Category Archives: 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

I Am a Monster

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I am a monster, a hybrid, a construction, a bio-hacked assemblage,  a coming-together-of-parts, a body without organs, a realization, a far-off dream. My body is a mismatch. My brain is an amalgamation of many intersecting contradictions. I am a monster – hear me bellow, listen to me pull myself apart and put myself back together again. My identity is fractured. My self-knowledge is clouded. I am a wolf-pack, a multitude, a colony. I am a refusal, an unregulated biomass, a gender terrorist. I am not a person – I am a becoming, a process, a field, a flow of atoms. I am monstrous star stuff.

My only stability is my desire for change, my desire to become someone (whoops – I mean “something“) I am not, a desire to evolve, mutate, and self-assemble. I refuse to be comforted by the soft glow of identity. I don’t want to be a subject – I want to be a force, a physical manifestation of quantum reality. My brain is continuously devouring itself, recreating itself in a new image. My brain sends feelers out into the world to touch what it is not, to gather information about the reality I crave to inhabit. These tentacles also reach back into myself, creating an infinite hallway of mirrors, a blackhole of subjectivity that keeps turning in on itself, warping itself into a field of potential.

Monster politics seeks to destroy the integrity of the human body. Technology is our saviour. Monster politics seeks to destabilize the metaphysics of gender. Gender cannot save us – we must escape from it at maximum velocity. Not everyone is a monster, not everyone wants to be a monster. But monsters feed off the fear of not wanting to be a monster. It is the fuel which drives us to be even more hideous, to cast off the shackles of evolution to become cyborgs, beings that transcend the mere human.

The hormones flowing inside my body are not produced within my body. They are products of technogender bio-hacking. These hormones are right now as I write this working to deconstruct and reconstruct my insides, turning me ever more into a monster.

The problem with monsters is that everyone thinks they are ugly. But on the contrary, monsters are beautiful creatures. Monsters inhabit the part of reality that no one else can. We inhabit the liminal spaces, the in-between-ness, the dimensions that exist outside of the comforting confines of the gender binary. My gender is a mess. It cannot be reconciled with the old transsexual narrative of being a woman trapped in a man’s body. I am a monster trapped in a non-monstrous body. I am a contradiction imprisoned inside a stable field of containment. I am taking hormones to shatter the prison cell, to escape from normalcy. I am experimenting on my body not because I am in the “wrong  body” but because I aim to see just how far my body can change. I want to push my body to its extreme hormonal limits. I want to unleash the biological creativity lurking inside all my cells.

The traditional explanation of transgenderism is that I am “uncomfortable in my body”. My explanation is that my body is not enough for me. It just doesn’t cut it. Discomfort is a watered down way of saying that I want to become a monster, a hybrid, a field of intersecting biological contradictions.My body cannot be reduced to a single category. My body refuses easy definitions. My body is an act of terrorism. It strikes terror in the hearts of those who cannot see the body for what it is: a field of potential, a virtual hyper-space of biological possibility.

I am a monster. But that does not define me. Monster politics recognizes that monstrosity itself is monstrous, it cannot be contained within easy conceptual organizations. And don’t tell me I am not a monster. Don’t tell me I am pure and whole. Don’t tell me because I won’t believe you. The wolf-pack inside me will not listen – it will simply attempt to devour you.

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Filed under My life, Trans studies

How do I know I am trans?

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It’s an interesting question, and not at all obvious. Clearly my knowledge of my transness cannot come from mere external observation. There is no clear empirical evidence in the same way I know my height or my weight. For knowledge of my weight I simply step on the scale. But how do I know I am trans? It’s not the same type of self-knowledge such as knowing I am hungry. In the stomach there are nerve endings that can detect my hunger levels which then send those signals to my brain which interprets them and I gain self-knowledge of my hunger. But my gender identity is not clearly physiological in the same way. There is no instrument, to my knowledge, which can be pointed at my brain and it determines my gender with certainty. Gender is essentially a subjective process, known only through introspection.

The only known way for others to know my gender is for me to tell it to them. They cannot read it off my dress or my behavior or whatever. Such things do not deliver gender conclusively, though they can certainly be cues. Is that where my own knowledge of my gender comes from? Observation of many many clues and then inductively piecing together the conclusion I am trans? Or does my trans knowledge come from a more direct introspective source in the same way I just “directly” know whether I am in pain? I don’t have to infer that I am in pain – I just know I am in pain. Similarly, do I just know I am trans? Or do I have to infer it?

In my own case, and all I can do here is speak for myself, my trans knowledge certainly seems more like an inference than it does direct knowledge. I’ve never “felt like a woman trapped in a man’s body”. I didn’t have a clear and distinct female identity in childhood. It’s never been something that is obvious to me. It was a hard-fought introspective battle to reach my current state of knowledge regarding my trans identity.

To this day my own gender is not obvious to me. I have proclaimed before that I am gender agnostic: I claim no certain knowledge about my own gender. Am I a special type of man or a special type of woman? I do not know. It does not seem important to me. What matters more is self-knowledge concerning my desires to continue transition. I desire to keep using female pronouns, shopping in the women’s section, taking HRT, using the name “Rachel”, etc.

Just like I am aware of my desire for food I am aware of my desire to keep transitioning. This is the knowledge that grounds my knowledge of myself as trans. I know I am trans because I know I never want to go back to being a testosterone-based creature. I know I love estrogen. I know getting gendered as female by other people makes me extremely happy and being perceived as male/man makes me extremely unhappy.

But I didn’t always know that I loved estrogen. Before I transitioned, I did not have certain knowledge that I would love estrogen. So how did I gain enough self-knowledge about my desires in order to be confident enough to start transitioning? In early Spring of 2015 I was exploring my gender-bending and crossdressing more and more, taking things to the next level in terms of trying to pass and going out into public. The feeling was intoxicating. I’ll never forget the feeling of walking my dog around the block in a dress for the first time. I was hooked. I didn’t want to stop dressing in femme, but I also didn’t want to interact with the world as a man with a male name and a male body, being seen by everybody as a crossdresser or pervert. And let’s be honest, few groups of people in this country are more derided than male crossdressers. In my opinion, if you are not part of the drag community it is harder to be an out and about public crossdresser than it is to be a trans woman. The reason is that trans women usually go on hormones in an attempt to blend into society. But if you’re a male crossdresser you are stuck trying to pass with your AMAB body – and unless you are very lucky – it’s going to be difficult to blend in without doing all the things associated with transition such as facial hair removal and HRT.

