5.20.25 HHS questions transgender treatments, barriers to detransitioning, and challenges of teaching overseas

Summary

The World and Everything In It: Episode Summary – May 20, 2025

Host: WORLD Radio's "The World and Everything In It" delves deep into pressing global and domestic issues with a commitment to sound journalism grounded in God's Word. In the episode released on May 20, 2025, titled "HHS Questions Transgender Treatments, Barriers to Detransitioning, and Challenges of Teaching Overseas," the hosts Mary Reichert and Nick Eicher guide listeners through a multifaceted discussion on transgender healthcare, insurance hurdles for detransitioners, and the nuanced experiences of teaching abroad.

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1. HHS Report on Gender Affirming Treatments for Minors

The episode opens with a significant focus on a new federal report by the Department of Health and Human Services (HHS) concerning gender-affirming medical interventions for minors. This comprehensive 400-page review scrutinizes the existing medical literature surrounding treatments such as hormone therapy and surgeries aimed at addressing gender dysphoria in children.

Key Findings:

• Weak Evidence for Efficacy: The HHS report concludes that there is insufficient evidence to support the long-term benefits of gender-affirming treatments for minors. Many studies reviewed were criticized for small sample sizes, lack of long-term data, and absence of control groups.
• Significant Risks Identified: Potential adverse effects include reduced bone mineral density, infertility, sexual dysfunction, and cardiovascular issues associated with hormone treatments.

Notable Insights: Mary Muncie interviews Precia Mosley, a detransitioner whose personal journey embodies the complexities highlighted in the report.

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2. Personal Journey of Precia Mosley

Precia Mosley shares her harrowing experience with gender dysphoria and the subsequent detransitioning process, offering a poignant narrative that underscores the report's findings.

Early Struggles and Transition:

• Traumatic Beginnings: At age 14, Precia was sexually assaulted, leading to a pregnancy and miscarriage. This traumatic event catalyzed her struggles with her identity and body image.

  "When I was 14, I was sexually assaulted and I became pregnant as a result of that and miscarried." [08:06]

• Influence of Online Communities: She became involved with online groups that encouraged her to view her distress through the lens of gender dysphoria rather than addressing the underlying trauma.

  "A bunch of trans identifying adults came in and explained to us that our distress was actually based on the fact that we were born in the wrong body." [08:20]

• Medical Interventions: At 17, Precia began testosterone therapy, feeling validated and stronger initially, which led to a double mastectomy shortly after her 18th birthday.

  "I thought that I was having a life-saving procedure that was going to prevent my suicide and I was so suicidal." [09:11]

Detransitioning and Aftermath:

• Reversal Efforts: Facing infertility and complications during pregnancy, Precia sought to reverse her transition. However, she encountered significant barriers, including insurance companies deeming detransition procedures as medically unnecessary.

  "We are cutting into the body to address a mental health issue. We don't. It's completely inappropriate and completely unethical." [17:55]

• Legal Action: Precia is currently suing the doctors involved in her transition, marking a landmark case as the first to proceed to court.

  "Now she and her son are living with that for a very, I mean, about a decade or more of my life." [13:35]

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3. Insurance Barriers to Detransitioning

The episode further explores the systemic challenges faced by individuals seeking to reverse gender-affirming treatments, focusing on the intricate relationship between healthcare providers and insurance companies.

Case Study: Abel Garcia

• Initial Transition Coverage: Garcia's transition, including estrogen supplements and breast implant surgery, was covered by his insurance.

  "[Abel] decided he wanted to get the implants removed, but he discovered that gender transition in the United States is a one way street." [15:37]

• Challenges in Reversing Procedures: When Garcia opted to detransition, his insurance company classified the reversal as medically unnecessary, denying coverage for the removal of implants.

  "They replied back to me saying that my request to detransition by getting the implants removed were considered medically not necessary." [16:33]

Systemic Issues:

• Lack of Medical Billing Codes: The absence of specific billing codes for detransition procedures complicates the approval and documentation processes, as highlighted by Dr. Jared Ross.

  "There isn't a code for someone who wants to reverse a gender change procedure." [18:00]

• Policy Developments: In response to these barriers, Texas has approved a bill mandating that insurance companies cover medical care related to detransitioning. If signed by Governor Greg Abbott, Texas will pioneer this legislation, potentially setting a precedent for other states.

  "There are minors there that were harmed." [20:55]

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4. Expert Commentary and Analysis

Dr. Jared Ross, an emergency medicine physician and senior fellow with the research group Do No Harm, provides critical analysis of the HHS report and the broader implications for healthcare policy.

