‘Are you a girl or a boy?’ A study into the reinforcement of gender binary through medical...

8/10/2019 Are you a girl or a boy? A study into the reinforcement of gender binary through medical transition and the NHS.

1/87

SO71089A - Gender, Media & Culture DissertationStudent number: 3330 9!"

#ord $ount: 1 ! 0

Are you a girl or a boy? A study into the reinforcement of

gender binary through medical transition and the NHS.


2/87

An in-depth critique and discussion into the medicalization

of the transgendered person in both historical and current

conte ts! and the normalization of transse uality through

the implementation of the gender binary model in terms of

language and medical inter"ention.

#ntroduction

%


3/87

'is dissertation #ill be loo(in) into t'e #a*s trans +eo+le must

$on orm to s+e$i $ )ender binaries in order to be le)itimi.ed as a

rans)ender +erson and to re$ei/e and )ain a$$ess to sur)er* and

'ormone treatments, s+e$i $all* t'rou)' t'e national 'ealt'$are

s*stem

#is' to e2+lore t'e #a* stereot*+i$al )ender roles are en$oura)ed

in order to le)itimi.e medi$al transition, and 'o# a$$ess to )ender

reassi)nment ser/es as a re#ard or ul llin) t'e uota o

4mas$uline male4 and 4 eminine emale 5

#ill loo( into t'e e6e$t t'is 'as on non-binar* identi ed trans

+eo+le and t'e e2tent to #'i$' medi$al $on$e+tions o se2ed

identit* asso$iated medi$al +ra$ti$e 'a/e a detrimental e6e$t to t'e

en$om+assin) o all trans +eo+le #it' /ar*in) )ender identities#it'in so$iet* and #it' a$$ess to medi$al $are

#ill do t'is b* rstl* loo(in) into t'e 'istor* o medi$ali.ation o

trans and )ender /ariant +eo+le in bot' 'istori$ and $urrent

$onte2ts 'is #ill in$lude a loo( into $orre$ti/e5 sur)er* on nterse2

+eo+le and t'e #a* ambi)uous )ender is +er$ei/ed as abnormal5

#it'in medi$al +ra$ti$e #ill also be loo(in) into t'e initial

$on$e+tion o trans5 into medi$al dis$ourse and t'e $'an)es and

+ro)ression made o/er time #it' re+la$ement o terms su$' as

)ender identit* disorder5 to )ender d*s+'oria5 #it'in t'e DSM-

3


4/87

manual Do t'ese $'an)es in medi$al terminolo)* re e$t a $'an)e

in attitude and a ne# understandin) o )ender identit*

#ill address issues o Gender binar* as a s*stem o o++ression b*

loo(in) at te2ts su$' as; 199 ?

and Alison @oo(e5s ellin) rans Stories,5 >%010? #'i$' o$uses on a

+ro e$t in/ol/in) debates bet#een *oun) rans +eo+le and medi$al

+ro essionals in/ol/ed in t'eir $are as #ell as Oral Bistor* ta(en

rom literature b* o#ie Da/* >%010?

n t'e nal +art o t'is dissertation #ill be dra#in) u+on m* small

s$ale resear$' stud* o non-binar* identi ed trans inter/ie#

+arti$i+ants, and an online sur/e* t'at as(ed uestions relatin) to

t'e medi$al intera$tions and $are t'e* 'ad re$ei/ed as a non-binar*+erson it' t'is a++roa$' and b* dra#in) u+on ea$' indi/iduals5

e2+erien$e, 'o+e to illustrate t'e #a*s in #'i$' t'e 'ealt'$are

s*stem is ailin) non-binar* trans +eo+le


5/87

$ac%ground

%01 'as been a )ood *ear in re)ards to raisin) /isibilit* o rans

+eo+le and +uttin) issues o rans)ender ri)'ts into t'e s+otli)'t

Erom Fa/erne Co2 ma(in) 'istor* as bot' t'e rst trans)ender a$tor

to be nominated or an mm* >Cullen, %01 ? and or bein) t'e rst

rans +erson to eature on t'e ront $o/er o ime Ma)a.ine >Ba$'H,

%01 ?

Bo#e/er, in$reased /isibilit* 'as meant t'at mainstream media andso$iet* 'a/e $onstru$ted t'eir o#n ideas and ideals o #'at trans5

si)ni es to t'em based on +otentiall* outdated ideolo)ies and

de nitions o trans)ender 5 ==C Online or e2am+le, de nes a

trans)ender +erson as, ISomeone #'o 'as a $on/i$tion t'at t'e*4re

tra++ed in t'e #ron) bod* J >bb$ $o u(?

'ere 'a/e been man* $riti$isms o t'e #ron)-bod*5 model su$' as

alia =ett$'er5s ra++ed in t'e ron) 'eor*,5 in #'i$' s'e states,

IK 'e #ron)-bod* narrati/e is dee+l* $onne$ted to )enital

re$onstru$tion te$'nolo)ies, t'e narrati/e, ust as t'e

!


6/87

te$'nolo)ies, is o+en to #orries about $lass and ra$e-

di6erentiated a$$ess 'e #ron)-bod* narrati/e outlines a

standard )enital re$onstru$tion sur)er*, and an* identit* t'at

ails to desire t'at is ruled ineli)ible t t'ereb* attem+ts to

restri$t a$$ess to #oman'ood or man'ood itsel t'rou)'

'e)emoni$ $lass-, ra$e-, and $ulture-in e$ted modalities J

>=ett$'er, %01 : 0%?

=ett$'er outlines 'o# limitin) rans identit* to a #ron)-bod*

narrati/e di$tates t'e aut'enti$it*5 o a trans +erson5s identit* t'at

must ollo# t'e )uidelines o an o++ressi/e medi$al de nition, su$'

as: t'e desire or $orre$ti/e5 )enital sur)er* #'i$' #ill dis$uss

urt'er, in t'e se$tion 'e +roblem #it' Corre$ti/e sur)er* 5

"


7/87

&onte t 'art #( &larifying )rans )erminology

o ensure $larit* o t'e sub e$t, eel it ne$essar* to de ne #'at

mean b* trans +eo+le5 t'rou)'out t'e $onte2t o t'is essa* 'eterm trans5 $an usuall* be in$or+orated #it'in man* le/els o

)ender ambi)uit* n a$t one o t'e rst +roblems en$ountered

#as )i/in) it a narro# de nition as it is utili.ed as su$' an e2tensi/e

umbrella term

'is notion o a term t'at en$om+asses )ender /arian$e on su$' a

'u)e s$ale is em+'asi.ed in anessa S'eridan5s Com+lete Guide o

rans)ender n 'e or(+la$e 5 As S'eridan e2+lains,

I rans)ender is a /er* bi) tent t'at $o/ers a lot o territor*,

#it' mu$' o it diL$ult to $ate)ori.e A use ul understandin)

7


8/87

o t'e term is t'is: trans)ender in$ludes e/er*t'in) not

$o/ered b* our $ulture5s narro# terms or man5 and

#oman 5J >S'eridan %009:1?

n t'is dissertation, #ill use t'e term trans5 to des$ribe t'ose #'o

do not identi * #it' t'e biolo)i$al )ender t'e* #ere assi)ned at

birt' One im+ortant a$tor t'at S'eridan >%009? ails to mention is

t'at t'e medi$ali.ation o trans +eo+le does not seemin)l*

a$(no#led)e t'is /ast s+e$trum o alternati/e )ender identities t'at

t'e term trans5 $o/ers

'is #a* o /ie#in) )ender 'as been debated b* man* ueer

t'eorists > 'ittle, %000; %00"? #'o ar)ue t'at )ender is /er*$om+le2, is a so$ial $onstru$t > 'illi+s, %00";


9/87

IKMost +'*si$ians a)reed t'at t'e true se2 'ad to be de ned

b* t'e stru$ture o 'isN'er )onadal tissue Dre)er labeled t'is

+eriod 'e a)e o )onads 5 Ar)uin) t'at no matter 'o# an

indi/idual li/ed in a )ender role- t'e* #ould be labeled male

or emale b* t'eir anatomi$al )onads J >Ma( %00!:"9?

As Ma( >%00!? e2+lains, t'e belie #as 'eld t'at t'e $onstru$tion

and a++earan$e o *our )enitalia ultimatel* de ned ones )ender

identit* 'ilst Ma( ar)ues t'ere 'ad been ueries and dis+utes

re)ardin) t'e $on$e+t o se2N)ender lon) be ore'and, Dre)er

ar)ued t'at =lair =ell, a sur)eon in Fi/er+ool >191!?, #as one o t'e

rst to +ubli$l* uestion t'is +ra$ti$e b* as(in) I 'et'er #e are

usti edK in brandin) +atients #it' a se2 t'at is o ten orei)n not

onl* to t'eir a++earan$e but also to t'eir instin$ts and so$ial'a++inessJ >Ma(, %00!: "9?

e $an $on$lude t'at =ell #as ad/o$atin) t'e idea t'at anatom*

s'ould not ne$essaril* re e$t )ender identit*, and b* dra#in) u+on

t'e so$ial 'a++iness5 o indi/iduals, =ell re$o)ni.es t'e ad/erse

a6e$ts t'at brandin) +atients5 $an 'a/e on ones emotional

#ellbein)

it' t'is in mind, Ma( >%00!? states 'o# a ne# understandin) o

biolo)i$al se25 be)an to in uen$e t'e lan)ua)e used to de ne

)ender Ma( #rites, IOt'er (inds o biolo)i$al se2 #ere bein)

dis$o/ered, e ) 'ormonal se2 and $'romosomal se2 A s'i t in

9


10/87

$on$e+tuali.ation also attributed a s'i t in name, rom

'erma+'rodite to interse2 J >Ma(, %00!:"9?

&onte t 'art ##( )he #ssue *ith correcti"e and #nterse

surgery

n t'is se$tion #ill loo( into t'e $on$e+t t'at nterse2 sur)er* as

$orre$ti/e5 is a esterni.ed $ultural idea in uen$ed b* a belie

s*stem t'at $onsiders )ender ambi)uit* abnormal5 and in need o

medi$al inter/ention b* #a* o sur)i$al normali.in) >in t'is $ase?

se2ual or)ans to ma(e t'em a++ear more male5 or emale 5 n

10


11/87

ot'er #ords; en or$in) a binar* )ender identit* on an ot'er#ise

)ender-neutral indi/idual

o illustrate t'is, am )oin) to o$us on an$* 'renrei$'5s essa*

nterse2 sur)er*, EGC and t'e sele$ti/e $ondemnation o $ultural

+ra$ti$es5 >%00!? n #'i$' s'e $om+ares $riti$isms o A ri$an $ultural

+ra$ti$es o Eemale $ir$um$ision5 more $ommonl* (no#n as

Eemale Genital Mutilation >EGM?,5 and loo(s into #'* t'ese same

$riti$isms are not a++lied to t'e +ra$ti$e o interse2 sur)er*

'renrei$' states t'at mu$' o t'e ar)ument for nterse2 sur)er* is

based around t'e #a* it is re+resented as res+e$ted +ra$ti$e +urel*

#it'in a medi$al $onte2t, I 'e estern medi$al $ommunit* 'as

re+resented its )enital $uttin) as modern, s$ienti $ and abo/e

re+roa$' J > 'renrei$', %00!:71? =* t'e same to(en, A ri$an )enital$uttin) is +resented as a barbari$, irrational and 'arm ul5 +ra$ti$e

due to it bein) $onsidered une$$essar*5 > 'renrei$', %00!:71? due

to t'ere bein) no s$ienti $ or medi$al e2+lanation or t'e +ra$ti$e

'renrei$' ar)ues t'at +la*in) EGC under in t'e $ate)or* o t'e

ot'er5 means t'at estern eminist s$'olars >and medi$al

+ra$titioners ali(e? ail to a$(no#led)e t'e similarities bet#een t'e

t#o +ra$ti$es

One su$' +ro$edure, s'e ar)ues, t'at o sur)i$al )enital $uttin)

on$e $onsidered ne$essar* to be +er ormed on interse2 in ants

$arried ar )reater ris(s t'an A ri$an )enital $uttin), isenrei$'

$omments t'at t'ese +ro$edures are medi$all* une$$essar*5

11


12/87

> isenrei$', %00!:7 ? #'i$' is one a$tor u+'eld in ar)uments

a)ainst A ri$an EGC 'e im+ortant +oint is made o/er t'e use o

medi$al terminolo)*5 and a$$e+table lan)ua)e t'at 'arbor +ositi/e

and 'armless $onnotations su$' as $ir$um$ision o/er t'e use o

terminolo)* used to des$ribe EGC su$' as mutilation5 and $uttin) 5

> isenrei$', %00!:7%?

