GRSJ224/Medicalization of Transgender Identities

Trans Terminology

The trans flag was created by Monica Helms to represent girls, boys, and intersex people, those who are transitioning, and those who are gender neutral.

The Transgender Health Information Program is an organization based out of British Columbia that aims to provide information and resources to Canada's trans community. Their website includes a full glossary of trans related terms. Among them, trans is defined as an umbrella term for a variety of people whose gender expression doesn't match their sex, determined by biological characteristics at birth.

What is medicalization?

When something is medicalized it comes to be seen as a condition that can be diagnosed and treated. The medicalization of trans bodies has a long history that is especially obvious in the representation of transgender individuals in the DSM, The Diagnostic and Statistical Manual of Mental Disorders. Gender identity disorder in children and transsexualism were first added to the DSM in 1980. In the fifth edition of the DSM, published in 2013, these diagnoses were removed in favour of gender dysphoria, defined as "formal diagnosis given... to people who experience distress because of a significant incongruence between the gender with which they personally identify and the gender with which they were born".

A gender dysphoria diagnosis is often used as a means of gatekeeping, it is used to determine who is eligible for gender affirming procedures that some governments deem necessary to legally change parts of your identity.

Requirements for People Seeking Gender Affirming Procedures
For more information on the requirements trans people must meet in Canada in order to receive gender affirming procedures see: Centre for Addiction and Mental Health.

Criticisms of the inclusion of gender dysphoria in the DSM are wide ranging, from the argument that framing gender variation as a disorder stigmatizes a minority group, to creating a criteria for what counts as "trans enough.", to concerns that it restricts an individual's ability to decide how to proceed with their social, legal, or medical actions. Unfortunately, gender dysphoria as a diagnosis is pervasive and both directly and indirectly determines a number of ways trans people can or cannot act in their day to day lives.

What problems does medicalization create for trans people?

Restricts access to health care

Trans people in Canada who seek gender affirming surgeries or treatments (for example, hormone therapy, or surgery on their genitalia or breasts) may only do so through one Canadian clinic, the Centre for Addiction and Mental Health, in Toronto. A person must meet a checklist of criteria before they are deemed eligible for these procedures. This includes a diagnosis of Gender Dysphoria, and a requirement that the person must have told key people involved in their lives that they are trans. Not only do these requirements exclude people from medical procedures who may not feel safe disclosing their trans identities, but they make the assumption that trans people are incapable of deciding what actions they need to take to fully express their gender.

In the USA, where a gender dysphoria diagnosis is not federally mandated as a necessary precursor to trans related surgeries, clinics themselves within the largely private sector of health care that caters to trans needs may require a diagnosis. It has been found that this practice has lead to an unfortunate tendency for health care professionals to serve as "gatekeepers," denying their services to trans people they do not deem fit candidates. This is true in Canada as well, where diagnoses are required. Imposing strict guidelines serves to create a binary view of gender. What this means is that, if a trans person feels they require medical intervention to express their gender identity, they are allowed to do so as long as their gender identity falls within the binary of male or female. This "[fails] to recognize the right of trans people to formulate their own views of gender identity". As noted in the following sections, the medical model asserts diagnosis and treatment as necessary to being trans by requiring genital surgery to legally identify with your expressed gender, by imposing work place restrictions on those who have not physically transitioned, and by creating hostile social environments.

Further Barriers to Trans Medical Care
Trans people are further restricted in their access to medical procedures due to the long wait lists to see psychiatrists for diagnosis and gender affirming procedures, as well as the cost of procedures and differential insurance coverage. Read more here.

Creates legal barriers

"Imagine that the federal or state government provided important legal protections, benefits, and access to social programs to minorities only if the person conformed to a predetermined set of physical characteristics that were more typical in non-minorities."

The above quote by Anne E. Silver pulls our attention to one way the medicalization of trans identities takes a real toll on trans people. In order to live as their expressed gender, some trans people feel that it is necessary to legally change their name, their birth certificates, and other legal documents. In British Columbia, gender affirming surgery is not necessary to make the following legal changes: changes to name, legal identification, social insurance cards or birth certificates, including those issued in Alberta, Ontario, Manitoba and Nova Scotia. However, proof of gender affirming surgery may be necessary in order to make changes to ones passport. Additionally, although gender affirming surgery is not required to make changes to federal documents, transhealth.ca, a transgender health information program, recommends submitting proof of surgery in order to support ones request for name or gender changes on federal documents.

Although Canada has come a long way from requiring proof of gender affirming surgery to justify similar changes in the past, government officials continue to act as gatekeepers in some areas where they may deny requests they believe are unfounded.

Creates social barriers

The necessity of gender affirming treatments or surgeries may be pushed on an individual in contexts outside of the medical community and the legal system. For example, when trans people and their experiences in the work place were studied by sociologists Kristen Schilt and Laurel Westbrook, it was found that employers had ways of policing what surgeries their trans employees pursued. One man, called John, reported that his employer was open to, and supportive of, his transition, but that he was forced to wear the female uniform until he began taking testosterone. Schilt and Westbrook also looked at how friends and colleagues of these transmen treated them. On numerous occasions, friends and colleagues were supportive of their transition until they thought about genitalia. When women thought about their trans coworkers, they had trouble imagining them in sexual or romantic relationships if they had not received gender affirming surgery. Some made comments about their inability to have sex, because they lacked the appropriate masculine genitalia. These ideas come from an assumption that gains support from this medical model, that in order to be a real man you must have a penis and be capable of penetrative sex, a sentiment that ignores gender and gender identity and reduces people to their genitalia.