With Jesus as your High Priest, you are anchored behind the veil into the presence of God himself: anchored to his forgiveness, and anchored to his blessing, favor, and love. You are anchored there because Jesus is standing right there, representing you. He brings the blood of a sacrifice—his blood—evidence that your sins have been punished and dealt with. With Jesus as your High Priest you have absolute assurance that you are free from condemnation. And he brings to you, from God, abundant mercy, forgiveness, and life. 

Unlike our beloved Anglican cousins, Presbyterians don’t believe that it is right to ordain priests into the church. But that doesn’t mean that we don’t think that we need a priest. On the contrary, we most desperately need a priest! Not a mere human priest, however, but the one great High Priest, Jesus Christ.

For every high priest chosen from among men is appointed to act on behalf of men in relation to God, to offer gifts and sacrifices for sins. He can deal gently with the ignorant and wayward, since he himself is beset with weakness. Because of this he is obligated to offer sacrifice for his own sins just as he does for those of the people. And no one takes this honor for himself, but only when called by God, just as Aaron was. (Heb. 5:1-4)

First, what is a priest? A priest is a go-between, someone who represents God before humanity, and humanity before God. A go-between is needed because God is holy, and we are not.
The Holy God hates sin with a passion and breaks out against it with fierce anger (remember the Flood, the Ten Plagues, the Exile…). But we are sin-full. In the West Australian town of Greenough, constant strong winds have bent the trees to grow right-angled to the ground. Humans are bent by sin to do what God has forbidden, and to fail to do what God has commanded.
Sinners cannot stand in God’s holy presence without being destroyed.
This is why Isaiah said “Woe to me! I am ruined!” when he found himself in the presence of the “Holy! Holy! Holy! LORD Almighty!” (Isa. 6:1-5). This is why the Beloved Disciple, confronted by the Holy Son of God, fell at his feet “as though dead” (Rev. 1:17).
Sinful humanity must come to God to plead for his mercy and blessing. But how can we? It isn’t safe to be around him, since we would be destroyed in his presence like a tissue in a bonfire, like a comet straying near the sun, disintegrated to ashes by the nuclear heat.
God on his side longs to bring us grace, forgiveness, and blessing. But how can he? His holy presence would destroy us, we who are fouled black by sin to our very core.
Two nations are at war, trying with might and main to obliterate one another. If there is to be any dialogue, any hope of reconciliation, a go-between is needed: traditionally, someone from neutral Switzerland. We need a Switzerland: a go-between to approach God on our behalf, to plead for his mercy and blessing; and someone who can come from God to us, to bring mercy and blessing. That is what a priest is. He represents sinful humanity before Holy God, and Holy God before sinful humanity.
A priest must have two qualifications.
First, in order to represent humanity, a priest must be one of us. He must know what we know, he must have felt and experienced what we have felt, to plead for us from a place of personal knowledge and encounter. Yet, though human, he must be sinless, so that he can enter Holy God’s presence without annihilation.
Second, in order to represent God, the priest must himself be divine. A true mediator between God and man must himself be—a God-man.
A priest has duties to perform.
In order to reconcile Holy God and sinful humanity, the priest must satisfy God’s demand for the execution of just punishment upon human sin. God can no more overlook and disregard sin than a human justice can overlook premeditated murder. If God and humanity is to be reconciled, human sin must be dealt with.
How can God bless sinful humanity, when he must punish us? God in his wisdom and grace has provided a sacrifice: a means by which our sin can be punished in another, in a substitute.
Just punishment for our sin can be executed upon the substitute, so that we may instead be blessed. The priest can make this sacrifice, and then bring evidence to God that the sacrifice has been made, and that sin has been justly punished. The priest brings the blood of the slain victim: “Look, here is the evidence that this person’s sin has been punished, that justice has been administered.”
God sees the blood of the substitute, and his holy justice is satisfied. The person for whom the sacrifice was made is no longer the object of his wrath: for his wrath has already fallen upon the sacrificial victim.
Then God sends the priest back to the people he represents: to pronounce God’s forgiveness and favor, God’s promises and reassurance.
The high priest was Israel’s only priest.
This was the awesome office and duty of the Old Testament priest: he was a mutual representative of Holy God and sinful humanity; he brought bloody evidence to God that Israel’s sin had been justly punished; he took God’s blessing to Israel, whose sin had been lifted.
The singular magnificence of the dress of the high priest showed that he was actually Israel’s only priest—the other “ordinary priests” merely served as his assistants.
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Some critics describe the kind of treatment offered at places like the Transgender Center where I worked as a kind of national experiment. But that’s wrong. Experiments are supposed to be carefully designed. Hypotheses are supposed to be tested ethically. The doctors I worked alongside at the Transgender Center said frequently about the treatment of our patients: “We are building the plane while we are flying it.” No one should be a passenger on that kind of aircraft.