'e di6eren$e in 'o# t'ese sur)eries are re erred s'o#s 'o# one

t*+e o )enital sur)er* is $onsidered a$$e+table o/er t'e ot'er due

to t'e belie t'at one is ne$essar*5 and s$ienti $all* usti ed

be$ause t'e medi$al +ro essional sees t'e sur)er* as $orre$ti/e,

e/en i t'e +ro$edure itsel 'olds more 'ealt' ris( and is more

in/asi/e t'an EGC isenrei$' ar)ues t'at it is t'e $onstru$tion o

A ri$an so$ieties and +ra$ti$es bein) +resented as +rimiti/e,

+atriar$'al and barbari$5 > isenrei$', %00!:7!? essentiall* im+l*in)t'at A ri$an understandin)s o t'e bod* are merel* $ultural5 t'at

ser/es as usti $ation to $ondemn su$' +ra$ti$es

Considerin) t'e similarities bet#een to t'e t#o sur)eries in t'at

t'e* bot' run t'e ris( o in e$tion, are medi$all* unne$essar*, $an

a6e$t se2ual un$tion and $an $ause +roblems later in li e, 'o# is

sur)er* on nterse2 in ants usti ed

One e2+lanation as illustrated in an arti$le rom 'e nde+endent

ar)ues t'at it is due to t'e medi$al +ro essional5s re usal to allo# or

t'e e2isten$e o t'ose babies #'o do not all neatl* into t'e

$ate)or* o male or emale 5 >Morrison, %013?

1%


13/87

Sara' Morrison re+orts t'at,

IP nterse2 +eo+leQ ar)ue t'at t'eir /er* e2isten$e 'as been

eradi$ated5 b* =ritis' so$iet* Generations o $'ildren 'a/e

been o+erated u+on to normali.e5 t'eir )enitalsK #'ile

oL$ial do$umentation rom birt' $erti $ates to +ass+orts

re uires a male or emale bo2 to be ti$(ed J >Morrison, %013,

m* em+'asis?

Morrison not onl* 'i)'li)'ts t'e a$t t'at nterse2 +eo+le are bein)

or$ed into a )ender binar* b* #a* o 'a/in) t'eir )enitals

normali.ed5 and t'eir interse2 identit* subse uentl* eradi$ated, but

also introdu$es t'e $on$e+t o bein) or$ed into a )ender binar* b*de ault due to la$( o a++ro+riate do$umentation su$' as: 'a/in) to

ti$( a male or emale bo2 on a +ass+ort

I n t'e 19"0s it be$ame t'e norm to o+erate on $'ildren #it'

at*+i$al se2ual anatom* at a *oun) a)e Do$tors assi)ned t'e

$'ild5s )ender and o+erated to rein or$e it J >Morrison, %013? 'is

$on$e+t o sur)i$al inter/ention on se2 or)ansNanatom* en or$es t'e

idea t'at )enitaliaNse2 e uates to )ender identit* and t'e t#o

be$ome indistin$t rom one anot'er

13


14/87


15/87

Mone* ar)ued t'at t'rou)' sur)eries and 'ormone treatments5 'e

$ould turn a $'ild into #'i$'e/er se2 seemed most a++ro+riate

> oo, %00 ? n t'e $ase o @eimer 'o#e/er, t'e se2 t'at #as

deemed a++ro+riate5 #as +urel* based on t'e ailed $ir$um$ision

attem+t as o++osed to t'e $'ild5s )ender identit* and e2+ression

m+ortantl*, Mone* is also uoted as statin) 'e 'ad e2+erien$ed

su$$ess $'an)in) t'e se2 o babies born #it' in$om+lete or

ambi)uous )enitalia 5 > oo, %00 ? Ambi)uous )enitalia5 im+lies

t'at it does not $orres+ond #'at #ould medi$all* be $onsidered

normati/e, i e male or emale )enitalia

e $an subse uentl* +resume t'at Dr Mone* +er ormed #'at #ould

t'us be $onsidered $orre$ti/e5 sur)er* on interse2 in ants

Dr Mone*5s e2+eriment #as unsu$$ess ul as Da/id #as re e$tin) 'is

emini.ed sel ,5 IKDa/id 'ad steadil* re e$ted >'is? assi)nment

rom male to emale, at 1! 'e re used to $ontinue li/in) as a )irl J

> oo, %00 , m* em+'asis? Da/id e/entuall* $ommitted sui$ide due

to bouts o de+ression namel* brou)'t about b* 'is traumati$

$'ild'ood >Dail* mail re+orter, %010? 'is s'o#s 'o# )ender is

intrinsi$ to t'e indi/idual Sur)er* $annot be +er ormed to di$tate

#'et'er a $'ild is one binar* )ender or t'e ot'er

n udit' =utler5s Tndoin) Gender,5 s'e illustrates 'o# t'e ailure o

Dr Mone*5s e2+eriment )ained 'im man* $riti$s #it'in t'e medi$al

1!


16/87

eld in$ludin) se2 resear$'er Milton Diamond, #'o a$$ordin) to

=utler belie/es in t'e 'ormonal basis o )ender identit* >=utler,

%00 :"0? =utler states t'at t'ose $riti$al o Dr Mone*5s t'eories

belie/ed t'at Da/id5s ailure to be a$$e+t 'is so$iali.ed role as a )irl

s'o#s us t'at t'ere I#as some dee+-seated sense o )enderK one

t'at is lin(ed to 'is ori)inal set o )enitals as an internal trut' and

ne$essit*, #'i$' no amount o so$iali.ation $ould re/erse J >=utler,

%00 :"%?

=utler $omments t'at t'e =rendaNDa/id $ase #as no# bein) used in

order to +ro/ide e/iden$e or t'e re/ersal o Mone*5s t'esis

As su$', t'ese ne# ar)uments #ere, IKsu++ortin) t'e notion o

essential )ender $ore, one t'at is tied in some irre/ersible #a* to

anatom* and to a deterministi$ sense o biolo)* J >=utler, %00 :"%?

=utler dra#s u+on Gender studies +ro essor Anne Eausto-Sterlin) touestion t'is ideolo)* statin),

IBer >Anne5s? /ie#K is t'at alt'ou)' a $'ild s'ould be )i/en a

se2 assi)nment or t'e +ur+oses o establis'in) a stable so$ial

identit*, it does not ollo# t'at so$iet* s'ould en)a)e in

$oer$i/e sur)er* to rema(e t'e bod* in t'e so$ial ima)ine o

t'at )ender Su$' e6orts at $orre$tion5 not onl* /iolate t'e

$'ild, but lend su++ort to t'e idea t'at )ender 'as to be borne

out in sin)ular and normati/e #a*s at t'e le/el o anatom* J

>=utler, %00 :"3, m* em+'asis?

1"


17/87

t $ould be ar)ued t'at b* su))estin) a $'ild s'ould be assi)ned a

se2, t'is +uts t'e o$us ba$( onto t'e biolo)i$al and medi$ali.ed

as+e$t o se2 rat'er t'an t'e $'ild5s o#n )ender identit* Alt'ou)'

Anne stron)l* $riti$i.es t'e idea o $orre$ti/e sur)er* and

normati/e5 ideas o )ender and t'e anatom*, it seems '*+o$riti$al

to $riti ue so$ial norms o )ender #'ile im+l*in) t'e ne$essit* o

se2 assi)nment,5 es+e$iall* on a $'ild #'ose )ender identit* ma*

not t into a maleN emale binar*

Ali$e Dre)er illustrates t'e +roblems o Dr Mone*5 Con$ealment-

$entred5 a++roa$' o interse2 +atients in 'er +a+er S'i tin) 'e

aradi)m o nterse2 reatment,5 #'i$' dire$tl* $om+ares t'e$on$ealment-$entred model >su$' as t'e one utili.ed on Da/id? #it'

a +atient-$entred a++roa$'

'e +a+er #as +re+ared or t'e nterse2 so$iet* o ort' Ameri$a

> S A? Dre)er5s $om+arisons dre# attention to t'e #a* bein)

nterse2 #as inter+reted #it'in medi$al dis$ourse #it'in

$on$ealment $entered model as bein) a rare abnormalit* #'i$' is

'i)'l* li(el* to lead to )reat distress,5 to t'e +atient-$entered model

o nterse2 #'i$' states t'at it is merel* an anatomi$al /ariation

rom t'e standard5 male and emale t*+es; ust as s(in and 'air

$olor /ar* alon) a #ide s+e$trum 5 >Dre)er, S A, %01 ? 'e

17


18/87

Con$ealment a++roa$' re)ards nterse2 as an abnormalit* #'ereas

t'e atient a++roa$' ri)'t ull* understands )ender ambi)uit* as

merel* a /ariation o #'at is $onsidered t'e norm

n t'e se$tion Are nterse2ed )enitals a medi$al +roblem 5 'e

$on$ealment a++roa$' ar)ues t'at i untreated, it is 'i)'l* li(el* to

result in de+ression and sui$ide 5 nterse2ed )enitals must be

normali.ed5 to #'ate/er e2tent +ossible i t'ese +roblems are to be

a/oided 5 >Dre)er, %01 ? 'ere is a dire$t $onnotation #it' nterse2

and abnormalit* as #ell as an im+li$ation o mental 'ealt' issues in

t'e Con$ealment a++roa$' 'e atient-$entered a++roa$' ar)ues

t'at nterse2ed )enitals are not a medi$al +roblems5 and t'at t'ere

are no e/iden$e or t'e $on$ealment +aradi)m 5 >Dre)er, %01 ?

Ar)uabl* t'e belie t'at an nterse2 +erson #ill )ro# u+ to bede+ressed5 or sui$idal5 due to not 'a/in) normal5 )enitalia are

merel* +re$on$ei/ed ideas o t'e medi$al +ro essionals as o++osed

to t'e li/ed realit* o t'e nterse2 +erson

18


19/87

edicalizing )rans( )he 'roblem *ith edicalizing bodies

and edical )erminologies

n t'e boo( rans)ender ation >199 ?, Gordene Ma$(en.ie

dis$usses t'is notion o t'e dama)in) e6e$ts o medi$ali.ation,

IO ten #e lose si)'t o t'e indi/idual #it' $lini$al

$ate)ori.ations and ri)id de nitionK As Eou$ault and lanner

su))est, t'e* 'a/e sti)mati.ed, de'umani.ed, $ondemned

and usti ed t'e barbari$ torture o #'ole )rou+s o +eo+le as

19


20/87

si$( and de/iant,5 sim+l* be$ause t'e* did not $on orm to t'e

status uo J >Ma$(en.ie 199 :!!?

Ma$(en.ie >199 ? $ontinues: IMu$' o t'e medi$al and le)al

+ressure or se2 reassi)nment sur)er* is based on t'e +ersistent

Ameri$an belie t'at some'o#, )ender emanates rom t'e )enitalsJ

>Ma$(en.ie, 199 : !"? Similar to t'e $riti ue o t'e A)e O Gonads,

it is a++arent t'at t'ere is a la$( o se+aration bet#een )ender

identit* and biolo)i$al se2 Ma$(en.ie >199 ? notes;

I 'is idea o trans +eo+le born in t'e #ron) bod* 5 Common

sense di$tates t'at t'e idea o #ron) bodies assumes t'e

e2isten$e o ri)'t bodies @i)'t bodies, a$$ordin) to

transse2ual ideolo)* must mat$' t'e )ender o t'e indi/iduala$$ordin)l* Mas$uline-male, eminine- emale, t'ereb*

rein or$in) se2 and )ender $on)ruen$e demanded b*

$ontem+orar* Ameri$an so$iet* J >Ma$(en.ie, 199 :"1, "%?

