Unfolding Miracles: Human Sexuality

“Imagine that you woke up in a world where everyone looked pretty much like you do, and you thought it was a normal world… until you realized it wasn’t. People around you said yellow was blue, and down was up. They were talking about murder and rape and stealing as though they were the right moral choices… while self-sacrifice and giving and loving were the wrong choices. You begin to realize that EVERYONE except you seems to agree, and you start to wonder if you’re crazy. You think surely someone, somewhere will say words that make sense… but it never happens. You’re able to blend in because you look similar to everyone else, but you know that every fiber of your being is an alien in this world. You know that very soon something will happen that will reveal to the world that you are not like them. You live every moment terrified of a mistake… while at the same time feeling like such a piece of crap because you are pretending to be something you don’t even WANT to be. If you can truly put yourself in that place, and feel the terror and confusion and guilt, then you can maybe understand 1% of what I live every single moment of every single day.”

This is the description of an articulate, sweet, young transgender teenager. It haunts me. And it’s been echoed, in one form or another, by thousands of young LGBTQ kids that I’ve met and listened to and cried with. It’s the reason that I can’t keep my mouth shut about this topic, even if it alienates some friends or colleagues or fellow Christians. Ignorance, even if it is covered in or excused by “faith”, is still ignorance. And it gives birth to a form of “love” that is actually much closer to hate.

So here goes. My attempt to take a scientific grand rounds presentation, and turn it into a blog post! It will be much longer than blog posts are “supposed to be,” but it can’t be helped.

ChromosomesIt all starts with the chromosomes.

We have 23 pairs of chromosomes, of which one pair are the sex chromosomes. Two X chromosomes (XX) and you’re genetically a female. One of each (XY) and you’re a male (shown in the picture). Our DNA is the “building block” of our bodies, determining everything from our eye color to our risk of developing specific diseases. The sex chromosomes, then, are the “building blocks” of our human sexuality. While some of the other chromosomes also impact our sexuality, this chromosome pair is the biggie. Rarely, there may be an extra sex chromosome, extra parts on one or both chromosomes, or something missing from one or both chromosomes. But in general, the sex chromosomes determine whether we are a boy or girl and get the ball rolling in lots of ways.

The first thing that the sex chromosomes direct, in an unborn human baby, is the internal sexual organs. This is called the gonadal sex, meaning the boy/girl parts on the INSIDE. Boys have testes; girls have ovaries.Gonadal sex

These inside sex organs aren’t visible to us… but my GOODNESS are they important. They produce hormones, and direct the formation of the outside boy or girl parts. The testes of boys produces mainly testosterone, while the ovaries of girls produces mainly estrogen. But the pathways of how these sex factories make hormones is complicated… and sometimes in a long pathway (kind of like a recipe with lots of steps) something gets off-kilter, and the actual hormones produced may be quite different. Even when everything goes according to plan, small amounts of the opposite hormone are released.

Phenotype and Brain SexualityNext up: the internal sex organs, by producing testosterone or estrogen, then direct the formation of the outside sex parts and the brain sexuality. (If you don’t think these hormones are incredibly powerful, then you haven’t experienced one of my hot flashes!!)

The outside parts are formed by the end of the first trimester, and are fairly simple… usually. If a baby has a penis and testicles, they are assigned the male gender at birth. If the baby has a vagina, they are assigned the female gender. This assignment usually happens by the medical team within moments after birth, and is finalized within the hour in the medical chart. Surprisingly to some, though, it isn’t always obvious… and a baby may rarely be born with what is called “ambiguous genitalia”, meaning we can’t tell from the outside parts whether the baby is a boy or girl. In the old days, the baby was assigned a gender based on what was the easiest to make “look good” on the outside through surgery. Nowadays, with our ongoing knowledge of what’s happening INSIDE, it isn’t nearly that simple. But that’s another topic for another day.

The other really important part of the sex hormones is to develop the brain sexuality. Now, most of us don’t really think about the sex of our brain… but there’s all sorts of things, from the way our brain is structured to how it works that bear witness to our brain sexuality. Whether we think out loud or quietly… whether or not we can multitask… even the physical size of certain structures within our brain is heavily impacted by the sex hormones. These things have been discovered through highly precise imaging, as well as functional MRI’s… and the subject could make up 10 more blog posts all on its own! But for now, just think about the age-old saying,“Men are from Mars; women are from Venus.” While some of the behaviors we assign to women or men are stereotypes, and while many of us feel that we don’t fit the prototype, the truth remains that there are important, irreversible differences in brain structure based on the sex chromosomes, internal sex organs, and the hormones that they direct.