"The US has a long way to go, not just to undo the damage, but also to prevent it from happening." [20:26]

Camille Kiefel, head of Detrans Help, emphasizes the necessity of medical billing codes for detransition procedures to facilitate access and improve data collection on detransitioning trends.

"They would have an easier time getting approved for reversal procedures." [19:41]

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5. Additional Features

Beyond the central discussion on transgender treatments and detransitioning, the episode also covers a variety of other compelling stories:

a. Teaching Overseas: Challenges in Spain

Elizabeth Corley shares her decade-long experience as a language assistant in Seville, Spain, highlighting cultural adjustments and the emotional toll of living abroad.

• Cultural Shock: Corley describes the classroom environment in Spain as noisier and more casual compared to American standards, which initially shocked her.

  "The behavior in the classrooms is, I don't know, it was just kind of a shock for me, just how I would say that the classroom in Spain in general is just noisier and more casual." [24:24]

• Personal Growth: Through persistent challenges, Corley found stability and community within a local church, leading to her marriage to a Spaniard named Adrian.

  "God has really, through these years that I've been abroad, brought me closer to him and made me realize that my security is in him and not a country or my blood family." [28:58]

b. Presbyterian Church USA Shuts Down Global Missions

Nathan Finn, World Opinions contributor, explores the Presbyterian Church USA's decision to terminate its foreign mission efforts, attributing the decline to theological shifts rather than purely financial reasons.

• Historical Context: Finn traces the roots of this shift back to the fundamentalist-modernist controversy of the early 20th century, highlighting how theological liberalism has led to a diminished commitment to traditional evangelical missions.

  "Theological liberalism is incompatible with authentic Christianity." [35:36]

c. Human Interest: Subway Sprint Race

A light-hearted segment features a friendly competition between Vicki Conroy and Noah Cracknell racing to reach a Mets game first—Noah via human-powered sprint and Vicki via a 32-minute subway ride. The race concludes with both reaching Citi Field simultaneously, encapsulating the spirit of camaraderie and competition.

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6. Closing Remarks and Future Previews

As the episode wraps up, hosts Mary Reichert and Nick Eicher provide teasers for upcoming content, including President Trump's foreign policy post-Middle East deals and an unexpected friendship between an author and a bookseller.

"Tomorrow, with President Trump back from the Middle East with a portfolio of deals, we'll look into what they say about his foreign policy goals." [35:36]

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Conclusion

This episode of "The World and Everything In It" offers a comprehensive exploration of the contentious and deeply personal issues surrounding transgender healthcare for minors, the systemic barriers faced by those seeking to detransition, and the broader implications for healthcare policy and insurance practices. Coupled with engaging human interest stories and insightful analysis, the episode serves as an informative resource for listeners seeking to understand these multifaceted topics.

Transcript

[Mary Reichert]

Good morning. A new federal report points to a quiet retreat from devastating surgeries on children. But for thousands, the damage is done.

[Precia Mosley]

I thought I had gotten a proper diagnosis and that I was going to be given a cure that was going to cure all of my distress and trauma.

[Nick Eicher]

Also, more insurers are paying for all that. But what happens when a patient wants it reversed? Well, those same companies often disappear. And later teaching English in Spain's public.

[Elizabeth Corley]

Schools, the behavior in the classrooms, it was just kind of a shock for me.

[Mary Reichert]

It's Tuesday, May 20th. This is the world and everything in it from listener supported World Radio. I'm Mary Reichert.

[Nick Eicher]

And I'm Nick Eicher. Good morning.

[Mary Reichert]

Time for the news. Here's Kent Covington.

[Kent Covington]

President Trump says Russia is ready to move ahead with negotiations to end the war in Ukraine. That comes after the president spent more than two hours on the phone Monday with Vladimir Putin. Trump said he was trying to convince Putin to re engage in negotiations. And he added that he thought the call went very well.

[Dr. Jared Ross]

I thought there was a very good.

[Precia Mosley]

Chance, like 50, 50 chance that he.

[Kent Covington]

Would say, I want to take the whole thing.

[Dr. Jared Ross]

I didn't know what he was going to say. And then they have a different kind of a problem.

[Precia Mosley]

But I believe he wants to stop.

[Kent Covington]

The president also addressed an offer by Pope Leo XIV to host ceasefire talks at the Vatican.

[Precia Mosley]

There's tremendous bitterness, anger, and I think.

[Dr. Jared Ross]

Maybe that could help some of that anger.

[Precia Mosley]

So having it at the Vatican would be in Rome would be a very. I think it'd be a great idea.

