I still recall one of my first meetings with Sara. Sara is a Christian who was born male and named Sawyer by her parents. As an adult, Sawyer transitioned to female.
Sara would say transitioning—adopting a cross-gender identity—took 25 years. It began with facing the conflict she experienced between her biology and anatomy as male, and her inward experience as female. While still Sawyer, she would grow her hair out, wear light makeup, and dress in feminine attire from time to time. She also met with what seemed like countless mental-health professionals as well as several pastors. For Sawyer, now Sara, transitioning eventually meant using hormones and undergoing sex reassignment surgery.
Sara would say she knew at a young age—around 5—that she was really a girl. Her parents didn’t know what to do. They hoped their son was just different from most other boys. Then they hoped it was a phase Sawyer would get through. Later, two pastors told them that their son’s gender identity conflicts were a sign of willful disobedience. They tried to discipline their son, to no avail.
Sara opened our first meeting by saying, “I may have sinned in the decisions I made; I’m not sure I did the right thing. At the time, I felt excruciating distress. I thought I would take my life. What would you have me do?” The exchange was disarming.
I have worked with people like Sara for more than 16 years. Although most of my published research and clinical practice is in the area of sexual identity, I regularly receive referrals to meet with people who experience conflicts like Sara’s. The research institute I direct, housed at Regent University in Virginia, published the first study ...1