But here’s the seriously tricky part. The outside parts are formed in the first trimester, but brain sexuality finalized in the second and early-third trimester. And in between, a lot can happen… meaning they may not “match” in the way we think they should. (That’s a teaser – more about that in a minute.)

Gender identity

So. Once the sex chromosomes, the inside parts, the outside parts, and the brain sexuality are in place, then the next thing to be formed is gender identity.

Gender identity is our internal sense of whether we are a girl or a boy. It’s a complex interaction between our sex chromosomes, internal sex organs, outside parts, hormones, and brain sexuality. It is probably set in place by the end of the second trimester or mid-third trimester (whenever the brain sexuality is fully completed)… but it isn’t actually expressed until a child is around 18 months or 2 years old. Expression is usually complete by age 3 – and if you don’t believe me, just TRY calling a 3-year-old boy a girl, and see what kind of response you get! Most often (but not always) it lines up with the sex chromosomes and internal/external sex organs. Gender identity is an involuntary biological response (more on that later) that is formed in utero and expressed in early childhood, and there’s no evidence that anything that happens after birth can change our gender identity. It is entirely separate from sexual orientation — apples and oranges.

Sexual orientationThe last step is sexual orientation, defined as consistent sexual attraction to either the opposite sex, the same sex, or both sexes. Like gender identity, it’s probably formed by around the end of the second trimester or mid-third trimester of pregnancy, but it isn’t actually expressed until after the sex cycle springs to life and a child goes through puberty. During early adolescence, sexual attraction may flip back and forth… but by the end of adolescence sexual orientation is generally fixed and unchangeable. Bisexual individuals aren’t changing back and forth; their sexuality is “fixed” as attraction to both sexes, with a spectrum of which sex is most attractive. (I know, I know, that’s really confusing, but I can’t help it.) Sexual orientation is also an involuntary biological response, and there is no evidence that anything that happens AFTER a baby is born can impact sexual orientation. It is separate from gender identity – again, apples and oranges.

So here’s the whole thing. Chromosomes direct the internal sex organs, which direct the outside sex parts and the brain sexuality. All those things together direct gender identity (expressed by about age 3) and sexual orientation (expressed around the end of adolescence.)

Human Sexuality

The diagram looks pretty straightforward, right? But it isn’t. There are a lot of things that are confusing… especially if we haven’t taken the time to think them through. And for the most part as a society, as parents, as teachers, as churches, we haven’t taken the time to think them through. So let’s touch on some of the puzzlers.

Involuntary Responses

I’ve used this term a couple of times now, and some of you may be getting mad at me because you think I’m saying that we are sexually programmed robots. You may be thinking, “I’m married, and when I see a pretty woman I have the CHOICE of whether to respond to her or be faithful to my wife!” And that’s absolutely true. And yet, you did NOT have control over whether to be attracted to your wife (or the pretty girl) to begin with. You just… were. So the attraction itself is involuntary, but you have control over what to do with it.

Involuntary biological responses are the things our bodies do without us “telling” them to. Our brain breathes for us while we’re asleep… triggers a cough if something gets stuck in our throat… regulates our temperature… and sends us to the bathroom (and MILLIONS more things), all without our conscious thought. We have NO control over the involuntary response getting started, but have at least a little bit of control over what to do with it. So… if I’m in church, and drink too much coffee and need to go to the bathroom, I can probably wait until the end of the sermon. But I couldn’t wait until next Sunday!

That’s what is so hard about telling LGBTQ people that they can choose whether or not to act on their sexuality. It’s a hard enough sell to get young straight kids to wait until marriage for sex… and we know that church kids fare the same in this area as everyone else. But telling a gay teenager to NEVER have sex with who they are actually attracted to is like telling yourself to never again go to the bathroom. Eventually, something has to give, and all the faith in the world isn’t gonna prevent a serious mess!

Delayed Expression

Things that are put into place at one time, but expressed later are also confusing. It seems for all the world like they are HAPPENING at the time that we first SEE them; but in truth the “happening” is long gone, and all that is left is for the trait to show up. There are many examples of this – simple things like eyes that start out blue and then end up brown, or hair color that is blonde in the toddler years and turns dark by adulthood. We say, without hesitation, “Just like his Mom’s hair did!” without another thought. It can also happen with much more serious things – like Huntington’s Chorea, a progressive, fatal disease which is genetically determined before birth, but shows absolutely no symptoms until adulthood. Another example, more pertinent to sexuality, is the size of the outside sex parts. These things are determined before a baby is born, and there isn’t anything after birth (barring injury or disease) that alters them. But they aren’t EXPRESSED until puberty… because before that it just isn’t yet time.

