols and social policy proposals are developed and reviewed at biennial, international symposia. Just as the American Psychiatric Association no longer views homosexuality as a mental illness, WPATH has proposed to the APA that gender variance is not a mental disorder but a medical condition that often causes gender dysphoria, which is resolvable with medical intervention on the body.

Working with the transgendered will include witnessing the grief and loss that beleaguers the marginalized; like those afflicted by chronic illness, there are financial constraints due to job loss or expensive medical treatment. Very little of the cost of transition therapy is covered by American health insurance plans; genital and facial surgeries, hormone therapy, voice training, and facial hair removal currently cost upwards of $35-50,000 U.S. dollars. By contrast, in the United Kingdom and The Netherlands, among others, most of these treatments are covered medical expenses. Transgender people usually suffer lost marriages and families, careers, religious membership, and other social affiliations; they are also at risk as targets of hate crimes.

Transgender people should not be confused with gay or lesbian people, who generally feel no discordance between gender and sex identity. Sexual orientation is different from gender identity. Questions of celibacy, loneliness, divorce, and the challenges of transgender people in courtship and love will often emerge as needs for discernment and prayer in counseling and spiritual direction. Like lesbian, and gay, and bisexual Catholics, transgender people often face a life of celibacy that is imposed, not chosen or received as a charism.

Sex is a biological term regarding how an organism reproduces; gender is a psychological concept regarding how a person experiences the self, both interiorly and interpersonally, as male, or female, or in-between. “Transgender” is used as an umbrella term nowadays, while “transsexual” is falling out of common use. While it is impolite in casual conversation to ask about one’s genital “status” (“Have you had sex-change surgery?”), there is no harm in asking what name and pronouns to use.

At the end of a mini-retreat for transsexuals several years ago, I led a ritual in which people of different Abrahamic faiths read from Psalm 139 and passed a lit candle around the circle, each person announcing their chosen name. Currently some Jewish and Christian communities in the United States are developing naming ceremonies for adults who wish to be known from now on as their true selves.

With an attitude of awe and openness instead of fear and constriction, the ambiguity we feel when getting to know a transsexual person is our gateway into liminality with them, in which we might accurately sense the sacred instead of the demonic. Living with ambiguity presents us the opportunity to let God in, precisely because our inability to decipher the marvel before us renders us creaturely once more, standing in awe of the mystery of creation. God created ambiguity by placing transsexuality in many nations. Native American peoples call their transgender members various names such as winkte or Two Spirit,” and view them as blessed (Dollarhide). In the East, India has its hijras, who came to the homes of newborns to offer blessings until secularization shunned them and reduced their role to street beggars and sex workers (Kalra). Judeo-Christian theology is beginning to make room as new “queer theology” calls for a more pastoral response.

Like many, I have experienced how the holy work of companioning religiously marginalized and ostracized people is radical in nature; our companionship gives witness and aid to their own holy work of “storming Heaven’s gates” to find God where religious institutions and dogmas can’t yet grant access. So deep is many transgender persons’ absorption of negative religious messages that their spiritual health involves a process of birthing the spiritual self; ours as “midwives” is to remind our clients, and ourselves, that life in all its diversity is welcome in the Divine milieu. ▼


An earlier, fuller version of this essay appeared in Presence: An International Journal of Spiritual Direction, Vol. 19, # 4 (December, 2013).

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Arlington, VA: American Psychiatric Association, 2013.

Dollarhide, Kenneth. National American Spirituality: Understanding Gender as Sacred. Transgender Tapestry No. 115: J. of the International Foundation for Gender Education. Waltham, MA: IFGE, 2008.

Gold, Shefa. In the Fever of Love: An Illumination of the Song of Songs. Teaneck, NJ: Ben Yehuda Press, 2009.

Hagan, Joseph F., Judith S. Shaw, and Paula M. Duncan, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed. Elk Grove, IL: American Academy of Pediatrics, 2008.

Kalra, Gurvinder. “The Cultural, Psychiatric and Sexuality Aspects of Hijra Community,” paper presented at the World Professional Association for Transgender Health 7th Symposium, Atlanta, GA 2011.

Moers Wenig, Margaret. “Male and Female God Created Them: Parashat Bereshit (Genesis 1:1-6:8),” Torah Queeries: Weekly Commentaries on the Hebrew Bible, ed. Drinkwater, Gregg, Lesser, Joshua, and Shneer, David. New York: New York University Press, 2009.

Roughgarden, Joan. Evolution’s Rainbow: Diversity, Gender and Sexuality in Nature and People. Berkeley and Los Angeles, CA: University of California Press, 2004.

World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender and Gender Non-Conforming People, 7th Version. Minneapolis, MN: WPATH, 2012.

Zevit, Shawn. May You Know Peace. On Morning I Will Seek You (CD). Pennsauken, NJ: Disc Makers, 2009.    ▼