Gender-Affirming Surgery as a Liberation of the Self

This text is the English translation of „Geschlechtsangleichungen als Befreiung zum Selbst“, first published on December 4, 2023, on y-nachten. Click here for access to the original post.

Transgender is a hot topic in the media and even more so on social media. Few discourses evoke so many emotions. Opinions are equally divided when it comes to gender-affirming surgery. All these different perspectives and the way in which they are discussed were the subject of last year’s conference of the Association of Bioethicists in Central Europe (BCE), which was held in cooperation with the Institute of Ethics and Law in Medicine (IERM) of the University of Vienna. Under the title (“Der Körper, in dem ich lebe”) “The body I live in”, speakers from various disciplines discussed gender-affirming surgery in the interdisciplinary transgender discourse.

First of all, it should be noted that what is referred today as transgender is not a new phenomenon in European, Christian-dominated cultural history. Protestant theologian Gerhard Schreiber, for example, has pointed to illustrations of St. Wilgefortis or changed genders in historical baptismal registers. But, according to current knowledge, the distinction between biological, social, and psychological gender does not exhibit the clear binary logic that dominates social discourse. As there are only few texts on this topic in the EKD and the Catholic Church, it is now all the more time to address the issue.

Transgender from a medical perspective

Attention should also be paid to the terminology. Since “transsexuality” was classified as a disease up until (International Statistical Classification of Diseases and Related Health Problems) ICD 11[1] from the 1st of January 2022, today it is mainly referred to as trans identity, transgender or gender incongruence or gender dysphoria. From a medical perspective, trans medicine specialist Florian Breitenecker has also emphasized that transgender concerns the classification of one’s own gender and that this must therefore be strictly distinguished from one’s sexual orientation. The diverse explanations for transgender indicate multifactorial causes. Monocausal interpretations must therefore be rejected. Transition takes place gradually through social, hormonal, and surgical interventions and is accompanied in many ways. The concordant medical and psychotherapeutic statements that are required before a surgery are, on the one hand, often an obstacle for those affected. But, on the other hand, they are also necessary from a medical and legal perspective. This is because, as the lawyer Karl Stöger from the IERM emphasizes, only curative treatments can justify such severe interventions in the body, as one would otherwise be committing grievous bodily harm.

However, as trans identity is not a disease and there are no concrete legal regulations in this regard, classifications as curative treatment is only possible on a case-by-case basis. As a result, in Austria such decisions had to be fought for in court ruling by the Supreme Court. The concordant statements are therefore required and are also intended to guarantee the best quality of medical treatment.

Psychotherapeutic perspective: Ethics of congruence

In order to describe the suffering of affected individuals without classifying transgender as a disease, psychotherapist and head of COURAGE-counseling center[2] Johannes Wahala expanded on the concept of gender incongruence. This suffering from incongruence is also the medical indication that bridges the gap between overcoming classification as a disease and continued funding by health insurance companies. Furthermore, the broad spectrum that exists between gender incongruence and the discrepancy between the self and social gender roles must be considered. For psychotherapist Cornelia Kunert[3], this constitutes the need for individual support and explains why only a fraction of trans*people go down the path of gender-affirming surgery.

From her many years of experience in urgently recommended psychotherapeutic support for transgender people, she also points to one specific phenomenon. What she calls the dynamic of congruence, which can develop through the embedding of the body image in the self-model, can heal psychological disorders as severe and difficult to treat as stuttering. This leads her to an ethics of congruence. Good is what supports and promotes an unfolding of existence and enables an experience of meaning, while that which hinders the dynamics of congruence is considered bad.

Socio-ethical considerations on gender as a polarizing field of discourse

But why is this toping being discussed so emotionally? Is it because gender as a social construct is irreconcilably opposed to biological essentialism? But why are other social constructs such as adoption, national borders, or money not just as emotive? From a socio-ethical perspective, the philosopher Lukas Kaelin[4] assumes that meaningful discourse is becoming increasingly difficult due to the digital structural change in the public sphere. Through social media, the filtering power that used to lie with editorial offices has now been transferred to users and personalization supported by algorithms. As a result, discourse is characterized by personal involvement and emotionality, which are the yardstick for algorithms. Added to this is the fact that transgender people question deep-rooted beliefs about gender binary, which in turn triggers emotional reactions that are amplified on social media.

Finally, what about theology?

I would like to conclude with an interesting question from the Catholic theologian Stephan Ernst, wo analysed the magisterial argumentation on this topic.[5] It is based on a presumed natural order of the world. However, this includes human nature as a unity of body and soul, whose physicality also includes the male or female sex which in this essentialist argumentation also includes gender. Interventions in nature are only justifiable if they involve the sacrifice of a part for the good of the whole body. Accordingly, gender-affirming surgery would be an unauthorized change to the physical nature of the human being. But could it not rather be seen as the sacrifice of a part for the good of the whole person? Isn’t it about restoring personal identity, i.e. the unity of body and soul?

These questions show that this topic has not been definitively clarified yet, even with magisterial argumentation. I therefore conclude from this conference that, on the one hand, a respectful and understanding approach to this topic is not impossible. On the other hand, we must also face up to the strong emotions that such issues generate, both positive and negative, and take this into account in the discourse. Finally, this conference has shown me the importance of inviting transgender people to such events. Not only for the discussion, but also for personal understanding, it made a big difference to not only talk about trans* people, but also with them.


Schreiber, Gerhard (ed.), Das Geschlecht in mir. Neurowissenschaftliche, lebensweltliche und theologische Beiträge zur Transsexualität. Berlin – Boston: 2019.

Committee on Doctrine. United States Conference of Catholic Bishops, Doctrinal Note on the Moral Limits to Technological Manipulation of the Human Body, 20.03.2023, (date of last access: 01.12.2023).

COURAGE: (date of last access: 01.12.2023).

ICD-11: (date of last access: 01.12.2023).

Kaelin, Lukas/Telser, Andreas/Hoppe, Ilaria (eds.), Bubbles & Bodies. Neue Öffentlichkeiten zwischen sozialen Medien und Straßenprotesten. Bielefeld: 2021.

Kunert, Cornelia: „Sag mir nicht, wer ich bin! Über die Erste-Person-Perspektive und die Unbestimmbarkeit des Geschlechts“, in: Claudia Maier-Höfer/Gerhard Schreiber (eds.), Praktiken von Transdiskursen. Ein multidisziplinärer Zugang. Wiesbaden: 2022, pp. 45-66.




[3] See Kunert, Sag mir nicht, wer ich bin!, pp. 45-66.

[4] See Kaelin/Telser/Hoppe, Bubbles & Bodies.

[5] See Committee on Doctrine, Note on the Moral Limits.

RaT-Blog Nr. 01/2024

  • Paul Draganoff befindet sich gerade in der Abschlussphase seines Studiums der Katholischen Theologie an der Universität Wien. Gegenwärtig arbeitet er als Studienassistent am Institut für Systematische Theologie und Ethik im Fachbereich Theologische Ethik. Im Rahmen seiner Diplomarbeit befasste er sich mit TIerethik und ist nun in der Vorbereitung eines theologisch-ethischen Dissertationsvorhabens.