That’s how it works with gender identity and sexual orientation. Our bodies are miraculous packages, designed to provide what we need at just the right time… and so we express our gender identity and our sexual orientation at the right time, even though they were set in place while we were being formed in our mother’s womb.

In my opinion, this is the heart of the arguments about sexual orientation and gender identity being a “choice.” The age that we SEE a young person declare themselves to be gay or transgender is usually in the teen or young adult years… an age when kids make choices that are often rebellious ones. But the reality is that the only choice occurring is when and how to REVEAL their identity or orientation to others. The actual event happened long before, and has been internally “known” by the person for a very long time. But like my friend in the opening paragraph, they’ve been blending in, trying to figure out if they are the crazy ones or if everyone else is! Imagine, just for a moment, how lonely that must be. And imagine, just for a moment, whether you might finally get fed up, and just bare yourself to the world in whatever way you feel like… not particularly caring at the time if it makes others uncomfortable.

Timing is Everything

Another puzzler – and a big one. In between the formation of the baby’s outside parts in the first trimester of pregnancy, and the formation of the brain sexuality in the second/third trimester, there are hormone surges. These hormone surges can and do impact brain sexuality… but the outside parts have already been formed and are irreversible. This means that the chromosomes, internal sex organs, outside sex parts and brain sexuality may not “match” in the way that we humans (who have somewhat arbitrarily defined “normal” as what we see happening most often) expect them to. A baby might have boy sex parts on the outside, but the part of the brain that controls sexual orientation may be attracted to boys rather than girls. Or a baby might have girl parts on the outside, but a hormone surge impacts the brain at the precise time that gender identity is put into place, and that young child knows without a shadow of a doubt that he is a boy, regardless of what parts are on the outside. Why? Because his brain says so.

Imagine, just for a moment, that the very core of your brain was telling you that you were a boy, while the parts of your body you can see look like girl parts. And then, imagine that everyone you know kept saying you were a girl. Even though your brain KNOWS that you aren’t. Imagine that your parents correct you, over and over again, reminding you that you’re a girl. And they are the people who feed you and take care of you, and love you, and you have absolutely no concept for how to reconcile what they are saying with what you know inside. And then, imagine that a famous preacher that millions of people listen to – like, say, Dr. Franklin Graham – referred to transgender people as “sexual predators and perverts.” Try as I might, I cannot put myself fully in that place… but even the attempt leaves me in a cold sweat. Is it ANY wonder that transgender teens and adults face an astronomically-high rate of depression and suicide?

Ancient History

We’re almost done. Hang with me for a final, hugely important concept: what humans USED to know about sexuality. Here’s the diagram of what was known about sexuality when the Bible was written:

Ancient Culture

That’s it. That’s all they had, all they knew. See a penis? It’s a boy. Yay! Our family name will continue! He will grow up strong and tall, have children and grandchildren! Praise God!

No penis? It’s a girl. Bummer. Well, maybe next time. Meanwhile, let’s teach her to cook and maybe she will bear children for someone else..

End of story.

Over time, we learned more about sexuality, and we began to add in things… but the ancient history understanding was so deeply ingrained that we just sort of stuck the other things in around our old way of thinking. So now, our understanding all too often looks kind of like this:

Ancient Culture Amended

It’s like a house with a whole bunch of additions and extra rooms, but the proportions are out of whack. It reminds me of when Jesus chastised his followers, saying, “You can’t put new wine in old wineskins.” Sometimes – most especially for followers of Christ – you have to be willing to blow up your old way of thinking and let him make something totally new out of the rubble.

Now, don’t brand me a heretic just yet. Not unless you know me well enough to know my deep love for Scripture. Not until you understand that I have memorized and kept current over 350 verses. Not unless you know that God’s word gets into me, changes me, transforms me. Before you brand me a heretic, just think for a moment about this beautiful passage:

He has removed our sins as far from us as the east is from the west. (Psalm 103:12)

When the psalmist penned this, he thought the world was flat. So for our sins to be removed as far as the east to the west, he probably imagined as, I don’t know… maybe 2000 miles. That’s a long way. And when scientists started to realize the world was round, they caught LOTS of flack from people defending the Bible. But over time, we’ve learned to reconcile the two. We’ve realized that if the psalmist thought the world was flat, that didn’t mean that GOD thought it was flat! It just means that God (for whatever reason) decided to use simple human beings to speak through. He could’ve just floated the Bible down to us, but he didn’t. So the human perspective is, apparently, worth the risk.