Bere #e $an ar)ue t'at trans +eo+le5s )ender identities are di$tated

b* so$ietal +resum+tions on )ender binaries; male and emale 'is,

on$e a)ain, s'o#s t'e rein or$ement o )ender diale$ti$s and

binaries

n 199 ? s'e dis$usses 'o# t'ese

binar* ideolo)ies on )ender in uen$ed 'er de$ision to 'a/e sur)er*,

%0


21/87

I ne/er 'ated m* +enis; 'ated t'at it made me a man R in

m* o#n e*es and in t'e e*es o ot'ers Eor m* $om ort,

needed a /a)ina R #as $on/in$ed t'at t'e onl* #a* $ould

li/e out #'at t'ou)'t to be m* true )ender #as to 'a/e

)enital sur)er* to $onstru$t a /a)inaKJ >=ornstein, 199 : 7?

=ornstein5s desire or sur)er* #as born out o 'er desire to $on orm

to #'at s'e belie/ed at t'e time R #ould ma(e 'er more o a

#oman,5 and t'is #as dire$tl* e uatin) )enitals >se2? to )ender

'is ne2t se$tion #ill be o$usin) on t'e arliamentar* Guidelines

or t'e $ommissionin) o 'ealt'$are treatment ser/i$es or trans

+eo+le, and some o t'e issues t'is brin)s u+ in re)ards to t'elan)ua)e used and t'e de nitions +ut or#ard #it'in t'e )uidelines

'e )uidelines de ne )ender d*s+'oria as,

I> 'e? e2+erien$e o onesel as male or emale t'at is a

)ender identit* #'i$' is in$on)ruent #it' t'e +'enot*+e >t'e

e2ternal se2ual $'ara$teristi$s o t'e bod*? 'e +ersonal

%1


22/87


23/87

Bo# $an a ser/i$e be e2ible #'en it denotes 'o# one must eel to

le)itimatel* be e2+erien$in) )ender d*s+'oria 5 On t'e one 'and it

em+'asi.es t'e a$t t'at treatment s'ould be +atient-led5 im+l*in)

it must a$$ommodate to a +atient-$entred treatment a++roa$' to

ensure ea$' indi/iduals +ersonal needs 'is )i/es a sense t'at

t'ere is some a$(no#led)ement t'at ea$' $ase #ill be di6erent to

ea$' trans +erson, but a)ain, ailin) to a$(no#led)e 'o# ea$' trans

+erson5s d*s+'oria and )ender identit* ma* not re e$t t'e ri)id

de nition o #'at )ender d*s+'oria en$om+asses sin$e t'ere is no

mention o an*t'in) outside o t'e male5 emale5 binar*

n t'e se$tion mar(ed terminolo)*5 t'e )uidelines illustrate t'e

e2tent to #'i$' t'e de nition o )ender d*s+'oria and

transse2ualism5 still utili.e )ender binaries to di$tate 'o# t'e trans+erson #ill identi * nterestin)l*, t'e* also a$(no#led)e t'e #a*s in

#'i$' man* o t'e terms are e/ol/in) I 'e lan)ua)e used in t'e

elds o )ender d*s+'oria is $onstantl* e/ol/in) as understandin)s

and +er$e+tions o t'ese $onditions $'an)e J >G @ S, %009: ?

it is understood t'at +er$e+tions are $'an)in), #'* is it not

ne$essaril* re e$ted #it'in t'e medi$al terminolo)*

IA +erson #'o is transitionin)K s'ould be addressed a$$ordin) to

t'e name and title >Mr, Mrs, Miss or Ms? J >G @ S, %009: ? 'e

)uidelines on$e a)ain onl* oresee binar* )ender titles as a++li$able

to t'e trans indi/idual

%3


24/87

'e )ender-neutral title M25 o e2am+le, 'as not been in$luded

#it'in t'e )uidelines 'e reason #'* t'is is im+ortant is due to t'e

a$t M25 'as been im+lemented b* man* ma or or)anisations and

$or+orations as a le)itimate title $'oi$e, re e$tin) a $'an)e in

attitude re)ardin) )ender identit* and t'e reedom and ri)'t to

e2+ress onesel outside o t'e binar*

An arti$le ta(en rom +ol*in+i$tures online ma)a.ine entitled 'e

Gro#in) Tse o M25 as a Gender- n$lusi/e itle in t'e T%01 ?

illustrates t'is b* listin) /arious $om+anies and or)ani.ations o

#'i$' M2 is an a$$e+ted or o6ered title orm 'ese in$lude t'e

D FA, D , BS, BM@C, ost OL$e Ftd, and most o t'e ma orban(s in$ludin) =ar$la*s, BS=C, @=S Santander, Bali a2 and Co-O+ 5

>+ol*in+i$tures, %01 , online arti$le?

t is +u..lin) t'ere ore, t'at in-de+t' )uidelines set about to edu$ate

and in orm medi$al +ro essionals and or)ani.ations re)ardin)

treatment o trans +eo+le do not en$om+ass t'is t'e )uidelines

state t'at t'e terminolo)* is e/ol/in), t'en t'is s'ould be re e$ted

#it'in t'e literature

Ot'er as+e$ts o terminolo)* e/ol/in) in re)ards to understandin)s

o rans and )ender identities is in t'e tea$'in)s o rans)ender

issues, as illustrated in Faurel estbroo(5s =e$omin)


25/87

Gendered 5 estbroo( $omments, I n $'allen)in) dominant

understandin)s o )ender, tea$'in) trans)ender arti$les +romote an

idea o )ender as a $ontinuum5 as di/erse5 and as uid 5 'ese

understandin)s e2+li$itl* ar)ue a)ainst a belie t'at t'e #orld is

$om+rised o t#o mutuall* e2$lusi/e )enders J > estbroo(,

%008: 9?

t is interestin) to see t'at in tea$'in) trans)ender arti$les, it

+romotes t'e ideolo)* t'at t'ere are more t'an t#o binar* )enders,

sin$e mu$' o t'e in ormation based on medi$al (no#led)e o

trans)endered +eo+le does t'e o++osite

I=esides $'allen)in) $urrent )ender norms 'ese tea$'in)

trans)ender arti$les dis+ute dominant understandin)s o

)ender b* ar)uin) t'at all +eo+le s'ould be allo#ed to $'ooset'eir )ender and t'at )ender s'ould not be determined b*

se2 J > estbroo(, %008: 9?

estbroo( ar)ues t'at it is t'e indi/idual #'o s'ould $'oose t'eir

)ender identit*, dire$tl* o++osin) t'e idea t'at medi$al

+ro essionals are t'e ones #'o )et to di$tate an indi/iduals )ender

identit* or a rans)ender +erson5s status b* #a* o le)itimi.in) t'e

rans status based on a dia)nosis o )ender d*s+'oria 5

n Boll* =os#ell5s 'e rans)ender Alternati/e5 s'e states,

%!


26/87

IMan* $on use se2 #it' )ender Se2 is biolo)i$al, )ender is

+s*$'oNso$ial biolo)* does not trul* di$tate )ender or

+ersonalit*, t'en di$'otomies o mas$ulinit* and eminit* ma*

onl* ser/e to $oer$e or restri$t t'e +otential /ariet* o #a*s o

bein) 'uman J >=os#ell, 1991:31?

=os#ell is essentiall* im+l*in) t'at mas$ulinit* and emininit* do

not re+resent or $oin$ide #it' eit'er )ender identit*, and are in a$t

so$ial $onstru$ts t'at #or( a)ainst a notion o )ender uidit*

'e )uidelines )o on to state, I t is im+ortant to note t'at man*

+eo+le A ter re$ei/in) t'e a++ro+riate medi$al $are do not identi *

as trans, but sim+l* as men5 and #omen 5J >G @ S, %009: ? 'e

$on$e+t o trans +eo+le sim+l*5 identi *in) as men or #omen )i/e anotion o normali.ation, and t'e im+lementation o t'e #ord sim+l*5

im+lies t'at identi *in) in t'is #a* is a ar less $om+le2 identit* t'an

it is to identi * as trans)ender @emo/e t'e trans5 status and

underneat' t'e* are ust re)ular men and #omen li(e e/er*one

else

=* statin) t'at rans +eo+le identi * in t'is #a* a ter re$ei/in) t'e

a++ro+riate medi$al $are5 su))ests t'at trans +eo+le $ould onl*

reall* identi * as men5 or #omen5 +ost sur)er* or 'ormones

'en a trans +erson dis$ounts t'eir trans identit*, t'is is #'at is

(no#n #it'in literature and trans $ommunities as li/in) in stealt' 5

%"


27/87

O+inions on stealt'5 /ar* drasti$all* #it' some ad/o$ates o trans

+eo+le denoun$in) it as 'a/in) ne)ati/e $onse uen$es on t'e

$ommunit*

An arti$le in 'e ransad/o$ate or e2am+le, stated 'o# it is onl*

#'en trans+eo+le are out and o+en about t'eir )ender identit*, t'at

$'an)e #it'in so$ietal o+inion and +oli$* 'a++en IKOnl* bein) out

and +roud o bein) trans 'as led to t'e ma or )ains #e5/e made in

t'e +ubli$ +oli$* realm t'e last e# *ears J >@oberts, %013?

@oberts ar)ues t'at bein) stealt' +er+etuates t'e narrati/e o trans

+eo+le bein) or$ed to 'ide t'eir trans identit*, ar)uabl* asso$iatin)

bein) trans)ender #it' an innate sense o s'ame

IBo# are t'e* 'el+in) t'e trans $ommunit* b* O bein) out

at t'e t#o lar)e )a* in$lusi/e or)anisations 'e* #ill bemore $on$erned about 'idin) t'eir trans status at all $osts

t'an bein) er$e ad/o$ates or our $ommunit* alon)side

t'ese or)anisations J >@oberts, %013?

'is statement is in re)ards to t'e " alle)ed stealt' trans +eo+le

#or(in) at B@C and GFAAD t $ould be ar)ued t'at so$ial and

medi$al rein or$ements on a$$e+table )ender identities 'a/e an

im+a$t on a trans +erson5s #illin)ness to dis$lose $ertain

in ormation about t'emsel/es

%7


28/87

Anot'er #a* o inter+retin) t'is is b* loo(in) at it rom a

+ers+e$ti/e o aturali.in)5 rans)endered +eo+le, and instead o

$onsiderin) bein) trans)endered outside o t'e normati/e,

understandin) it as somet'in) t'at 'as merel* been $onsidered as

su$' b* *ears o so$ial $onditionin)

Faurel estbroo( dis$usses t'is idea b* loo(in) into rans)ender

arti$les t'at address issues o aturalisin)5 rans)ender

I 'rou)' t'eir tone and ormattin), as #ell as e2+li$it $laims

t'at trans)ender +ra$ti$es $ome rom nature, t'ese tea$'in)

trans)ender arti$les naturalise t'e $on$e+t o trans)ender5K

Aut'ors re uentl* ar)ue t'at trans)ender is natural and

biolo)i$al Eor e2am+le, Boll* =os#ell #rites t is our $ulture

t'at 'as brain#as'ed us and our amilies and riends, #'omi)'t ot'er#ise be able to lo/e us and embra$e our di/ersit*

as desirable and natural R somet'in) to be $elebrated 5

> estbroo(, 1991:31?J

Eor =os#ell, it is $ulture and so$iet* t'at 'as made trans)ender

identit* or )ender ambi)uit* abnormal5 as o++osed to t'e identit*

itsel , #'i$' s'e states is natural 5 t $ould be ar)ued, t'at medi$al

dia)nosis o Gender D*s+'oria5 and medi$al literature 'a/e also

$ontributed to an ideolo)* o rans)endered +eo+le not ne$essaril*

ttin) in #it' t'e norm t is also im+ortant to note, t'at or t'ose

rans +eo+le #'o do not identi * into eit'er binar* )ender, ail to

%8


29/87

'a/e t'e o++ortunit* to be )ranted normalisation5 due to t'e a$t

t'at t'eir identit* is not $onsidered le)itimate

/egitimizing )rans #dentities 'art #( 0ender ecognition Act

and Acceptable "s. 1nacceptable )rans #dentities

'is se$tion #ill be o$usin) on #'at (inds o trans +eo+le uali * or

le)al $iti.ens'i+ and are re$o)ni.ed #it'in t'e le)al s*stem and

so$iet* and im+ortantl*- t'ose #'o don5t t #ill also loo( into

le)islati/e $'an)es su$' as t'e Gender @e$o)nition A$t >%00!? and

#'et'er t'is 'as been bene $ial or trans +eo+le and i not, #'*,

%9


30/87

and i it 'as been bene $ial- or #'o o aid t'e dis$ussion #ill be

o$usin) on Sall* Bines rans ormin) Gender: So$ial $'an)e and

rans)ender Citi.ens'i+ 5 >%00"?

