There are three levels of transformation for those that seek to exist within a different gender identity. The first and least invasive level of transition is identification. This means that anyone experiencing gender dysphoria or incongruence can identify as the opposite gender, nonbinary, or nongendered through the use of different clothing, pronouns, names, etc.
The second level of transition is hormonal intervention. This is where a person undergoes hormone replacement therapy by receiving inordinate amounts of hormones that are correlated with the opposite sex. That is, natal males receive high amounts of estrogen or progesterone, and natal females receive high amounts of testosterone in order to produce secondary sex characteristics correlated with the opposite sex. Natal females who take cross-sex hormones will often experience changes such as: facial hair growth, a widening of their face, a body shape that is less curvy, and a deepening of their voice. Natal males who receive hormone therapy treatment may gain some softness in their features, particularly in their face and chest. Their voices may become higher in pitch, and they may stop growing facial hair.[i]
The third and most invasive level of transition is surgical intervention. This could involve a series of multistep procedures, for both men and women, to remove the primary sex characteristics (e.g., penis, vagina, breasts) in order to create genitalia and other primary sex characteristics correlated with the opposite sex.
Some people within the LGBTQ+ community (and beyond) correctly assert that these levels of intervention allow one to become a trans man or a trans woman. That is, they still belong to the category of their natal sex, but they have altered their identity, hormones, or genitals to correlate with the opposite sex. Others in the LGBTQ+ community (and beyond) believe these levels of transition constitute a literal shift in natal sex, thus correcting a felt reality through biological intervention.
Modern science is a marvel capable of many things. However, sex (aka gender) is a biological fact that cannot be altered. Although a person can alter their gender identity by changing their name, pronouns, hormones, and even their genitals, one cannot alter their gender. Gender is not just skin-deep; it is woven into our chromosomes, our DNA, even our very bones![ii] These fundamental, structural, and unalterable parts of self all point to the gender binary that God intentionally created. Gender is not just a social construct; it is a biological fact and a theological wonder that cannot be altered by humans.
[i] Preston M. Sprinkle (Host), “Are Puberty Blockers and Cross-Sex Hormones Safe? Dr. Michael Laidlaw,” Theology in the Raw, 6 May 2021, https://www.patheos.com/editorial/podcasts/theology-in-the-raw/2021/864–are-puberty-blockers-and-crosssex-hormones-safe-dr-michael-laidlaw.
[ii] Abigail Shrier, Irreversible Damage: The Transgender Craze Seducing Our Daughters (Regnery Publishing, 2020), 161–162.