Category Archives: feminism

There Is Nothing Universal to Say About Trans Women and Male Privilege

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There has been a lot of ink spilled lately about trans women and male privilege. I have seen so many discussions recently where people ask the question “Do trans women as a whole have male privilege and if so what kind and how much?” And then you see some trans women writing articles responding to this drivel by arguing “That doesn’t match my experience” and then go on to detail how their lives were not filled with privilege and how in fact they were brutalized for being feminine as children and did not internalize society’s messages about male socialization the same way cis boys did.

And on the other hand, some trans women are writing articles saying “I did have male privilege but I gave it up or am in the process of giving it up oh and btw I’m still a woman” or something along those lines. I’ve seen some of these articles also make the general claim that some types of male privilege were afforded to ALL trans women in virtue of living a life pre-transition as someone who was coded as male. But then other trans women deny this reflects their own experience growing up and we are going in a circle, with universal claims being negated by individuals claims and individual claims being taken as proof of some universal claim.

This is tiresome.

We have a general claim about ALL trans women being refuted by individual claims about SOME trans women. But the trans women who did not experiences themselves as having male privilege often make the same mistake of thinking their experience is universal. That’s what so wrong with this whole discussion. There are no universals. There are no generalizations to be made in terms of ALL trans women – every trans woman has a difference experience of living pre-transition as well as experiences their loss of privilege via transition differently.

And furthermore, people like to frame the discussion in terms of the pointless question of whether trans women’s experiences are identical to cis women’s experiences. But who cares? It doesn’t matter. Our experiences don’t need to perfectly match the cis experience to be representative of womanhood because to think otherwise is to buy into the cis-sexist belief that the cis experience is the “default” and the trans experience is a pale imitation. But in reality the trans experience is equally valid, it’s just more rare.

Personally, my own experience pre-transition featured a good deal of male privilege which I’ve wrote about elsewhere . I’ve retained some vestiges of that male privilege such as the privilege having grown up not thinking of myself as an emotional creature but rather a rational creature. I still have the privilege of not worrying about getting pregnant. But much of the other privileges I gave up during transition or am in the process of giving up. I now fear walking down the street at night whereas before I never did. I now fear cat-calling – before it was not even on my mind. I’ve lost the privilege of not worrying about my drink being drugged at a bar. I’ve lost the privilege of not fearing men. The list goes on.

The point is that privilege is rarely so monolithic or one-dimensional. My privilege as a white person and the vestigial remains of my male privilege is balanced against my loss of privilege as a woman and especially as a trans woman.

But my experience says nothing about the experiences of other trans women, who experienced their gender much differently than I did as a child and as I do now. I was never really made fun of for being feminine – my feminine behaviors were done in secret behind closed doors and so they weren’t a target for harassment. I was able to regiment my personality into a public boyish self and a private feminine self. It’s a myth that gender identity is formed for life within the first 5 years of life. While that might be true for many people it is not a universal truth. My gender identity has evolved significantly since I was 5 years old and I know I am not alone though I have the feeling that many trans people have a bias towards interpreting their memories as having an earlier identity  because that narrative is seen as “more valid” than the ones where gender identity evolution occurs later in life.

Not all young trans girls are able to hide their natural femininity and they are brutalized for it. If someone went through that experience and they are telling you they did not have male privilege then I believe it’s epistemically best practice to head what they are saying and take their narrative seriously. Likewise if a trans woman says she used to have male privilege but has since given most of it up, we need to listen to that narrative as well.

Cishet people seem to be more convinced that if a trait is displayed earlier in life it is “more natural” and thus a product of someone’s core essence. But that’s the wrong question to be asking. Innate or not, natural or not, what we should care about is if a behavior, trait, or personality is authentic and representative of someone’s deepest vision for how they want their life to go, regardless of the “origins” of that vision. If someone’s trans identity originated in their 40’s that does not make their trans identity less authentic than someone who’s trans identity originated in childhood. If someone starts painting in their 40s does that make them “less” of a painter than someone who has been painting since infancy? A painter is someone who paints. A trans person is someone with a gender identity different from their assigned gender. It’s not “gender identity different from assigned gender but also having emerged by five years old”. It just has to be different. But the causal origins of the identity itself in terms of when it originated in the life-line are not relevant for determining the authenticity of of the identity.

My trans identity only surfaced in my late 20s. It would be SO easy and no one could prove me wrong if I began saying things like: “I felt off during puberty but I only learned the words to articulate my feelings years later”. In a sense that would be perfectly true. I did have gender issues at a young age. But I think I would be deluding myself if I claimed I had any awareness of ever wanting to transition at that age. Just like gender identity doesn’t have to be cemented in childhood, neither does dysphoria have to originate in childhood. Dysphoria can surface at any point in a trans person’s life. I didn’t start feeling real dysphoria until my late 20s. The longer we hold onto the traditional narrative that all trans people somehow “knew” then they were children, the longer we will be unable to see the true diversity of the trans community.

The problem comes when we try to generate a one-size-fits-all theoretical framework for thinking about ALL trans women as sharing some kind of universal essence. But that’s a pipedream. There is no universal narrative. The human mind strives to “connect the dots” and create some kind of overarching generalization that is true of all trans women. But we need to resist that and instead focus on studying individual differences.

 

 

 

 

 

 

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Filed under feminism, Gender studies, Trans studies

Let Trans Women Grow

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Left: Me when I first started transition | Right: Me roughly two years later

Trans women are under intense pressure, internal and external, to perform femininity to a high level. They are seen as more “valid” in their identities the better they pass for cis women and in order to compensate for testosterone poisoning some trans women are pressured to wear makeup, accessories, and feminine styles of clothes to be gendered properly by strangers as well as fight their dysphoria. The common assumption is that trans women who are uber feminine are just narrow-minded 1950’s housewife artificialities who are putting on a costume to validate their own womanhood. Our femininity is never seen as natural – always artificial.

But in reality it’s often about pure survival, a defense mechanism. If we don’t perform femininity at a high level we get accused of being too manly and our womanhood is challenged and we are at more risk of misgendering, harassment, violence, and being discriminated against in general. But if we are feminine we get shit for just being caricatures of womanhood who think being a woman is all about dresses and heels. It’s a double bind: damned if you do, damned if you don’t – trans women lose either way.

But I don’t think the problem here is about femininity. The problem is that people don’t like the idea of a male-assigned person transitioning socially and medically. It’s the very idea of trans women that gives people a problem regardless of how well we perform femininity. The double-bind is thus a product of transmisognyny and not fundamental to femininity itself. The problem is that cis identities are seen as fundamentally more healthy and normal than trans identities. And I mean “normal” as in “normative” not “statistical”. Trans people are obviously in the statistical minority – but that alone doesn’t make our bodies or our identities pathological. Anomalous but not necessarily pathological. Trans women often get a lesser metaphysical status in the realm of valid identities but there’s nothing about our transness that is itself intrinsically pathological.

As philosophers like to say, you can’t derive an “ought” from an “is”. It is the case that trans people are rare, but from that it doesn’t entail that we ought to eradicate trans identities. Imagine if we found a “trans gene” that caused transness and scientists had the power to edit that out before or after conception. We has a society would then have a choice whether to eradicate transness out of existence or not. My view is that the world would be much worse off if trans people weren’t around to shake up the cis-normative world.

Part of the pressure for trans women to perform femininity comes from a desire to relieve dysphoria. If I lived on a deserted island that had a Sephora I would still wear makeup because I just enjoy it and it makes me feel better about myself. But part of the pressure comes from how trans women are judged as less valid if we are not uber feminine.