'e Gender @e$o)nition A$t $ame into or$e in A+ril %00! allo#in)

trans +eo+le to be$ome t'e a$ uired )ender5 b* #a* o a++l*in) or

a Gender @e$o)nition Certi $ate t'at 'ad to be a++ro/ed b* a

Gender @e$o)nition anel 'e Certi $ate #ould allo# t'e trans

+erson to 'a/e t'eir birt' $erti $ate and +ass+ort altered so t'at

t'e )ender #ould mat$' t'eir li/ed5 )ender

n S'eila M$Fean5s Eirst Do o Barm5 >%013? s'e $omments t'at t'e

a$ uirin) o a G@C is:

IKSub e$t to $ertain e2+e$tations J >M$lean, %013:!"3? I 'ea++li$ant >must 'a/e? 'a/e )ender d*s+'oria, 'as li/ed in t'e

a$ uired )ender or at least t#o *ears, and intends to

$ontinue to do so or t'e rest o 'is or 'er li e As su$', t'e

anel5s de$ision is one o a$t rat'er t'an ud)ment J >M$Fean,

%013:!"3?

M$Fean 'i)'li)'ts t'e a$t t'at t'e G@C $an onl* be obtained b*

ul llin) $ertain uotas su$' as t'e dia)nosis o )ender d*s+'oria,

and li/in) in role5 or t#o *ears

30


31/87

As +re/iousl* establis'ed, t'e uota needed to ul ll a dia)nosis o

)ender d*s+'oria rests uite rml* on a notion o identi *in) onesel

male5 or emale5 t'at di6ers rom biolo)i$al se2 'is #ould ma(e it

in$reasin)l* diL$ult or a trans +erson #'o does not identi * #it'in

a binar* to be eli)ible or a Gender @e$o)nition Certi $ate =ut #'*

does t'is matter t matters be$ause t'e G@A #as $onsidered a s'i t

in $'an)in) attitudes to#ards trans)ender +eo+le and in

en$om+assin) t'em as le)al $iti.ens as illustrated b* Sall* Bines

>%013?

Bines $ommented t'at t'e Gender @e$o)nition A$t re+resented t'e

$i/il re$o)nition o )ender transition5 and mar(ed an im+ortant

$'an)e in attitudes to#ards trans)ender +eo+le 5 >Bines S, %013:%?

'is s+e$i $ $'an)e in attitudes #as in re eren$e to t'e a$t t'e

le)islation no lon)er re uired sur)i$al inter/ention as a re uirementto obtain a G@C Bines states t'at t'is IKbrin)s a ne# rame#or(

or understand se2 and )ender, and t'e relations'i+ bet#een t'ese

$on$e+ts J >Bines, %013:%?

'ilst it is +ositi/e t'at s'i ts in understandin)s o )ender and se2

'a/e +ro)ressed so ar as to not di$tate )ender /ia )enitalia, in 'er

+a+er rans ormin) Gender,5 Bines ar)ues t'at t'e G@A is still

rooted in medi$alised #a*s o t'in(in) t'at mar)inali.e +ra$ti$es o

)ender di/ersit* >Bines S, %007:1? n ot'er #ords- t'e G@A still

limits #'at is a$$e+table and le)itimi.ed )ender di/ersit* and #'at

31


32/87

isn5t I ormati/e binar* understandin)s o )ender under+in re$ent

so$ial and le)islati/e s'i ts J >Bines, %007:1?

'is is e/ident in t'e a$t t'e G@A onl* a$$ommodates t'ose trans

+eo+le loo(in) to $'an)e t'e )ender on t'eir birt' $erti $ate rom M

to E or /i$e /ersa, and t'e ri)'t to marr* in t'eir ne#5 )ender

One o Bines5 inter/ie#ees C'ristie5 'i)'li)'ted t'e a$t t'at t'e

ri)'ts t'e G@A )ranted #ere not e2tended to non-)endered +eo+le

$ommentin),

I $ould onl* su$$ess ull* a++l* or )ender re$o)nition i #ere

to identi * #it'in t'e )endered so$ietal $onstru$tK 'e la#

does not re$o)ni.e 'uman e2isten$e outside t'e )endered

so$ietal stru$ture J >Bines, %010:100?

'e le)islation onl* ser/es t'ose trans +eo+le #'o 'a/e t'e desire

to $'an)e rom one binar* )ender mar(er to t'e ot'er

n Ste+'en 'ittle and ar*n itten5s 'e )re*in) o rans)ender

and t'e Fa#,5 t'e* dis$uss t'ese e2a$t issues in relation to t'e G@A

$ommentin), I t is bot' medi$all* in$orre$t and et'i$all* #ron) to

assume t'at trans +eo+le5s needs onl* relate to )ender

reassi)nment t'era+ies and sur)eries J > 'ittle, itten, %00 :!11?

'is a$(no#led)es t'e a$t t'at t'e needs o rans +eo+le )o

be*ond medi$al inter/ention 'ittle and itten 'i)'li)'t t'e a$t

3%


33/87

t'at t'e +at'olo)isin) o rans bodies $an be e2tremel* dama)in)

to indi/iduals

'is is illustrated in t'e $ase o rans man ames5 #'o at 71 and

#it' earl* sta)es o Al.'eimer5s #as +la$ed #it'in a lo$al aut'orit*

#'ere e/er* ot'er $lient #as emale > 'ittle, itten, %00 :!13?

I 'e sta6 at t'e $are 'ome #ere /er* un$om ortable #it' meetin)

'is bodil* needs and #ere /er* un'a++* #it' 'is $onstant remo/al

o 'is in$ontinen$e +ads J > 'ittle, itten %00 :!13? n$identall*,

ames 'ad under)one $'est re$onstru$tion sur)er*, but not )enital

sur)er* A lo$al /olunteer $onta$ted a su++ort )rou+ a ter

dis$o/erin) ames /er* distressed A rans man met u+ #it' ames

to dis$o/er 'e #as /er* distressed #it' t'e use o in$ontinen$e +ads

used, and re)arded t'em as #omen5s aids 5 > 'ittle, itten,

%00 :!13? A ter a t'reat to in/o(e Disabilit* Dis$rimination ames#as e/entuall* mo/ed into a Men5s 'ome and be$ame mu$'

'a++ier 'ittle and itten $omment,

I 'e estern biomedi$al 'ealt'$are s*stem, #it' e#

e2$e+tions, +at'olo)ises trans-be'a/iours and interse2ed

bodies R ri)'t mindNri)'t bod* /s #ron) mindNri)'t bod* or

ri)'t mindNambi)uous bod*K rans5 is in/isibilised as #ell as

+at'olo)ised, t'rou)' a $lassi $ation o mental +at'olo)* J

> 'ittle, itten, %00 :!13-!1 ?

33


34/87

'e em+'asis on marria)e5 'i)'li)'ts an idea o a$$e+tabilit* t'at

is rooted in 'eteronormati/e ideals, su$' as marria)e and binar*

)ender Bines $omments, IK otions o $iti.ens'i+ are

'eterose2ualised, su$' boundaries o toleran$e de+end u+on ri)'ts

based $laims >su$' as t'e ri)'t to marr*? #'i$' t #it' a

'eterose2ual model o t'e )ood $iti.en 5J >Bines, %007:7? t $ould

be ar)ued t'at t'e same $an be a++lied to notions o a$$e+table

trans +erson5 /s una$$e+table 5 Eor e2am+le: a binar* identi *in)

trans +erson /s non-binar* trans +erson Bines utili.es t'e )'t or

lesbian and )a* ri)'ts as an e2am+le o t'e #a* arti$ulatin) t'e

ri)'ts o lesbian and )a*s t'rou)' t'e $on$e+t o $iti.ens'i+ 5

>Bines, %007:7?

n Mi$'ael arner5s 'e trouble #it' ormal,5 'e $omments t'atIMarria)e, in s'ort, #ould ma(e or )ood )a*s R t'e (ind #'o #ould

not $'allen)e t'e norms o strai)'t $ulture, #'o #ould not aunt

se2ualit*, and #'o #ould not insist on li/in) di6erentl* rom

ordinar* ol( J > arner, %000:113?

arner ma(es an im+ortant +oint; t'e $on$e+t o not li/in)

di6erentl*5 rom ordinar* ol( 5 'is notion $ould de nitel* be

a++lied to rans)ender +eo+le in t'e sense t'at t'ose #'o $om+l*

#it' medi$al transition in order to +resent as a binar* )ender are

ordinar* ol(5 $om+ared to t'ose #'o don5t

3


35/87


36/87

be a$$e+ted #it'in 'eteronormati/e so$iet* b* ollo#in) t'e alle)ed

san$tit* o marria)e

'e idea o a$$e+table /s una$$e+table in re)ards to alternati/e

se2ual identities $an also be noted in =ell

and =innie %000:19? Alternati/e se2ual +ra$ti$es and identitiesare +us'ed into t'e +ri/ate and in/isible s+'ere, $ausin) a

di/ision bet#een )ood )a*s5 and >disre+utable? bad ueers 5J

>=ro#ne


37/87

/egitimizing )rans #dentities 'art ##( edical )reatment

Narrati"es and 0endered &itizenship

'is se$tion #ill loo( into t'e medi$al narrati/es a rans +erson

must usuall* ollo# in order to be seen as a le)itimate $ase or

medi$al inter/ention and treatment #ill also be loo(in) into t'e

#a*s rans +eo+le are a6orded Citi.ens'i+ b* loo(in) into t'e

$on$e+t o #'at is seen as a$$e+table5 and una$$e+table5 in

37


38/87

re)ards to identities t'at are situated outside t'e norm, and t'e

+attern o a$$e+tabilit* one must ollo# in order to attain

$iti.ens'i+

Bines $omments t'at, IK 'ilst some ne# orms o trans

emininities and mas$ulinities are bene ttin) rom re$ent +oli$*

de/elo+ments, ot'er e2+erien$es and +ra$ti$es o )ender

trans ormation remain mar)inali.ed J >Bines, %007:%?

t $ould be ar)ued, t'at t'ere is a real la$( o resear$' on t'e to+i$

o mar)inali.ed trans +eo+le due to a la$( o re+resentation and

a$(no#led)ement o t'ese trans +eo+le5s e2isten$e n man* $ases,

a non-binar* trans +erson #ill ollo# a medi$al narrati/e o a binar*

trans +erson +urel* in order to mo/e t'rou)' t'e 'ealt'$are s*stem

ro/idin) t'ese trans +eo+le identi * as one binar* )ender or t'eot'er and +resent t'emsel/es in a satis a$tor* #a* t'at +ro/es t'e*

$an $on orm to a s+e$i $ )ender role,5 t'e* are able to ul ll t'e

medi$al +ro essionals e2+e$tations and t'us re$ei/e a$$ess to

medi$al $are and a$$ess to $ertain le)islation and ri)'ts to

$iti.ens'i+ Ot'er trans +eo+le are e2$luded be$ause t'e* do not

$on orm to t'e rules set out b* t'e 'eteronormati/e state

'is idea is illustrated in o#ie Da/*5s ransse2ual A)ents5 >%010?

in #'i$' s'e inter/ie#ed /arious sel -de nin) rans +eo+le and t'eir

e2+erien$es #it'in t'e 'ealt' $are s*stem One su$' +arti$i+ant

named =en amin res+ondin) #'en as(ed about t'e +ositi/es rom

t'e BS stated, I 'e +ositi/es are onl* t'at *ou )et #'at *ou need

38


39/87

rom 'e ne)ati/es #ereK /er* )enerali.ed and out o date

uestionin) #'i$' resulted in standard ans#ers J >=en amin,

transman rom Da/* , %010:11!?