And now that we understand a round world, what has happened to this passage? Is it rendered useless? NO — It is even better! Because now we understand that in our round world, you can NEVER get from east to west! Now we realize that our sins aren’t just cast 2000 miles away from us; no, the distance is infinite. Immeasurable. Further than we have the capacity to understand. We could walk around and around and around the earth… and never, ever catch up to them. How cool is that?

So, friends, that’s what I think is happening with human sexuality. You think it’s an abomination? Not me. I think it’s an unfolding miracle. I think God allowed our simple understanding of male and female for long enough… and now, he is ready to blow our minds with the width and length and height and depth of human sexuality.

In closing, let’s return to Franklin Graham. He is quoted as saying, “Gender identity is what an individual ‘feels’ their identity is regardless of the biological reality.”  (www.thenewcivilrightsmovement.com, Feb. 6, 2016)

If you follow an ancient historical understanding of sexuality – if we are fully defined by the parts on the outside, and nothing else – then that is a true statement. If you take a pre-scientific understanding of sexuality, add on a few rooms, and call it done, then that’s a true statement.

But, if you choose to follow that thought process, know this:

It is medically unsupported and biblically unaddressed. The Bible never, ever says, “God created them male (which means a penis) and female (which means a vagina.)” No, we humans added our ideas of what was meant by male and female. Not God.

If a world-renowned leader and evangelist chooses to use the term “biological reality”, then it’s reasonable to expect him to have a sound understanding of what biological reality is. To fail to do so is misleading, inaccurate and irresponsible. It isn’t faith; it’s cowardice.

Fear keeps us enslaved in Egypt, while faith urges us toward the promised land. Fear worries that a human scientist will discover something that will knock God off his throne, while faith looks deeply into the telescope AND the microscope. Perfect love casts out fear… and gives us the courage to look at people and things we don’t understand with eyes wide open, ready and eager to see what God will blow our minds with next.

Remember our young transgender teenager from the opening lines of this post? I don’t believe she’s an abomination, or a mistake, or a sexual deviant. I don’t believe she’s a pervert. I don’t even believe she’s abnormal. I believe that she’s a creation of God. I believe that she is an important part of his revelation.

I believe that she is an unfolding miracle. Open your eyes and your heart, if you dare, and see her.








46 thoughts on “Unfolding Miracles: Human Sexuality

  1. Thank you for this, Dr. Jack. Curious if you think prenatal exposure to hormone disruptors has anything to do with increased diversity of gender identity and sexual preference? I personally don’t think it is part of God’s perfect plan for creation. (Nor as your blog post presents, do I think it’s a choice.)

    1. Thanks for the comment, Marie. Hormones seem to play a huge role. As to God’s perfect plan – I see so much disease, and am always struck by God’s hand in every moment of our diseased lives. He seems much more interested in relationships than any particular design… so I give very little thought to which parts of us may or may not be part of an original plan. Grace and compassion seems, in my humble understanding, to trump all…

      1. I should clarify that I don’t think cancer and diabetes and autism and Downs are part of God’s perfect plan for creation either. But we don’t shun and blame the victims. I pray we all learn to love without conditions. Thank you for your courage to write this as a well-reasoned professional and as a faithful Christian.

        1. We also don’t “celebrate” the diabetes, but treat is as the abnormality it is. Why shouldn’t transgenderism be the same?

          1. That’s an excellent question… and I don’t pretend to have the final answer. The hardest thing in medicine is deciding what’s a disease, what’s abnormal, and what’s a variant of normal. Those definitions are human constructs that often reflect the culture. We certainly wouldn’t call it sinful for a diabetic to take insulin, or a child with a heart defect to have it corrected surgically… and I think the same principles apply in making medical corrections that allow the chromosomal, brain, internal and external sex to align as best we can. Thanks for your comment, Jay…

  2. Joini- Thanks so much for sharing such a compelling article that needs to be shared so that folks can begin to understand the terrible struggle that transgendered individuals endure every day. I can’t imagine how difficult it would be to live trapped in a body that contradicts everything you feel in your mind and heart. It is so easy to fall into judging others because of ignorance. I applaud you for being a Godly advocate for these misunderstood young people who need our Christ-like love and compassion.

  3. Love it! Can I use this as a resource for education on my blog site ? (Grace and a Safe Place, it is a ministry to allow people, esp parents, to come and process through your child coming out.)

  4. I think you are mis-quoting Franklin Graham. If you read that paragraph completely in the original article, he goes on to say that the definition is absurd.

