Tag Archives: Gender Roles

Integrity and “Gender-Affirming Care”

In the current issue of the Journal of Medical Ethics, Dr R Rowland argues that mentally healthy people have a right to “gender-affirming healthcare” (i.e. hormone therapy or surgery to appear like the opposite gender), because they have a right to live and act with integrity. Rowland argues that “to live with integrity is to live in line with one’s ideal of what a good or meaningful life for one looks like.” This requires “authenticity” that can be understood as self-discovery of one’s “inner voice” or as self-creation. If someone’s idea of a good and meaningful life includes being perceived as the opposite gender, then to live with integrity he must overcome his natural limitations and change his appearance. 

This article, which claims to represent the “standard view,” seems to be written from an existentialist worldview. According to this view, humans are not bound by their own nature, but define for themselves what a good and meaningful life looks like for them. Our bodies are limitations that should be overcome to fulfill the wishes of our “inner voice.”

True Integrity

The Lord tests Job’s integrity by allowing Satan to ruin his life. Job passes the test because he is “a blameless and upright man, who fears God and turns away from evil” (Job 2:3). The standard is not Job’s inner voice, but his complete conformity with what a man ought to be. His wife speaks with authenticity but not integrity: “Do you still hold fast your integrity? Curse God and die.”

Job describes his integrity in detail in Job 31. He is free from lust and deceit (1-12). He listens to the complaints of his slaves, shares every meal with widows and orphans, and clothes the naked (13-23). He does not trust in wealth or worship the sun (24-28). He loves his enemies, confesses his sins, and does no injustice (29-40). This integrity is rightoeusness, internal and external, that conforms to God’s standards of what a man should be.

Gendered Integrity

A man of integrity will act as a man ought to act, and a woman of integrity will act as a woman ought to act. God made men and women different because they have different roles, so integrity will not look exactly the same for them. Humans are not souls trapped in a body; our gendered bodies are an integral aspect of our humanity. To act with integrity, a man must become the kind of man God created him to be, and not abdicate his role in an attempt to become something else.

Boaz shows integrity on his farm and at the city gate, and Ruth shows integrity in her relationship with her mother-in-law. They both fulfill their distinct gendered duties by raising their firstborn son: Boaz preserves a dead man’s name and strengthens Bethlehem, and Ruth cares for her mother-in-law and for the next generation (Ruth 4:9-22). Integrity looks different in the roles of husband and wife (1 Peter 3:1-17). Paul’s commands to old men, old and young women, young men, and pastors are related, but not identical (2:1-8).

Gendered integrity begins on the inside, but is expressed in external appearances. A man should look and act the part of a man, and a woman should look and act the part of a woman, from the inside out. This is why cross-dressing is considered an abomination under the law of Moses (Deut 22:5), and why Paul speaks confidently about hair length and head coverings for women (1 Cor 11:2-16).


Integrity does not begin with introspection or self-creation. A man of integrity conforms body and soul to what a man ought to be. A woman of integrity conforms body and soul to what a woman ought to be. The Bible has no category for a man trapped in a woman’s body; there are only men and women, whose gendered bodies are integral to who they are and to who they are called to be.