Da/* states t'at t'is res+onse ollo#s a standard narrati/e,5 >Da/*,

%010:11!? and t'e res+onses are t'ere ore not trut' ul a$$ounts o

t'e trans +erson5s identit* +er se, but rat'er obli)ator* res+onses

rooted in +re$on$ei/ed (no#led)e o #'at re uirements are

ne$essar* to a$$ess medi$al $are

IAs #it' t'e ma orit* o +arti$i+ants in t'is resear$'K =en amin

understood t'at ta2onomi$ le)itima$* and a dia)nosis are re uired

to a$tuali.e trans ormation o >'is? bod* J >Da/*, %010:11!, m*

em+'asis? Da/* 'i)'li)'ts t'e a$t t'at =en amin 'ad +rior

(no#led)e t'at t'e $ondition5 >in medi$al terms? o I ransse2ualismJ >Da/*, %010? 'ad to be le)itimi.ed b* a medi$al

+ro essional, and subse uentl* +ersuadin) t'e )ate(ee+er to allo#

or a$$ess to t'e treatment

IMost +arti$i+ants demanded medi$al ser/i$es e/en t'ou)'

some #ere s(e+ti$al about t'e +s*$'iatri$ +ro$ess #it'in t'e

BS 'e +ro$esses in/ol/ed in +ersuadin) t'eir +s*$'iatrist

>)ate(ee+er? t'at t'e* #ere le)itimate $andidates or

'ormonal and sur)i$al inter/ention #ere /ie#ed as

ritualisti$KJ >Da/*, %010:11?

39


40/87

'e $on$e+t o medi$al ransition as ritualisti$5 is a notion

su))ested in 'itne* =arnes +a+er 'e Medi$ali.ation o

rans)enderism 5 =arnes states t'at rans +eo+le are ull* a#are o

t'e +ro$edures t'at need to be ollo#ed and are not +assi/e a)ents

in t'e medi$ali.ation o t'eir e2isten$e 5 >=arnes, %001?

I 'e e/iden$e t'at trans)endered indi/iduals nd it ne$essar*

to $ir$um/ent t'e rules )o/ernin) t'eir a$$ess to le)itimate

and ade uate 'ealt' $are, o ten t'rou)' means o dis'onest*

andNor embellis'ments brin)s one to uestion t'e /er*

e2isten$e o t'ose re)ulations t'e* must #or( #it'in and

a)ainst An* institutional stru$ture #'i$' $auses +eo+le to

+ro/ide t'eir 'ealt' $are +ro/iders #it' less t'an entirel*

'onest in ormation is sub e$t to s$rutin* J >=arnes, %001?

Bere, =arnes $riti$i.es t'e medi$al institution b* su))estin) t'at t'e

rules t'at are +ut in +la$e to de$ide #'o )ets a$$ess to 'ealt'$are

and #'o doesn5t or$es rans +eo+le to lie and )i/e dis'onest

a$$ounts in order to re$ei/e t'e 'ealt'$are t'e* need 'is is not a

ne)ati/e re e$tion on t'e rans +erson, but a re e$tion o t'e ri)id

re)ulations set out b* t'e medi$al +ro essionals

'is is a notion re e$ted b* S$'olars su$' as Cali a and amaste,

#'o su))est t'at, I rans)endered +eo+le read #'at +s*$'iatrists

#rite about t'emK so t'at t'e* $an enter t'e $lini$al settin),

+resent t'e $lassi$5 transse2ual narrati/e, and re$ei/e t'e 'ealt'

0


41/87

$are and medi$al te$'nolo)* t'e* desire J >Cali a, 1997:19%? And

t'at I 'e )ender $ommunit* 'as at t'is +oint a$$umulated a lot o

ol( #isdom about #'at *ou need to tell t'e do$tors to )et admitted

to a )ender-reassi)nment +ro)ram J >Cali a, 1997:%% ?

'e idea o medi$al +ro essionals a$tin) as Gate(ee+ers5 or

treatment and t'e +at'olo)ised treatment o rans indi/iduals is

also re e$ted in uliet a$ ues arti$le +ublis'ed in 'e Guardian

>%010? in #'i$' s'e do$uments 'er e2+erien$es as a rans)ender

+atient o t'e BS )oin) t'rou)' )ender transition

a$ ues $omments,

5JC'arin) Cross5 >Fondon5s Gender Clini$? R stru))les to s'a(e

a re+utation or bein) $old and o/erl* demandin) 'is is not

al#a*s diminis'ed b* t'e e2+erien$es +osted online b*+atients, some o #'om 'a/e reser/ations about )ender

ser/i$es bein) +at'olo)ised under mental 'ealt' J > a$ ues,

m* em+'asis, %010?

a$ ues addresses t'e issue t'at t'e )ender $lini$ 'as a

re+utation,5 ar)uabl* uelled b* online dis$ourse o +eo+le5s

e2+erien$es at t'e $lini$ #'o are dissatis ed #it' t'e +at'olo)ised

a++roa$' o treatment and ser/i$es

a$ ues $omments, I *ou arri/e +re+ared to #or( #it' t'e

$lini$ians, *ou s'ouldn5t 'a/e man* +roblemsK 'ad +lent* )oin)

or meK 'a/in) $'an)ed m* name and be)un li/in) in role 5J

1


42/87

> a$ ues, %010? Bere, a$ ues illustrates t'e #a*s in #'i$' it is

+ossible to )et t'rou)' t'e s*stem more eL$ientl* +ro/idin) *ou

#or( #it'5 t'e $lini$ians S'e mentions 'a/in) $'an)ed 'er name

and li/ed in 'er desired )ender role, im+l*in) t'ese are a$tors

ta(en into $onsideration b* t'e Gender Clini$

'at e2a$tl* is meant b* li/in) in role 5 >Sometimes $alled @eal Fi e

2+erien$e?

n a do$ument ta(en rom Ontario Buman @i)'ts Comission >OB@C,

%01 ? entitled Medi$alisation o dentit*,5 it dis$usses t'e issue o

real li e e2+erien$e5 >or li/in) in role5? and t'e +roblems t'is $an

en$om+ass

I 'e real li e e2+erien$e re uires t'e +re-o+erati/e indi/idual

to li/e5 in t'eir elt )ender or a +rolon)ed +eriod o about one

to t#o *earsK 'ere is si)ni $ant $ontro/ers* #it'in t'e

trans)endered $ommunit* about @F 5 and its medi$al

ne$essit* One indi/idual #it' a medi$al ba$()round stated

t'at @F does not +ro/ide use ul in ormation to t'e +atientK it

is rat'er a +eriod o $om+lian$e #it' a ri)id set o $riteria J

>OB@C, %01 ?

'is is an im+ortant +oint, as it addresses t'e a$t t'at li/in) in

role5 does not ser/e to in orm t'e rans)endered +erson about #'at

%


43/87

s'ould be e2+e$ted in se2 reassi)nment5 or indeed an* (ind o

medi$al inter/ention t'at rans +erson ma* $'oose to underta(e,

but instead is merel* a medi$al re uirement one must $om+l* #it'

in order to )ain medi$al ser/i$es

Con$e+ts o li/in) in role5 and real li e e2+erien$e5 also brin) about

t'e $on$e+t o assin) 5 A$$ordin) to Fori Girs'i$( >%009?

I 'e #ord as it is used toda* )enerall* re ers to ttin) into t'e

)ender binar* as a man or a #oman n order to +ass in t'is

sense it is not enou)' to be #'o *ou are R *ou 'a/e to alter

*our )ender a++earan$e and be'a/iors to t notions o

mas$ulinit* and emininit* J >Girs'i$(, %009:108?

Girs'i$( 'i)'li)'ts t'e a$t t'at to +ass #it'in so$iet* means li/in)

u+ to so$iet*5s e2+e$tations o male and emale Feslie Eeinber)stated t'at assin) #as a +rodu$t o o++ression,5 >Eeinber),

199":89? #'ilst


44/87

n ose+'ine Bo5s rans)ender bod*Nsub e$t ormations in ai#an5

>%00"? s'e e2+lores t'e #a*s in #'i$' +assin)5 o ten allo#s or

easier inte)ration #it'in so$iet* or t'e rans +erson

IK 'e $on$e+t o +assin) R alon) #it' its $onnotations o

de$e+tion R entails +ro ound (no#led)eN+o#er maneu/ers or

rans sub e$ts Eor +assin) +resu++oses t'e un$'allen)eable

naturalness5 and trut' ulness5 or e/identiall*5 o t'e +'*si$al

bod*, and aLrms t'e meanin) and status assi)ned to su$' a

bod* b* t'e so$ial $ulture J >Bo , %00":%30?

Bo su))ests t'at +assin) as t'eir $'osen )ender )rants

a$$e+tabilit* and status o t'e rans +erson #it'in t'e so$iet* in

#'i$' t'e* mo/e

I 'e o+eration o su$' as trut' re)ime t'us ser/es to

redu$eNsti)mati.e t'e trans sub e$ts5 bodil* sel reali.ation as

not'in) but s$ams and de$eit, not to mention $reatin) a

+ro ound sense o s'ame and inse$urit* in t'e sub e$ts in

re)ard to t'e $lear dis$re+an$* bet#een one5s bod* and one5s

$'osen identit* J >Bo, %00":%30?


45/87

Bo ar)ues t'at t'e ne)ati/e $onnotations and $riti$isms o +assin)5

en$oura)e t'e idea t'at a rans +erson5s bod* >+ost sur)er*? and

t'e li/in) in role o t'at )ender identit* or +assin)5 is not'in) more

t'an a s$am 5

Bo su))ests t'at bodies are not )i/en, 2ed materials and instead

$omments t'at t'e* are +'*si$al embodiments o t'e sel >Bo,

%00":%30?

I rans sub e$ts di6er rom ot'er sub e$ts onl* in t'at t'e* 'a/e

ormed a /er* di6erent eelin) o at-'omeness5 as t'eir endo#ed

bod* $om+letel* ails to +ro/ide t'at eelin) J >Bo, %00":%30-%31?

t $ould be ar)ued t'at a rans +erson5s bod* +ost sur)er* or

'ormones is no di6erent rom an* ot'er )endered indi/idual and isnot an attem+t at +assin)5 as one s+e$i $ )ender or anot'er 'e

need or medi$al inter/ention is se+arate rom t'e need to be

a$$e+ted5 #it'in so$iet*,5 and is merel* a #a* o eelin) at 'ome5

#it'in a bod* Bo#e/er, Bo5s +a+er mainl* o$uses on t'ose rans

+eo+le #'o #is' to ass5 #it'in so$iet* and s'e ails to address

issues o )ender ambi)uit* #it'in t'e rans $ommunit* in #'i$' 'er

+a+er is based

Con$e+ts o medi$al inter/ention and rans =odies 'a/e al#a*s

been a to+i$ o debate and disa)reement bet#een medi$al

+ro essionals and rans +eo+le t'emsel/es

!


