The Vatican on Monday declared gender-affirming surgery and surrogacy as grave violations of human dignity, putting them on par with abortion and euthanasia as practices that reject God’s plan for human life.

The Vatican’s doctrine office issued “Infinite Dignity,” a 20-page declaration that has been in the works for five years. After substantial revision in recent months, it was approved March 25 by Pope Francis, who ordered its publication.

In its most eagerly anticipated section, the Vatican repeated its rejection of “gender theory,” or the idea that one’s gender can be changed. It said God created man and woman as biologically different, separate beings, and said people must not tinker with that plan or try to “make oneself God.”

“It follows that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception,” the document said.