Transmedicalism: An Ideology of Exclusion

By Jiner Huang ‘28

Though conversations about transgender rights have grown louder in recent years, they have not necessarily been kinder. Even in LGBTQ+ spaces, supposed allies characterize trans identity exclusively as a medical condition defined by diagnosed gender dysphoria and treated by medical transitioning. This ideology, known as transmedicalism, claims to bolster authenticity but instead reinforces the placement of trans existence under external control. In fewer words, transmedicalism is the belief that to be transgender is to have a medical condition that requires treatment. However, when its legitimacy depends on a diagnosis, the trans identity falls prey to cisgender authority; transmedicalism thus polices trans bodies under the pretense of protecting them. If self-understanding builds the foundation of identity, transmedicalism is the cage built to contain it.

According to undergraduate writer CJ Hendrie of the University of Colorado at Boulder in 2022, transmedicalism justifies and even encourages the surveillance and oppression of trans people under the guise of science. Indeed, deeming medical transition the only gateway to being “legitimately trans” makes the trans identity inherently exclusionary to social groups lacking access to quality, affordable healthcare, a fact especially concerning given the racialized nature of health access in the United States. Specifically, as of 2023, Latino, Black, and indigenous people disproportionately belong to the roughly 26 million Americans who lack health insurance coverage, per a Kaiser Family Foundation report from February. Those who are granted access to “legitimate transness” through medical narratives, as defined by cisgender metrics, are also granted legal benefits. Policies rooted in these ideologies affect lives every day, in every instance where trans people are asked to present medical documentation to change gender markers or acquire hormone therapy.

As trans activist Dan Irving wrote, our current medical system allows medical experts to decide, via a gender dysphoria diagnosis, whether a person is “trans enough” to begin transition. “Gender dysphoria,” as defined by the American Psychiatric Association’s DSM-5, is “a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least [six] months” and manifesting through a number of symptoms. Unfortunately, the assessments required to verify these symptoms bring us back to the issue of medical inequities. More broadly, when medical professionals are handed the keys to an individual’s self-determination, medical surveillance subsumes trans identity. Herein lies the trap of transmedicalism: it denies the validity of “other” constructions of trans identity, thereby turning mainstream discourse about transgender identity into an idealized debate where everyone has access to unbiased healthcare. More concerningly, transmedicalist ideology tends to translate into the narrative that transgender people do, and should, hate their bodies to fit the model of gender dysphoria as the core of transness. Transgender bodies are not portrayed as empowering, but rather as a source of shame. Gender dysphoria defines “the experience of being transgender [as] inherently one of great psychological distress… the result of a medical condition,” according to an award-winning undergraduate gender studies paper from the University of Texas at Austin. When the perceived legitimacy of an identity hinges on the extent to which an individual hates their own body, identification processes actuate a self-fulfilling cycle of dysphoria. When transmedical views of self are popularized and then internalized, the hegemonic systems of hierarchy constructed to oppress trans subjects are internalized as well.

On a societal level, though, transmedicalism dismisses the difficulties associated with holding a transgender identity by describing them as innate to the identity itself rather than a consequence of living in a structurally transphobic society. Thus, transgender people remain far behind the curve of social reform simply because their bodies have been scapegoated for their struggles. The body is not the problem; society’s disgusted` reaction is. A prerequisite to recognition of trans identity should not be discomfort, much less hatred.

It’s far easier to label a body as disordered than to admit that our society is. Not one person is unworthy of transition, “not trans enough,” or a “transtrender,” as many young trans and nonbinary individuals have been labeled. The idea that someone else has to make sure that being trans is the right choice for someone was invented by cisgender people to prevent transitioning while claiming to support transgender decisions. To achieve trans liberation, we must stop conflating medical validation with self-knowledge.