46/87

n Alison @oo(e5s ellin) rans Stories,5 >%008? s'e brin)s to)et'er a

+a+er in #'i$' bot' Medi$al ro essionals and rans)endered +eo+le

are able to +ut t'eir o+inions on medi$al ser/i$es and t'e treatment

o rans bodies to)et'er in t'e same orum @oo(e o$uses on t'e

S$identit* ro e$t5 #'i$' #as a #or(s'o+N+anel dis$ussion brin)in)

to)et'er a$ademi$s, arts +ra$titioners, medi$al +ro essionals and a

)rou+ o 18 *oun) trans)endered and transse2ual +eo+le bet#een

t'e a)es o 1!-%% #'o #ere li/in) t'eir se2 and )ender #it' a

de)ree o $om+le2it* 5 >@oo(e, %008:"!?

=* brin)in) to)et'er bot' medi$al +ro essionals and rans)ender

+eo+le and allo#in) a dialo)ue to initiate bet#een t'e t#o +arties, it

allo#s t'e rans +erson to /oi$e t'eir e2+erien$es @oo(e su))ests

t'at t'eir trans identit* ma* allo# or a more $om+le2understandin) o se2 and )ender t'at sa* R a medi$al +ro essional

#ould not 'a/e n li)'t o t'is, it brin)s about t'e uestion, #'o 'as

t'e ri)'t to dia)nose #e se+arate )ender d*s+'oria rom a

medi$al de nition and understand it as more o an identit* t'at is

indi/idual to ea$' +erson as o++osed to a medi$al $ondition R #'o

'olds t'e ri)'t to )i/e t'e )o a'ead or sur)er* o/er someone else5s

bod*

"


47/87


48/87

$on ormit*, b* ndin) and relatin) to similarities t'rou)' t'e stories

and e2+erien$es o trans +eo+le

'is im+lies t'at it is +ossible to edu$ate and in orm $is-)endered

+eo+le >non trans +eo+le? o )ender ambi)uit* and )ender /arian$e

t'rou)' rans narrati/es t also brin)s medi$al de nitions o #'at it

is to be rans)enderN ransse2ual under s$rutin* and medi$ali.ation

o rans +eo+le into uestion Bo# $an one trul* $om+re'end and

de ne #'at ma(es a le)itimate trans +erson unless t'e* 'a/e

e2+erien$ed t'e eelin)s o trans-ness5 t'emsel/es

Grou+ dis$ussions allo#ed trans+eo+le to dis$uss t'eir e2+erien$es,

#orries and eelin)s about t'eir identit* in a sa e s+a$e 'e

+resen$e o medi$al +ro essionals also )a/e t'em t'e o++ortunit* to

$'allen)e t'e status uoI 'e +arti$i+ants o#n 'istories and e2+erien$es #ere trans ormed

t'rou)' $'allen)in) t'e aut'orit* o t'e s$ien$e o se2 and )ender J

>@oo(e, %008:"8?

'e* de/elo+ed $riti ues o t'e s$ienti $ and medi$al +ra$ti$es t'at

re+rodu$e t'e $o'eren$e o se2 and )ender in t'e )ure o t'e

man5 or #oman 5

e $ould ar)ue t'at t'e +ra$ti$e o tellin) trans stories and

narrati/e means t'e medi$al +ro essional #ill 'ear t'e trans

+erson5s indi/idual e2+erien$e and o#n relations'i+ #it' t'eir

)ender identit* as o++osed to basin) treatment o all trans +eo+le

8


49/87

on one s+e$i $ +roto$ol or stru$ture a$$ordin) to medi$al

)uidelines

all trans +eo+le are not t'e same, t'en t'e treatment model to

#'i$' t'e* are as$ribed s'ould not be t'e same or all trans +eo+le

One rans +arti$i+ant in t'e +ro e$t named S'annon brin)s u+ uite

an im+ortant +oint re)ardin) $osmeti$ sur)er*

I o )et *our tits enlar)ed *ou need mone*, but to )et t'em

$ut o6 *ou need a )ender s'rin( 'at5s blood* #eirdV K '*

is one more o a +roblem or so$iet* t'an t'e ot'er '* does

so$iet* re uire t'at #e 'a/e an eit'erNor )ender J >@oo(e,%008:"9?

S'annon ma(es and e2tremel* /alid +oint one e2+erien$es

bod*N)ender d*s+'oria, #'* does t'e desire or a s+e$i $ bod*

modi $ation sur)er* re uire someone to um+ t'rou)' medi$al and

)ender binar* 'oo+s in order to a$$ess one s+e$i $ t*+e o sur)er*

9


50/87

&itizenship

I=ell and =innie +ro+ose ueerin)5 $iti.ens'i+ to

a$(no#led)e and $elebrate t'e #a*s in #'i$' normati/e

+ra$ti$es and arran)ements >e ) non mono)am*? $'allen)e

t'e institution o 'eterose2ualit* and traditional

$on$e+tuali.ations o $iti.ens'i+ J >Bines, %007:7?

t $ould be ar)ued t'at i ueerin)5 $iti.ens'i+ $an $'allen)e

normati/e ideolo)* o t'e re)ulations one must ollo# in order to be

a$$e+ted as a le)itimate $iti.en, t'ere is s+a$e to ueer5 )ender in

t'e same #a*, so t'at t'ose #'o do not ul ll t'e $orre$t re)ulations

o )ender ambi)uit*5 as set out b* 'eteronormati/e ideals and

medi$al +ra$titioners ma* too be a$$e+ted

Can $iti.ens'i+ be Gender eutral 'is is a uestion +osed b* Mar(

@i2

!0


51/87

@i2 loo(s into so$ial $iti.ens'i+ and as(s #'et'er it5s +ossible to

'a/e )ender-neutral $iti.ens'i+ in$or+orated into t'e $iti.ens'i+

s*stem #'en it 'as lon) been burdened5 #it' t'e issues o )ender

ine ualit* >@i2, %00":1?

@i2 su))ests t'at be$ause le)al $iti.ens'i+ o$uses on t'e idea t'at

all $iti.ens are e ual be ore t'e la#5 it is able to es$a+e t'e )ender

ine ualit* embedded #it'in so$ial $iti.ens'i+ >@i2, %00":1? 'is, @i2

ar)ues R is due to so$ial $iti.ens'i+5s o$us on +aid em+lo*ment5 as

an eli)ibilit* re uirement to t'e +ubli$ s+'ere and t'e ri)'ts o

$i.ens'i+ I 'is meant t'at #omens traditional roles o $'ild bearer,

$are)i/er and 'omema(er #ere usuall* re)arded as bein)

in$onsistent #it' so$ial $iti.ens'i+ and ull +arti$i+ation in t'e +ubli$

s+'ere J >@i2, %00":1?

Erom t'e outset @i2 +aints a +i$ture o $iti.ens'i+ bein) ull*)rounded in ideolo)ies o binar* )ender and traditional )ender roles

based around ine ualities o $iti.ens'i+ t'rou)' )endered #or( 5

'is is an im+ortant +oint, be$ause it reinstates a notion o

$iti.ens'i+ en$om+assin) binar* )ender, rein or$in) t'e a$t t'at

non-binar* )endered +eo+le ma* not be /alid $andidates or t'is

s+e$i $ $iti.ens'i+ model

=ut it $an be done German* is t'e rst $ountr* in uro+e to le)all*

re$o)ni.e a t'ird )ender, #'ile se/eral ot'er nations 'a/e alread*

ta(en similar ste+s >==C e#s, %013? German +ass+orts no# 'a/e

a t'ird desi)nation W5 or interse2 'olders Allo#in) le)al

!1


52/87


53/87

199 :10!? n 199 ? s'e loo(s at

binar* )ender as a orm o o++ression made all t'e more dan)erous

b* t'e belie t'at it is an entirel* natural state o a6airs 5 >=ornstein,

199 :10!? =* +resentin) t'e )ender binar* as natural5 > +re/iousl*

dis$ussed $on$e+ts o naturalisin) trans5? non-binar* )ender

be$omes unnatural and t'e ot'er 5

=ornstein loo(s into )ender binaries as a s*stem o $lass and +o#er,

and 'o# one $annot e2ist >or indeed, o++ress? #it'out t'e ot'er

=ornstein $omments,

I n t'e eit'erNor )ender $lass s*stem t'at #e $all male and

emale, t'e stru$ture o one u+, one do#n ul lls t'e re uisite

or a +o#er imbalan$eK t5s an arena in #'i$' rou)'l* 'al t'e+eo+le in t'e #orld $an 'a/e +o#er o/er t'e ot'er 'al

it'out t'e stru$ture o t'e bi-+olar )ender s*stem, t'e +o#er

d*nami$ bet#een men and #omen s'atters J >=ornstein,

199 :107?

=ornstein is essentiall* statin) t'at t'e )ender binar* e2ists +urel*

to en or$e t'e o++ression o #omen and ensure t'at men retain

t'eir +osition as t'e dominant $lass 5 it'out )ender binaries, t'ere

#ould be no di/ision o +o#er And #it'out t'e di/ision o +o#er,

one 'al 5 o t'e +o+ulation #ould not be better o6 t'an t'e ot'er

!3


54/87

Does t'e se+aration o medi$ali.ation and )ender identit* 'el+ to

eliminate )ender binaries n #'at #a*s, i an*, is t'e mo/e a#a*

rom medi$ali.ation detrimental to t'e ri)'ts and 'ealt'$are o

rans +eo+le

#ssues *ith the ,e- edicalization 2f )ransgendered 'eople

I 'e demedi$ali.ation o transse2ualism is a dilemma 'ere

is a demand or )enital sur)er*, lar)el* as a result o t'e

$ultural )enital im+erati/eK ransse2uals, es+e$iall* middle-

$lass +re-o+erati/e transse2uals are 'ea/il* in/ested inmaintainin) t'eir status as diseased5 +eo+le 'e

demedi$ali.ation o transse2ualit* #ould urt'er limit sur)er*

in t'is $ulture, as it #ould remo/e t'e label o illness5 and so

+ro'ibit insuran$e $om+anies rom ootin) t'e bill J

>=ornstein, 199 :119?

'is se$tion deals #it' t'e +otential +roblems t'at arise rom

ar)uments t'at $all or t'e mo/in) a#a* rom a medi$ali.ed /ie#

and treatment o rans)ender +eo+le belie/e it is im+ortant to

address t'is issue as t'e bul( o t'is dissertation 'as e2+lored t'e

!


55/87

ne)ati/e as+e$ts o medi$ali.in) trans +eo+le #it'out

a$(no#led)in) t'e #a*s in #'i$' Medi$ali.ation also +rote$ts and

allo#s or t'e treatment o rans +eo+le

=ornstein >199 ? 'i)'li)'ts t'e a$t t'at maintainin)

ransse2ualism5 as a medi$al issue or a disease5 means t'at rans

+eo+le maintain an a$$ess to medi$al inter/ention i t'e* need it

'e* are +rote$ted in t'e sense t'at #it' a dia)nosis $omes medi$al

assistan$e I ransse2ualit* is a medi$ali.ed +'enomenon 'e term

#as in/ented b* a do$tor 'e s*stem is +er+etuated b* do$tors J

>=ornstein, 199 :119?

#e are to a$(no#led)e t'e ransse2ual or rans identit* o an

indi/idual, #e must a$(no#led)e t'e term and identit* #as$onstru$ted b* medi$al +ro essionals utili.in) medi$al

terminolo)ies Subse uentl*, $an it e/er be +ossible to demedi$ali.e

t'e rans +erson and rans)ender identit*

=arnes >%001? $omments;

I rans)ender identit* is $laimed b* t'e +s*$'iatri$ $ommunit*

as a disorder5 or $ondition 5 'ese re)ulator* un$tions

in$lude t'e ne$essit* or transse2uals to $laim illness5 be ore

bein) $onsidered or se2 re-assi)nment 'ormones andNor

sur)er* 'is illness5 is itsel transse2ualit*, and unless one

a$$e+ts transse2ualit* as an illness5 and as a $om+onent o

!!


56/87

t'eir o#n +ersonalit*, t'e* #ill be e2$luded rom most se2-

reassi)nment +ro)rammes J >=arnes, %001?

