(upbeat music) - Rob Smith joins us again. Rob is a theologian who lectures in systematic theology and ethics at Sydney Missionary and Bible College in Australia. Rob, I have a lot of questions for you. Today I wanna talk technology first. It seems that earlier transgender discussion of maybe 30 years ago seemed especially to center on things like cross-dressing and external behaviors.

With the rise of medical technology and the new possibilities for how our bodies can be physically rearranged, to what degree does technological advance drive the new possibilities and the new expectations of transgender changes within the body? - Yes, well, I think the answer is in a major way. It's the old thing of technology leading the way and morality having to catch up, which is really the wrong way of doing things.

We often are asking, can we do this before we ask, should we do this? And so things get back to front. Again, just in terms of the history of sex reassignment surgery, I mean, there's about a century of attempts that have gone on here. And you're right, it's really in the last few decades that I think it's, I guess, become more possible and more successful.

So all the issues, however, still go on. I mean, there's cross-dressing who have no desire to even engage in cross-hormone therapy, let alone sex reassignment surgery. And again, for some people with gender dysphoria, that's one of the ways they try to manage or partially resolve the distress is through, whether it's cross-dressing or simply some kind of gender bending.

And so you get a whole range. I was watching some YouTube clips just a week or so ago of a number of people, a number of women who began on a sort of cross-hormone therapy, taking testosterone injections and so on, and then decided to stop and to go back.

And so you get people who begin down the path and then retreat. And well, obviously in my view, a very good thing when they do that, if they've resolved their questions in the process. But I guess what's happening now more and more is that sex reassignment surgery is becoming available and affordable, and more and more doctors becoming able to deliver it.

Although perhaps not enough to meet demand. I was reading an article just the other day from the UK where a urologist was complaining that not enough of his colleagues knew how to create a vagina. And so he was being inundated with requests for reconstructive surgery for men who wanted to transition into women.

So yeah, I guess that's just where we are. All these medical advances, medical possibilities, surgical developments and so on going on. But I guess the question in back of all of that is, should we be doing this? Is this really an appropriate form of treatment for what is at heart a psychological condition?

- Yeah, and as we mentioned earlier, I mean it raises the question over the purpose of medicine itself. So the goal of medicine is to fix an unhealthy body. So how much does gender reassignment put medicine into a tricky business of trying to fix a healthy body? - Well exactly, yeah.

There's nothing wrong with the body. Again, unless we're dealing with a condition, an intersex condition where there is again some ambiguity and some need to resolve that ambiguity, which sometimes isn't. But again, if the body is straightforward and intact, then it really is I think going in the opposite direction to the Hippocratic principle of do no harm.

You're now perhaps mutilating a perfectly healthy body to try and address a psychological problem. Now some would say, well that's the best option open. That's the only option open. Or unless we go this path, this person may take their own life. And perhaps if I'm just gonna pause on that point for a moment.

- Yeah, certainly. - This is one of the things I think is driving the transgender revolution is what many call the suicide narrative. That unless we affirm and enable, we're gonna drive people into suicide. Now that's a heavy threat to hang over anyone's head, isn't it? - Yeah. - That's enough to make most people step out of the way.

Now of course the reality is the instance of suicide or attempted suicide post transition is as high as it is pre transition. So there's no guarantee at all that allowing or encouraging somebody to try and transition is going to preserve their life in the longer term. And this is one of the reasons why Johns Hopkins University have ceased to do sex reassignment surgery.

They just saw the outcomes were, didn't justify it. So again, there's a lot of misinformation and things that people have to wade through to get a clearer view. But obviously we want to know the best way to help people. And again, we ought to be filled with compassion for the genuine sufferer, a person with gender dysphoria who finds it almost intolerable to step out the front door and to look in a mirror.

And that does beg the question, how do we help them? But I don't believe that encouraging or enabling them to try and become something that in the end they can't actually become is the way to do it. If there's depression, if there's anxiety, if there's a range of other things going on, let's try and deal with those first.

Let's try and provide the help that's necessary for this person to function. But again, it's not simple. And it'd be lovely to have silver bullets and easy answers and quick fixes. It's just not like that. - No, it is certainly not. Thank you, Rob. And for more on the statistics here, see the op-ed by the former psychiatrist in chief at Johns Hopkins Hospital, Paul McHugh.

He wrote a Wall Street Journal piece titled "Transgender Surgery Isn't the Solution." It's a fascinating read. You can find it online. And we have addressed suicide on the podcast in the past. See episode number 352, which is titled "Suicide and Salvation." Heavy. Well, the week is coming to an end and so is our time with Rob.

And we return tomorrow to look at the hopes and the tensions and the roadblocks faced by those who are pursuing transgender transitions. Thank you for listening to the Ask Pastor John podcast with guest Rob Smith from Sydney, Australia. For more details about the podcast, to subscribe to the audio feed or send us a question, go to our online home at DesiringGod.org/AskPastorJohn.

I am your host, Tony Reinke, and we will see you tomorrow. (upbeat music) (upbeat music)