But here’s the thing: trans women are often not even given a chance to grow into our femininity. As soon as we come out as trans we are expected to perform femininity flawlessly. We are expected to know how to do makeup, how to be stylish, have an extensive wardrobe of gender-affirming clothing, look sharp, natural, etc. But cis women have had decades to learn how to perform femininity, experiment with makeup, style, and figure out what looks good for their body shape. Not to mention, not all trans women can afford laser or electrolysis and the makeup techniques to flawlessly cover beard shadow are pretty advanced even for experienced makeup junkies.

Some trans women have been performing femininity from a very young age but that’s not true of all trans women. Some trans women such as myself repressed their feelings deeply and went through very “macho” stages to prove their masculinity to the world before their feelings finally surfaced fully and it was no longer possible to perform masculinity without great pain. But the little crossdressing I did in secret since childhood did not even slightly prepare me the pressure to perform femininity as a transitioned woman. The pressure is felt by all women but trans women feel it especially acutely. So I basically had to learn in a couple years what it took decades for cis women to figure out. Some trans women are just not interested in all that though and they should not be judged for it, no more than cis women should be judged for being butch or tomboys. The “tomboy” trans woman is often judged as less valid than feminine trans women. Many cis women say they are not scared of highly feminine cis passing trans women who have medically transitioned – it’s all those other, “bad ones” they are scared of in women-only spaces, the one who don’t perform femininity to some arbitrarily set cis-normative standard.

We need to let trans women grow into themselves. We are expected to perform femininity flawlessly within months of transition but often it can take years to come into a natural sense of style just like it takes years for cis people to figure out how to perform their genders. We need to let trans women have the space and time to explore themselves before we judge them as “successful”. Or better yet, how about we stop judging people who don’t conform to any gendered expectation and stop placing judgments on whether a transition is a “success” or not. If the trans person is happy at the end of the process it was a success, period. TERFs like to talk about how many trans women are just “pigs in wigs” but usually they are just selectively sampling from trans women just starting transition. Give them a few more years and get back to me. Let trans women grow. Give us time to figure this shit out without invalidating our identities because we have the audacity to look or sound like ourselves and not just flawless imitations of cis women.

Trans people are valid regardless of whether people have a hard time telling whether we are cis. That shouldn’t be the standard. There are no standards. Find me a rule book in the universe that tells me how men and women “ought to look”. There is no such book. There are just atoms in the void – but we place value on some arrangements of atoms and not on others. All value is created from the minds of creatures such as ourselves. Cis people often don’t place much value on trans lives. Our lives are seen as diseased. Just today someone commented on my youtube telling that I am “sick” and “need help”. Yeah – that’s a fun notification to get on my phone. That’s just part of what it’s like to be trans in 2017. And I have it easy! I am very, very privileged as a trans woman, both in terms of passing and my material status, but I still get constant reminders that my existence is seen by many in this country as an existential threat to the moral fabric of society. Here I am just trying to survive and somehow am the threat to society? Yeah, right.

Let trans women grow. Not all trans women have had a strong sense of identity since childhood. That’s the narrative that plays well with cis audiences and trans women are under immense pressure to reshape their histories to conform to that narrative but it’s not representative of the diversity in the community. Some of us need time to unlearn old patterns of behavior and learn new patterns of behavior. Some of us need time to figure out simple things that cis women take for granted like putting your hair up in a bun. Many of us were not taught by female members of our family how to perform femininity. If anything, we were usually punished for displaying the slightest amount of femininity. So how can cis people turn around and expect trans women to be perfect exemplars of femininity when they at the same time stamp out femininity in their own male-assigned children? It’s the double-bind of trans femininity.

When you start to look, the double-bind is everywhere. We cannot escape it. But we must. The liberation of trans women cannot happen unless the double-bind is loosened and we are allowed to grow.

 

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Filed under feminism, Gender studies, Trans studies

The Paradoxical Duality of Cat-calling as a Trans Woman

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It doesn’t happen often but last night I got cat-called. I was walking back to my car at a gas station and there was a group of guys standing around outside. Already on edge, one of them calls out “Hey sweetheart, how’s it going?” Many feelings rushed through my head as I answered back “I’m good” and tried to get in my car as fast as possible.

One of the feelings I felt was fear. I was afraid that my response “I’m good” would clock me cuz of my voice and that the man, having clocked me, would feel his masculinity is threatened and then proceed to beat the shit out of me, hence getting in my car as fast as possible.

Another feeling was disgust. I was disgusted at how piggish men can be towards women and felt a twinge of injustice in solidarity with other woman-identified people who get cat-called.

But here is the paradoxical feeling: In addition to fear and disgust, I also felt a boost to my self-esteem because being cat-called is an indication that hormones and my presentation are working such that people perceive me to be female. That is my goal, and it feels good to get positive evidence of getting closer to that goal.

I have seen TERFs talk about this as another example of why trans women have male privilege and don’t understand what it’s like to be a woman: according to them we like being cat-called. But that’s not true at all. The response is paradoxical because it contains within itself competing elements of fear/disgust and a positive feeling of gender euphoria at evidence of “passing” as your identified gender. It’s not that I liked being cat-called – I was afraid of being beat-up or worse and my deep feminist intuitions scream at the horribleness of cat-calling as a phenomenon that negatively affects women. It’s not so simple as either liking it or not liking it. But I would be lying if I said that I had zero positive feelings at being cat-called – the negative feelings were mixed into the positive feeling of gender euphoria, at feeling like I am passing and attractive.

I would be curious to know if cis women ever feel this paradoxical feeling as well e.g. feeling like your outfit and hair must be killing it today because you got cat-called which is unusual for you but also feeling disgusted at the misogyny on display while also feeling fear. I’ve never asked a cis woman about this so I don’t know for sure but I would wager that some cis women do in fact feel the paradox as well.

But I would also wager that for trans women the paradox is felt to a greater extent. For many trans woman, including myself, passing is of great importance and sometimes it’s difficult to garner “objective” evidence that you are passing. Cat-calling is a form of evidence and thus brings with it a positive feeling associated with feeling like you are passing. Nevertheless, we need to do a better job of raising young men to also feel disgust at the practice of cat-calling and call-out and shame fellow men for doing it when they see it.

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Filed under feminism, Gender studies, My life, Trans life

Hyper-vigilance in the Gender Machine: What It’s Like to Be a Trans Woman Who Doesn’t Pass 100%

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Did that customer just “sir” me?

When he said “Thanks man” would he have said that to a cis female or was that just for me?

Did that person just say “dude” to me in a gender neutral way or not?

Is my co-worker going to use the right pronoun for me at the end of this sentence? Is there any hesitation in their usage of “she” pronouns for me or is it natural, automatic?

Did that customer just include me in their reference to “ladies?” *internal leap of joy*

Pronouns are the primary fuel of the gender machine. The gender machine is the whole apparatus of gender, the constant way in which life on Earth is filtered through the lens of whether you are a man, a woman, or something else. The gender machine is omnipresent, though if you aren’t paying attention it can seem like it doesn’t exist at all. The gender machine is brutal and impersonal: you are subject to it regardless of whether you want to be or not. The gender machine is deeply metaphorical: it provides the foundation for our entire understanding of culture, pop culture, songs, movies, etc.

Before I transitioned, I only had a passing familiarity with the gender machine. I knew it existed, of course, and was obviously a product of it and regulated by it, but I didn’t really know it. I never paid much attention with occasional exceptions: being read as a male with long hair and ear piercings was sometimes interesting. Getting punished by my parents as a young child for wearing women’s clothes certainly made me aware of the gender machine and the rules of what boys are “supposed” to be like. My relationships with women exposed me to the gender machine a little bit. Being a husband made me self-conscious of my role within the gender system.  I had read a bit of gender theory here and there but didn’t really understand the gender machine on a super personal level. I was like the proverbial fish who lives and breathes water but doesn’t has a concept of water because it surrounds them 24/7.