So I had a choice. Attempt to subvert traditional gender roles in an attempt to be an openly crossdressing male or adopt a trans identity and transition, blending into society as a woman-identified person. I think I made the right choice. The longer I transition the more confident I am that I did the right thing for my happiness and well-being. Never again do I have to choose between expressing my masculine self vs my feminine self. I never have to hide my femininity in the closet again. I never again have to feel ashamed of my femininity. I have the freedom to be exactly who I want to be and no one is stopping me. It’s a wonderful feeling, the feeling of liberation from the gender role I was assigned at birth, liberated from the body I was born with, free from the thought patterns I was socialized to think, free from the shackles of masculinity. I can be feminine!

It’s surprising to me just how deep my desire for femininity runs. It’s part of my DNA, part of my deep wiring. While it is possible that I could have lived a life as a very feminine male, I do not think I would have been able to express myself in the same way I have unless I fully transitioned to take on a female identity, with female pronouns and a female name. When I think of my birth name it gives me a strange sensation, like having a ring of familiarity but still seeming quite estranged. I can’t imagine that I would have lasted long if I had tried to live life as a feminine male. Femme males are spit up and chewed out by society. They are torn down, beaten down, and sometimes even killed. Though I don’t pass perfectly and thus expose myself to a similar risk of being clocked as a man in drag and thus a target for violence, I blend well enough that if I keep my mouth closed I can pass as a woman in society without raising too many eyebrows. This gives me existence a kind of security that I otherwise wouldn’t have if I had tried to express myself without transitioning.

Deep down I am a gender agnostic. I do not know with confidence if I am male or female, man or woman. But I do know I am femme. I am a femme person, that much is clear. But it’s so much easier to be femme with a government ID that has a female name and “F” on it. It’s so much easier to be femme with the help of HRT. It’s so much easier to be femme if I tell the world I am trans. Which is not to say that being trans is an easy path, or without its own set of inherent problems. Being trans is no walk in the park. It can be a hard life. But it is also very rewarding. I get to enjoy the feeling of joy of self-determination, the joy of picking a pathway and walking down it with my head held high, the joy of having a vision for how I want my life to go and being able to follow it. It’s an indescribable feeling. Cis people can of course feel the same feeling when they choose a career or whatever, but gender transition is an example par excellence of autonomy and self-actualization. Trans people fight against so much just to be true to their deep inner selves. They make so many sacrifices, giving up friends, family, and career opportunities just for the chance of authenticity.

So, for me, I know I am trans because I have knowledge of my desires. Knowledge of my desires allows me to make a grand inference: whatever my gender is, it’s different from the gender I was assigned at birth. Thus, I am trans.

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Filed under Gender studies, My life, Trans studies

The Promise and Failure of Gender Nihilism

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The gender nihilist, the gender abolitionist, looks at the system of gender itself and see’s the violence at its core. We say no to a positive embrace of gender. We want to see it gone. https://libcom.org/library/gender-nihilism-anti-manifesto

Such is the ultimate goal of gender nihilism. Gender nihilism wants to see gender destroyed. But is this actually possible? Is it possible to live in a world without gender? Gender nihilism argues that there is no gendered subject, no metaphysical core self to which our gender identity “rings true”. Because there is no essential gendered subject, any attempt to reify gender into a metaphysical truth is a form of violence that works against the gender and sexual minorities of the world.

For gender nihilism, gender is a system of signification that operates through political regulation of coded signs. But the very way in which gender nihilism views gender renders it impossible to banish. The raises the question of whether gender nihilism’s goal of gender absolution is even conceptually coherent.

Gender works through difference, functions through difference – so as long as there is difference between people then gender will work to codify and regulate those differences into a system of norms, rules, scripts, institutions, signs, punishments, and rewards. Gender nihilism insists that gender is a social construction, one they seek to see deconstructed entirely. But deconstruction never exists in a vacuum – there is always the corresponding constructive component working inside all human minds. We are social creatures in our core – social interaction within a milieu of semiotics structures the development of the mind-brain system even from within the womb. Sociality is part of the essential structure of the formation of human minds. This illustrates another incoherency of gender nihilism: its insistence on anti-essentialism blinds it to the essential social nature of human experience, the fact that we are all raised in a culture of signs, a culture that works to take difference and turn them into constructed reality.

Masculinity and femininity are constructed realities of coded significations that operate on the individual differences between persons. Broadly speaking there are estrogen-dominant persons and testosterone-dependent persons, and many intermediate cases. But from a statistical perspective it’s possible to break the human species into two large camps. One camp is assigned male at birth and is capable of producing small mobile gametes. The other camp is assigned female at birth and is capable of producing large immobile gametes. That it’s possible to break humans into two camps is product of evolutionary history. Sex has not always existed but once created it reinforced a dimorphism between small gamete producers and large gamete producers, a crucial physiological building block that constructs biological difference. Biological differences that are not neutral mutations lead to real differences than manifest in different behaviors, thoughts, perceptions, desires, motivations, and physiological properties. These biological difference operates along a diverse and variable sexual spectrum. Although it is possible to divide humanity into two distinct camps it is never wise to ignore the alternative perspective: which is to view humanity in terms of the radical spectrum of individual differences that make us each unique beings.

These two views are complimentary. Appreciation of evolutionary history compels us to see sexual dimorphism as a biological realty that works to create difference between males, females, and those in between. People who give birth to children have different behaviors than people who do not. This difference has existed for millions of years. At the same time, the radical individuality of human beings suggests that biological difference operates along a spectrum or continuum of traits. Appreciation of individuality helps us realize that the differences within the group of males is larger than the difference between males and females and vice versa for females. Individuality trumps sexual dimorphism but sexual dimorphism does indeed generate real difference. There is no such thing as a strictly “male” brain or a strictly “female” brain – all brains are a mixture of male and female structures with more overlap than difference. But statistically there is a difference between male and female brains – though is unclear whether the difference paints a clear causal pathway to the gendered differences between men and women. The intersection of nature and nurture makes it impossible to clearly delineate the contribution of biology to the types of high-level behaviors we see in human reality, such as being a scientist or politician.

