Newton genuinely loved his people. And they knew that he loved them. He wouldn’t use the pulpit to clobber them, to share their secrets, or anything of the sort. But he was often among the people and heard their hearts. This would inform his preaching. When he picked a text he likely had a conversation in mind. He always aimed to help his congregation. His passion for Christ and his congregation bled out into the pulpit. He spoke their language.

John Newton was not that great of a preacher. Newton preached during the time of great orators like Whitefield, Wesley, Davies, Tennent, and many more. Those who heard Newton were sometimes surprised that he had such a full congregation. He was sincere, orthodox, pious, but he was not “graceful in delivery”. Richard Cecil, a fellow Anglican clergyman, said this:
With respect to his ministry, he appeared, perhaps, to least advantage in the pulpit; as he did not generally aim at accuracy in the composition of his sermons, nor at any address in the delivery of them. His utterance was far from clear, and his attitudes ungraceful.
So why, in an age when preaching was at a premium, was a middling orator like Newton pastoring a congregation filled with people? Cecil gives the answer:
He possessed, however, so much affection for his people, and zeal for their best interests, that the defect of his manner was of littler consideration with his constant hearers: at the same time, his capacity, and habit of entering into their trials and experience, gave the highest interest to his ministry among them.
Newton genuinely loved his people. And they knew that he loved them. He wouldn’t use the pulpit to clobber them, to share their secrets, or anything of the sort. But he was often among the people and heard their hearts. This would inform his preaching.
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Speech and silence can both be vices. Knowing the difference between the two requires wisdom. And through wisdom, we will find the virtue between the vices, and learn how to give life through both our words and the silences between them.

If something is of ultimate importance, you should say it as soon as possible, right? If something is true, and vital to know, then circumstances be damned, we just have to say it. The person we’re talking to will, in the end, be better off than if we hadn’t said it.
Christians often apply such logic to evangelism and discipleship. These tasks deal, necessarily, in ultimates – life and death, curses and blessings, first things and last things. If the Good News is so good, the judgement so terrible, and the task so unfinished, then we should surely be turning every possible moment into a conversation about Christ and the Gospel. The truth, by virtue of being true, demands restatement whenever possible. Even if people are not ready or willing to listen, they will have heard the word of God, which is living and active, and that is never a bad thing. And who knows – perhaps the Holy Spirit will zap them with new life out of nowhere.
And yet thinking about truth in this way is actually quite odd. If we consider how some of history’s greatest philosophers (i.e. those who love wisdom) and theologians (i.e. those who speak about God) have thought about speaking ultimate truth, we find they have this in common: there is a right time to speak of ultimate things, and a right time to remain silent.
This week, I’ve been reading Plato’s dialogue Alcibiades for a Davenant Hall class, taught by my colleague and podcast co-host Colin Redemer. The work is a conversation between the philosopher Socrates and the title character, young Alcibiades (a genuine historical figure who became a great Athenian leader, defecting at different points to both Sparta and Persia). Alcibiades has reached young manhood, and his ambitions to enter into politics are finally blossoming into reality. This is what kicks off the dialogue: Socrates has long seen Alcibiades’ drive and ability, but only now does he approach the younger man to take him under his philosophical wing before he begins his political career. Why? Because he knows Alcibiades is now ready to listen. Socrates says:
“It is impossible to put any of these ideas of yours into effect without me – that’s how much influence I think I have over you and your business. I think this is why the god hasn’t allowed me to talk to you all this time; and I’ve been waiting for the day he allows me.
I’m hoping for the same thing from you as you are from the Athenians: I hope to exert great influence over you by showing you that I’m worth the world to you and that nobody is capable of providing you with the influence you crave, neither your guardian nor your relatives, nor anybody else except me – with the god’s help, of course. When you were younger, before you were full of such ambitions, I think the god didn’t let me talk to you because the conversation would have been pointless. But now he’s told me to, because now you will listen to me.”
Alcibiades 105.d
The blossoming of a serious desire for leadership signals to Socrates that Alcibiades is finally ready to listen to him regarding ultimate things. And it is ultimate things Socrates really wants to talk about. His main message to Alcibiades is that there is no point embarking upon a political career if he has not first cultivated his very soul. It is hard to imagine a more important topic of discussion, and yet Socrates did not badger Alcibiades with it every day. He waited. In fact, he says that God himself made him wait.
You find a similar thought in Augustine’s Confessions.
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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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