But nothing prepared me for what it’s like to be a wrinkle in the gender machine, a nail that sticks out, an anomaly, a person who was first assigned male, raised male, and regulated as male but who eventually pushed back and bucked the system, who self-consciously rejected their position in the gender machine and chose another path, the path towards womanhood.

But violations in the gender machine are highly regulated by misgendering, transphobia, and enforcement of gender conformity. If you don’t look and sound “like a woman” then the gender machine will refuse to play along and you will get hurt. You will get “sirred”. You will get nasty stares as you walk out of the bathroom. You will be harassed, threatened, or maybe even violently assaulted or killed. The gender machine will attempt to chew you up and spit you out. You will be called “freak” and seen as less than human. You will be called slurs. You will be slandered as a pervert. Your sanity will be called into question. The gender machine has it especially out for nonpassing trans women and non-binary trans femmes due to the way masculinity and femininity is strongly regulated for those who are assigned male at birth. Any hint of a assigned-male person dabbling in femininity is brutally regulated so much so that trans women repress their desires for decades, or even repress them forever.

Does my adam’s apple stick out too much at this angle? I worry about this as I stand at the counter and adjust how I’m standing so the customer won’t see it right away. I maximally “prime” them with my available gender cues, minimize the cues I want to hide, and slightly adjust the way I’m standing and holding my head to hide my adam’s apple. But I know they’ll eventually see it. They always do. That or my voice will reveal my history of being exposed to testosterone. What will they think of me? Not how will they treat me. Most people are nice. But how will they internally think of me? “Oh, there’s one of those ugly trannies. Freak.” Or worse. My paranoia about this runs deep. It affects my relationships with people I don’t know extremely well. Many TERFs these days are hardcore TERFs but keep their opinions to themselves. That’s almost worse. The fake smile. The deference with the pronouns, but secretly thinking “You’re a man.”

“Hi, what can I get started for you today?”, I speak over the intercom in a strained voice, desperately doing all I can to avoid the inevitable “Sir”. Often I don’t get it. But sometimes I do. I wonder if I would get misgendered more if we lived in a time when the gender machine regulated gendered communication and encouraged “sirs” and “ma’ams” at all times. Nowadays, thank God, people more lax on the honorifics. I personally try to never use them unless absolutely necessary. What’s the point? They do practically no good and often cause much harm to trans and gender-nonconforming people. My voice is the Ur-factor in how I am perceived within the gender machine. It determines everything. Unfortunately, I know my voice is not perfect and still gets read as male to those unsuspecting strangers who might expect something else out of my mouth based on my appearance or dress.

I wake up super early for work to placate the gender machine with makeup. I know many cis women across the world are pressured by the gender machine to wear makeup to work in order to be seen as “professioanal”, “hygienic”, or even “competent”, but I am pressured into waking up extra early to shower, shave, and put on makeup in order to maximize my available gender cues, minimize the negative ones, and ultimately reduce my chance of getting misgendered, avoiding dysphoria as much as possible. With my voice and my adam’s apple and my masculine features, makeup is a defense mechanism for me, a way to reinforce the gender cues I give off. But what I’d give to have the option to just wear a bare face but still be so effortlessly feminine that no one in their right mind would question my status in the gender machine.

Whether I eventually get misgendered or not depends on many factors, mainly to what extent these people are self-conscious regulators in the gender machine aka transphobic assholes. But it’s also ignorance. And not paying attention. But still. Regardless, the most common thing that happens is that people don’t gender me at all. I get greeted as female all the time but rarely depart as an acknowledged female. When others around me get pronouns, I often get none. Which isn’t too bad I guess. Could be worse.

My coworkers, or “partners” as we call them at Starbucks, are my literal life blood. Their acceptance of me as a woman and their automatic usage of “she” pronouns are my primary coping mechanism for dysphoria and misgendering at work. The small little genderings that happen through the day literally sustain me. It means so little to them, yet so much to me.

Life as a non-passing trans woman for me means constant vigilance within the gender machine. Professional pronoun detector should be written on my business card. Constant awareness of all things gender defines my worldview. When I am hanging out with cis males, I can’t help but notice their masculinity and define myself as apart from them, down to tiny little mannerisms like the small inflection they put on the end of a word, or how much space they are taking up. When I am around cis females, I can’t help but compare myself to them and get self-conscious about every little feminine detail that comes so naturally to them. Even hanging out with butch lesbians does little to make me feel better because even they are so dripping with womanhood that I can’t help but feel “less”. Such is life as a non-passing, late transitioning trans woman.

The gender machine is fueled by pronouns, and regulated by conformity. It is all around us. Even in today’s post-modern liberal society of increasing LGBTQIA diversity awareness, the gender machine is working harder than ever to regulate gender. It might seem like we are now living in a laissez faire world when it comes to gender, but don’t let surface trends fool you: The growing acceptance of trans and GNC people in society has done absolutely nothing to placate the gender machine. It is still hungry – it still needs to feed. It simply finds a new tactic, a new way of regulating gender, new rules, regulations, associations, connotations, expectations, etc.

Gender is still all pervasive, as any trans or observant person will tell you. Some gender theorists like to talk about a future, hypothetical society where the gender machine is no more. But that’s a thought experiment only. A fantasy. A utopia that will never come to be. All we can do is force the gender machine to evolve in small, hopefully progressive directions. But despite the gender machine’s dominance and finality being out of our control, we can as individuals take self-conscious steps towards understanding our place within the gender machine and working to make sure everyone feels safe as they can be within the machine. Respecting pronouns and reducing the usage of honerifics is a huge part of this and definitely something cis allies can do. Good luck.

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Filed under feminism, Gender studies, My life, Trans life

Feminism and Makeup: Are They Compatible?

First, let’s distinguish two different broad types of feminism, what I’ll call radical feminism and liberal feminism. Obviously you can be a mixture of the two views in various ways but for purposes of this post I’ll just assume they are diametrically opposed on the issue of makeup.

Liberal feminists often talk about how makeup is empowering, about taking control of our appearance and reclaiming femininity to boost our self-esteem as well as engage in an artistic endeavor that is pure, fun, empowering, and something that is open to all genders. Liberal feminism is characterized by maximum inclusivity, respecting all forms of makeup as equally valid, including more controversial extremes such as drag makeup and glamour looks with a million products. For liberal feminists, makeup is not a fundamentally corrupt enterprise, it is a legitimate and totally valid way to express yourself.

In contrast radical feminists are more likely to say things like:

-Women wear makeup for men and makeup is a product of the patriarchical institution of men demanding women wear makeup in order to be considered “normal” and is thus fundamentally corrupted as a practice no matter how “artistic” it aspires to be.

Furthermore, the radical feminist insists we cannot escape the social influence of unattainable beauty ideals being pushed on women everywhere, the obsessive judgments against women who don’t reach those beauty ideals, and the negative influence this has in the workplace and everywhere else, where a woman’s professional qualifications are called into question if she comes in with her natural face with dark undereye circles, etc.

Ok, so that’s the two opposing feminist positions on makeup in a nutshell. I’ll get into more differences later in the post.

As someone who has been lurking makeup forums for awhile, my impression is that that most of the people who consider themselves “makeup addicts” vehemently deny that they wear makeup for men. Personally, I think it’s best practice to take these people at face value and if they say they don’t wear makeup for men, then they don’t wear makeup for men, plain and simple. I mean, most men prefer women to wear less makeup anyway so if women are just catering to the demands of men why not wear less makeup? No, women who are true makeup lovers do not wear makeup for men. If anything they wear it for either themselves or for other makeup addicts. When I positively comment on people’s makeup in real life it always makes me happy to see their face light up as someone appreciates the work they did that day.

