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Transmedicalism

Transmedicalism is the conservative belief that being transgender is not a trait, but a medical condition. Transmedicalists support one or more disease models to describe their gender identity and expression:

  • Psychosexual pathology (the sexual disorder model)
  • Psychopathology (the mental illness model)
  • Pathology (the birth defect model)

Transmedicalism is closely tied to transsexual separatism, a political movement to distinguish between transsexual people and other gender diverse identities and expressions. Transmedicalists often distinguish their community by claiming there is a clinical threshold for being transgender or transsexual. For instance, they may say you have to have “gender dysphoria” or a similar mental illness in order to be part of the community, or they may only include people who take hormones and/or have bottom surgery as part of the community.

Because transmedicalism often excludes many people who consider themselves trans, it is often viewed as controversial, especially by those who are excluded by transmedicalists.

Background

The value-neutral scientific model presents gender identity as a trait and gender expression as a behavior. Because the expression of gender identities can include medical options, several medicalized disease models were proposed in the 20th century. People trained in medicine often conceptualize traits in metaphors of disease and impairment, especially traits that some consider socially undesirable. For instance, American psychiatrists categorized “homosexuality” as a disease until 1973.

Some people in our community have supported disease models for many reasons:

  • To make gender diversity more acceptable to others (social desirability)
  • To get healthcare providers to help us
  • To get our healthcare paid for by governments or private insurers
  • To support political or legal goals in the short term
  • Self-recognition / sense of belonging
  • Self-hatred

Gatekeeping of trans healthcare was strictly controlled throughout much of the 20th century. The goal of this gatekeeping was to distinguish the “true transsexual” (or “primary transsexual”) from other gender diverse people. In these taxonomies, the “true transsexual” was the top of the hierarchy. Others were “pseudotranssexual” or other invalidating terms that suggested a true/false binary. Some trans people internalized this true/false binary. In the 21st century, the slur “truscum” was popularized to insult transmedicalists, which many later reclaimed as a term of pride. The slur “tucute” came into use in apposition to “truscum.” A “tucute” is someone who does not believe a person has to have a diagnosis or take medical steps to be part of the community.

References

Konnelly, Lex (June 4, 2021). Both, and: Transmedicalism and resistance in non-binary narratives of gender-affirming care. Toronto Working Papers in Linguistics. 43 (1). https://doi.org/10.33137/twpl.v43i1.35968.

Ben, Vincent (July 2, 2020). Non-Binary Genders: Navigating Communities, Identities, and Healthcare. Policy Press. ISBN 978-1-4473-5194-8

Kisner, Logan Ashley (June 10, 2019). “Truscum”: Why Do They Hate The Way They Do? Medium https://atranslog.medium.com/truscum-why-do-they-hate-the-way-they-do-23d5f9fe21aa

Ballard, Jason Robert (March 26, 2019). Identifying as Truscum is a Disservice to Yourself. FTM Magazine https://ftmmagazine.com/identifying-as-truscum-is-a-disservice-to-yourself/ [archive]

Baril, Alexandre (November 2015). Transness as Debility: Rethinking Intersections between Trans and Disabled Embodiments. Feminist Review. 111 (1): 59–74.https://doi.org/10.1057/fr.2015.21.

Wijnants, Alexander (Spring 2013). Identity of Neurology Social Media and the Politicization versus Medicalization of Trans People. Synaesthesia http://www.synaesthesiajournal.com/uploads/Wijnants_v1_n4.pdf [archive]

James A (2006). A defining moment in our history: Examining disease models of gender identity. Gender Medicine. 3. S56. https://doi.org/10.1016/S1550-8579(06)80121-X

Resources

Wikipedia (en.wikipedia.org)

RationalWiki (rationalwiki.org)

Gender Wiki (gender.fandom.com)

reddit (reddit.com)