[Kent Covington]

Ukrainian President Volodymyr Zelenskyy said he also spoke with President Trump by phone yesterday. He said he stressed that Ukraine will never agree to pull its troops out of its own sovereign territory. Also at the White House on Monday, President Trump signed the Take It down act into law. The bill sets stricter penalties for distributing or exploiting another person's image online in certain ways without their consent, such as pornographic images. Those include images created using AI or Photoshop. The president signed it alongside his wife, Melania Trump, and had her sign it as well. She said the law is intended to.

[Precia Mosley]

Ensure that every American, especially young people.

[Camille Kiefel]

Can feel better protected from their image or identity being abused through non consensual intimate imagery.

[Kent Covington]

The first lady helped usher the measure through Congress. She used her first public appearance since resuming the role of first lady to travel to Capitol Hill back in March to lobby House lawmakers to pass the bill. The U.S. supreme Court has ruled almost unanimously that the Trump administration can strip legal protections from thousands of Venezuelan migrants while a larger legal battle plays out. World's Kristina Group has more.

[Kristina Grube]

The 8 to 1 ruling on Monday pauses a lower court ruling. A judge had blocked the administration from lifting temporary protected status, or TPS, from 350,000 Venezuelans. Only Justice Ketanji Brown Jackson dissented. That earlier decision kept the protections in place that had been set to expire last month. The Biden administration granted TPS to Venezuelans due to unsafe conditions back home. But the Trump administration argues that the judge's order usurped executive authority and that conditions have changed. The decision does not mean that migrants will be automatically deported, but it may leave them without legal status. The the case is part of a broader push by the Trump administration to roll back protections for immigrants from several countries, also including Haiti and Nicaragua. For World I'm Christina Grube Former President.

[Kent Covington]

Joe Biden's recent cancer diagnosis has sparked concerns about whether doctors at the White House missed the cancer during its early stages and if so, could something else be missed affecting the current president? But White House Press Secretary Caroline Levitt told reporters there are no concerns about President Trump or his health staff.

[Kristina Grube]

We returned home from a very long and tiring trip last week and on Saturday. Where was the president? In the Oval Office working all day.

[Dr. Jared Ross]

He doesn't stop, he doesn't quit.

[Kristina Grube]

He's in great health and he trusts his physicians.

[Kent Covington]

82 year old former President Biden is said to have an aggressive form of prostate cancer. The Mexican Navy tall ship that struck the Brooklyn Bridge had departed less than five minutes before its masts crashed into the historic span of. That's according to a timeline laid out by investigators on Monday. Michael Graham with the National Transportation Safety Board this is the start of a long process.

[Michael Graham]

We will not be drawing any conclusions.

[Kent Covington]

We will not speculate.

[Nick Eicher]

We will also not be determining the.

[Kent Covington]

Probable cause while we're on scene. Graham also said there was no significant structural damage to load bearing elements of the bridge. Meanwhile, many crew members have flown home from New York. The Mexican Navy says seven officers and 172 cadets who were aboard the sailing ship arrived early Monday at the port of Veracruz, where Mexico's naval school is located. Two cadets were killed in Saturday's crash. The UK and the European Union have reached new agreements on trade and security following a summit in London. British Prime Minister Keir Starmer this is.

[Mary Reichert]

The first UK EU summit.

[Kristina Grube]

It marks a new era in our.

[Mary Reichert]

Relationship and this deal is a win win.

[Kristina Grube]

It delivers what the British public voted.

[Kent Covington]

For last year, starmer said the deal gives the UK unprecedented access to the EU market, the best of any country outside of the EU or the European Free Trade Association. And European Commission President Ursula von der Leyen said, we're turning a page.

[Dr. Jared Ross]

We're opening a new chapter in our unique relationship. This is the story of historical and natural partners standing side by side on the global stage, facing most of the same challenges.

[Kent Covington]

And as part of the deal, the UK's defence industry will be allowed to participate in the EU's program to ramp up Europe's collective defense. I'm Kent Cuffington and straight ahead. HHS has reviewed the medical literature and reports there is no evidence that so called gender reassignment is helpful. Plus insurance companies and double standards. This is the world and everything in it.

[Mary Reichert]

It's Tuesday the 20th of May. This is World Radio. We're so glad you've joined us today. Good morning, I'm Mary Reinkert.

[Nick Eicher]

And I'm Nick Eicher. First up on the World and everything in it, a warning about risky medicine for vulnerable kids. Now a quick heads up for parents. These next two stories deal with some pretty sensitive topics. It may not be appropriate for your younger children. So there is still a moment before we get those stories underway.