    1. Thanks for your comment. The definition isn’t absurd; the notion that the “biological reality” is only the outside parts is what is (in my opinion) absurd.

  5. Dear Joani,
    Even though we don’t know each other, your words had been a sweet balm to my soul in a timely manner. As the Bible says in Proverbs 16:24 “Gracious words are like a honeycomb, sweetness to the soul and health to the body”
    I still I don’t see how could the Bible support same sex marriage or homosexuality, I do believe that GOD is and always has been very much interested in relationships trough grace and compassion than anything else, and we have a lot to learn about.
    Also I believe that science has been created to glorify God and His creation.

    You wrote :
    The Bible never, ever says, “God created them male (which means a penis) and female (which means a vagina.)” No, we humans added our ideas of what was meant by male and female. Not God.

    God created Adam and Eve and even though there are no references to “penis” and “vagina” we can infer their existence from Gen 4:1 “Now Adam knew Eve his wife, and she conceived and bore Cain” because there is no way procreation can be done between 2 vaginas or 2 penis right?
    So could you please elaborate more on what you wrote?

    1. Thanks so much for your comments and question, Mary Jo. My point wasn’t to say that men and women had different outside parts. My point is that God NEVER limited sexuality (or anything else) to what’s visible on the outside. WE as humans have made that decision – to base the totality of male/female on external parts. That isn’t consistent with science and medicine, and it is not based on the Bible. It’s based on a primitive understanding of the human body that we’ve failed to update, and are then superimposing back onto Genesis and pretending it’s a mandate from God. I hope that makes sense, and thanks so much for taking the time to read it. Blessings and peace. Joani

      1. God never limited sexual activity and expression to male and female? What Bible do you read or what God do you know? God most definitely reveals Himself in the creation of a physical male and female human being. Jesus specifically defines marriage (when asked about divorce) in Matthew 19 and quotes Genesis 1 and 2: “have you not read that God made them male and female, THEREFORE, man shall leave father and mother, hold fast to his wife and the TWO shall become ONE flesh.”

        I have DEEP sympathy for those who struggle with gender identity and same sex orientation but to say that God hasn’t spoken on male and female in a physical sense and to say that we somehow created the idea of a penis, vagina and sex is to be your own God. Let’s face it: we all like to be our own gods and create our own “scripture” of sorts but to have an identity and hope based on our own understanding and not God’s will leave us in shambles and mentally/physically/emotionally/spiritually unstable.

        1. Thanks for reading and commenting, Brian. What I actually said was that God never defined male and female as purely based on outward physical parts; we have made that assumption through the years but limiting our definition to ONLY physical parts isn’t biblically or scientifically supported. I personally love that as we study God’s revelation through creation and then look again at his biblical revelation and his revelation through Jesus, it all becomes MORE remarkable rather than less! The hard part for all of us is clearing out our own bias for we humans spend much of our time blinded because of our assumptions… and then often misrepresenting God in the process. Makes for quite a tangled mess sometimes… but having respectful dialogue helps slowly sort it out. Thanks again for your reply…

  6. Joani, I love this; it is genius; it gets the conversation flowing. If we talk to each other, open-mindedly, we may increase our understanding of reality. I know you as an open minded, brilliant person. Thank you for this excellent piece.

  7. As a new lover of all people LGBTQ and a lover of Jesus for over 45 years, I find this has been a wonderful primer on human sexuality and gender identity. Thank you and blessings to you, JoaniLea.

    1. Paul, we have much in common! I’m a lover of LGBTQ for 3-ish years and a lover of Jesus for 43! The Holy Spirit seems to be up to something… ?

  8. Thank you so much for this post Joani! This makes so much sense and very understandable for the non medical mind. This should be required reading for everyone! I am meeting with my SOGI (Sexual Orientation and Gender Identity) school group tomorrow and I will let them know about this post. One of the presenters said yesterday that sexual attraction can be changed and when I questioned her on it, she backtracked a bit and seemed to be referencing Bisexuals. With your response, even there she is incorrect. We all need further education on this!

    1. Thank you Tana… and thanks a bunch for passing it along to your school group. The more education the better.

  9. With all due respect, I disagree on nearly every point you made. But before I share, let me say that all people should be treated with love and respect. I am for love and kindness, but also for truth. Love and kindness without truth is shallow and misguided and can be dangerous. And it is truth which compels me to comment on your blog post.