=arnes illustrates t'e #a* t'at a rans +erson as a +atient see(in)

medi$al 'el+ 'as to $on orm to t'e rules and re)ulations laid out b*

>in t'is instan$e? t'e +s*$'iatri$ $ommunit*5 #'o 'a/e )i/en

rans)ender identit* t'e label o a disorder or a $ondition o uali *

or medi$al attention and to 'a/e t'eir rans identit* le)itimi.ed t'e

rans indi/idual must a$$e+t, #'et'er t'e* eel it is t'e $ase or not R

t'at t'e* 'a/e t'e illness5 o ransse2ualit* 'e* must as$ribe to

t'e $ondition alread* set in +la$e b* t'e Medi$al +ro essional #'i$'

in turn en or$es rans)ender identit* as a medi$al $ondition5 as

t'ere is no ot'er $'oi$e or t'e rans +erson i t'e* #ant to re$ei/e

treatmentt $ould be ar)ued t'at de-medi$ali.in) rans)ender #ould run t'e

ris( o remo/in) re)ulations t'at t'e medi$al +ro essional deems

ne$essar*5 in order to treat +atients

Bo#e/er man* t'eorists ar)ue t'at ransse2ualism5s +la$e #it'in

medi$ine and +s*$'iatr* #ill $ontinue or a lon) time to $ome

>=arnes, %001? as =arnes $omments t'e t#o 'a/e )ro#n to)et'er

and be$ome intert#ined

n ani$e @a*mond5s 1979 +ubli$ation 'e ransse2ual m+ire5 s'e

$ontro/ersiall* ar)ues t'at transse2uals are $reated t'rou)'

medi$ine5 and t'at +s*$'iatri$ e/aluation as #ell as t'e a/ailabilit*

!"


57/87


58/87

Ar)uabl*, t'e desire or t'ese $'an)es ma* 'a/e e2isted, but

=arnes does not address t'e a$t t'at t'ese desires and needs or

sur)i$al inter/ention +resu++ose t'e e2isten$e o estern medi$ine

'e a$t estern medi$ine be)an to in$or+orate su$' sur)eries and

medi$al o+tions or rans +eo+le must 'a/e been born out o a need

or it

Feslie Eeinber) >1998? addresses t'is +oint:

I t5s true t'at t'e de/elo+ment o anest'esia, and t'e

$ommer$ial s*nt'esis o 'ormones, o+ened u+ ne#

o++ortunities or se2 reassi)nment Bo#e/er, t'e ar)umentK

doesn5t ta(e into a$$ount an$ient sur)i$al te$'ni ues o se2-

$'an)e de/elo+ed in $ommunal so$ieties t'at o6ered moree2ible se2 and )ender $'oi$es J >Eeinber), 1998:10!?

Eeinber) a)rees t'at ad/an$es and de/elo+ment #it'in medi$al

treatment meant t'at se2 reassi)nment5 #as made urt'er +ossible

b* #a* o sur)eries and 'ormones Bo#e/er, Eeinber) ma(es t'e

im+ortant +oint t'at t'ese estern medi$al inter/entions are

restri$ti/e and limited sin$e t'e* +er+etuate t'e notion o binar*

)ender b* o6erin) sur)er* and 'ormones in order to $'an)e rom

one se2 to t'e ot'er 5 Eeinber) also states t'at sur)i$al te$'ni ues

to assist rans +eo+le e2isted +rior to estern medi$ine, and in a$t

!8


59/87

a$$ommodated )ender uidit* as o++osed to en or$in) )ender

binaries

IDes$ri+tions o ati/e Ameri$an5s uid +er$e+tions o se2 and

)ender +oi)nantl* illustrate t'at trans)endered indi/iduals a$$essed

re$o)nition o t'eir )ender identities #it'out t'e aid o modern

estern medi$ine or te$'nolo)* J >=arnes, %001?

t $ould be ar)ued, t'at be$ause +er$e+tions o )ender identit*

#it'in t'ese $ommunities embra$ed notions o )ender ambi)uit* >or

in t'e $ase o tribal $ommunities #it'in ati/e Ameri$an so$ieties -

#o-S+irit5 +eo+le? >=arnes, %001? t'ere #as less o a need or se2reassi)nment5 sur)er* sin$e uid )ender identities #ere a$$e+ted

#it'out t'e estern so$ial e2+e$tations o ul llin) a s+e$i $ binar*

)ender uota

'ere ore, #e $ould ar)ue t'at modern estern so$ial e2+e$tations

o )ender 'a/e an in uen$e on not onl* t'e (ind o sur)eries and

medi$al ser/i$es a rans)ender +erson is able to a$$ess, but also

t'e (ind o sur)eries and medi$al ser/i$es a rans +erson desires

At #'at +oint does Medi$ali.ation o rans +eo+le be$ome

bene $ial One ma or ar)ument in a/our o medi$ali.in) rans

!9


60/87

identities is t'e a$t t'at t'rou)' medi$al terminolo)* and t'e

arti$ulation o ransse2ualit*5 t'rou)' medi$al dia)nosis, $omes

le)islation, ri)'ts, and medi$al im+lementation in order to

a$$ommodate t'ose #'o 'a/e been dia)nosed #it' t'e $ondition 5

One e2am+le o 'o# medi$al dia)nosis ser/es to +rote$t and

a$$ommodate rans indi/iduals are in $ases su$' as; #'ere a

rans)endered +erson 'as been in$ar$erated

Al/in Fee >%008? re$ounts t'e in$ident o Donna Fee,

%008: 8?

n t'is instan$e, it is e/ident t'at t'e la# ensures rans)ender

+eo+le are able to a$$ess t'e medi$al ser/i$es, in t'is $ase t'e

'ormones t'at t'e* re uire dentit* is le)itimi.ed t'rou)' t'e

medi$al de nition o Gender dentit* Disorder, and #it'out t'at

"0


61/87

de nition or dia)nosis, t'ere #ould be no oreseeable reason to

allo# medi$al treatment or t'e rans +erson

Fee a$(no#led)es t'e $ontro/ers* #it' medi$ali.ation and as(s,

IDoes t'e use o medi$al e/iden$e $reate or +er+etuate an ima)e o

trans +eo+le as mentall* diseasedK does t'e use o medi$al

e/iden$e a$tuall* do more to 'arm t'an 'el+ t'e trans $ommunit* J

>Fee, %008: 8?

'ilst it 'as been establis'ed t'rou)'out t'e duration o t'is +a+er

t'at medi$ali.ation retains o$us on maintainin) binar* )ender, it

also brin)s about issues o rein or$in) rans)ender identit* 'is is a

notion dis$ussed in Mar* =ur(e5s G D and t'e $ontested terrain o

dia)nosis5 >%011?

I 'rou)' medi$ali.ation and dia)nosis in +arti$ular, +atients

are also able to orm $olle$ti/e identities, #'i$' oster t'e

$reation o su++ort net#or(s and ad/o$a$* )rou+sK

institutional re$o)nition, a$$ess to ser/i$es and resour$e

allo$ation J >=ur(e, %011:188?

Bo#e/er, as +re/iousl* dis$ussed in t'is +a+er, dia)nosis o Gender

dentit* Disorder or Gender D*s+'oria - #'ilst +ositi/e in t'e sense

it subse uentl* o+ens )ate#a*s to treatments and le)islati/e

measures or t'ose su$$ess ull* dia)nosed; reinstates notions o

emininit* and mas$ulinit* and denies rans)endered +eo+le #'o

"1


62/87

do not $on orm to a +arti$ular, narro#l* de ned set o standards 5

>=ur(e, %011:189?

M* data $olle$tion deals #it' rans +eo+le5s +er$e+tions and

e2+erien$es #it'in t'e BS and medi$al 'ealt'$are s*stem, and

o6ers a /ie# o medi$ali.ation o rans)ender +eo+le rom t'e rans

+erson5s +ers+e$ti/e

ethodology

M* resear$' dra#s u+on 1? A ualitati/e stud* based on 77

+arti$i+ants #'o $om+leted an online sur/e* t'at as(ed Eour main

uestions, t'ese in$luded multi+le $'oi$e, statin) t'eir a)reement

or disa)reement #it' $ertain statements and also t'e o++ortunit* to

add t'eir o#n in+ut and o+inion on $ertain uestion to+i$s

"%


63/87

%? #o S(*+e inter/ie#s 'ad $ondu$ted man* more inter/ie#s

o/er S(*+e and in +erson, but 'adn5t s+e$i ed t'at needed non-

binar* rans)ender +eo+le, t'us t'e ma orit* o m* inter/ie#ees

e2+erien$es did not re e$t t'e issues a non-binar* rans)ender

+erson a$ed and 'ad to be omitted also 'ad not le t enou)' time

to trans$ribe t'e inter/ie#s $ondu$ted

3thics

M* et'i$s orm #as a++ro/ed b* Goldsmit's Tni/ersit* O Fondon

'e resear$' 'as been $ondu$ted in a #a* to +re/ent an* 'arm to

+arti$i+ants 'is entails a ull brie n) o t'e resear$', its +ur+oses

and t'e #a* in #'i$' it #ill be utili.ed so t'e inter/ie#ees $an

+ro/ide ull* in ormed $onsent to ta(e +art o uestions re uired

t'e +arti$i+ants to identi * t'emsel/es and t'ere #as no #a* totra$e +arti$i+ants5 identit* so t'e sur/e* #as automati$all*

anon*mous 'e terms and $onditions are stated on t'e rst +a)e o

t'e sur/e* >see a++endi2 1? in$ludin) ad/isin) +arti$i+ants t'at

t'e* must be 18 or o/er

45 2nline Sur"ey

'e sur/e* $an be /ie#ed in ull at:

'tt+s:NN### sur/e*mon(e* $omNsNBX X8UF

"3


64/87

'e onl* demo)ra+'i$ t'at #as as(ed #as )ender identit* elt t'at

t'is #as t'e onl* demo)ra+'i$ rele/ant to t'e resear$' sin$e t'is

dissertation o$uses on t'e $om+le2ities o binar* )ender and

#is'ed to illustrate t'at in m* results

+romoted t'e sur/e* /ia nternet lin(s on m* o#n +ersonal

Ea$eboo( +a)e as #ell as multi+le rans)enderNGender /ariant

Ea$eboo( )rou+ +a)es also attended a Xueer $lub ni)'t and made

an announ$ement in re)ards to m* sur/e* to tr* and en$oura)e

more +eo+le to ta(e it o$used on t'e rans $ommunit* sin$e t'e

uestions #ould be re/ol/in) around t'eir o#n e2+erien$es as a

rans +erson dealin) #it' t'e BS and medi$al 'ealt'$are

+ro essionals

'e sur/e* #as $onstru$ted online usin) a #eb-based sur/e*$reator $alled Sur/e* Mon(e*, #'i$' #as ree o $'ar)e to use and

allo#s t'e $reator to anal*.e t'e results online elt t'is #as t'e

best met'od o data $olle$tion due to it bein) anon*mous and

online-based o+ted or a met'od (ne# #ould be easil* a$$essible

to +eo+le and rea$' a ar 'i)'er number

"


65/87

2nline Sur"ey esults

#ill rstl* address t'e demo)ra+'i$ result re)ardin) t'e )ender

identit* o +arti$i+ants Xuestion 1 as(ed: Bo# #ould *ou des$ribe

*our )ender identit* 5

)a/e a total o 18 di6erent )ender identities or +arti$i+ants to

$'oose rom and im+ortantl* allo#ed t'em to ti$( as man* o t'e

o+tions as t'e* elt a++lied 'ere #as also t'e o+tion to add a

$omment to state t'eir o#n )ender identit* i t'e* elt it #asn5t one

o t'e $'oi$es o6ered >See a++endi2 %?