[Mary Reichert]

This first piece has to do with a big report by the Department of Health and Human services. It's a 400 page review of medical interventions for children with gender dysphoria. The findings, in short, what many people expected, weak evidence to support it and serious risks from it. World's Mary Muncie talked to one detransitioner who says what's being offered should not be called treatment.

[Kristina Grube]

Preesha Mosley knows exactly what started her gender dysphoria.

[Precia Mosley]

When I was 14, I was sexually assaulted and I became pregnant as a result of that and miscarried.

[Kristina Grube]

She developed anorexia and joined an online group that encouraged her not to eat.

[Precia Mosley]

A bunch of trans identifying adults came in and explained to us that our distress was actually based on the fact that we were born in the wrong body.

[Kristina Grube]

Before this, her doctors had been telling her the truth about her body. She wasn't fat, she should eat. And they refused to give her liposuction.

[Precia Mosley]

And when I went to my doctors and the narrative had changed and I was no longer saying that my life was bad because I was fat. It was bad because I was born in the whole wrong body. All of a sudden they were agreeing with me.

[Kristina Grube]

At 17 she started testosterone and she felt better. For the first few months I got.

[Precia Mosley]

Validation and affirmation from feeling stronger. I really did gain some muscle and that made me feel safer.

[Kristina Grube]

But those feelings started to wear off.

[Precia Mosley]

And that's why I thought it was time to have my breasts removed.

[Kristina Grube]

So Shortly after her 18th birthday she got a double mastectomy.

[Precia Mosley]

I thought that I was having a life saving procedure that was going to prevent my suicide and I was so suicidal, I mean that I would have cut off my breast to live. And I did.

[Kristina Grube]

Mosley is not alone. Advocacy organization Stop the Harm found that between 2019 and 2023, almost 14,000 minors had interventions to change their sex characteristics and almost 6,000 underwent reassignment surgery.

[Precia Mosley]

We know that the harms are significant just by having knowledge of what takes place.

[Kristina Grube]

Kurt Micelli is the medical director for do no Harm.

[Precia Mosley]

And we know that there are significant side effects, significant downsides in terms of bone mineral density. We also understand that there is infertility that results when one is taking puberty blockers and then adding cross sex hormones to that. There's sexual dysfunction that folks experience. There are the cardiovascular effects that come with the hormones.

[Kristina Grube]

But he says that perspect isn't published in the literature.

[Precia Mosley]

The literature has tended to focus on the notion of what benefits might exist.

[Kristina Grube]

But this month the Health and Human Services Department, or hhs, published a literature review saying the evidence is weak that gender affirming interventions for minors are beneficial. It follows several other countries reversing their policies. The HHS report is an umbrella review, meaning the authors compiled reviews of the evidence and reviewed those systematic reviews are.

[Precia Mosley]

Really a gold standard.

[Kristina Grube]

The HHS report found that many published studies promoting gender affirming care are poorly done. Some feature small sample sizes, others lacked long term analysis, and still others don't have a control group. For example, the HHS reviewed one study published in the New England Journal of Medicine that claimed to prove gender affirming health care is safe and effective. In that study, researchers asked three hundred and fifteen adolescents about their physical and mental health before starting treatment for gender dysphoria. Then they followed up two years later. Physically, the follow up included biomarker tests but did not include information about growth or fertility. On the mental health side, when they started the study, they were testing for 19 outcomes, but at the end of two years they only reported four, excluding the outcome of patients, gender, dysphoria, suicidality and self harm, among other things. Critically, two people committed suicide within a year of starting hormones. The HHS found that due to these shortcomings and others, the study didn't have enough information to know whether Medical intervention helped their subjects gender dysphoria. Despite the study's claims.

[Precia Mosley]

I know oftentimes we defer to autonomy and to how people want to be self directed and such. But I think what has happened here is we've fallen very much into a.

[Kristina Grube]

Almost consumeristic child driven process instead of life altering procedures. The HHS report encourages doctors and parents to focus on psychotherapy if their child is struggling with gender dysphoria. Precia Mosley was 24 and starting to detransition before she truly realized what the interventions had done to her body.

[Precia Mosley]

I had given up on the idea of pregnancy. I was infertile.

[Kristina Grube]

As she started detransitioning, a doctor helped her even out her hormones. She also began dating a man in Michigan.

[Precia Mosley]

I started birth control because my doctor wanted me on estrogen and progesterone. While we were waiting for bioidentical hormones to. And within like, I mean, weeks of starting the birth control, I got pregnant. It was shocking to me.

[Kristina Grube]

She was terrified she would have to quit all of her psychiatric medications. And because she transitioned so young, her hips were too small for her baby's head. She would have to have a C section.