I am a 42-year-old St. Louis native, a queer woman, and politically to the left of Bernie Sanders. My worldview has deeply shaped my career. I have spent my professional life providing counseling to vulnerable populations: children in foster care, sexual minorities, the poor.
For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt.
All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children’s Hospital, which had been established a year earlier.
The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus.
During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility.
I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.
Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.
Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.
The Floodgates Open
Soon after my arrival at the Transgender Center, I was struck by the lack of formal protocols for treatment. The center’s physician co-directors were essentially the sole authority.
At first, the patient population was tipped toward what used to be the “traditional” instance of a child with gender dysphoria: a boy, often quite young, who wanted to present as—who wanted to be—a girl.
Until 2015 or so, a very small number of these boys comprised the population of pediatric gender dysphoria cases. Then, across the Western world, there began to be a dramatic increase in a new population: Teenage girls, many with no previous history of gender distress, suddenly declared they were transgender and demanded immediate treatment with testosterone.
I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school.
This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe.
The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.
Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).
The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.
To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription.
That’s all it took.
When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.
Side Effects
Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.”
There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are.
Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”
Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.
How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.
We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.
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The view that Christianity and Islam are more similar than different is mainstream within the Muslim community. And though many Americans live in areas with relatively small Muslim populations, that’s likely to change in coming years. It’s important to be ready to engage our Muslim neighbors in meaningful conversations about our faith. A helpful first step in any such conversation is to explain just how pessimistic Christians are about human nature.

“Christianity and Islam worship the same God and are fundamentally the same at their core.”
I regularly encounter this assertion in my church-planting efforts in Dearborn, Michigan. (Dearborn has the distinction of having the highest concentration of Arabs in North America.) Most commonly I hear this phrase, or one like it, coming from the mouths of young Muslim men and women. Their intentions are wonderful. They’re trying to bridge the gap between our cultures and religions. Indeed, there’s much need for mutual understanding and respect between our faiths.
However, this assertion comes from a misunderstanding of the foundational principles of Christianity.
“I’m curious,” I often say. “What’s the ‘core’ that Christianity and Islam share? What makes our religions so similar?”
“Well, at the end of the day,” the response usually goes, “we’re all trying to live the best lives we can to please God and get into heaven.”
“What if I told you,” I reply, “that Christianity is far, far too pessimistic to believe that? In fact, I think Christianity is the most pessimistic religion in the world.”
Pessimism at the Heart of Christianity
This response often piques curiosity. They genuinely want to know why I think Christians are so pessimistic. The conversation usually goes something like this:
Them: “What do you mean, Christians are pessimistic?”
Me: “Well, you said we’re all trying to please God. Christians don’t think that’s possible. Because of sin, we’re entirely incapable of pleasing God.”
Them: “So how in the world do Christians think people end up in heaven?”
If you’re not careful, you might mistake a question like that as an evangelistic opportunity.
I jest, but it should be noted: this isn’t a difference merely between Christianity and Islam. Our deep-seated pessimism about human nature sets Christianity apart from nearly every other worldview. Most non-Christian faiths and philosophies offer various strategies for striving toward perfection (or at least adequacy). Only Christianity insists we must throw up our hands in utter defeat at any attempt at self-justification.
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