Gatekeeping is a direct product of transphobia. Transphobia manifests in the ideology that being trans is a malady that needs to be prevented at all costs – that a child or adult transitioning represents a failure of character, a sickness, a failure or breakdown of what is right and proper for normal development of gender identity. Gatekeepers seek to limit the amount of people transitioning to it’s lowest possible number. The more cis people created, the better, since trans is a disease, a negative outcome that must be stopped. Gatekeepers are ultimately worried about cis people transitioning and then regretting their transition because they weren’t “truly trans”. This is why gatekeepers go out of their way to find reasons to discourage people from transitioning. Maybe you’re just a crossdresser. Maybe you’re too masculine/feminine to be trans. Maybe your hobbies do not align with the stereotypes that dwell within a therapist/doctor’s mind. Maybe your childhood doesn’t conform to classical “true trans” transsexual narratives.Maybe you walked into your doctor’s office wearing the wrong item of gendered clothing, making them doubt you are “really” trans. These acts of gatekeeping are direct products of transphobia.
Gatekeepers universally believe that trans people who pass better are more valid or real in their gender identity than trans people who pass less well. The is the basic function through which gatekeeping occurs. One of the most historically prominent endocrinologists, Christian Hamburger, was explicit in his recommendation of HRT only for those trans women who were not overly masculine. In discussing recommendations for HRT in trans women he writes:
The attempts at feminization have better chances of being successsful in patients having a neutral or not pronounced masculine appearance.If the patient presents a black and vigorous growth of beard, deep voice, excessive hairiness on trunk and limbs, strong muscles and prominent veins, it is unlikely that the estrogen treatment will give a harmonious result. In such extreme cases it may be possibly wise to try to persuade the patient to abstain from any endocrine treatment unless the psychologic disposition makes such persuasion out of the question (Green & Money, 1969, p. 302)
Hamburger represents the essential gatekeeping mindset. Passing equals validity in the mind of the gatekeeper. Non-passing means you are a deluded freak, a pervert, a confused cis person, and faker, a trans-trender. Strangely, gatekeepers think they are helping us – preventing us from making a mistake that we will later regret because of not having a “harmonious result” where harmonious means replicating the cis body to perfection such that society does not torment you to suicide or detransition. Notice how gatekeeping feeds off the larger transphobia of society. Because society shits all over trans people gatekeepers want to prevent “weak” trans people from transitioning because they will be chewed up and spit out by the transphobes of society, unable to find employment, housing, or love. If there was no transphobia, there would be no gatekeeping except for the minimal kind used to make sure the patient is rational and of sound mind in their desire for medical treatment.
The anti-thesis to gatekeeping is radical informed consent. Radical IC insists that trans people themselves are the best authorities on deciding whether medical transition is a rational decision. IC is fundamentally about respecting the autonomy of persons to decide which gendered body they want to live in: male, female, or something in between. It is the right of every rational person to have access to treatments that rectify fundamental incongruities of the mind-body that lead to psychosocial dysfunction. The difference between gender dysphoria and diseases like anorexia is that if anorexics had their way, their condition would lead to severe physical dysfunction. But if gender dysphorics had their way, their resulting condition post-HRT/GCS is not physically unhealthy when done under the supervision of doctors. If anorexics had their ideal body they would be physically unhealthy. If gender dysphorics had their ideal body, they would be perfectly normal functioning humans, aligned in their gender and their sexed body.
Gatekeeping is not compatible in a society that respects the autonomy of trans people. Some minimal gatekeeping is necessary to prevent medical contraindications, obviously. But that kind of gatekeeping is not pernicious. What’s pernicious is the Hamburger-style assumption that non-passing trans people are better off not transitioning at all. Pernicious gatekeeping is reflected in the idea that gender ambiguity is an “unharmonious result” and that the only acceptable result of gender transition is cis-passing. While many trans people of course also aspire to cis-passing, it should not be a hidden criterion implicitly used by therapists and doctors to discourage people from transitioning. At the heart of it all is cis-sexism, the pernicious idea that everything about the cisgender identity and body is superior to the transgender identity and body. It represents a metaphysical hierarchy of gender that places cis-ness at the top and trans-ness at the bottom.
In contrast, radical informed consent assumes that trans identities and bodies are just as real and just as valid as their cisgender counterparts. It accepts that people choosing to medically transition is not a bad thing, that hormonal and surgical treatments should be available to all those seek them with a sound mind and rational assessment of the risks and benefits. Gatekeeping strips the autonomy of the patient and installs a false authority onto the doctor, a false sense that it is up to the doctor to decide whether transition is a beneficial decision. Informed consent puts the nexus of decision making back where it belongs: in trans patients.