Demedicalising trans

If trans people are not sick, and not defined by the psychiatrists, what are we? Is it something we are- really of the opposite sex or gender- something we desire, or something we do, transition? Is it about gender roles, or about sex? Is it defined by other people- you know that self-righteous way they have of cornering you and asking if you’ve had your bits chopped off- in a sneaking, sideways manner, not straight out. One asked me if I’d transitioned “with a big T or a little t”. Or the trans groups, by turns expressing delight that we are having operations, or bemoaning the long wait, or the psychiatrists’ gatekeeping. “I know it won’t grow back,” we say. “I don’t want it to!”

The cis police us, and we police ourselves. I remember strong doubts expressed that a “non-op” could be a “true transsexual”, even though she said she had a heart condition and no doctor would anaesthetize her.

What would the cis police think of a trans woman before her op? Possibly treat them as suspiciously as they would treat someone who was Not Transsexual. When someone corners me like that, it feels that it’s grudging toleration on offer, if I am anatomically correct, and torches and pitchforks if not- for, otherwise why ask?

If we are not sick, and we do not need psychiatry, or counselling, or correction so that our gender identity matches our sex, why do we need our bodies altered? Is that what “being trans” means- the desire to alter your body and approximate sex characteristics of the acquired gender?

I wonder if “knowing you are of the opposite gender, or wanting to be of the opposite gender” is who we are, a question of being, or how we explain ourselves, just the words we have learned to use to describe ourselves. “I knew I was a girl when I was six,” we say, but what did you think a “girl” was? A girl, dressed differently, playing different games, going to grow up to be a Mummy who was different from a Daddy. But the cultural differences between the two change over time and the anatomical differences may not be so noticeable to that six year old.

In the Keira Bell case the judges said that at 14 you don’t know what sexual fulfilment would be like, or whether you will want children of your own.

The concepts, the verbal formulae, come from psychiatrists or scientists, observing us like a primitive tribe or a mental illness. They are hammered out in the press, talking of sex changes and giving a stereotyped story of My Transsexual Struggle. We then become jealous of them. If this is the price of continued toleration in society, we want to fit the Rules, and exclude anyone who might not more ruthlessly than the straights do.

Is how we conceptualise ourselves the most important thing, what we do, or what we desire? I would say desire and action- the person, desperate yet terrified to transition, or who transitions. If there are ten times more transitioned people in the UK than there were twenty years ago, this shows that more will transition as we learn about it and see it is possible, and the societal opposition decreases. But then, the conception can create the desire. If the operation is the symbol of acceptability, we desire that symbol, and might imagine we desire it for itself, rather than because the cis require it of us.

Don’t have GRS. If you tuck, there is almost no visible difference unless you are naked. You might find a use for that penis. If we are not sick then we don’t need treatment, including hormones or surgery. Be certain you want the surgery for itself, not as the symbol of True transsexuality. Transition should not be a process involving changes to expression, role, and body, but a series of discrete choices.

In the “stable version” ICD 11, there was a long definition of gender incongruence, involving desire for the other sex’s sexual characteristics. Now that has been dropped, and the definition is this:

Gender incongruence is characterised by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex. Gender variant behaviour and preferences alone are not a basis for assigning the diagnoses in this group.

ICD 11 does not say what, if anything, should be done to such people. Don’t define yourself by what other people demand of you.

2 thoughts on “Demedicalising trans

  1. Thank you for writing this. This is definitely a issue that I sometimes question myself. With society constantly showing more fluidity with the definition of gender, it really does raise the question: why bother transitioning?

    For me personally, it is more about anatomy. I was never content with my male body. I despised it. My hatred for my look was so strong, I didn’t want my picture taken. I didn’t want to even look in a mirror. I hated looking at myself. To this day I still hate looking down and seeing an unwanted hose dangling between my legs. I am literally counting down to my planned surgery date. So, for me, it is definitely about anatomy.

    That being said, I have noticed the my personal relationships have shifted upon coming out. When I presented predominately as a male, I didn’t have the type of conversations I do now with my female friends and colleagues. I am enjoying our private conversations more, now as a woman than I did when I was a man.

    I cannot speak on behalf of others, nor will I try. Everyone has their own reason for transitioning, but this is mine. Thank you, again, for this piece. Cheers.


    • Welcome, Ayame. Thank you for commenting, and congratulations on your upcoming surgery.

      You give the alternative perspective. Some of us want surgery. I don’t know if your parents were particularly intolerant of you looking even slightly feminine, but it sounds as if you had to pretend hard to be conventionally masculine, and approximate that look. That traumatises trans children. I fear it inculcates too rigid ideas of what is a man, or what is a woman, in the child.

      We all have to answer the question “Who am I?” It is particularly difficult after having to suppress ourselves.


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