    Your statements are conjecture or opinion at best. Recently your colleagues, the American College of Pediatrics posted an article that disagree with much of what you’ve posted, perhaps everything you posted. See here for more information: http://www.acpeds.org/the-college-speaks/position-statements/gender-ideology-harms-children

    But even without the American College of Pediatrics statement on gender identity, the Bible is clear. A person would really have to bend and twist the Scriptures to interpret Genesis 1:27 (“So God created man in his own image, in the image of God created he him; male and female created he them.”) as God having designed men and women to be something a person discovers later in life that may or may not be consistent with their biological anatomy. God covers a lot of ground in the Bible and quite a bit of it gets very specific. If God’s design was as you purport, surely he would have covered this to eliminate confusion and discrimination. The Bible was meant to be very simple in many of its teachings. What you read concerning salvation, creation, men and women, etc. is straight forward. We can believe it as it’s written.

    Consider the following Scriptures in addition to Genesis 1:27:

    Deuteronomy 22: 5 ” The woman shall not wear that which pertaineth unto a man, neither shall a man put on a woman’s garment: for all that do so are abomination unto the Lord thy God.” Who is the woman, it is the woman who is one biologically. Who is the man, it is the one who is one biologically.

    1 Corinthians 5:9-10″Know ye not that the unrighteous shall not inherit the kingdom of God? Be not deceived: neither fornicators, nor idolaters, nor adulterers, nor effeminate, nor abusers of themselves with mankind, Nor thieves, nor covetous, nor drunkards, nor revilers, nor extortioners, shall inherit the kingdom of God.” Why would God have wrath for a woman who is “effeminate”? The answer is he wouldn’t and doesn’t. But for a man to be effeminate, that is not according to God’s design and it does bother God.

    1 Peter 3:7 “Likewise, ye husbands, dwell with them according to knowledge, giving honour unto the wife, as unto the weaker vessel, and as being heirs together of the grace of life; that your prayers be not hindered.”

    1 Corinthians 11:14-15 ” Doth not even nature itself teach you, that, if a man have long hair, it is a shame unto him? But if a woman have long hair, it is a glory to her: for her hair is given her for a covering.”

    I am referencing very specific Scriptures about a very specific topic. These Scriptures are for those who profess to believe in Jesus and who claim to follow him, like the author of this blog. For those who don’t know much about the Scriptures or who are not Christian…I would encourage you to start with the doctrine of God’s love for you and for the world. John 3:16-17 “For God so loved the world, that he gave his only begotten Son, that whosoever believeth in him should not perish, but have everlasting life. For God sent not his Son into the world to condemn the world; but that the world through him might be saved.” None of us (me first) are worthy of God’s love…we haven’t earned it by being good enough..it’s a free gift given to those who believe (as the Scripture you just read said) that Jesus was sent to be punished for their sins to satisfy the just wrath of God. God didn’t want to punish us, because he loves us…so because he is perfect, just and merciful…he punished Jesus.


    1. Bill, the American College of Pediatrics is a tiny fringe group with around 100 people – the tiniest “college” in the world! In contrast, the American Academy of Pediatrics is the leading professional organization for pediatricians worldwide and fully support my statements. You may disagree with the science if you choose, but it is evidence-based; not opinion. Thanks for your reply, Bill.

      1. Hello Dr. Joani – I’m glad to see you are willing to publish and allow dissenting comments. That is to your credit. I have a response to your recent reply saying that I’m ignoring the science behind your statements.

        You did not share ANY references to scientific studies/articles to support your theory. Also for those who are reading your blog post and comments…consider the following: 1,2,3…even X number of scientific studies doesn’t prove anything even if the study finds evidence for its support. Many medical and/or scientific studies are published every year on various topics with evidence that supports a particular theory. It remains theory until a massive amount of indisputable evidence is discovered that support the underlying theory. This evidence then has to be further scrutinized by undergoing additional testing to ensure that it is consistently repeatable. If it is not consistently repeatable then it falls short of being factual. If apples fell from trees 90 times out of 100 we wouldn’t have gravity. We would have something really close, but it wouldn’t be gravity as we know and understand it today. So again, not only did you not share ANY references/bibliographical material, but you did not share scientific “proof” that what you are claiming is true. It is a fact Dr. that your blog post is merely a theory.

        Since tone is nearly impossible to tell when writing…and when the writing isbetween two people who have never met…please know that I write this with an easy calm and respect for you Dr. as a person, though I disagree with your theory.