#ill o$us on t'e most rele/ant results !%Y o res+ondents

identi ed #it' rans)ender, !0Y identi ed #it' Gender ueer, 31Y

identi ed #it' ransZ and % Y identi ed as Andro)*nous

m+ortantl*, onl* 9Y identi ed as ransse2ual,5 #'i$' is a term'ea/il* asso$iated #it' medi$al terminolo)* and +ra$ti$e

too( into $onsideration t'e a$t t'at man* o t'ese +eo+le ma*

identi * t'emsel/es as )ender /ariant, t'e results indi$ate t'at t'is

is t'e $ase e $ould ar)ue t'at t'ese +eo+le 'old )reater

understandin) o t'e issue due to t'eir o#n +ersonal e2+erien$e o

)ender /ariant bodies t also s'o#s ust 'o# broad and /aried

rans)ender +eo+le5s )ender identities $an be

Xuestion % as(ed, 'en $onsultin) a medi$al +ro essional >G or

Gender Clini$? about transition, did *ou 'a/e an* +rior (no#led)e o

"!


66/87


67/87

'ese t#o ndin) are o (e* im+ortan$e as it re e$ts a notion o

'a/in) to le)itimi.e ones rans)ender sel in a binar* )ender in t'e

+resen$e o medi$al +ro essionals t is also im+ortant to

a$(no#led)e t'e a$t t'at t'e ma orit* o t'e Sur/e* +arti$i+ants

alread* 'ad +rior (no#led)e o t'e #a* t'e medi$al s*stem #or(ed

in order to treat rans)ender +eo+le and t'at t'is must 'a/e been a

a$tor in t'e #a* t'e* +re+ared or a++ointments

80Y o res+ondents A)reed or Stron)l* A)reed t'at t'e* Eelt t'e*

'ad to +ro/e t'eir rans identit* 5 t $ould be ar)ued t'at t'is

+ressure to +ro/e t'eir rans identit*5 is a ma or a$tor in t'e #a*

rans +atients a++roa$' and deal #it' t'eir a++ointments #it' t'e

medi$al +ro essional7"Y o res+ondents A)reed or Stron)l* A)reed t'at t'e* le t out

$ertain as+e$ts o t'eir 'istor*Nli est*le #'en tal(in) to t'e medi$al

+ro essional 5 t $ould be ar)ued t'at t'is su++orts =arnes >%001?

$omment t'at institutional stru$tures $ause +eo+le to +ro/ide t'eir

'ealt' $are +ro/iders #it' less t'an entirel* 'onest in ormation

s'ould be sub e$t to s$rutin* 5 >%001?

78Y A)reed or Stron)l* A)reed t'at t'ere #as a s+e$i $ rans

arrati/e t'e* $ould ollo# in order to )et treated more eL$ientl* 5

'is su++orts t'e notion t'at rans)endered +eo+le 'a/e an

understandin) t'e medi$al 'ealt'$are s*stem and reali.e t'at b*

ollo#in) a narrati/e,5 it is easier to a$$ess treatment

"7


68/87


69/87

and )ender ambi)uit* 5 'ese #ere t'e most +o+ular res+onse

$'oi$es and interestin)l*, t'e* all in$or+orate a notion o better

medi$al ser/i$es and a$(no#led)ement o non-binar* rans +eo+le

'is re e$ts t'at t'e ma orit* o +arti$i+ants 'eld an understandin)

t'at non-binar* rans +eo+le are ailin) to be a$$ommodated b* t'e

'ealt'$are s*stem, and 'old a desire to see more done in order to

a$$ommodate t'em

O/er 70Y o +arti$i+ants a)reed #it': reatin) rans +atients on a

$ase b* $ase basis,5 and Mo/in) a#a* rom t'e 4 ra++ed in #ron)

bod*4 medi$al narrati/e 5 'is im+lies t'at rans +eo+le #is' to 'a/e

less o a medi$ali.ed em+'asis on t'eir treatment and desire a

mo/e a#a* rom t'e traditional medi$al narrati/es 5

"9Y o +arti$i+ants a)reed t'at Sur)er* s'ould be o6ered #it'out'a/in) to be on 'ormones 5 'is too de/iates rom t'e medi$al

re uirement and treatment narrati/e o 'a/in) to be on 'ormones

be ore sur)er* and #ould subse uentl* a$$ommodate t'ose rans

+eo+le #'o did not eel t'e* needed or #anted to be)in 'ormone

treatment

A minorit* o %Y a)reed #it' Foo(in) at treatment or rans

+eo+le as more o a need or $om ort5 as o++osed to medi$al

inter/ention 5 n t'e Ot'er5 res+onse, one +arti$i+ant stated,

I 'ile a)ree #it' t'e de-+at'olo)isation o rans +eo+le,

t'in( it4s still im+ortant to re$o)ni.e t'at $are +at'#a*s are

"9


70/87

$ommissioned on medi$al terms $'est re$onstru$tion

doesn4t all under a medi$al +at'#a* s+e$i $ to t'e

4treatment4 o )ender d*s+'oria, t'en it be$omes +er$ei/ed as

a +urel* ele$ti/e $osmeti$ sur)er*, and t'en t'ere4s a dan)er

t'at t'at $are $ould be ta(en a#a* rom +eo+le #'o reall*

need it and $an4t a6ord +ri/ate treatment J >Anon*mous,

%01 , see a++endi2 ! 1?

'is +arti$i+ant re-iterates t'e a$t t'at #'ilst it is +ositi/e to resist

t'e +at'olo)i.ation o rans bodies R i sur)er* and medi$al

inter/ention is redu$ed to $osmeti$5 needs, t'en it #ill no lon)er be

$o/ered b* 'ealt' ser/i$es 'is #ould +ut t'ose rans +eo+le #'o

desire medi$al transition and $annot a6ord it, at ris(

'e nal uestion #as anot'er multi+le $'oi$e #'ere +arti$i+ants

$ould ti$( as man* statements t'e* a)reed #it' and as(ed Bo# do

*ou t'in( t'e Go/ernmentNSo$iet* $ould a$$ommodate non-

)endered +eo+le 5 >See a++endi2 "?

O/er 90Y a)reed t'at t'ere s'ould be better edu$ation on non-

binar* )ender identities and di6eren$es bet#een se2 and )ender

identit* in s$'ools and t'e #or(+la$e 5 O/er 90Y also a)reed t'at

t'ere s'ould be a$(no#led)ement and t'e o6erin) o )ender-

neutral titles and +ronouns in all a++li$ation orms >su$' as M25?

70


71/87

'is s'o#s t'at t'e /ast ma orit* o rans +eo+le #ould li(e to see

t'e o+tion o )ender-neutral in$lusi/it* in do$umentation t also

'i)'li)'ts t'e desire to 'a/e better in ormation #it'in edu$ation

s*stem and t'e #or( +la$e in re)ards to rans and non-binar*

)ender identities, su))estin) t'at t'e in ormation out t'ere alread*

is +otentiall* inade uate and outdated Or t'at it does not re+resent

non-binar* )endered +eo+le

O/er 80Y o res+ondents a)reed to Allo#in) $iti.ens to sel -de ne

as )ender-neutralNt'ird )ender #it'out a medi$al dia)nosis 5 'is is

im+ortant as it illustrates t'e belie t'at Gender dentit* s'ouldn5t

ne$essaril* need a medi$al dia)nosis in order to le)itimi.e ones

rans status t also reinstates t'e a$t t'at +eo+le s'ould be able to

sel -de ne as t'ird )ender >not ust male5 or emale5?

65 S%ype #nter"ie*s

71


72/87

'e S(*+e inter/ie#s #ere $ondu$ted /ia S(*+e te2t $'at 'e t#o

inter/ie#s utili.ed in m* resear$' #ere $ondu$ted utili.in) t'e te2t

$'at met'od as t'is made t'e trans$ribin) ar easier 'e S(*+e

inter/ie#ees #ere also in ormed o t'e terms and $onditions +rior to

t'e inter/ie# and 'ad to state A)ree5 to si)ni * t'e* 'ad

understood t'e terms o t'e inter/ie# and t'at t'eir res+onses

#ould be utili.ed in m* dissertation >see a++endi2 7?

All names 'a/e been altered to +rote$t anon*mit*

All uotes ta(en rom t'e inter/ie#s 'a/e been dire$tl* $ited rom

t'e S(*+e te2t $'at inter/ie#s 'e ull trans$ri+tion rom #'i$' t'e

inter/ie#s are uoted $an be lo$ated in A++endi2 art

n order or me to be re e2i/e it is im+ortant to re$o)ni.e t'at m*

o#n )ender identit* is similarl* ali)ned #it' t'ose #'om amstud*in); am also a trans +erson 'i)'l* a$ti/e #it'in FG= issues

'is in itsel enabled me to )ain a$$ess to a +otentiall* 'ard to

rea$' so$ial net#or( o +eo+le =* usin) m* o#n identit* to )ain

+arti$i+ants in t'is resear$' t'rou)' so$ial $a+ital it 'as enabled me

to a$$ess m* sam+le more easil* and a$(no#led)e t'is a$t

7%


73/87

S%ype #nter"ie* esults

M* t#o inter/ie#s #ere $ondu$ted usin) S(*+e5s online e2t C'at

eature 'e inter/ie#s ollo#ed a /er* loose stru$ture o 9 +reset

uestions >See a++endi2 8? based around t'e inter/ie#ee5s )ender

identit* and e2+erien$es as a non-binar* rans +erson #it' t'e

'ealt'$are s*stem Bo#e/er due to t'e nature o inter/ie#s, to+i$s

#ould o$$asionall* bran$' o6 into more +ersonali.ed areas o t'e

+arti$i+ants li e and e2+erien$e and m* uestionin) #ould

subse uentl* re e$t t'is

M* rst inter/ie#ee #as a %7-*ear-old non-binar* rans identi ed

+erson named d#ard 5 #ill utili.e male +ronouns, as t'ese are

#'at d#ard 'ad re uested d#ard e2+lained 'is understandin) o t'e term rans)ender5 to me,

I t'in( trans)ender is a reall* $om+li$ated term t'at $an

mean reall* di6erent t'in)s to di6erent +eo+le ound out

about t'e term +rett* late, onl* reall* +ro+erl* in m* last *ear

o m* under)rad de)ree rom #'at $an remember So it #as

t'rou)' a$ademi$ te2ts and t'rou)' a $ourse on

eminism J> d#ard, %01 ?

d#ard5s understandin) o t'e term 'adn5t been in uen$ed b*

medi$al ideolo)ies o rans)ender>ism? and 'ad instead 'e 'ad

73


74/87

$ome to an understandin) o rans identit* t'rou)' rans literature

and a$ademia R and also t'rou)' eminism

t $ould be ar)ued t'at learnin) about t'e term in t'is $onte2t ma*

'a/e 'el+ed in understandin) rans identit* in a more /aried

s+e$trum t'an i 'e 'ad learnt about rans identities t'rou)'

medi$al dis$ourse t'at tend to utili.e more narro# and binar*

de nitions

'en as(ed about 'is e2+erien$es #it' t'e BS, d#ard

em+'asi.ed t'at 'e didn5t eel li(e #'at 'e #as doin) #as

ransitionin), I Strai)'t a#a* don4t eel li(e t #'at t'e BS

s*stem #ould #ant me to sa* to t'em J > d#ard, %01 ?

d#ard noted t'at some o t'e t'in)s 'e 'ad 'eard t'rou)' ot'er

rans riends o #'om 'ad been t'rou)' t'e BS s*stem t'at 'admade 'im a++re'ensi/e about a++ointments at t'e >in t'is instan$e?

C'arin) Cross Gender $lini$,

I 'ad 'eard $om+lete 'orror stories about )ender +oli$in),

about trans #omen #'o #eren4t ta(en seriousl* be$ause t'e*

turned u+ to a++ointments #earin) trousers (ne# about t'e

re uirement to ta(e >testosterone? and t'e +'rasin) used

su$' as 4li/in) in role4 =asi$all* (ne# a lot o +eo+le #'o

#ere #a* more binar* identi ed t'an me, #'o alread* #ere

)

Date post:	02-Jun-2018
Category:	Documents
Upload:	seth-corbin
View:	215 times
Download:	0 times

‘Are you a girl or a boy?’ A study into the reinforcement of gender binary through medical...

Documents