Why even distinguish makeup addicts from the casual or seldom makeup user? Because I think a more interesting question is not whether casual makeup use is compatible with feminism but whether the LOVE and addiction to makeup as a hobby is compatible with feminism. After all, the casual use of almost any consumeristic product in today’s day and age is bound to lead to ethical problems but this is contaminated by all sorts of other complicated questions about what it means to be complicit but not fully cognizant of problematic capitalistic systems.

Another point of contention that radical feminists make in order to argue against makeup is that women are expected to wear makeup in the workplace but men are not and this sets up a fundamentally problematic dynamic that is destructive to the goal of liberating women.

In my view, this is a valid thing to be concerned about. I of course have problems with any kind of expectation that says women MUST wear makeup in order to be seen as professional, clean, pretty, or competent. But we can be critical of this expectation while at the same time not denying the intrinsic joy makeup lovers get out of makeup, the joy it brings them, the pleasure it gives them from feeling good about themselves, etc. If we start getting hyper ethical, where do we stop? How many radical feminists are willing to stop drinking wine or coffee even though if we as humans used all the land and resources growing those things to grow food for starving people then the world would be much better off for women to live in, but you don’t see radical feminists go around protesting those things.

Another thing radical feminists argue is that the institution of makeup perpetuates the impicit bias that women’s natural faces are seen as ugly and in need of correcting with makeup. Just think of Benefit’s recent “Yuck!” campaign, it perfectly encapsulates the idea that women NEED to buy a million makeup products to be seen as valid and beautiful otherwise they are somehow “nasty” or “icky”, not fully women. It’s been a longtime assumption that women who don’t wear makeup are either lesbians or somehow less fully their gender than women who wear makeup.

As a trans woman this is definitely something I can relate to because I wear makeup to work as a coping mechanism for gender dysphoria and misgendering but I resent the implication that I need to do these things in order be seen as my gender. Don’t get me wrong, I actually enjoy the process of makeup application and it’s not a chore to me. But for many women it is a chore, and not something they look forward to doing yet they do it anyway because if they didn’t they would get negative feedback. I think like most women, I wear makeup for multiple reasons. Because I enjoy it, because it makes me feel good about myself, it’s an avenue for artistic expression, there’s always room to improve, the technical details, to combat the possibility of misgendering and to help cope with dysphoria, because I enjoy the community of makeup lovers, the camaraderie it brings me with fellow enthusiasts, the small connections that happen when someone says something nice about someone else’s makeup.

Another argument radical feminists makeup is that the makeup world is fueled by Youtube gurus and rampant, dangerous, unhealthy consumerism based on trends and fads.

Dont get me wrong, there is a lot of problematic capitalistic tendencies to the makeup world. There are probably people out there, including myself, who perhaps use makeup as retail therapy a little too much than we should. But this is true of almost anything, from spending $50 on a new videogame because you’re stressed, to going out to eat and bar hop blowing tons of money. Everything in life is subject to the same possibility of taking it to the extreme, but if radical feminists held other things in their life to the same standard as makeup then they would have to radically change their own lives or admit to being hypocrites.

One thing I’ve noticed is that radical feminists who are against wearing makeup….often don’t wear makeup! It’s almost like you have to like and enjoy makeup to be able to like and enjoy makeup and the people who don’t wear makeup don’t like it and thus rationalize their dislike of it by inventing problems against it even for people who use it as a source of enjoyment and empowerment. Imagine that. But I want to reiterate that I agree that it’s fucked up how much pressure women are under to wear makeup otherwise they get comments about whether they are sick or feeling under the weather.

But in my view just because there are some problematic issues with the makeup world doesn’t mean makeup is inherently incompatible with feminist ideals and goals. Women are under immense pressure to be fit and slim but that doesn’t mean there’s anything inherently wrong with eating healthy and going to the gym. It’s all about the intention you have when engaging in an activity and how it effects you and those around you. Yes, it’s possible to wear makeup for quite possibly the wrong reasons, but it’s also possible to wear makeup for the right reasons, for reasons that are compatible with feminist ideals

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Filed under Beauty culture, feminism, Gender studies

Are Pussy Hats Inherently Transphobic?

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First off, disclaimer: I didn’t actually attend the local Women’s March, so read what I have to say with a grain of salt.

With that said, I want to comment on the current controversy about whether the cornucopia of pussy-themed images at the Women’s March is inherently transphobic.

The first thing I want to say is that the mere mention of vagina and female anatomy is not inherently transphobic. It is perfectly fine if a cis woman or AFAB person (or post-op trans woman) wants to talk about their anatomy in the context of furthering reproductive rights, such as the right to a safe abortion or access to birth control or in the general context of bodily autonomy and female empowerment. When the Republicans are dead-set on attacking these reproductive rights it is perfectly ok for vagina-owners to talk about their vaginas, pregnancy, rape, and anything else relevant to reproductive health or any other issue facing vagina-owners.

Furthermore, we need to place the pussy images in the proper context, which is Trump’s comments about grabbing women’s pussies. I don’t believe it is inherently transphobic for vagina owners to use pussy imagery to respond to Trump’s misogynistic comments that centered around grabbing AFAB anatomy. Take, for example, the following sign:

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I don’t believe this sign is inherently transphobic because it’s dealing with the GOP obsession with restricting the reproductive rights of people capable of getting pregnant. Furthermore, nothing about this sign indicates that only women have vaginas or that women are defined by their genitalia are that vaginas are the Ur-symbol to represent the Women’s Rights movement, femininity, or feminism in general. So we have set an example in which it is possible to use vagina imagery in a way that is not transphobic. In contrast, let’s look at this other sign:

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This sign is much more problematic than the previous sign. It is obviously a play on “we the people”. In my opinion, the underlying implication of the sign is that the “we” is referring to all women who are fighting back against Trump and the republicans. The problem is that not all women fighting back have pussies. The picture is clearly trying to make a general statement about feminism and the Women’s Rights movement and it is not explicitly focused on the GOP obsession with taking away reproductive rights from vagina-owners. This image is arguably transphobic because it ignores the way in which non-pussy owners are just as much part of the “we” which is fighting for body autonomy and Women’s Rights. This sign is problematic in the same way the next sign is:

laub-womens-march-dc-017.nocrop.w1800.h1330.2x.jpg

“Pussy power” with a female symbol next to it. The underlying implication is that female = pussy and pussy = female and that the power to fight the GOP lies only with pussy-owners. This is transphobic because not all females have pussies. Furthermore, the underlying context of the sign is supposed to represent the power of women to protest Trump and fight back against the Republicans who are taking away women’s rights. But obviously not all the women who have the collective feminine power to fight back have pussies.

However, there is nothing wrong with taking pride in having a pussy, or thinking that pussies are powerful, or in trying to organize with people who also have pussies. But why exclude trans women from the symbolic image of those with the female power to fight Trump and the GOP? Trans women are incredibly powerful fighters. We have so much power to contribute to the fight. Furthermore, trans women are female. We have just as much claim to the female symbol as pussy owners. By associating the female symbol with pussies this works to alienate trans women from the collective female fight against Trump and the GOP.

In conclusion, pussy hats and pussy imagery are not inherently transphobic. Wearing a pussy hat is not inherently transphobic. But the context certainly matters. The nuance of language certainly matters. There are non-transphobic and transphobic ways to use pussy imagery to represent the fight for Women’s Rights. If feminism is going to work in the 21st century it needs to do better to be inclusive of trans women. This is not to say that everything has to be about trans women or that people should give up on using vagina-based imagery altogether. The pussy is still a powerful symbol because the vast majority of women have vaginas and conservatives have traditionally focused on controlling pussies. But the fight for bodily autonomy is a fight that is equally shared with trans women and trans women are powerful allies that feminism excludes at the risk of losing amazingly powerful allies. We can do better.

