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"Transmedicalism" isn't medical.
Since 2015, the American Psychological Association's guidelines have said nonbinary genders "are a normal part of human diversity that should be affirmed rather than pathologized."
https://sci-hub.se/https://www.sciencedirect.com/science/article/abs/pii/S1077722918301020?via%3Dihub
And the guidelines for healthcare?
Since 2015, the American Psychological Association's guidelines have said nonbinary genders "are a normal part of human diversity that should be affirmed rather than pathologized."
https://sci-hub.se/https://www.sciencedirect.com/science/article/abs/pii/S1077722918301020?via%3Dihub
And the guidelines for healthcare?
"The World Professional Association for Transgender Health promotes the highest Standards of Care for the Health of TGNC People. The SOC are based on the best available science and expert professional consensus."
Since 2011, they've been nonbinary-inclusive.
Since 2011, they've been nonbinary-inclusive.
"Other individuals... may describe their gender identity in specific terms such as transgender, bigender, or genderqueer, affirming their unique experience that may transcend a male/female binary understanding of gender....
"They may not experience their process of identity affirmation as a 'transition,' bc they never fully embraced the gender role they were assigned at birth, or [because that process] does not involve a change from one gender role to another.
"For example, some youth identifying as genderqueer have always experienced their gender identity and role as such (genderqueer). Greater public visibility and awareness of gender diversity (Feinberg, 1996) has further expanded options for people with gender dysphoria....
"Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics).
"Treatment is individualized: What helps one person alleviate gender dysphoria might be very different from what helps another person. This process may or may not involve a change in gender expression or body
modifications."
https://www.wpath.org/publications/soc
modifications."
https://www.wpath.org/publications/soc
I can't find it right now, but I remember seeing a list of examples of "gender euphoria" on Tumblr once, on which a whole bunch of transmeds had said, "lmao you're literally describing gender dysphoria." Like... yes, they're two different ways of looking at the same thing.
Now, about that claim that the SOC come from "the best available science and expert professional consensus."
Trans people fought for decades to demedicalize it this far. It's trans activists who finally got WPATH to include trans voices and leadership, and to reduce gatekeeping.
Trans people fought for decades to demedicalize it this far. It's trans activists who finally got WPATH to include trans voices and leadership, and to reduce gatekeeping.
It continues to make progress. The upcoming version of the SOC had each chapter go through revision by the communities it affected, including health professionals within those communities.
It's still not informed consent.
It's still not informed consent.
One of the most common transmed arguments is that we need to medicalize being trans, because otherwise nobody will cover transition.
There are a LOT of important reasons that the trans community has been fighting to DEmedicalize it.
There are a LOT of important reasons that the trans community has been fighting to DEmedicalize it.
1. Medicalizing transition means requiring trans people to be sterilized before they can legally change their gender.
It's often not phrased this way. Instead, governments will require hormones and surgical procedures that result in sterilization. https://tgeu.org/trans-rights_europe_map_2016/
It's often not phrased this way. Instead, governments will require hormones and surgical procedures that result in sterilization. https://tgeu.org/trans-rights_europe_map_2016/
2. Letting cis doctors decide who should transition, and when, led to horrifying barriers.
For example: for decades, the Standards of Care required you to be straight. In the 80s, Louis Sullivan led the fight to change that. But it took years. https://cfshrc.org/article/living-and-dying-as-a-gay-trans-man-lou-sullivans-rhetorical-legacy/
For example: for decades, the Standards of Care required you to be straight. In the 80s, Louis Sullivan led the fight to change that. But it took years. https://cfshrc.org/article/living-and-dying-as-a-gay-trans-man-lou-sullivans-rhetorical-legacy/
I transitioned in the late 90s. We all knew: you have to tell doctors the Standard Very Binary Trans Story. They want to hear that you've always known you're the opposite gender. You refused to play with cars/wear dresses. You're the right gender in your dreams. Etc.
The narrative doctors were used to, and wanted to hear, was passed around the trans community like sacred oral history. It was like sharing the passcodes to transition.
It was very classist, too. They wanted to see that you were a gender-conforming, successful man or woman.
It was very classist, too. They wanted to see that you were a gender-conforming, successful man or woman.
They wanted to see heels, skirts, nylons, makeup, jewelry, hair done. Or ties, button-down shirts, short neatly groomed hair, slacks. Anything else might be a sign of gender confusion. Of frivolity. Of being too young, poor, or mentally ill, to know your own mind.
We also passed around info about which clinics/doctors/therapists were trans-friendly. A tiny number were known as "gender mills" -- places that let you transition quickly. Where they were trans-competent, and trusted you to make decisions about your own body.
But even those could be nightmares. I was determined to be open about being genderqueer, to try to pave the way for others. I went to one of those clinics -- the Tom Waddell Clinic, in San Francisco -- and the doctor I saw was, uhhh....
She decided that my explanation of being gender-fluid, and wanting to be able to pass as more than one gender, meant that I wanted to take testosterone to "be more dykey." She told me to see the therapist for 6 months and then if I still wanted to transition, maybe we could talk.