Gender nihilism attempts to collapse entirely into individualism without realizing that tremendous forces are operating to construct a dimorphic difference between male and female realities. Gender essentialism, in contrast, fails to grasp how sexual dimorphism is not biological destiny. People assigned male at birth are not imprisoned by this biological cage – technologies of gender now allow people to modify their biological sex through hormonal and surgical techniques. Hormonal technologies have also allowed for sex to be decoupled from reproduction through birth control. The pill has ushered in a new age of bioengineering. Trans people are also riding this wave of biohacking, being able to escape the confines of their assigned sex and transform the fundamental building blocks of their physiology through hormonal replacement.

Gender nihilism is a half-truth. But it is not a complete theory. Its goal of living in a world without gender cannot be reconciled with its own proclamation of what gender is. If gender is a system of signs that operate on difference, then gender will never go away because differences will never go away. The only consolation the gender nihilist might have is that the strict gender binary might loosen its dependence on sexual dimorphism and be expanded into a multidimensional system of variables that arise from human biocultural individuality. Gender itself is not going away but that doesn’t mean gender is a static phenomenon, destined to never change. It’s next to impossible to predict what the human gender system will look like a million years from now. But I guarantee it will be radically different, especially as systems of gender technology become more pervasive as social mechanisms of personal change. As technology loosens the grip of evolution on our sexed bodies, gender itself will expand to represent the infinite individuality of human variability.

Variation has always existed in nature. Variation is the essential building block of evolutionary change. And when you then add in the infinite variability of human culture you take a variable system and exponentially increase its potential for variability. This is where gender nihilism gets it right. Gender dimorphic binary could in theory die off and be replaced by a system of gender that is multidimensional. But gender itself is not going away. We cannot escape it. Nor should we necessarily want to. The violence inherent in the gender system is the same violence that drives evolutionary change. It is an inescapable part of the human experience. Of course we can work to reduce the worst examples of violence, especially the violence of patriarchy. But the violent oppression of patriarchy is not the same as the creative violence of evolutionary change that works to create healthy variability in a population. Such creative violence is necessary for keeping the population adaptive to the changes in the environment.

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Filed under feminism, Gender studies, Trans studies

Gatekeeping Is Transphobia

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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.

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Filed under Ethics, Gender studies, Trans studies

Yes In Fact You Are a TERF

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“Gender critical” blogger Purple Sage recently wrote a post about the term “TERF”. In essence Sage argues that the term “TERF” is over-used by angry trans activists and that moreover “everyone is a TERF” because all it takes to be a TERF is to piss off a trans activist by, e.g., mentioning the fact that cis females can get pregnant. Let’s take this from the top folks cuz I’m gonna break down everything that’s wrong with her poorly reasoned post.

First of all, nobody is actually a TERF. This is not actually a descriptive acronym, it’s a slur. The way it is used in speech is the same way people use bitch, whore, cunt, or feminazi.

TERF is not a slur in and of itself in the same way f*ggot and n*gger are. The f-word and the n-word are paradigmatic examples of slurs. There is NO way to use those words without causing some kind of tacit harm. That’s what makes them slurs. But TERF is an acronym. It breaks down to Trans Exclusionary Radical Feminist. None of those words in and of themselves is a slur because they can all be used in non-inflammatory sentences. The same cannot be said of “whore” and “cunt” – if these words remain in sentences the sentence becomes inflammatory in virtue of the decision to not use less inflammatory versions like “sex worker” or “vagina”. Obviously “trans” is not a slur. Nor is a slur to call someone “exclusionary”. Nor is it a slur to call someone radical or to call them a feminist. So when you break down the meaning of TERF it becomes possible to use the term TERM in a non inflammatory manner to describe those people who identify as feminists with a “radical” bent who want to exclude trans women from the category of women and trans men from the category of men. Furthermore, the term “TERF” itself was coined not by trans people but by cis feminists. It was started as a neutral term. The same cannot be said of REAL slurs like the f-word or the n-word.

Nobody identifies as a TERF and this isn’t an accurate description of anyone’s politics

This is totally false. Just because “gender critical” folks themselves don’t like the term TERF that doesn’t mean it’s not an accurate description of people’s politics. The term means “trans exclusionary radical feminist”. It basically means anyone who thinks that trans women are *really* deep down just men and trans men are *really* deep down just women. This perspective is almost universally shared by people in “gender critical” circles and thus it becomes a highly convenient tool for trans people to have a widely recognized term that describes “gender critical” politics.

I don’t actually “exclude” trans people though. I read the words of trans people, I watch their videos, I talk with them, they comment on my blog, and I have not excluded any trans people from anything in real life.

This is a hilariously bad interpretation of what the “exclusionary” element of TERF actually means. It doesn’t mean exclude trans people from your social circle, or exclude trans people from your youtube watchlist. It means exclude trans women from the category of women and exclude trans men from the category of men. “Gender critical” people believe that only assigned female at birth people are REAL women and trans women are just men/males. This is what TERF means. It means excluding trans people from the gender they identify with. Just because you talk with trans people and put on an air of politeness does not excuse you from being a TERF. It’s not about your actions – it’s about what you believe. If you don’t think trans women are women, then you’re a TERF plain and simple.

There is a second meaning behind the term “exclusionary” which has to do with things like excluding trans women from the women’s restroom and other “women only spaces”. I have not read Purple Sage’s entire blog so I am not familiar with their views on bathroom politics but if they toe the “gender critical” line then I almost guarantee they would argue that trans women should not be allowed in women only spaces. That is exclusionary. You are excluding trans women from the spaces that only women are allowed to go to. Another example is the Michigan Women’s Festival, a classic case of cis females excluding trans women because they believe that trans women are not women.

You’re a TERF if you know that women menstruate, you’re a TERF if you understand how babies are made, you’re a TERF if you know that lesbians aren’t interested in dick, you’re a TERF if you even say the words “female” or “biology.” Since reality itself is transphobic, everyone who understands reality is a TERF.

This is total bullshit – classic strawman argument meant to make trans people look deranged. I don’t know a single trans woman who thinks it’s transphobic in and of itself to talk about pregnancy or cis female biology. What’s transphobic is to say that only women can get pregnant because that erases trans men.