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Filed under feminism, Gender studies, Trans studies

The Corrective Model of Trans Healthcare

In order to think about the logical limits of the informed consent model (IC) we need to imagine if it was practically feasible to do same-day bottom surgery on trans folks and someone woke up one day wanting gender confirmation surgery (GCS) after spending the entire morning making themselves informed on the risks and benefits. Furthermore, assume they are of sound mind and not having a psychotic episode. Would it be permissible for surgeons to perform GCS on this patient? The case seems absurd because under reasonable assumptions about how IC works there is an implicit assumption that the desire for GCS must not be a whim but rather a deeply held desire. Thus it seems reasonable there needs to be some persistence criterion built into informed consent (IC), and some diagnostic factor to ensure the persistence is there in order to prevent people from making rash decisions that they will later regret.

Furthermore, imagine the case isn’t about trans surgery. Suppose someone walks in same day to get a hysterectomy because they decided that morning they didn’t want kids. Or they have Bodily Integrity Identity Disorder and want to amputate a leg. We can multiply the examples endlessly to show that an extreme informed consent model does not work – some amount of gatekeeping needs to be in place to ensure that the decision is rational and in the best-interest of the patient.

Although the IC model represents a significant advantage over the traditional gatekeeping model, I do not think it goes far enough in addressing the needs of all people who seek out either HRT or GCS. Instead of the medical system, I propose that access to HRT and GCS should be modeled on the basis of the cosmetic surgery industry, where people seek treatment intervention in order to change their bodies to better align with their desired body image, or what I am calling one’s fundamental self-conception. I call this the “Corrective Model”, in the sense that cosmetic surgery is sometimes called “corrective surgery”. But the phrase “corrective” should not imply the Corrective Model assumes the desire for HRT/GCS is necessarily derived from an underlying medical condition or pathology. If I order a laptop off the internet and they send me a perfectly good but wrong model, I can request that they send me the “correct” laptop without assuming the laptop they sent me is in anyway defective. That is, one can desire to “correct” their body to better conform to an ideal image without believing they have a medical condition or underlying pathology. This ideal image I call someone’s “fundamental self-conception”. Not all self-conceptions are fundamental though. Making the distinction between fundamental and non-fundamental self-conceptions will be crucial for my project in carving out the uniqueness of transgender corrective surgery as opposed to traditional cisgender plastic cosmetic surgery.

Intuitively, the Corrective Model seems like a poor fit for the treatment of people seeking HRT and/or GCS. First, many trans people see themselves as having a medical condition, not a cosmetic condition. That is, they claim they want to change their bodies not for vain or superficial reasons but because they have a gender dysphoria, what they see as a medical condition that is characterized by significant distress over their sexed body and/or social role. Furthermore, the Corrective Model seems like a poor fit because of the need of trans people to have their treatments covered by insurance. If we model transgender healthcare after the cosmetic industry then it seems like this would limit access to HRT/GCS because cosmetic surgeries are typically not covered by insurance. The Corrective Model also seems like a poor fit because it treats gender dysphoria individuals on par with so-called “freaks” who want to radically modify their bodies through extreme cosmetic surgery, e.g., the Lizard Man. This invites further stigmatization to a marginalized group of people who just want to be seen as normal.

So the Corrective Model faces steep challenges. But none of these are fatal to the Corrective Model. All these concerns can be adequately addressed. First I will outline several distinct advantages the Corrective Model has over both the gatekeeping model and the IC model. Then I will address several worries about the Corrective Model.

Advantages of the Corrective Model

Lack of Gatekeeping

By modeling transgender healthcare on the Corrective Model, it necessarily removes the paternalistic gatekeeping based on the WPATH SOC that sets up strict requirements for access such as an in-depth documentation of gender dysphoria through a licensed therapist or medical professional. 

Allows for Non-Classical Treatment

There exist men who self-identity as men yet nevertheless desire to have breasts. These men do not want to live as women. They want to keep their male name, wear masculine clothing, and otherwise present themselves as normal cisgender men. Yet they sincerely desire breasts. For many of these men, their desire is sexual in nature. Having breasts would significantly improve their sex life and bring them psychosexual satisfaction. These men are rational and generally have no other mental health problems.

The traditional gatekeeping model would not recommend that these men get access to breast augmentation procedures or HRT. The IC model would also not recommend that these men get access to intervention because it is not a medical issue and there is not enough significant distress to warrant surgical/hormonal intervention.

The Corrective Model would make it permissible for surgeons to treat these men provided they have signed the appropriate waivers recognizing the physical and social risks involved. Crucially, the Corrective Model would not recommend that these treatments are covered by insurance because the desire for treatment is not rooted in dysphoria but rather euphoria at the thought of having breasts. These men are not suicidal because they do not have breasts nor is their psychosocial functioning significantly compromised from not having breasts. Rather, their psychosexual lives would be significantly improved if they had the treatment. I see no principled distinction between a cisgender man seeking breast augmentation and a cisgender woman seeking breast augmentation in order to make her feel better about her appearance. Both people are (1) rational and of sound mind, (2) have a strong desire to change their body, and (3) would not be hurting anyone else in virtue of getting their treatment.

On my view, the principle of autonomy makes it permissible for surgeons to treat these men who want breasts. These men have a fundamental conception of how they want their bodies to look and a vision for how they want their lives to go. They are not hurting anyone and they would be much happier if they had corrective treatment. There would of course be social risks for these men, risking social ostracization. But it should be part of their autonomous decision making process to decide whether the benefits outweigh the social risks.

Removes the stigma of pathologization

Increasingly trans people have started pushing back against the pathologization of their identities. Trans activists were responsible for removing “gender identity disorder” from the DSM, where, for decades, it was considered a mental disorder to have a gender that was different from the gender you were assigned at birth. GID was replaced simply by “gender dysphoria” such that it’s no longer a disorder to be trans in and of itself but dysphoria can be so bad as to warrant a mental diagnosis. Trans activists pushed for the non-pathologization of trans identities because of the societal stigmas that comes with being diagnosed as having a mental health disorder. Trans people were seen as not being rational enough to make autonomous healthcare decisions when it came to access to hormones or surgery.

Although this is a contentious issue in trans communities, I am going to follow the DSM in arguing that being trans in and of itself is not a medical disorder but rather simply a natural variant with the spectrum of human difference, like being tall, or being gay. This has important ramifications for how we think of access to HRT/surgery. If I am right that the correct model is the cosmetic surgery industry, then it’s important that we fully appreciate how surgeons will sign off on giving someone a face lift without needing any kind of well-documented diagnostic referral stating they are in psychological distress over their face lift. Rather, the patient simply consults with the doctor about their desires in accordance with their self-conception about how they want their body to look.
Thus, the advantage of the Corrective Model is that it moves away from the psychiatric conception of people who seek HRT or GCS. The psychiatric conception sees the desire for HRT/GCS as pathological, as a medical condition to be fixed, cured, or managed. While it is true that many trans people do in fact see their transness as a medical condition and many trans people experience gender dysphoria to the point of it being incredibly psychosocially distressing, this is not necessarily the case for all people seeking access to HRT, GCS, or top surgery. Some trans people claim to experience no significant gender dysphoria at all. Rather, their desire for HRT/GCS is rooted in gender euphoria, the palpable sense of relief and joy that comes from having their desired body and/or being treated as their identified gender. The Corrective Model is maximally inclusive because it enables these gender euphorics to actualize their autonomy by giving them a means to change their bodies in accordance with their fundamental desires without having to distort their narratives to fit into the classical transsexual model of gender dysphoria.