I had a very confusing conversation with the clinic's therapist, because I didn't realize he had NO context, had not looked at my chart, and hadn't been told anything about why I was there, and that I was expected to repeat my story, what I wanted, and why, to every new person.
At some point during that visit, I finally figured out that they didn't understand and didn't want to help me. Trying to explain myself to providers who had no idea what I meant and didn't believe me was really traumatic, and threw me back into questioning everything.
A year or so later, my trans youth group went to see Gendernauts at @framelinefest. I remember it as being a really encouraging, interesting documentary about the experiences of a lot of nonbinary people: intersex activists, performance artists, and more. https://www.intersexequality.com/e-d-hida-viloria-in-the-groundbreaking-gendernauts/
And in the middle of it, 30 ft tall on the silver screen, the doctor I'd seen was suddenly repeating what I'd said - that I was bigender and wanted to be more androgynous - as an example of someone she didn't think should transition. As the equivalent of "I want to look dykier."
My hands were literally shaking for the rest of the movie, and most of the Q&A after.
I was very lucky to be able to share that with the filmmakers during the Q&A. They were horrified to hear the context for what she'd said.
I was very lucky to be able to share that with the filmmakers during the Q&A. They were horrified to hear the context for what she'd said.
And I was even luckier that I had a trans youth group. And that the late Dr. Deborah Brown came to it when she was starting a queer youth clinic ( http://dimensionsclinic.com ), to ask trans youth what we needed. And that they were well-informed about enbies. So I did microdose T.
That's one of the BETTER stories of what can happen with gatekeeping. By far.
Because even the Tom Waddell Clinic was supposedly using the informed consent model.
In this longer clip, you can see what some of the alternatives were, and how much it can vary by who you see.
Because even the Tom Waddell Clinic was supposedly using the informed consent model.
In this longer clip, you can see what some of the alternatives were, and how much it can vary by who you see.
I've heard nightmare stories of sexual assault from trans women who went to that clinic. I'm sure that happens elsewhere, too.
Because when you control whether someone can transition, you have, potentially, the power of life and death over them.
Because when you control whether someone can transition, you have, potentially, the power of life and death over them.
3. As you can probably tell, that all creates serious barriers to being honest and open with a therapist who's involved in your transition.
Many people have pointed out that requiring therapy is, at best, kind of pointless under these conditions. https://medium.com/@alysonescalante/abolish-the-standards-of-care-respect-transgender-agency-81af0e6dfc18
Many people have pointed out that requiring therapy is, at best, kind of pointless under these conditions. https://medium.com/@alysonescalante/abolish-the-standards-of-care-respect-transgender-agency-81af0e6dfc18
At worst, it gives abusive therapists carte blanche to get away with abuse.
And much of the time, as this doctor shows, it means having unrelated mental health issues -- or ones that would be helped by transitioning -- prevents you from transitioning. https://www.psychiatrictimes.com/view/transition-care-transgender-patients-with-psychiatric-substance-use-disorders
And much of the time, as this doctor shows, it means having unrelated mental health issues -- or ones that would be helped by transitioning -- prevents you from transitioning. https://www.psychiatrictimes.com/view/transition-care-transgender-patients-with-psychiatric-substance-use-disorders
4. The myth is that we need medicalization in order to get trans medical care covered by insurance. But that doctor, above, also points out that even when it's medicalized, it's not necessarily covered. (As was the case from 1981 - 2014.)
It doesn't have to be this way. And it isn't this way everywhere.
Argentina is the only country in the world where you can change your gender markers without either a psychiatric diagnosis or medical treatment. https://www.ozy.com/around-the-world/argentinas-trans-formation-is-reshaping-latin-americas-gender-rights/225293/
Argentina is the only country in the world where you can change your gender markers without either a psychiatric diagnosis or medical treatment. https://www.ozy.com/around-the-world/argentinas-trans-formation-is-reshaping-latin-americas-gender-rights/225293/
Their 2012 Gender Identity Law also "permits... hormone treatments, and partial or total surgical interventions without requiring judicial or administrative authorization. These procedures only require the patient’s informed consent."
https://www.huesped.org.ar/wp-content/uploads/2018/03/Ley-de-Identidad-de-Genero-y-acceso-a-la-salud-de-personas-trans-ING.pdf
https://www.huesped.org.ar/wp-content/uploads/2018/03/Ley-de-Identidad-de-Genero-y-acceso-a-la-salud-de-personas-trans-ING.pdf
Based on that document, their messy, inequitable insurance system is similar to the one in the United States. And this law requires all of them to cover trans care. Including their version of Medicare.
It doesn't have to be like this.
It doesn't have to be like this.
P.S. Great news, we're still passing around "the lies that medical gatekeepers want to hear" and being forced to jump through outdated hoops. Because, again: when they have the power of life and death, they can do whatever they want. https://www.reddit.com/r/ask_transgender/comments/bs2y9w/wpath_soc_7_questions_likely_to_get_asked_by/
We need more than just the Argentine model. We need widespread, common understanding of trans experiences and what good trans-aware medical care looks like.
We are in the WEEDS.
And pushing to medicalize and gatekeep our own care just makes that worse.
~Fin~
We are in the WEEDS.
And pushing to medicalize and gatekeep our own care just makes that worse.
~Fin~