Furthermore, Sage is just confused on this point. She is confusing the idea that talk of pregnancy can trigger people’s dysphoria with the idea that talk of pregnancy is inherently transphobic. Yes it’s true that some trans women have their dysphoria triggered by discussion of cis female biology. But that’s not the same as saying such discussion is inherently transphobic. What would be transphobic is to say that just because trans women can’t get pregnant they aren’t “real” women. Or it’s transphobic to try and reduce the entirety of the concept “woman” to the biological characteristics typical of cis females because that essentially begs the question. But discussion of biology or the differences between AMAB and AFAB bodies is not inherently transphobic. Cis females and trans women have different biological properties. That is a fact. I don’t know anyone who would deny that fact. Nor do I know anyone who considers the recognition of that fact to be transphobic.

And as a matter of fact, some lesbians do in fact like dick. My ex-fiancee was a classic “goldstar lesbian” before she met me but she loved my dick. It’s simply not true that all lesbians/queer people are not interested in dick. To think otherwise is to be very ignorant of the lived reality of cis female self-identified lesbians who date preop/nonop trans women. And if it’s not just ignorance it’s outright erasure.

All humans the world over know the difference between male and female, so all of us are TERFs.

I am very skeptical that “all” humans are aware of the hidden complexities in trying to define how many sexes there are or what constitutes male or female biology when the existence of intersex conditions complicates the simplistic binary narrative believed in the Western world. Expert biologists who actually know what they are talking about are coming to a consensus that biological sex is a spectrum and cannot be so easily cleaved into two and only two utterly distinct categories.

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Filed under feminism, Gender studies, Trans studies

Learning to Say “Fuck it” to Passing

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If you’re a trans person like me then you’re probably hyper aware of all gendered activities directed your way. Last night I was at Denny’s with some cis female friends and when the server brought the food out she was giving the food to the other girls and was like “And this is for this lady right here”, etc.,  but when she got to me she didn’t repeat the pattern – she didn’t know how to gender me – didn’t know whether I was lady-enough to warrant being called a lady. In my own assessment it was probably my voice, the downfall of many trans women.

For probably like the first 10-11 months of my transition I put a LOT of effort into trying to make my voice more passable. My results were not fantastic, probably because I never saw a professional voice therapist. And now I’ve just given up entirely because I am trying to learn to say “fuck it” to passing. It’s so hard. So so hard. I want to pass more than anything. I want to interact with people just for once and not have them question my gender. And not just like a fleeting interaction – like I want just for once to have an intimate one on one conversation with someone and not have them suspect I was born male. Oh that would be nice.

I suppose I am lucky though. I fall into that strange class of trans women who don’t pass perfectly but people say are attractive. The very concept of a beautiful nonpassing trans woman is almost a contradiction in terms if you are to believe all the transmisogynist bullshit TERF rhetoric out there. If you don’t pass you look like a man – yet how can a woman who looks like a man be considered beautiful? And yet it’s definitely a thing. Beauty and passing are not the same. You can pass but not be beautiful. And you can be beautiful but not pass. So I don’t have it that bad. I’ve actually be accused by others in the local trans community of being the “epitome” of passing privilege. But I live my own experience and I know from how I interact with strangers that I get clocked pretty much every time because of my voice. So I don’t actually have passing privilege because I don’t pass. I get clocked. It is currently impossible for me to go stealth. Most people are polite/smart enough to not “sir” me but I don’t always get those gendered pronouns I so crave for validation. My experiences are often genderless despite me observing other people around me getting gendered correctly. I pass enough to largely be avoided being gendered male (though it does still happen sometimes) but not enough to be consistently gendered female, especially after I open my mouth. At the intercom for a drive through? Forget about it. Over the phone? No way. Still a man.

So is there is a secret to learning how to say “fuck it” to passing? No. I have no tips. No advice. For some people it’s literally impossible to totally say “fuck it” to passing. Their dysphoria is too high for that. I’ve been blessed to have relatively low levels of dysphoria. Others are not so lucky and they literally cannot ignore the pressing concerns of passing. For some passing is an omnipresent concern. I have no words for these people – all I can offer is empathy and a hug (if needed). My advice instead is for the people who have the privilege of being able to learn to say “fuck it” to passing. If you have that internal fortitude and resolve – it’s possible to learn to care less about passing. If you live in an area of the world that is relatively friendly to trans people, or at least not actively unfriendly, then you too can learn to say “fuck it” to passing.

The number one goal is to learn to not care what others think of you. Easier said than done. But it is possible to foster this attitude within yourself through deliberate cognitive practice. Say to yourself “I don’t give a shit. Fuck you.” It helps. Or at least it helps me. If someone misgenders me, I try to just tell myself it doesn’t matter what strangers think of me. What matters is how I am gendered by my friends and people who know me and are close to me. If they see me as a woman, then that’s what matters because they actually know me as a person and respect my gender in its true authenticity. Strangers are just judging you based on cis-sexist stereotypes about how people are supposed to look or sound. Trans woman with deep voice? You’re fucked. But I’d rather spend time with people who don’t assume that a deep voice makes you less of a woman. It is the company of people like that that I cherish. Strangers are just reacting to surface-level gender cues. But gender is not a surface level phenomena. It goes into the core of my being. Strangers can’t see that, nor should I expect them to.

There are two types of transphobes. Those who can be educated to change their minds and those who can’t. The latter type of people are always going see me as a man so why not just blow their minds with how much a “man” can shatter gender stereotypes by embracing their femininity? In a way, TERFs use misgendering as a political weapon, used to upset trans women and get under their skin, provoking anger which can then be used to “prove” they’re still male socialized. Another tactic is to call trans women “male to trans” (MtT) instead of “male to female”(MtF) because they don’t believe trans women can actually change their sex. Once male always male. But one of my personal strategies for learning to say “fuck it” to passing is to flip TERF logic on its head. If they’re always going to see me as a man no matter what I do then it ultimately doesn’t matter if I put more effort into passing. I’m not going to change their minds. They are a lost cause not worth stressing about. But TERFs are supposedly all about shattering the stereotypes associated with what “males” are supposed to be like. So go ahead. Think of me as a man. You’re not going to change my femme identity. Femme man or femme woman – ultimately these are just labels with no concrete definition. People are free to define these terms for themselves how they wish. I have long since given up on getting the world to unite behind what it means to be a man or woman, male or female. Everyone has their own pet theory. TERFs think they can dehumanize me by saying I only transitioned from a male to a tranny. But echoing Kate Bornstein – I am proud to be trans! It’s an identity I welcome and embrace. Not because being trans is without its problems but because being trans is the only way I can genuinely be myself. My trans identity is a source of many difficulties but it’s also a source of great happiness through the power of self-determination and self-actualization.