A bio-political argument for the corrective model

In his ground-breaking book Testo Junkie (2013) Paul Preciado writes:

I refuse the medico-political dose, its regime, its regularity, its direction. I demand virtuosity of gender; to each one, its dose; for each context, its exact requirement. Here, there is no norm, merely a diversity of viable monstrosities. I take testosterone like Walter Benjamin took hashish, Freud took cocaine, or Michaux mescaline. And that is not an autobiographical excuse but a radicalization (in the chemical sense of the term) of my theoretical writing. My gender does not belong to my family or to the state or to the pharmaceutical industry. My gender does not belong to feminism or to the lesbian community or to queer theory. Gender must be torn from the macrodiscourse and diluated with a good dose of micropolitical hedonist psychedlics. (p. 397)

Preciado’s call for “micropolitical hedonist psychedelics” represents a push towards a “radical” informed consent model that is in line with the Corrective Model. The decision to experiment with hormones, and yes it is nothing but an experiment, must be allowed by the medical profession to create “viable montrosities” of gender and sex through techno-medical treatment. Notice that Preciado is not merely meekly asking for access to HRT but “demanding” it. But where does this demand derive its moral-political authority? The authority derives from the “micropolitical” authority inside all of us, the autonomous center of decision making that helps constitute our personhood. We all have a vision for how we want our lives to go. We are the best authorities on what this vision in – only we can place the valuations upon what hormonal treatment means to us.

An upshot of the Corrective Model and Preciado’s call for virtuosity is that trans people should have the right to experiment with hormones without losing access to legal pharmaceutical drugs. If a doctor values maximizing cardiovascular health during healthcare treatment, but the patient values maximizing the relief of dysphoria through masculinization or feminization, then it should be up to the patient which pathway they choose. The job of the doctor is to provide information that is relevant to the decision making procedure but doctors should not have dictatorial power in influencing what treatment option is pursued. If a trans woman wants to be on 8mg a day of estradiol based on a careful consideration of the risks and benefits but the doctor thinks a conservative 4mg a day is less risky and thus preferable, the trans woman should be able to get access to the extra dosage so long as she signs off on the increased risks. If we are free to cause our own death by smoking excess cigarettes and eating cheeseburgers then presumably we should be able to take on a higher risk in our medical treatment. 

One might think this argument falls apart upon considering a parallel case in healthcare. Suppose a patient on opiates demands a higher dosage but the doctor is worried about the health effects and possibility of addiction. It seems preposterous that the doctor should be obligated to assent to the demands from the opiate patient. So why should patients demanding a higher HRT dose be allowed to get access to that dosage level? The problem with this opiate analogy is that it begs the question against the corrective model because it implicitly assumes we are working in a medical-pharmaceutical model instead of a model that is based on the cosmetic surgery industry. If a patient is demanding more botox, but the doctor thinks that they don’t need it or that they are already attractive enough, it is usually the patient demand that wins out. There are limits to this, however, no doctor would inject more botox than is medically safe in terms of causing immediate dangerous physical consequences. The corrective model does not advocate direct suicidal overdose by doctor prescription though it does advocate for informed risk taking. But the relevant analogical parallel is in terms of evaluating the risk with respect to the psychological effects of changing one’s face with botox. If a patient places enough value on a smoother face then it doesn’t matter if the doctor thinks it risks making them less attractive. It is the prerogative of the patient to get bigger lips or bigger breasts even if the doctor does not place the same aesthetic valuation on the change. The plastic surgeon is essentially a techno-surgical mercenary, willing to perform a procedure so long as the patient can pay for it.

So who pays for Preciado’s micropolitical hedonism? According to the corrective model, it is not the insurance companies unless there is a documented case of gender dysphoria. But Preciado explicitly devows the label “gender dysphoric” to describe himself. He calls himself a gender rebel, a biopolitical gender terrorist, performing a hormonal experiment to make a philosophical point. So gender dysphoria should not be the criterion used for getting a prescription of HRT. But if you want to get it paid for, then you must go through the medical-pharmaceutical-insurance system in order to get a diagnosis. This model is designed explicitly for the United States. In a country with universal healthcase, the question of who pays for micropolitical hedonism is trickier. Following the model of Basic Income, one could argue the government has a responsibility to provide the basic means for citizens to pursue their vision of healthiness and happiness.

Now, onto the objections:

Objection: Cosmetic Surgery is shallow

Reply: Cosmetic surgery is not necessarily shallow

There is a common assumption that when we are talking about cosmetic surgery we are necessarily talking about something that is “shallow” and superficial, that hovers on the surface and is largely inconsequential, that it doesn’t do anything but deal with someone’s vanity or desire to fit into today’s beauty culture. When we think of cosmetic surgery we think of someone unhappy with the size of their breasts, or someone who does not like the fat accumulation in their stomach. When we think of cosmetic surgery we think of treatments that are not medically necessary, that do not save lives or prolong life. Sure, cosmetic surgery might make you happy but you could have just learned to accept your appearance for a lot cheaper.

I believe this conception of cosmetic surgery is deeply flawed. I believe that cosmetic surgery can be both shallow and deep. It can address surface issues such as age-related wrinkles but it can also deal with deep psychological problems. All that “cosmetic” means is that it deals with appearances. But how your body appears is inseparable from how your body is and how your body is is deeply connected to psychological well-being. If a person with severe burn scars on their body wants to change their appearance, is that “superficial” or “shallow”? When we think of cosmetic appearances we think of a superficial focus on beauty, such as wearing makeup. But sometimes appearances can involve fundamental psychosocial issues such as when people with severe facial disfigurement seek out face transplants. Part of the reason these transplants are done is to deal with functional issues such as blinking or sensation, but the primary reason they are done is to deal with the “superficial” issue of how their face looks. But it would be insensitive to dismiss the psychosocial needs of these disfigured people as being superficial or shallow even though they are “cosmetic” i.e. dealing with appearances and not an underlying medical or biophysical problem.   

Feminist Critiques of the Cosmetic Surgery Industry

Studies have shown that cosmetic surgery is on the rise. Feminist scholars and historians argue that the rise of the plastic surgery business is directly a result of the increasing objectification of female bodies in the media, the way that the media judges the validity of a woman based on her appearance rather than her intelligence. With this critique in mind, some have argued that the entire Western obsession with unattainable feminine beauty ideals is an negative influence on young girls and women that has led to an unhealthy obsession with plastic surgery. Thus, if the cosmetic surgery industry is morally suspect then it would be bad to model trans healthcare on such a morally corrupt institution.

Along these lines, one might say to a trans woman seeking Facial Feminization Surgery (FFS) that she is just influenced unduly by society’s beauty norms and should seek self-acceptance instead of surgery in order to deal with the dysphoria she feels about her facial structure. But there is a key difference between “unhealthy” unattainable beauty ideals and the ideal body image of most trans women seeking FFS or other “elective” cosmetic surgeries. Trans women have been stereotyped as wanting to be nothing but Kim Kardashian-esque beauty models but in reality most trans women would be content with being perceived as an “average woman” rather than the most beautiful woman in the room. Feminist critiques of modern beauty culture focus on the cattiness and competitiveness of woman seeking to be the most beautiful in order to seek validation from society and to impress men. But most trans women seeking FFS are doing it fundamentally for themselves, in order to be happy just seeing a woman instead of a man in the mirror. Similarly, trans men seeking top surgery are not seeking approval of society – they are seeking corrective surgery in order to make their bodies line up with a fundamental self-conception of what their body should look like.


Insurance Coverage
One worry about the Corrective Model is that it would potentially take away the insurance coverage that so many trans people need in order to pay for their HRT and surgeries.But thinking about transgender treatment as being analogous to cosmetic surgery does not necessitate that no insurance company could cover the treatments.