[Precia Mosley]

I had to keep telling myself, like, okay, there's for sure, like actually a baby inside of me. I actually do need this surgery for something real. Like I can feel it and see it.

[Kristina Grube]

When her due date came, she yelled at the doctors not to touch her and couldn't stop throwing up even during surgery.

[Precia Mosley]

But when he was out and on me, you know, everything changed and it was only us in the room and everything was perfect again.

[Kristina Grube]

Mosley was not able to breastfeed her son. Now she's suing the doctors involved in her transition. Her case is the first to proceed to court. She says the people who were supposed to help her when she was most vulnerable failed her. And now she and her son are.

[Precia Mosley]

Living with that for a very, I mean, about a decade or more of my life. I really thought that I needed saving and I was bad and I was broken and I was looking for a savior.

[Kristina Grube]

Mosley says some painful experiences in the church were part of the trauma of her transition. But she says she has a personal relationship with God and now a nearly one year old son to share it with.

[Precia Mosley]

Detransition has brought so much healing and so much peace that I have such an abundance of love that another person was born out of my infertility.

[Kristina Grube]

Reporting for world I'm Mary Muncie.

[Nick Eicher]

Coming up next on the World and everything in at the cost of detransitioning. In the US Many insurance companies now cover cross sex hormones and surgeries to alter sex characteristics. But when someone wants to reverse those procedures, well, that's when coverage can get murky. Some companies don't cover detransition. Others bury the process in red tape. And that has the attention of lawmakers.

[Mary Reichert]

Last week, Texas approved a bill requiring insurance companies to cover medical care for side effects and procedures related to detransition. If Republican governor Greg Abbott signs it, Texas would be the first state to make that law stick. World's Juliana Chan Erickson has the story.

[Dr. Jared Ross]

For Abel Garcia, getting insurance to pay for his breast implants was the easy part. Once doctors diagnosed him with gender dysphoria at age 18, they wrote prescriptions for estrogen supplements and breast implant surgery.

[Precia Mosley]

They got me as soon as they could to transition to get the implants, did the recovery. Everything went well. No issues, no complications.

[Dr. Jared Ross]

But three months after the plastic surgery, Garcia came to a startling realization.

[Precia Mosley]

Yeah, it all came crashing down like an avalanche one day, and I had to ask myself, what am I doing?

[Dr. Jared Ross]

Garcia decided he wanted to get the implants removed, but he discovered that gender transition in the United States is a one way street. Therapist after therapist continued to affirm his chosen gender identity rather than his birth identity. And the insurance companies that said cross sex hormones and surgeries were medically necessary told a different story about reversal treatments.

[Precia Mosley]

They replied back to me saying that my request to detransition by getting the implants removed were considered medically not necessary.

[Dr. Jared Ross]

World reached out to Inland Empire health plan, Garcia's insurance company, to ask about that policy. The provider said that due to privacy rules, they could not confirm Garcia's membership or the treatments he received. Major health insurance providers generally cover gender affirming procedures, but when it comes to reversals, they vary. Some will only grant them on a case by case basis. Dr. Jared Ross is an emergency medicine physician in South Carolina and a senior fellow with the research group do no harm.

[Precia Mosley]

You would never imagine having an anorexic girl go to a doctor and say, I'm fat. I need ozempic, I need gastric bypass. I need liposuction. The doctor would never say, yes, of course you're fat.

[Dr. Jared Ross]

Ross says insurance companies used to only cover breast implants for women who've lost their breasts to cancer or a traumatic injury.

[Precia Mosley]

For someone to just say, oh, I want breast implants.

[Kristina Grube]

Oh no, I want them removed.

[Camille Kiefel]

Insurance doesn't really get involved in either side of that.

[Dr. Jared Ross]

But cases like Garcia's Reveal an emerging trend. Most major insurance companies now cover breast implants in men diagnosed with gender dysphoria. And Ross says that's a problem.

[Precia Mosley]

We are, you know, cutting into the.

[Kristina Grube]

Body to address a mental health issue.

[Precia Mosley]

We don't. It's completely inappropriate and completely unethical.

[Dr. Jared Ross]

Ross says doctors, patients, and insurance companies have to grapple with the fact that most of these patients bodies will never truly return to normal when they change their minds.

[Precia Mosley]

The human body is not a lego set.

[Kristina Grube]

We can't simply remove parts and put them back.

