The transgender movement has exploded internationally in the last few years fueled by celebrity endorsement and high level media and political support. It raises profound challenges which are cultural, legal, medical, theological, and pastoral. What are its ideological and cultural roots? How has it impacted medicine and law? What is the science behind it? What is the difference between sex and gender and between transgender and intersex? How is the transgender agenda impacting the church and what opportunities and threats does it bring? How do we respond to the ideology and those involved both biblically and pastorally?