When most people think of cosmetic surgery they think of “beauty” enhancing treatments such as botox or face lifts. Surely, goes the argument, the desire for HRT or GCS is different than the desire to have less wrinkles on your face. Imagine April was born without a nose. April’s condition in no way affects her physical health. Yet she suffers extreme psychosocial distress about her appearance. Would plastic surgery on her nose be considered “cosmetic” or “medically necessary”? Arguably it would not be considered medically necessary because her lack of nose does not affect her physical health in any way. But I would argue that it would be ethically obligatory for her nose surgery to be covered by insurance and that even if her treatment is not medically necessary it is psychologically necessary.

In the DSM-V there is no diagnostic category for “nose dysphoria”. Yet April’s lack of a nose is psychologically stressful to the point of causing problems in her life, both at work, socially, and with her family. Why not think of gender dysphoria in the same way as April’s lack of a nose? Gender dysphoria individuals are born with a body that causes them tremendous psychological distress which often leads to a host of psychosocial problems including depression, anxiety, and high risk of suicide. Some trans men believe they should have been born with a penis. This belief causes them an incredible amount of stress and often leads to psychosocial dysfunction. Calling the treatment of their condition “cosmetic” in no way necessitates a lack of appropriate insurance coverage.
The key advantage of the Corrective Model is that it puts the autonomy of treatment decision making into the hands of the patient. The patient gets to decide if they want a procedure to change their bodies in order to relieve their distress.

As we can see there is a fuzzy line between what counts as cosmetic treatment and what counts as medically necessary treatment. The line is so fuzzy that the distinction itself breaks down, especially if the worry is about the distinction between cosmetic treatment and necessary treatment, not just medically necessary. Not all treatments that are necessary are necessarily medical in nature. A treatment can be necessary to the proper psychosocial functioning of an individual without that treatment being necessary in the sense of being life-saving or life-prolonging.

Let us think this through with an example. A cisgender woman who desires breast augmentation in order to make her feel marginally better about herself should not be covered by insurance because it is a “shallow” cosmetic treatment. But now considered Jane, a cisgender woman. Jane has a flat chest. Ever since she was young she has agonized over her flat chest. Her flat chest has caused her endless psychosocial stress and the stress is so great that it prevents her from going out of the house or working. Due to her flat chest, Jane has been contemplating suicide. Although breast augmentation for Jane would be considered “cosmetic” because it is not medically necessary I believe it is ethically obligatory for insurance companies to cover her breast augmentation procedure. We can even imagine an entry in the DSM-V for “cisgender breast dysphoria” and it would parallel the entry for “gender dysphoria”. I see no principled reason for insurance companies to treat transgender breast dysphoria differently from cisgender breast dysphoria so long as the underlying psychosocial distress is equivalent.

Furthermore, the Corrective Model does not assume that the only valid reason for insurance coverage is psychosocial distress. As Judith Butler writes,

Examples of the kinds of justifications that ideally would make sense and should have a claim on insurance companies include: this transition will allow someone to realize certain human possibilities that will help this life to flourish, or this will allow someone to emerge from fear and shame and paralysis into a situation of enhanced self-esteem and the ability to form close ties with others, or that this transition will help alleviate a source of enormous suffering, or give reality to a fundamental human desire to assume a bodily form that expresses a fundamental sense of selfhood. [Butler 2004 92 Undoing Gender ]

The Corrective Model is pluralistic in terms of the justifications for insurance coverage. Arguably a cisgender woman’s desire for liposuction does not conform to a fundamental sense of selfhood in the same way that a trans woman’s desire for breast augmentation does and so the Corrective Model would therefore not endorse all forms of beauty-enhancement for insurance coverage. However, the line here between justifiably “enhanced self-esteem” and unjustified self-esteem enhancement is difficult to draw sharply. The attempt of therapists to demarcate cases of cosmetic enhancement that truly lead to better flourish from those that are vain, shallow, and derived from beauty culture will likely lead to the same gatekeeping problems that plagued the traditional model of trans healthcare. Instead of sharpening up our criteria to separate out moral from immoral cosmetic surgery perhaps it would be more ethical to change the nature of the insurance system to better enable human flourish on a wide scale.

Objection: The CM is Unfair to Cisgender Women

The idea is that if insurance companies cover Facial Feminization Surgery for trans women why shouldn’t they also cover facelifts or rhinoplasties on cisgender women? What’s the philosophical difference?

I believe the difference comes back to the issue of fundamental self-conceptions that don’t have an undue or unhealthy casual history that traces back to unhealthy displays of objectification in the media. For most trans people, it is not a desire for an unattainable beauty ideal they see in the media. It is simply a desire to blend into society, to be perceived a normal functioning member of society who is not a “freak” because of their gender ambiguity. The 55 year old woman who wants a facelift to look 10 years younger might “see herself” as being “really” 45 at heart but she is not exposed to violence, insults, discrimination, etc. in the face of being seen as a normal 55 year old woman. She is not prevented from using public bathrooms because of her wrinkles. Thus, another factor in separating trans cosmetic surgery from cis cosmetic surgery is the issue of justice. Trans people have historically faced injustice at the hands of a system that makes their very identity subject to attack and ridicule. The cisgender 55 year old woman might feel depressed and might be harmed by being exposed to the unhealthy societal beauty ideals but the harms are not directed at her in such a way that expose her to legitimate violence and harassment on the street whereas a trans female who is gender ambiguous faces real violence and trans man without top surgery has to bind their chest daily which can introduce many complications and difficulties that a ciswoman seeking breast augmentation simply doesn’t face.  

Who Ultimately Decides To Change Trans Bodies?

One potential objection to the Corrective Model is that it should ultimately be the doctor who decides whether to go ahead with the treatment, not the patient. Although Hale (2007) agrees with me that the WPATH SOC should be done away with, he still prescribes to the view that transgender treatment should be modeled after the standard medical model, albeit with more emphasis on autonomy than proponents of gatekeeping. He writes:

“[Getting rid of the SOC] is not an endorsement of ‘surgery on demand,’ not even the more moderate view that surgery is a right to be granted upon request. Nor do I support Susan Stryker’s (1997) suggestion that the transsexual, rather than the psychotherapist, should ultimately determine what will happen to the transsexual’s body. Ultimately, decisions about whether to prescribe hormones and perform operations must be made by physicians – not prospective patients or mental health professionals – after careful patient-physician consultation and a thorough informed consent process” (Hale, 2007, 503)

Although Hale disavows any kind of gatekeeping through the SOC and advocates for an informed consent process, he mischaracterizes the nature of the shared decision making process by claiming that “ultimately” it is the doctor who decides what will happen to the trans person’s body.


If a trans patient comes into an IC clinic asking for HRT, the doctor checks for medical contradictions, and then decides to prescribe hormones, is it really the case that the doctor is “ultimately” making the final decision about what happens to the trans patient’s body? I think Hale is failing to distinguish between two different senses of what counts as the “ultimate decision”. On the one hand, the “ultimate decision” can mean the final step of the causal process, meaning that it is the doctor writing down the Rx on his pad that is the “final” decision. But in the other sense, the “ultimate” decision has already been made by the patient seeking HRT because it is their decision at a more fundamental level – they are the ones who stepped forward and made the decision to walk into the IC clinic with the intent of getting HRT. They are the ones who have decided to change their body.
Consider an analogy with an auto mechanic. A customer walks into the auto shop and requests a replacement of their exhaust system in order for it to sound louder. In one sense, it is the mechanic who “ultimately” decides what happens to the car because they are the ones who make the final causal step in agreeing to work on the car. But in another sense, it is really the customer who made the “ultimate” decision about whether to get a new exhaust system because it was their original desire for a louder exhaust system that brought them to the auto shop in the first place.