[Dr. Jared Ross]

Adding to the confusion, doctors and insurance providers don't have a billing code specifically for detransition procedures. For every doctor patient interaction, there is a multi digit code identifying it. For insurance billing, there is a code for everything a doctor could ever encounter from being struck by a duck to walking into a lamppost. But there isn't a code for someone who wants to reverse a gender change procedure. The American Medical association develops and maintains these medical procedure codes. When world asked the association why there aren't codes for these patients, a representative said many patients get the same procedure but for different reasons. So there doesn't need to be a distinction. When Garcia appealed and got approval for surgeries to remove the implants and reconstruct his chest, the surgeon didn't label that a reversal.

[Precia Mosley]

He mentioned it was gynecomastia.

[Dr. Jared Ross]

That's a condition when men have enlarged breasts. But that billing coat hides the truth of what Garcia was experiencing, and some want to change that.

[Precia Mosley]

We're not actually studying the people who've.

[Dr. Jared Ross]

Been harmed by this. Camille Kiefel is head of detrans help, a support group for detransitioners. She says if there was a medical billing code for detransition, Garcia and others would have an easier time getting approved for reversal procedures. It would also make it easier to figure out how many patients are asking for them.

[Kristina Grube]

Part of it's going to be documentation.

[Michael Graham]

And then the other thing is just.

[Precia Mosley]

Easily getting access to what we need.

[Dr. Jared Ross]

Kiefel herself had a double mastectomy when she was 30, back when she considered herself non binary. Now she wants to go back to looking like a woman. She acknowledges that breast implants aren't medically necessary, but says they're important in other ways.

[Kristina Grube]

It's important for their self esteem, for.

[Precia Mosley]

Their being able to go on and.

[Michael Graham]

Live their life, start a family, if they want to be in relationships.

[Dr. Jared Ross]

April Garcia has spent several years trying to fix what was broken. Along the way, he proposed to his girlfriend and is planning a wedding for next year.

[Precia Mosley]

I'm just working on trying to live my life, do the best that I can live as a man and say finally deserve some happiness after the insanity that I've been going through the last couple years.

[Dr. Jared Ross]

Dr. Ross says the US has a long way to go, not just to undo the damage, but also to prevent it from happening. He says Texas is heading in the right direction by requiring insurance to cover reversal procedures and prohibiting minors from receiving them in the first place.

[Camille Kiefel]

There are minors there that were harmed.

[Precia Mosley]

And there may be minors who were.

[Kristina Grube]

Harmed out of state who go to Texas for help because they see Texas.

[Precia Mosley]

As a beacon of light, as a state that has definitely led the path in trying to protect children from this.

[Dr. Jared Ross]

Reporting for world, I'm Juliana Chan Erickson.

[Kent Covington]

Additional support comes from Water's edge Kingdom Investments, personal investments that build churches, 4.75% APY on a six month term. Watersedge.com investor and from Dort University, whose online MBA and MPA programs prepare leaders for lasting impact. Dort University until all is made.

[Precia Mosley]

New.

[Nick Eicher]

First pitch. Forget about it. Here's a rivalry that started at the first first step and the first stop. A human powered Sprint racing a 32 minute subway ride right across the Big Apple.

[Kristina Grube]

Who makes it to the Mets game first?

[Nick Eicher]

That is the question. Vicki Conroy squaring off with Noah Cracknell racing across New York to Citi Field.

[Precia Mosley]

Here we go.

[Nick Eicher]

Diversions, detours, delays. But one mile down and so far, so good.

[Camille Kiefel]

First mile was like six miles.

[Nick Eicher]

Yeah, huffing and puffing just a bit, but Noah still making excellent time. The two were pretty much neck and neck by mile seven and a half, nearing the finish line.

[Camille Kiefel]

Gotta go. We gotta go.

[Nick Eicher]

The subway. Pulling in at the same time, the fleet footed Noah did both of them, reaching Citi Field at the same time.

[Precia Mosley]

I made it Ty.

[Kent Covington]

Go for the runner.

[Nick Eicher]

There you go. A true subway series. It's the world and everything in it.

[Mary Reichert]

Today is Tuesday, May 20th. We're glad you've joined us for today's edition of the World and Everything in It. Good morning. I'm Mary Reichert.

[Nick Eicher]

And I'm Nick Icker. Next up, when home away from home feels more away than home. For 20 years, Spain has welcomed native English speakers into its classrooms, tens of thousands of Americans among them.

[Mary Reichert]

Now teaching in Spain sounds like a dream for some. But the reality isn't always easy. As world associate correspondent Elisa Palumbo explains, culture shock and red tape can turn the dream into a test of resilience.

[Elizabeth Corley]

Okay, today we are going to be doing a warm up right team.

[Michael Graham]

In a classroom outside Seville, Spain, Elizabeth Corley works to keep her 25 students focused on their writing. Warm up. The seventh graders, dressed in private school uniforms, sit on blue plastic chairs, their desks arranged in groups of two. It might not look that different from the American classrooms Corlee grew up in, but it is.