But I recognize I am speaking from a place of privilege. Not all trans people are lucky enough to see their being trans as anything but a nightmare, a horrible biological malady that they wouldn’t wish on their worst enemy. Oh what has the world done to you? How has the cruelty and transphobia of the world twisted something so beautiful into a tragedy? I am a strong believer in the hashtag #transisbeautiful. It’s a powerful message precisely because so many don’t believe it’s true. They have been convinced that trans is ugly, sinful, diseased, pathological. But it’s only those things because we lived in a fucked up world. In a utopia there would be room for trans people to not just exist but flourish. Think about that. Think about life in a trans utopia. The very possibility of that imagination proves that trans is not inherently pathological – it’s not an intrinsically horrible experience. In a perfect world being trans would be like having freckles, just another thing that makes us unique individuals. In a perfect world, passing wouldn’t have the all-importance it does now because safety wouldn’t be an issue. If trans people could be assured 100% that the world did not pose a physical threat because of their existence I guarantee so many more trans people would come out of the closet and transition. So many trans people would learn to say “fuck it” to passing because they can finally just be themselves without worrying about all the pressure to pass.

It is the first type of transphobes, the ones who can be educated, that I truly care about. They are the ones who are merely ignorant about trans identities. Their minds can be changed. They can learn about gender and how it’s different from physiology. They can learn about neuroscience and the biological basis of gender. They can learn about pronouns and how important they are. These are the people who can learn to feel bad after they misgender you. They can’t help it. But they can learn. They can change. They can learn to see me as the woman I really am. They can learn to move beyond the rigid male-female binary essentialism that fuels cis-sexism. It is through this process of education that trans people have any chance of approximating our trans utopia. By holding onto that ideal, we can develop the all important idea of hope inside our hearts. Hope leads to optimism and optimism leads to change, even if just internal change. We are ourselves our own best source for mental contentment and satisfaction. By giving ourselves a chance to accept ourselves we can learn to say “fuck it” to passing and just be ourselves. Easier said than done (there is my privilege speaking again). But I am a dreamer. I can’t help but imagine a better world for trans people. A world where passing is done only for ourselves, not for others. A world where passing is about being true to our internal image of ourselves not a defense mechanism against transphobic violence.

I haven’t quite learned how to truly say “fuck it” to passing. I still care about passing very deeply and perhaps always will. But I’m learning. I’m learning there is an alternative way of existing, even if it’s an existence that is fleeting. But the moments where I can truly say “fuck it” are magical because it’s in those moments where I learn to be myself.

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Trans Without Transition? A Critique of Gender Identity

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I think many people fail to realize that the very idea of “gender” and “gender identity” as opposed to physiological sex is a modern concept, invented by mid-20th century psychiatrists working with gender dysphoric trans patients. Robert Stoller famously defined gender identity as “one’s sense of being a member of a particular sex”. The concept is best illustrated by trans people, where a person assigned male at birth could have the “opposite” gender identity of being a woman which stands in contrast to her male birth assignment and the gendered expectations associated with that assignment. For cis people, they fail to be amazed about their comfort in their assigned sex. Like the old joke about fish not knowing what water is, cis people often fail to realize that their own felt sense of gender is actively at work behind the scenes, filtering their desires and perceptions. In contrast, trans people, especially pre-transition trans people, feel the mismatch between their gender and birth assignment so acutely it can lead to constant negative rumination, depression, anxiety, and suicidal thoughts. 

But what does it mean exactly to “sense” one’s membership in a particular sex? What kind of sense is this? Is it like proprioception? Or like the visual sense? Can we just “see” our gender clearly or does it require an act of hermeneutics?   Are we constantly sensing our sex? Or is it only evident in gender dysphoric people where there is a mismatch? This is like the old philosophical problem called the “refrigerator light problem” whereby we use introspection to ask ourselves if we are conscious, but are we conscious when we are not thinking about being conscious? If we were not conscious we would not know it either way, just like we cannot know if the refrigerator light goes off after shutting the door – the act of investigating corrupts the process of inquiry. Same with gender identity. Is it a construction made each time anew when we reflect on our gender or is it a stable psychological foundation that exists when we aren’t reflecting?

What is the nature of gender identity? Can it “stand alone” by itself or does it need to be connected to other psychological states such as desires? Presumably gender identity is a type of belief – we have a belief we either belong or don’t belong to the male-female gender binary as assigned to us at birth. With trans people, is it merely enough to have the belief that one is a different gender in order to be trans? Or must the belief be connected to a desire to transition?

A thought experiment: imagine an AMAB trans person who wakes up one day and has a startling realization: they are transgender! But they have zero desire to engage in any act of transition. They don’t want to change their name, their pronouns, their dress, their mannerisms, their voice, their body, etc. They are totally fine in the gender role assigned to them at birth. Yet they have an internal sense of belonging to the class of females. Is this situation even conceptually possible? Remember: the idea is not that one has a desire to change but is pragmatically frustrated but that there is no desire in the first place. All that exists is a free-floating belief that one is a different gender from the gender one was assigned at birth. Presumably if gender identity is a coherent concept then this situation is possible (ignoring for now the problem in assuming that metaphysical possibility can be read off conceptual possibility).

Some trans theorists implicitly assume that to be trans is to transition in some way. Paul Preciado writes:

In the middle of the Cold War, a new ontological-political distinction between “cis-“(a body that keeps the gender it was assigned at birth) and “trans” (a body availing itself of hormonal, surgical, prosthetic, or legal technologies to change that assignment) made its appearance. Testo Junkie, p. 127

Preciado just flat out assumes that if you are trans than you are “availing” yourself of some kind of transitional technology to change or move away from one’s birth assignment. If you’re a trans man, that might mean wearing a binder, or a packer, or STP, starting testosterone, etc. If you’re a trans woman, that might mean shaving your body or starting HRT, buying clothes traditionally found in the woman’s section, etc. For a non-binary person it might involve changing your name and pronouns, binding one’s chest, or wearing different styles of clothing.