We can think of standard cosmetic surgery in the same way. A woman goes into the surgeon’s office seeking a face lift. The doctor checks for medical contraindications and then decides whether to go ahead with the treatment. As I see it, it is not the doctor who “ultimately” decides whether to change the woman’s face. The woman decides. It is her autonomous decision to do so. The surgeon is merely a technical expert that assists her and makes sure her desires are satisfied in a safe and effective manner.

Cosmetic surgery might be described as “surgery on demand”. But why is that problematic? It is not like you can walk into a plastic surgeon’s office and demand a surgery that will lead to immediately dangerous medical complications that will cause death the next day. The plastic surgeon still has to check for medical contraindications. So the “surgery on demand” is a red herring. What the Corrective Model really amounts to is “surgery on demand provided the surgery is medically safe”, which sounds decidedly less ominous than the way Hale describes it. Similarly, I believe we should adopt “HRT on demand provided there are no medical contraindications”. If someone just had a heart attack last week they should not be able to walk into a clinic, demand HRT, and then receive them. There are checks and balances in place that prevent such scenarios. But assuming the patient is healthy and of sound mind then it is ultimately the patient who decides what happens to their bodies.


Sexual Reasons for Wanting HRT or GCS

One might argue that treating transgenderism as a medical condition is appropriate because it weeds out “genuine” trans people who seek HRT/GCS from people who seek out HRT/GCS for “sexual” reasons. But this is no reason to abandon the Corrective Model.

Suppose Bob is a cisgender man who wants HRT and GCS because it would lead to a more satisfying sex life. Bob’s lack of HRT and GCS does not cause him any significant psychosocial distress. In my view, it is permissible for doctors to give Bob HRT and surgery on the basis of informed consent but I do not think his treatment should be covered by insurance.

The key difference between Bob and gender dysphoric people is that Bob does not experience significant psychosocial stress from not having HRT/GCS. Bob is not at increased risk of depression and suicide because he cannot have the body he desires.

Obviously it is a fuzzy line between “how much” distress is necessary in order to warrant insurance coverage. But presumably the professional class of doctors/therapists/psychiatrists would be able to determine if the gender dysphoria was significantly affecting the psychosocial functioning of the patient. On the Corrective Model, seeing a therapist is not a requirement for getting access to HRT/GCS but it is recommended. However, on the Corrective Model, if you plan on getting your insurance to cover your treatments then it would be necessary to seek out a professional therapist or psychiatrist to get a diagnosis of gender dysphoria showing that your gender incongruence is significantly causing psychosocial problems in your life.

Body Dysmorphia

Someone might object to the example of April wanting a nose by saying we already have a category in the DSM for people who are unhealthily obsessed with their physical appearance: Body Dysmorphia. People with body dysphoria, e.g., might think that their head is incredibly large and ugly and strongly desire to change their physical appearance. Isn’t this just the same as April, who is obsessed with her nose? Or perhaps this is akin to the anorexic who is obsessed with how their body looks. Treating these issues is not just a cosmetic issue – it is a medical issue. Shouldn’t we think of April’s case similarly as well as gender dysphoria?

The problem with this objection is that body dysmorphia and anorexia are both characterized by misperceptions of reality. The person who hates their head because they have a huge head actually has a normal size head – everyone in their life, doctors, friends, family, all ensure them that they have a normal size head. But no amount of external observation will change the belief that their head is too big. With April and her nose she is not making a perceptual mistake. Her nose really is gone.

Someone might object to my “distress” criterion by saying that the anorexic distress would be alleviated if we helped them achieve their desired thinness. But obviously we should not encourage or help the anorexic to become thinner. So the argument goes, the distress that Jane, the cisgender breast dysphoric, feels should also not be indulged as well. It would be better to put her in therapy in order to get rid of her chest dysphoria. But of course this never happens. If Jane walked into a plastic surgeon’s office seeking breast augmentation the surgeon would not deny her request and refer her to psychiatrist or therapist. He would listen to her desires and recommend the best course of action to satisfy her desires and relieve her chest dysphoria. If Jane’s dysphoria over her chest was so debilitating that she was unable to go out of her house or work a job then her treatment should be covered by insurance in the same way transgender surgery is covered by insurance.  

The Insurance Objection Redux

Someone might object that my distinction between who gets insurance is too fuzzy and reintroduces gatekeeping all over again. If who gets insurance coverage is determined by the amount of psychosocial distress, who gets to decide what amount of psychosocial distress is acceptable? The line seems so fuzzy that doctors and therapists would just be re-introducting their own biases and we have the same gatekeeping system the Corrective Model is meant to replace. Someone might instead argue that we should just have insurance cover all forms of cosmetic surgery rather than trying to argue the cisgender woman wanting breasts is “less deserving” of breast augmentation than the trans woman who wants breast augmentation. I am open to this objection.

Perhaps instead of trying to draw a line between acceptable and non-acceptable cosmetic surgery on the basis of diagnosed levels of psychosocial distress we should just be lobbying local and federal governmental systems to increase funding money for educational programs that seek to correct the fundamental problems of why cisgender women (and some men) seek out what many proclaim to be unnecessary cosmetic surgery. Feminists have long argued that media representations of women objectify and cast them as sex objects as well as give young girls and women unattainable beauty ideals. If we as a society spent more time and money on correcting this problematic media representation, then perhaps the issue of women wanting a face lift would not cripple the insurance system if that system did cover cosmetic surgery. Likewise, insurance companies would then have no basis to distinguish cis and trans desires for cosmetic surgery and everyone would be on equal footing in regards to using medical technology to make us feel more at home in our own bodies.

But this might just been as laughably naive. Cosmetic industry is a booming industry and if health insurance covered it willy-nilly then already rising premiums would increase dramatically. Which brings me back to my original claim: get rid of gatekeeping for cosmetic eligibility but have a system of therapists and professionals in place to assure that the people seeking corrective surgery have levels of distress that significantly affect their well-being. If psychiatrists and therapists can distinguish between sadness and clinical depression then surely they can distinguish between low levels of distress and significant distress when it comes to non-dysphoric individuals seeking cosmetic surgery. If the transgender woman seeking Facial Feminization Surgery is experiencing suicidal thoughts or is depressed by how she “doesn’t pass” because of her masculine facial features then a professional psychiatrist or therapist should be able to offer a diagnosis of dysphoria that enables insurance coverage. The cisgender woman who simply wants a face-lift because she feels “ugly” in contrast to beauty models likely will not receive a diagnosis of any kind unless she suffers from body dysmorphia in which the appropriate treatment would be covered by insurance.

Conclusion

There are two types of gatekeeping: minimal gatekeeping and transphobic gatekeeping. Minimal gatekeeping is about checking for medical contraindications such as heart disease or brain damage or psychosis and it’s about establishing whether someone is of sound mind to understand the risks and benefits of HRT. But I contend that in most cases it does not take 6 months of therapy to assess whether someone is of sound mind to start HRT. Transphobic gatekeeping is the type of gatekeeping whereby trans people are made to jump through many various hoops in order to get access. Transphobic gatekeeping is when trans women get turned down for HRT because they should up to the doctor’s office in jeans and a t-shirt (yes I have heard of such cases in the 21st century). Transphobic gatekeeping is the erasure of non-binary narratives and denying non-binary people access to HRT because they don’t fit into the standard narrative. Minimal gatekeeping is necessary and a part of the doctor’s duty. Transphobic gatekeeping is a much more pernicious idea insofar so it is the product of all the collective social biases we have against trans people and the very idea of transitioning. As a trans person I am highly aware that transphobia is alive and well. Doctors and therapist are not immune to that and thus have their own biases. This manifests in transphobic gatekeeping.

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Filed under Ethics, feminism, Gender studies, Trans studies