[Elizabeth Corley]

The behavior in the classrooms is, I don't know, it was just kind of a shock for me, just how I would say that the classroom in Spain in general is just noisier and more casual. Like there's not, it's not as formal.

[Michael Graham]

Corlee first experienced one of those classrooms on a year long study abroad trip in college. She loved it. She wanted to come back. That's when she decided to be a language assistant. The Spanish education system also calls them language auxiliaries.

[Elizabeth Corley]

I also met another auxiliary who was doing the auxiliaries program through the government. So I met her, talked to her because she worked at that school as an auxiliary.

[Michael Graham]

Over 49,000Americans have come to Spain as language and culture ambassadors since 2005. Spain's Ministry of Education wanted to expose students to the culture and the language of English speaking countries. The answer, get native English speakers into its language classes.

[Elizabeth Corley]

You help the a lot of times like in science classes and you teach, help teach the Christian curriculum in English or help with pronunciation with their English pronunciation. Also if you're with the older kids, sometimes it's like technology or like PE. Yeah, usually science.

[Michael Graham]

For more than 15 years, high school English teacher Cristina Munoz has relied on language assistants in her classroom. She teaches in Cazares, Spain.

[Dr. Jared Ross]

I really appreciate having a native speaker in the classroom. They give a very important cultural insight.

[Camille Kiefel]

From their perspective being young, being native.

[Michael Graham]

Many language auxiliaries look forward to their new life in Spain. But the process of starting life abroad can come with a lot of challenges. Language assistants don't have much say over who they work with or what town they live in. They can make a request, but where they get placed can still be random. And that may still be the easiest step in moving abroad. Elizabeth Corley, again, I think studying abroad.

[Elizabeth Corley]

Or living abroad or any of that type of stuff is just romanticized in general. And people think you're on like a year long vacation and you're like, no, this is like never. This is actually really difficult.

[Michael Graham]

Corley had to find an apartment, open a bank account and get a Spanish phone number. She had 90 days to finalize her visa process. Nearly everything had to be done in Spanish.

[Elizabeth Corley]

I had to renew every single year. A student Visa, and it always would, like, expire in the summer, so then you would have to do all the paperwork in the summer. But until that was sorted, you weren't supposed to leave the country.

[Michael Graham]

She also had to navigate a new school system.

[Elizabeth Corley]

And like, here in Spain, students, like, call you by your first name or just say teacher. And it's just. It's just very like, okay, just to talk out of turn, basically, or kind of be talking, like, quietly while the teacher's talking. No talking right now. You're distracting. So una falta de los preto.

[Michael Graham]

But as that first school year came to an end, Elizabeth wanted more time in Spain. So she reapplied and came back seven more times.

[Elizabeth Corley]

I actually didn't think I would stay in Spain. When I was applying for programs to be an auxiliary, I thought, like, okay, I'll probably do this for two, three years.

[Michael Graham]

She says God has used the seemingly endless paperwork and visa renewals to teach her to trust him. She got involved in a local church filled with people from Spain, the US And Latin America. It provided stable relationships in uncertain times.

[Elizabeth Corley]

And then I kept thinking, like, I don't know, like, I feel like my time here isn't done. So I'd stay. And every year was like a big, like, what if?

[Michael Graham]

It also helped that she met a nice Spaniard named Adrian at church. He kept wanting to have long conversations with her. Then he asked her out. They dated and got married. European residency put the days of visa renewal behind her. But Corlee now faces a different problem. She's not sure where she belongs.

[Elizabeth Corley]

While I've been living here, I've gone through an identity crisis of, I don't feel like I'll never be Spanish. Of course not. But I also don't feel like when I go back to the US that I'm a US Citizen any. Well, no, I feel like I'm a US citizen, but I don't feel like I fit into the culture anymore. So I'm like, okay, what am I?

[Michael Graham]

Whenever she goes back to the US she experiences reverse culture shock. Sometimes it's the politeness of strangers at grocery stores. Sometimes it's the American idea of putting one's whole identity into work. Walking away from the career driven culture of the US has helped Corlee find her true identity.

[Elizabeth Corley]

And so God has really, through these years that I've been abroad, brought me closer to him and made me realize that my security is in him and not a country or my blood family or my church in the US like, no, no, it's in him.

[Michael Graham]

Elizabeth and Adrian don't plan to live in Spain forever. At some point, Lord willing, they hope to live in the US as well. For now, they both teach in Seville. They're content but ready to serve wherever they end up. Next Reporting for World I'm Elisa Palumbo in Seville and Cazeris, Spain.