        Best regards,


        1. Thanks, Bill. And you’re absolutely right that I haven’t attached references. This was adapted from a Grand Rounds presentation to academic physicians and therefore had to pass a high bar of evidence-based medicine. But I got frustrated with the amount of misunderstanding out there and published this post rather quickly. My plan was to add the bibliography soon after (there’s a page on my blog for references and resources) – but life got in the way. I’m a full-time pediatrician and chief of the department… So I’m just behind on pretty much EVERYTHING!! But I promise to post them soon… and they will be based on peer-reviewed literature meaning the studies are sound and have been appropriately critiqued. Thanks again…

          1. But again, research studies with evidence do not equal scientific proof/fact. As mentioned, there needs to be a large body of evidence, test methods that produce results that are both observable and repeatable with high levels of consistency and last of all, scrutiny from other scientists regarding both the test methods and any personal bias of the individuals conducting the tests. To the best of my knowledge this doesn’t exist. I’m assuming you know the above regarding the difference between scientific evidence and scientific proof/fact, but your readers may not….this was largely said for their benefit.

            Best regards,

    2. Bill,

      Quoting a handful of Bible verses referencing the ancient gender roles of men and women does not repudiate the good evidence and logic presented here so thoughtfully in Dr. Jack’s article. Was my mother living an unbiblical life because she spent her professional career working as a vice-president of a bank wearing a business suit? Is my wife living an unbiblical life because she wears her hair short? Grasping for isolated verses and expecting them to resonate in a modern culture is not very helpful. One thing we can know with definite certainty is that what we know about the universe is expanding. As our knowledge grows in these matters, so should wisdom as we relate to this expanding world. As our knowledge grows, so should our compassion, empathy, generosity hospitality and kindness.

      I also wonder about your comment “we are not worthy of God’s love.” You are worthy of God’s love. He created you Bill. You carry the divine spark. You are not just dust…you are also gold! You are not just ruin…you are also glory! You are not only marked by depravity…you are also marked by original dignity! Our glory predates our depravity. Your worthiness is inherent and Jesus came to demonstrate your great worth to you…in order to win your heart. Why else would Jesus die…for someone who has no worth? No, he saw/sees your infinite worth and by the way…your inability to see it, believe it or live in it does not make it any less true. Jesus died because you are worth it to him. You are an “image bearer” and it is for that very reason that God would go to such great lengths to invite you to know who you really, really are…your truest self. The world already leans toward a belief (and lie) that they are worthless. Jesus continues to invite us into reality…that we are of infinite value to the God who fashioned every single one us…Straight, LGBTQ and all.

  10. So…. if brain identity is the only correct one…. how a person feels or thinks is correct…. then why do we say that an anorexic who feels and thinks they are fat when biologically they are obviously thin… is wrong. Our thoughts and feelings often do not match reality… but I don’t know of any other instance where we say that the biological is wrong and our thoughts and feelings are right. I am not advocating that they are preverts etc… I am only questioning your logic. Love is a choice and should be unconditional not based on actions or beliefs.

    1. That’s a great question, Kris – I brought up the same point to a colleague recently. Great minds…? Here’s the important differences that we raised in that discussion: 1) Studies of identical twins indicate a strong concordance in transgender people, indicating a strong genetic influence. That goes against this simply being a misperception of body image as we see in eating disorders; 2) Functional MRI’s demonstrate in MANY studies that brain sexuality is demonstrable and provable, and it goes way beyond transgender issues. 3) Trsnsgender individuals are healthier both emotionally and physically when they are able to align their internal identity with their outward lives. In contrast, anorexics when allowed to follow their own bodily perception get worse and worse until they die. Lastly, I’m not advocating that brain sexuality is the “only” thing; I’m advocating that outward parts aren’t the “only” thing. Human sexuality encompasses the sum of chromosomes, inside parts, outside parts, brain sexuality, gender and sexual orientation. My problem with the ancient cultural understanding is that the ONLY thing that matters is the outside parts. This isn’t supported biblically or medically. Thanks so much for your thoughtful reply…

  11. Please help me understand the underlying principle then for the verses on homosexuality in Scripture that do seem to point to it being sin. I can wrap my head around needing to love everyone and we all have struggles. I still get stuck on those verses that seem to clearly state it is a sin. If I could see a way past without dismissing those verses entirely, that would be very helpful.

    1. Thanks for your comment, Judy… that’s a hard question! First, just a reminder that I’m a doctor, not a theologian. My post is intended to provide medical and scientific information to an audience that largely believes (as I do) that the Bible is God’s inspired word. I wanted to give medical context to Scriptures that discuss “male” and “female” by demonstrating that when the Bible was written, there was no concept of anything other than the outside parts. God knew, of course, but the humans did not. So as our understanding of all the different aspects of sexuality expands, then we should want to read Scripture with that new understanding – and I personally think that it increases rather than decreases the validity and beauty of the Bible to do so. As an example, then, when Paul discusses a person “going against their nature” (sexual desire) I think that we have to ask ourselves what exactly that means. Is nature the outside part ONLY? Or does nature also include brain sexuality? What are we to do when the outside parts and the brain sexuality do not match? These are difficult questions, but they represent real-live human beings who live out that reality everyday. So I guess my response to you, rather than giving an “answer” to what those passages mean (and I do have an opinion), is to ask you to prayerfully wrestle with them, seeking input from a variety of sources, and to consider the medical context as an aspect of your wrestling. I hope that makes sense, and thanks again for your comments.