But is my thought experiment actually conceptually incoherent? If the idea of “gender identity” is to make sense in its own right then it should be possible for there to be a trans person with a mismatched gender identity but with no desire to transition in anyway. Or perhaps it is impossible – if it is – then it shows there is something wrong with the idea of gender identity as distinct from physiological sex. It is not enough to simply have an identity that is different from one’s assigned identity – one must also have accompanying psychological states such as desires, desires for change, for transition through presentational, hormonal, surgical means, etc. I believe it is true that to be trans means more than just have a different identity. It means, as Preciado assumes but never argues for, that to be trans means to transition. There is no trans-gender without transition. One “transes” one’s own gender when one decides to self-consciously move away from one’s birth assignment. In a sense, the accompaniment of desires is a confirmation that the identity is not a fleeting whim or a random thought produced by the unconscious. The persistence of desire is in fact one of the defining diagnostic criteria for gender dysphoria.

Notice however that transition does not necessarily entail transition to medically relieve bodily dysphoria. The transitional elements could be done for some people without the assistance of medical technology. But availing oneself of legal technologies is certainly a valid and “complete” transition tool. Just to simply have one’s governmental ID match your felt sense of identity is a powerful feeling of validation. Furthermore, the position I’m putting forward is ecumenical between the “trans-medicalists”, who argue being trans is a medical condition defined by bodily dysphoria, and “maximals”, who want to expand the trans umbrella to be as inclusive as possible even for those trans people who don’t identity as gender dysphorics. For Preciado’s definition, bodily dysphoria is not the defining feature of trans identities. Rather, it is the desire to use multiple forms of transitional technology to reject one’s birth assignment. If a non-binary person is happy enough to bind and legally change their name, then that’s a form of transition. But where my position draws the line is with self-identified trans people have no desires to move away from their birth assignment.

But what’s the limit? If a trans person merely “transitions” through changing their gendered expression, is that enough to count as trans? I think the problem with trying to police gendered identities in this way is we cannot from the third-person realize the full psychological significance that expression has for different people. For some butch women getting a short hair-cut might be no big deal but from a trans boy it might mean the world. The same expressions can mean vastly different things to different people. For some people, the significance invested in how clothing is coded might be enough to satisfy latent dysphoria such that other transitional technologies are unnecessary. The point is that any kind of gatekeeping that tries to definitely say where “true trans” ends and begins will come up with the problem of trying to legislate from the outside what the internal felt sense of significance certain gendered activities have for some people. We will never be able to definitely build a singular set of criteria and apply them to all trans people picking out a unique shared characteristic. Trans people are perhaps one of the most diverse populations of people on the planet. I propose there is no “essence” to being trans, no necessary and sufficient conditions for being trans that are universal across all trans people. Instead, being trans is a family resemblance concept, a cluster concept that works in terms of paradigms, not necessary and sufficient conditions.

In conclusion, being trans is not just about identity. It’s about identity and desire. If there is identity without desire, it is passive, but desire without identity is blind.

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Is the Very Concept of “Passing” Problematic?

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If you hang out in trans circles long enough you start to realize the controversy surrounding the concept of “passing”. First off, what is “passing”? Typically, for a trans woman to “pass” is for strangers to not realize they were assigned male at birth. In other words, for a trans woman to “pass” is for the random passerby to think she’s cisgender i.e. not trans. For this reason, some theorists talk about “cis-passing” because that’s exactly what it is: passing for a cis person when in fact you are not cis.

And therein lies the controversy: why should cis people be the standard through which we define and understand the appearance of trans folks? To say that cis people are the ultimate standard is to buy into the whole concept of cis-normativity, which is the idea that cis people’s genders are more valid and real than the genders of trans people. Furthermore, the concept of passing implies that we are trying to “pass ourselves off” as something we are not. Thus, to “pass” can imply that we are being deceptive. A trans woman walks into a woman’s restroom and “passes” – does this mean she was pretending to be cis to enter the bathroom?

But that’s false: trans people are not being deceptive simply in virtue of walking down the street. How could we be deceptive when we are just trying to be ourselves? When I go to the grocery store I am not “pretending” to be cis and have zero intention of deceiving anybody. This is the dilemma that trans people face when we have to “come out” to people. Cis people often view this in terms of duplicity but that places trans people in a double-bind. Should we be expected to wear a sign on our heads? There is no way to be “non-duplicitous” in virtue of just being ourselves. I am not constantly lying with every footstep I take in public. I’m just being myself.

But there’s a conundrum here which is that trans people, including myself, go out of our way to “pass more” or “pass better” in many circumstances. When I go to the drive-through I try to pitch my voice up higher than normal in order to get gendered female over the intercom. Does this mean I was “faking it” in order to pass myself off as something I’m not? If you look at forums like reddit’s /r/transpassing it’s very clear that the vast majority of trans people, if not ALL trans people, care about passing to some extent. If they pass already, that’s great – they’re happy. And if they don’t pass, that’s a reason for much consternation. The belief that one will never pass can actually be a reason for some trans people to decide to not transition at all.

And there are very good reasons for trans people to care about passing. First and foremost, it’s about our safety. If you pass you are said to be able to “blend into society”. If you don’t pass, you stick out and are at greater risk for transphobic violence or harassment. This is especially true for trans women. Sex workers who are “found out” to be trans are often at risk of extreme violence from men. To pass as cis to be safe. To be visibly trans is to be less safe. So it’s quite rational to care about passing from a pragmatic safety perspective, especially if you are on the trans femme spectrum.

Not passing is also the source of much of gender dysphoria. If you’re a non-passing trans women , i.e. everyone can tell you’re trans by looking at you or talking to you, this can be a source of depression, anxiety, and suicidal thoughts. Why? Well it’s simple. First off, if you don’t pass you’re more likely to get misgendered, which is painful for trans people. Second, if you don’t pass then that means people in society are less likely to see you as your true gender. Third, if you don’t pass, then your body does not align with your desires with respect to having the characteristics of the “opposite sex”, which leads to dysphoria aka suffering. BUT WAIT.

Weren’t we just saying before that cis people should not be the standard by which the appearance of trans people should be judged? Why are cis people the standard? Why can’t trans people be judged with respect to their own standard? One of the deepest symptoms of transphobia is to think that more you pass the more valid your gender is and the less you pass the less valid or real your gender is. When we see a non-passing trans woman transphobic people are likely to think “that’s a man” because she does not pass. It requires a great deal of internal mental work to correctly internally gender trans people who do not pass because it is ingrained in our minds that men and women are “supposed” to look a certain way. A 6’5 300 lbs broad shouldered trans woman with a deep voice is automatically thought to be “less valid” than a petite attractive passing trans woman.

