Years after it mattered, a mainline American denomination has finally thrown its full support behind the crumbling façade of transgender medicine. In its 227th General Assembly this summer, the Presbyterian Church (USA) voted overwhelmingly to “Declare that the PC(USA) supports all individuals to have access to all medically necessary, evidence-based gender-affirming healthcare.” Such a declaration, coming in 2026, is a bit like waiting for the gale before spitting into the wind.

Significantly, the resolution in favor of transgender procedures came from the PCUSA’s Cherokee Presbytery, an administrative region covering Atlanta and much of North Georgia. Georgia is one of 27 states that has enacted laws to protect minors from gender transition procedures. Georgia passed its law three years ago as part of the major wave of 2023, and it put a legal challenge in the rearview mirror with the Supreme Court’s Skrmetti ruling last summer.

In other words, the PCUSA did not address the transgender medicine question while it was a hotly debated topic, nor even at its 226th General Assembly in 2024. It waited until the issue was settled by a Supreme Court precedent to come out in favor of the losing side.

Yet PCUSA elders were undaunted by the long odds. The Gender and Sexuality Justice Committee approved the resolution by a vote of 50-10 after one minor amendment. (Why does the assembly have such a committee, and why does it have 60 members? I don’t think I want to know.) The General Assembly in plenary session approved the final draft 441-30 (with 93.6% voting in favor).

The only amendment to the resolution changed the wording “all individuals, including minors” to simply “all individuals.” In an attached note, the committee clarified that it “chose to remove the phrase ‘including minors’ from this recommendation at the request of young people who did not want to see this overture misused to cause more harm to transgender minors. This phrase was removed with the clear understanding that ‘all individuals’ does, in fact, include people of all ages.”

In other words, the original resolution was explicitly aimed at state protections against transgender procedures for minors. The amended text incorporated the gist of the original but removed the emphasis out of an unexplained fear that mentioning it could “cause more harm to transgender minors.”

Strikingly, this point seems to be the only one debated in committee seriously enough to require an amendment. If the scientific basis of the amendment (or lack thereof) was raised at all, the denomination makes no mention of it.

Instead, the resolution’s accompanying Rationale simply declares, “Gender-affirming care is age-appropriate care that is medically necessary and evidence based for the well-being of many transgender, non-binary, and gender-expansive people who experience symptoms of gender dysphoria or distress that result from having one’s gender identity not match their sex assigned at birth.”

The U.S. Federal Trade Commission is now suing the World Professional Association for Transgender Health (WPATH) for describing their recommendations as “medically necessary” and “evidence-based” without evidence to support such claims.

“What is especially remarkable is that the denomination is doubling down on support for medical interventions for minors at precisely the moment the international medical consensus has become far more cautious,” responded Dr. David Closson, director of FRC’s Center for Biblical Worldview. “Following systematic evidence reviews, countries such as the United Kingdom have sharply restricted the use of puberty blockers for children, and a growing number of medical authorities have concluded that the evidence supporting these interventions is far weaker than previously claimed.”

Nor is there evidence that the PCUSA debated or even considered the Bible’s teaching on human sexuality before passing this amendment. When God created man in his own image, Genesis records, “male and female he created them” (Genesis 1:27). Jesus Christ then cites this creation principle as unchanging truth that was still relevant to the sexual debates of his own day (Matthew 19:4-6). By supporting transgender medical treatments for anyone, or even entertaining the notion that sex is “assigned at birth,” the PCUSA is not following in the footsteps of he who is the head of the Christian church.

“Once a church ceases to treat Scripture as its final authority, there is little principled basis for resisting the broader cultural revolution surrounding sex and gender,” Closson explained. “What we are witnessing is not an isolated decision but the fruit of years of theological compromise.”

In other words, “No one should be surprised by this development,” Closson told The Washington Stand. “The Presbyterian Church (USA) has been moving away from historic Christian orthodoxy for decades. Long before this vote, the denomination had abandoned biblical teaching on marriage and sexuality, redefined sexual ethics, and repeatedly rejected the clear authority of Scripture on issues of human identity. This latest action is not a departure from that trajectory. It is the logical continuation of it.”

Although unsurprising, the development still represents a shocking escalation. Never before has the PCUSA considered, much less approved, a resolution supporting transgender medicine, especially not for minors. At the 226th General Assembly in 2024, the PCUSA voted 389-24 to add sexual orientation and gender identity to the list of categories protected from discrimination (taking a step further even than the U.S. government). The transgender medicine resolution self-consciously “continues efforts to remove discrimination” from the resolution passed in the last assembly, according to the accompanying Rationale.

That escalation in the PCUSA’s LGBT agenda coincides with an ongoing decline in its membership. In 2025, the PCUSA counted only 1.0 million members, down from 3.1 million when two predecessor bodies merged to form it in 1983. The denomination is losing tens of thousands of members each year, for an average annual loss of 4.6% (although the loss in 2025 was only 2.6%), and nearly 60% of members are over the age of 56.

Correlation does not always equal causation, but here there are good reasons to draw a logical connection. By abandoning Christian orthodoxy to follow the culture, the PCUSA and other Christian bodies running to the left are undermining their own reason for existence.

Christianity offers a distinct gospel that gives Christ-followers compelling reasons to live in a Christ-honoring way. When a Christian institution abandons Christian distinctives, it quickly loses its uniquely compelling character and becomes nothing more than a social club that requires members to forgo any other Sunday morning activities. Once the organization cuts off its own reason for existence, its members gradually conclude there is no reason for their continued participation. Thus, denominations that jettison the authority of Scripture and the distinctive ethical norms that have characterized Christians for 2,000 years are often found dying on the vine.

“Christians should grieve the passage of this overture because it reflects a profound departure from the Bible’s good design for humanity,” Closson concluded. “Scripture teaches that God created humanity male and female, that our bodies are gifts to be received rather than obstacles to overcome, and that true human flourishing is found not in remaking ourselves according to our desires but in conforming our lives to God’s wise and loving design.”