I woke up from surgery wanting saltines. Instead, I got a migraine, a new port in my chest and two nurses who wanted to talk about my gender.
The port was the plan. After a year of chronic illness and six rounds of IV potassium, my veins have essentially filed a class action suit against me. They hide. They collapse. Watching a nurse hunt for one is like watching Captain Ahab hunt the white whale, and judging by the IV they once had to put in my foot, the whale is winning. A port gives my care team reliable access without the search party.
Liam Gent
The gender conversation was not the plan. For the record, I didn’t bring it up. It started with my chart. My driver’s license, Social Security card, insurance card and passport all say male. Four separate government agencies have reached a consensus, which almost never happens. The hospital still insisted my chart say female.
Then, while I was half under anesthesia and the migraine was just loosening its grip, they asked to see a picture of me from before. My phone was handy, and I was not functioning well enough to say no. The photo was passed from nurse to nurse. None of them could believe it was the same person. Same book. New cover.
“I’ve had my identity verified in hospitals more times than I can count. This was the first time anyone tried to verify my puberty.”
You’d think a room full of people raised on “don’t judge a book by its cover” would know what to do with that. Each one held it up next to my face and looked back and forth like a cashier checking a suspicious twenty. Deeply. I’ve had my identity verified in hospitals more times than I can count. This was the first time anyone tried to verify my puberty.
What followed is worth telling, because it shows two things I want Christians to understand: What the phrase “love the sinner, hate the sin” actually does to trans people, and what I’d ask of believers who hold our care in their hands.
The questions came in this order. Oh, you’re trans? I could never tell. Why did you transition? What surgeries have you had? Why haven’t you had bottom surgery (which is to say genital surgery)? Why couldn’t you just decide to be a woman? Why couldn’t you just be a stud (the term for a masculine-presenting lesbian, especially common in Black and Latina queer communities)? Why don’t you like yourself?
I answered every one. I’ve spent 16 years doing queer advocacy at the local, national and international level, and I’ve written workbooks on LGBTQ theology and gender identity. None of these questions were new to me.
“I told them I like myself very much. You don’t renovate a house you hate.”
I explained that brain research, while still young, points in a consistent direction: In one well-known 2014 study, adolescents with gender dysphoria showed brain responses that looked much like those of peers of their experienced gender. I explained that a common technique for phalloplasty takes skin, fat, nerves and an artery from about two-thirds of the way around the forearm, which surprised them and which my veins would like entered into evidence. And I told them I like myself very much. You don’t renovate a house you hate.
The two nurses were not the same, and the difference matters.
The first was curious in the way good clinicians are curious. She asked good questions and listened to the answers. I’d be glad to have her caring for me again.
The second told me she “hates the sin, loves the sinner.”
A few minutes later, she looked at the old photo again and told me she would have been interested in the woman in that picture. She did not mean as a Bible study partner. Then she added that I still have a lot of “female-like traits.” Her evidence was that my hands move too much when I talk.
I was raised as a girl. You pick things up, the way you pick up an accent. I can tone it down, but that takes a fully functioning brain, and half of mine was still in the recovery room.
So in one conversation, from one person, I was condemned, affirmed, retroactively flirted with and critiqued on my hand gestures. All while I couldn’t feel my own lips.
Where the phrase comes from
“Love the sinner, hate the sin” isn’t in the Bible. It traces to Augustine’s Letter 211, written in the 420s C.E. to a convent of nuns who had rebelled against their new prioress after Augustine’s own sister stepped down from the role. The Latin is cum dilectione hominum et odio vitiorum, roughly “with love for persons and hatred of vices.” It was guidance for how a community in conflict should correct its own members with charity instead of cruelty.
The phrase gained modern popularity through Gandhi, who wrote in his 1929 autobiography that hating the sin and not the sinner is a precept easy to understand and rarely practiced. He was right then, and he was right in my recovery room.
What the phrase does to trans people
Augustine’s line assumes you can separate a person from a thing they do. That might work for gossip or theft. For being transgender, it falls apart.
My transition is the shape of my life. It runs through my name, my voice, my face, the way my family introduces me and the way I pray. When someone says they hate the “sin” of who I am, there isn’t some separate, sin-free Liam standing off to the side waiting to receive the love. The love has nowhere to land.
That’s why the last question — “Why don’t you like yourself?” — tells you so much. It assumes transition is a form of self-rejection, a sin I’m committing against my own body. It’s the same assumption underneath “love the sinner.”
But for me, transition was the first time I liked myself enough to stay. I’ve had more than a dozen surgeries, most of them for illnesses I didn’t choose. One of them I did choose, and it’s the one I’d do again tomorrow.
“What trans people actually hear in that phrase is: I love you in theory and reject you in practice.”
So what trans people actually hear in that phrase is: I love you in theory and reject you in practice. And because it sounds gracious, the person saying it often walks away believing they were kind.
There’s an audience problem, too. The phrase is rarely said privately and gently by someone who has earned the right to say it. More often it’s announced, unprompted, by someone who wants it on the record that they disapprove. Augustine was writing to a community bound by shared vows. My nurse and I were bound by a hospital bracelet.
A word to Christians who work in health care
I’d love to tell you this was a one-off. It wasn’t. I have more than 20 doctors, and some version of this conversation has followed me to nearly all of them: eye exams, elbow surgery consults, cardiology, rheumatology, routine blood draws.
I have been asked about my genitals by people who were there to check my vision. I have fielded theology from someone whose only job was to find a vein, which, given my veins, is already a lot to ask of one person. Trans patients learn to budget for it. You show up to get your eyes dilated and you bring your insurance card, your photo ID and a short lecture on gender identity, just in case.
Many of the best nurses and doctors I’ve had are people of deep faith. Some have prayed with me, at my request, and it meant a great deal. Keep your faith. Bring it to work. But when the same conversation shows up at the eye doctor, the cardiologist, the rheumatologist and the lab, it stops being about one person’s manners and starts being about a culture. And underneath that culture is a question of power.
A patient in recovery cannot leave. Often they can’t sit up. They may be sedated and in pain, and they depend on you for basic dignity.
“A patient who can’t fully consent shouldn’t be asked for things that require consent.”
I handed over my phone and a picture of my former self because someone asked while I was too sedated to weigh the request. A patient who can’t fully consent shouldn’t be asked for things that require consent. That’s why the nursing profession’s own code of ethics begins with respect for the inherent dignity and worth of every person. The imbalance in that room is enormous, and anything you say carries its full weight.
So a few requests, from someone who has spent a great deal of time on the other side of the bed rail. Ask the questions you need for my care. If you’re curious beyond that, ask whether I’m willing to talk, and accept no for an answer. If I say yes, listen the way my first nurse did. Keep your assessment of my soul between you and God. I didn’t sign a consent form for that procedure.
Jesus describes the final judgment in Matthew 25, and the line is “I was sick and you took care of me.” It isn’t “I was sick and you evaluated my eternal standing.”
And a word to pastors: Plenty of the people who have said this phrase to me learned it from a pulpit. If you teach it, teach where it came from — a bishop writing to a convent in crisis about how to correct their own sisters gently. It was written for people who had made promises to one another, and that context belongs with it.
Liam Gent is a writer, church inclusion consultant and trans advocate. He creates Fearfully Made Trans, exploring trans identity and Christian faith, and founded What They Skipped, which brings biblical scholarship to readers the church left out of the conversation. He lives in Denton, Texas, with his wife and their four fur children.