      1. But think of the context Paul wrote this admonishing in. It doesn’t make sense he would have included same-sex or Transgender when elsewhere talking about some of you were these and not to go back to it. It’s hard to put the biblical altogether while realizing the struggle people would face. Celibacy is hard for any orientation so it’s not just an LGBTQ argument to say it’s so hard so don’t. We know when people are saved by Jesus and receive the Holy Spirit that some are rescued from their struggles and some are not. There isn’t an easy answer here when caught between the clear teaching of the Bible and the tough reality for the person who is Gay, etc.

        I think the science shows how a person comes to find themselves in a body with these issue be it sexual, physical mental etc But it doesn’t explain why that process came to be in the first place. That’s the Bible’s job. God cursed the world when sin entered. We all are under it. Jesus paid the price to save us. God loves us unconditionally. This is our example to all.

        1. Thanks for your comment. I disagree regarding the “clear teaching of the Bible”. I don’t think it’s clear at all; hence our many different interpretations. And I personally think that’s the point of the Bible… to help us develop wisdom and love and humility rather than following a set of rules and claiming we are right…

  12. I thought this was interesting and informative. I think it’s lacking theologically though. The Bible is clear about sin and a fallen world. This hasn’t been addressed. Instead it’s the assumption that the Fall never happened; God created the world and it never changed. It’s quite clear what make and female were and are in the original created order.

    I believe that human sexuality was corrupted like every other part of life and that needs to be recognized. The question is how to handle that reality in the sexual realm. Jesus died for all to pay for their sin. He loves everyone in their broken states. That is our example. Taking the male and female creation and claiming God created much more than we realize secually is quite a leap given the rest of the Bible! 🙂 I don’t find Biblical evidence for this. I also don’t find evidence for claims some make that God created LGBTQ or Transgender people to then write prohibitions clearly in the Bible. What kind of love is that?

    The best explanation is that sexuality was corrupted in many ways as was the rest of creation after sin entered the world and God cursed it. We are all part of that groaning creation and those who are redeemed by Jesus waiting to meet him someday having new bodies and a new heaven and earth.

    By the way the earth is referred to in a way that indicated globe in the Psalms whether the writer got it or not.

    1. Thanks for your comment. It actually is NOT clear what God meant by male and female; humans took those words and superimposed a primitive understanding of sexuality on them. My point as a physician is to ask people to reevaluate scriptural meaning with an understanding of that primitive context.

      1. Problem is we miss the point of the Bible then because it becomes man’s words and understanding at any given time in history rather than God’s inspiration written by men to stand through time. If we don’t go back to the original Greek and Hebrew we are left with whatever the reader interprets from English. Even Jesus affirmed Genesis. It’s clear that it was written in a factual style and not poetic. There is lots of geological evidence to backup a flood. It’s also clear that God created a perfect world which then became corrupt. So to say we don’t know what male and female meant seems unsupportable when the Bible was written for people who didn’t know anything but to take it literally at that time. They wouldn’t have known anything else to do. It also clearly prohibited alternate lifestyles in leviticus when the law was in effect and New Testament writings when grace was in effect for those who believe in Jesus. So once Jesus came and died we had the option of grace. But it says the believer should not sin so God’s grace can abound. At the same time it says we are all fallen and under judgement without receiving Jesus’ forgiveness. So reading the whole Bible, it’s clear where we came from and what God thinks of us a part from Jesus. Not much interpretation there. Sexual sin is outlined in the New Testament as sin against the body. Choosing a same-sex relationship is clearly sin as is other deviation from God’s original plan. As I said it’s a hard doctrine but it’s clear. It’s not to hold over people’s heads because that’s not the believer’s job. But it’s laid our clearly in the Bible as is adultery and so on as sin.

        1. What’s clear to you is unclear to many… and the Greek & Hebrew often make it more confusing (especially in the context of sexual sin when no 2 people can agree on what the word Paul used even means.) Thanks again for your comments, and I will end this thread here so as to avoid detracting from the main purpose of the post. Blessings & peace…

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