[Nick Eicher]

Today is Tuesday, May 20th. Good morning, this is the world and everything in it from listener supported World Radio. I'm Nick Eicher.

[Mary Reichert]

And I'm Mary Reichard. The Presbyterian Church USA is closing the doors on its global missions efforts. Nearly all of its missionaries have been let go. World Opinions contributor Nathan Finn explains what led to this shift and why it matters.

[Camille Kiefel]

The Presbyterian Church USA is shuttering its foreign mission work. Nearly all its missionaries have been terminated. The stated reasons for this move include a drop in the missionary force over the past 15 years and the financial repercussions of ongoing membership decline. But this is hardly the whole story. The roots of its decline are ultimately theological, not financial. In the 1920s and 1930s, American Protestants endured a number of denominational disputes that collectively came to be called the fundamentalist modernist controversy. In each instance, theological liberals gradually gained control over denominational institutions and leading pulpits. They called for the redefinition of older ideas like biblical inspiration, human sinfulness, the person and work of Christ, and salvation. As modernists gained power, theological conservatives resisted, and those conservative dissenters came to be called fundamentalists. As they contended for the fundamentals of biblical Christianity, they said, the world didn't need some revised version of the faith that tickles the ears. Rather, people still needed to hear that the Bible is an authoritative and truthful revelation from God, that all people are sinners, that Jesus is fully God and fully man, that he died for our sins and rose again on the third day, and that there is no salvation found outside of faith in Jesus. The two major fronts in the fundamentalist modernist controversy were theological seminaries and foreign mission agencies, and they were closely connected. Seminaries educate future pastors and missionaries so they necessarily shape how emerging church leaders think about the Bible, human nature, the gospel, and the Great Commission. Liberal pastors educated in modernist seminaries increasingly preached a social gospel that minimized the reality of personal sin and the need for salvation. Liberal missionaries focused their efforts on education, medical services, and economic development, but often to the exclusion of evangelism and church planting. The modernists and their pragmatically minded moderate allies gained control of denominational institutions, especially Princeton Theological Seminary and the Presbyterian Board of Foreign Missions. Theological conservatives challenged these changes. They established Westminster theological seminary in 1929, and in 1933 they started the Independent Board for Presbyterian Foreign Missions. Both offered alternatives to the modernist denominational agencies. Ultimately, most conservatives left the denomination for new groups, most notably the Orthodox Presbyterian Church. The most important Presbyterian conservative of the time was New Testament scholar J. Gresham Machen, who served for decades on the faculty of Princeton Seminary. Machen helped found Westminster Seminary, the Independent Board and the Orthodox Presbyterian Church. Most importantly, he wrote the definitive interpretation of theological liberalism and the threat it poses to authentic Christianity. In his 1923 book, Christianity and Liberalism, Machen argued that modernism wasn't an updated form of Christianity but rather was a different religion that rivaled biblical Christianity. Theological liberals may use the same vocabulary as Christianity, but they're working from a different dictionary because of their rejection of biblical inspiration and other fundamental doctrines. Liberalism doesn't lead to the renewal of Christianity for the modern world, but results in the rejection of authentic Christianity altogether. The end product of liberalism is unbelief. History has proven machen Correct. In 1983, the Presbyterian Church in the United States of America was one of the historically Reformed denominations that merged into what is now the Presbyterian Church USA. In 1983, the PC USA had over 3.1 million members. Today, membership is less than 1.1 million. Several of its seminaries still have elite reputations, but all of them are liberal, and declining churches continue to leave the denomination because of its progressive drift. None of this is a recipe for a robust commitment to Great Commission faithfulness. The story of mainline Presbyterianism over the past 100 years is a cautionary tale. Theological liberalism is incompatible with authentic Christianity. When churches or denominations begin to adjust to the spirit of the age, Jude 3 says, they inevitably deny the faith that was once and for all delivered to the saints. I'm Nathan Finn.

[Nick Eicher]

Tomorrow, with President Trump back from the Middle east with a portfolio of deals, we'll look into what they say about his foreign policy goals. We'll talk about it on Washington Wednesday and how a surprising friendship between an author and a bookseller turned into something lasting. That and more tomorrow. I'm Nick Iger.

[Mary Reichert]

And I'm Mary Reichard. The world and everything in it comes to you from World Radio. World's mission is biblically objective journalism that informs, educates and inspires. The Bible says, for freedom Christ has set us free. Stand firm, therefore, and do not sit down again to a yoke of slavery. Verse 1 of Galatians, chapter 5 Go now in grace and peace.