And therelin lies the problematic nature of the very concept of “passing”. The whole concept reduces gender to a certain set of physical traits. If you don’t meet some checklist of physical traits that are stereotypically associated with a certain gender, then your own gender is up for question. Why that is problematic should be obvious. The validity of anyone’s gender should never be reduced to the question of having certain physical traits. If a trans woman has a deep voice that does not make her less of a woman. Or at least that’s how things should work in an ideal world. But in the actual world cis people seem to have a problem properly internally gendering someone who does not pass. Sure, the good ones might gain a mastery of pronouns and be respectful but there’s always the lagging issue of what they “really” think – of how they are internally gendering someone. It’s quite possible for someone to use she/her pronouns for a trans woman but deep down see her as a man because she doesn’t pass perfectly. And if you think this is just a cisgender phenomenon then you are mistaken because trans people can also be deeply transphobic and harbor the same biases against nonpassing trans people. I’ve seen this in the community over and over, especially in the older generation of trans people who had to make it through the gatekeeping system in order to transition, a gatekeeping system that used to deny HRT/surgery to trans people who weren’t deemed passable enough or didn’t have enough passing potential.

So is the concept of “passing” deeply problematic? Yes and no. Should we do away with the concept altogether? I don’t think so. Clearly passing is important to the trans community. Just looking on online communities should make it obvious that most if not all trans people care deeply about how well they pass to some extent. But on the flip side I think it is our imperative to spread the message that our validity does not depend on how well we pass. We need to also spread the message that non-passing trans people can still be happy, find jobs, be romantically loved, and live successful, fulfilling lives. Passing should not be the gold standard by which we judge someone’s success in transition. However, we cannot ignore the fact that passing trans people have it much easier in our society than nonpassing trans people. If you watch the cis media, usually the trans people interviewed or recognized are highly passing trans people, which is unrepresentative of the whole trans community (this is especially true for the community of trans women, but less true for the trans male community which often has an easier time passing after years of testosterone). We need to do a better job to normalize nonpassing trans people as being “just as trans” as their passing counterparts. A holdover of the “true trans” era of medical gatekeeping is that “true transsexuals” were believed to be more passable than the people who are not “true transsexuals”. But the quest to define who is “truly trans” is a fool’s game – not one worth pursuing because you will inevitably exclude people based on arbitrary criteria such as your height or the deepness of your voice.

Passing is important. And I don’t think using substitute terms like “blending” are really going to by-pass the importance of passing to the trans community. But as we’ve seen the concept is also deeply problematic insofar as it implies deception and reinforces cis-normativity. Many if not most trans people wish they were cis but that’s not true of all trans people. Many trans people are happy being trans and wouldn’t change it for the world. I kind of fall into the later camp. It’s beyond this post to explain in detail why I love being trans, but part of it comes from my intrinsic distaste for normality. I like being different and different I am – I am not your average woman. But many trans people crave normality. They just want to be a normal man or woman in this society. And that’s fine. There’s nothing wrong with that. But there’s also nothing intrinsically wrong with being trans. It’s not an intrinsically horrible life, even in you’re nonpassing. Sure, living in a transphobic society can make being trans horrible – violence, loss of friends, job, family, harassment, discrimination, lack of healthcare, etc. – all these things can make being trans a nightmare. But those things are not intrinsic to being trans – they are a product of the society we live in. If society was lurched forward hundreds of years and trans people became widely accepted in society then things would be much different. The suicide rate would surely go down. Because being trans is not an intrinsically horrible experience. There are many horrible aspects of being trans such as dealing with dysphoria. But in a perfect society, we would be able to use technology to deal with dysphoria such that it would be drastically reduced in most trans people, especially by letting trans kids get access to blockers and start HRT before becoming masculinized/feminized by puberty. Greater awareness of trans people would give trans kids role models through which to identify and the average age of transition would probably go down, making HRT more effective and increasing the chances of dysphoria reducing.

So no, I don’t think the concept of passing is inherently problematic because it’s the only way to adequately deal with gender dysphoria. If passing made no sense conceptually then the concept of gender dysphoria would also be incoherent. But dysphoria is critical to understanding the trans experience and thus passing is critical as well. But we need to realize that passing is not the end-all-be-all of our identities. Nonpassing trans people deserve respect and deserve to have their genders recognized without emulating the cis-body perfectly. Trans people should not measure their intrinsic worth as people by how well they can pass as cisgender. I know plenty of nonpassing trans women who are happy being their authentic selves and go about their life like anyone else without too much concern for whether they pass perfectly. These women are role models on how to live successfully in a society that can be cruel and harsh to non-normative people. And furthermore, we need to spread the message in Laverne Cox’s hashtasg #transisbeautiful, which is that trans people are beautiful not just when they pass for cis, but rather, they are beautiful in virtue of not passing as cis.

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Is Dysphoria Necessary for Being Trans? The “Truscum” Debate

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There’s a debate raging in the trans world that has been on going for awhile. The debate is between self-described “truscum” (also called trans medicalists) vs what I will call “maximals”. Truscum believe that gender dysphoria is necessary for being trans and that being trans is essentially a medical condition defined by dysphoria and the desire for “opposite” sexed bodily characteristics. The name comes from the idea of “true trans” – the idea that we can develop a way of determining who is “truly trans” vs those who are merely “trans trenders” i.e. cis people confused into thinking they are trans for whatever sociological/personal reason, perhaps because they want to fit into niche internet communities or what truscum would call the “special snowflake” phenomenon.

Before I go on further, I need to point out that trans medicalists have self-consciously reappropriated the term “truscum” to describe their position. A more traditional way of talking about this debate is in terms of separating “true transsexuals” from “transgender” people where “transgender” means those trans people who don’t want to medically transition and “transsexual” means those that have dysphoria and want to medically transition. But “transsexual” is a very outdated term that comes from the old-school psychiatric community. Try to read this post without thinking the term “truscum” is pejorative. As you will see, I believe there is a huge amount of truth in the truscum concept so I’m not bashing the belief system, merely using the term I see most often used by self-described trans medicalists.

