Drew Cordes

The Pathologization of Trans* Identity

Filed By Drew Cordes | March 05, 2013 11:00 AM | comments

Filed in: Living, Transgender & Intersex
Tags: hormone replacement therapy, trans* identity, trans* pathologization, trans* pathology

Devoted Bilerico readers might remember a conversational post from Winter Tashlin and me about reclaiming words and accompanying issues of identity. While I found the discussion edifying, there is one prickly subject I glossed over in a comment that has been hounding me ever since. When discussing the reasons why trans* Thumbnail image for Thumbnail image for bigstock-Human-Gender-Icons-30597875.jpgfolks are privy to certain terminology while cis people are not, I said, "For trans people, it's about the body. Some of us are non-op, yes, but dysphoria regarding the body is always there."

Now, I can tell you definitively, because I'm the one who said it, this statement is complete bullshit. This reasoning of mine is faulty at best, and downright dangerous at worst.

I have a number of trans*-identified friends and lovers who are non-op and do not desire hormone replacement therapy. The fact that I failed to recognize as valid the existence of people I was already physically and emotionally intimate with shows the sobering extent to which trans* identity has become pathologized by the medical community/industry and the dominant cultural narratives that reinforce the diagnosis.

To be transgender is to harbor a gender-related dysphoria for one's body, it all says; and because this is the most easily understood narrative (and therefore, the most popularized and familiar), and because people in white coats who went to school for longer than us have devised some (debatably effective) treatment methods for it, "transgender" and bodily dysphoria have become synonymous.


Many trans*-identified people are not disaffected by their bodies, but rather by the gendered meanings, expectations, and associations attached to their bodies. Sometimes, it's both. Sometimes it's one or the other. However, because the cis medical world and the cis media have so effectively decided for us what "transgender" means, even we trans people often forget this. The medical-science-approved, increasingly socially accepted (though, obviously, still not that accepted), binary-reinforcing form of transness is not the extent of our diverse existence. Not that there's anything wrong with transitioning to or from a "traditional," masculine male expression from or to a "traditional," feminine female expression; what's wrong is our notion of transness being limited by this myopia.

The hyperfocus on what has become (for me, at least) the loathsomely simplistic and familiar "trapped in the wrong body" narrative only reinforces the gender binary system that causes trans* people such pain in the first place.[1] For many trans* people, our bodies are perfectly correct, thank you very much. The problem is how our body determines the way we are viewed and treated by a society that does not hear our voice, respect our wishes, or make much of an effort to change even once those latter points are acknowledged. For non-op, no-HRT trans* folks, their bodies are fine; it's the lens through which everyone views them that is wrong.

There is no treatment option for these trans* people, and with good reason -- they are perfectly healthy. It is the heteronormative gender binary that is the disorder, the disease. I guess we shouldn't be surprised that our cis overlords focus on medical treatment for the symptom instead of the real problem. Acknowledgment of those trans* people who are asymptomatic would be to acknowledge that real problem -- the binary lens -- and that would inconvenience the cis, heteronormative status quo, so don't expect it to happen without profound struggle.

Furthermore, the equation of trans* identity to medical condition divides our own community and alienates us from ourselves. Friends of mine who have serious issues with their gender identity and how it is perceived in the world feel hesitant and dissuaded from identifying as trans* because it is so ingrained in us that the "transgender" label is something one must qualify for via diagnosis, pills, therapy, or surgeries. This notion not only invalidates the feelings of those who do not want to change their bodies, but also drives a wedge between them and the rest of the community, since many will not want to claim trans* identity or inhabit trans* spaces because of some well-intentioned but fallacious notion of respect -- not wanting to infringe upon or misappropriate from those who do "qualify" and claim trans* identity.

The thought that there are gender-confused and gender-nonconforming people out there who willingly isolate themselves instead of bonding with and learning from others in the trans* community because they do not think they qualify or belong ... That is unacceptable. We cannot abide these delusory divisions. Just like any other, the trans* community is strongest when it is diverse.

We must remind ourselves of the most fundamental principles of gender and transness -- your body is not your gender; your physical sex is not your fate. If you can be a man with breast tissue and a vagina, if you can be a woman with a penis, you can be trans* with whatever body you possess, whether you choose to alter it drastically or maintain it the way it is.

[1] My more paranoid, pessimistic aspect worries the increased acceptance of this iteration of transness is the first step toward my greatest fear: assimilation -- erasure cloaked in acceptance, the smiling destruction of individuality, diversity, and culture. No word chills me more.

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