In contrast, “maximals” believe that dysphoria is not necessary for being trans and generally want to expand the trans umbrella to be maximally inclusive. Maximals often lump crossdressers and gender nonconforming people into the “trans” category (though this is an oversimplication I will discuss below). Maximals don’t believe being trans is necessarily a medical condition or believe that if you’re trans there’s something necessarily “wrong” with you. Instead of defining trans people as those people with gender dysphoria, maximals often define being trans as the state of having a gender that is different from the gender/sex you were assigned at birth. This definition is maximally inclusive because it doesn’t require dysphoria in the definition. For example, if you are non-binary, perhaps agender, you might not have dysphoria about your body but your gender is different from the gender you were assigned at birth.

Let’s get some other definitions out of the way. “Gender dysphoria” is generally defined as a disconnect between the sexed body and your self-model of how you want your body to be. If you were assigned male at birth but feel your body should be female instead then you have gender dysphoria and vice versa for trans males.

So what’s the beef between these two viewpoints? Truscum often argue they are trying to help “real” trans people get better access to medical care for transition. They also argue they are trying to break down gender stereotypes insofar as they argue that if you’re a guy who enjoys femme clothing and makeup that doesn’t necessarily make you trans and vice versa for butch women. The idea is that crossdressing and gender nonconformity is not enough to be trans – one must be deeply dissatisfied with your sexed body and desire the “opposite” sexed body, otherwise we lose the very distinction between gender nonconforming cis people and trans people.

In contrast, maximals generally argue that the line between gender nonconformity and being trans is fuzzy and hard to pin down precisely. They deny that dysphoria is necessary because they want to deny that gender can be reduced to any physical characteristics such that if you have an assigned-male body you don’t necessarily need to medically transition in order to feel comfortable in a female gender identity or live your life socially as a female – and they would go further and argue society should accept these people as “real” women just as real as any other woman, cis or trans. Furthermore, maximals often emphasize that sometimes trans people transition not because they experience gender dysphoria but rather they experience gender euphoria. Gender euphoria is the joy one experiences in taking on a new gender identity, expression, pronouns, social existence, etc. Euphoria can also be achieved through medical transition. One might not necessarily hate one’s body but nevertheless desire to medically transition because one believes that would bring greater satisfaction into one’s life.

Another argument available to maximals depends on transgenderism in non-Western societies. Take native “Two Spirit” people, which is generally the term for trans/gender expansive people in Native American society. The argument goes that being Two Spirit cannot be so easily mapped onto Western ideas of transgenderism which typically revolve around gender dysphoria and medical transition. Instead, transgenderism in non-Western societies or historical contexts generally depends on a more complicated gender role system that is outside the Western male-female binary. But we must be careful because historical trans people sometimes did take steps to alter their bodies e.g. eunuchs in the Bible would sometimes self-castrate. So we can’t necessarily say that non-Western transgenderism is entirely divorced from gender dysphoria. And I will admit frankly I don’t know enough about these other cultures to definitely state anything about whether trans people in these societies felt what is now called gender dysphoria. But the general point maximals make is that transgenderism has been around a long time before it was “medicalized” by the West into a pathological condition that needs to be corrected with HRT and surgery. For example, Two Spirit people would not necessarily believe there is anything wrong with being Two Spirit in the sense of it being a medical pathology.

But we need to be careful – I know a Two Spirit trans woman who does have dysphoria and has been on HRT to correct it – so Two Spiritism and modern medical transition are not at odds necessarily. But the general point maximals make is that transgenderism in non-Western societies cannot just be reduced to Western conceptions of what it means to be trans because that would be trying to force a complex system of beliefs and social roles into something they’re not.

Another argument the maximals can make is refer to the complexities of how the drag world relates to the world of trans people. Most drag queens are just cis males who enjoy expressing a feminine self from time to time but ultimately don’t desire female bodily characteristics and like being able to come home and take off the drag and get back into guy mode. But if you know anything about drag you know that some drag queens eventually do go on to identify as trans and medically transition. But these drag queens often continue to perform as drag queens during their transition. Is that fair? Allowing trans women to compete in what is traditionally a male activity? The issue is complicated because gender is complicated and messy, with boundaries between different identities being fuzzy. This is what fuels maximalist arguments: gender noncomformity is an expansive phenomenon that reflects many complex facets of identity and social roles.

But clearly truscum are right that gender noncomformity in and of itself is not sufficient for being trans. A man who wears makeup is not necessarily trans just because it’s noncomformist for men/boys to wear makeup. Similarly, a woman with short hair who shops in the men’s section is not automatically trans otherwise we wouldn’t have a distinction between butch women and real trans guys. To think otherwise is to buy into sexist stereotypes that men must act/behave in a certain way in order to be “real men” and vice versa for women. Interests in cars or barbies does not define gender. Whether you are assigned male or female at birth cannot predict the range of interests and activities that someone is going to take up in their lifetime. Some men are femme and some women are masc and some people are very fluid in their gender expression.

So who’s “right”? Truscum or maximals? In my view that debate boils down to a false dichotomy and over simplification. I take a non-reductionist view of transgenderism. It cannot be defined in terms of necessary and sufficient conditions universal to all trans people nor can it be reduced to any one physical condition or medical pathology. Where maximals go wrong is in saying that gender dysphoria has nothing to do with being trans. Gender dysphoria is experienced by almost all trans people in some fashion or another, but truscum go wrong in assuming this dysphoria can be defined neatly in terms of desires for the “opposite” sexed body. First of all, this relies on what Julia Serano calls “oppositional sexism” – the idea that men and women are total “opposites”. Instead, Serano argues that people overlook the massive similarity and overlap between the two sexes and further argues that the very idea there are only two sexes/genders is overly simplistic when we consider intersex phenomena and complex multi-gender systems in non-Western cultures where there are sometimes upwards of 5 different genders.

One thing philosophers learn is that there is often a grain of truth to all theories that have been developed by smart people. There are smart, informed people on both sides of the truscum debate. Both sides think they are doing something to help trans people achieve greater acceptance in society. But the problem with the “debate” is that it tries to reduce the phenomena of transgenderism into a narrow box. Both truscum and maximality are narrow-minded insofar as they try to reduce the complexity of gender and sex to a single ideological system.

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Filed under feminism, Gender studies, Trans studies