Transmedicalism

Transmedicalism is a perspective that views being transgender as primarily a medical condition, often focusing on the experience of gender dysphoria and the necessity of medical interventions, such as hormone replacement therapy or gender-affirming surgery, for transgender individuals. This relates to the incongruence between an individual's assigned sex at birth and their gender identity.

Diagnostic recognition allows gender dysphoria in transgender individuals to be acknowledged and included within the medical discourse. The situation on transmedicalists and their opponents is not a straightforward divide on medicalization. Both sides engage in complex discussions with medical discourses, revealing a nuanced perspective beyond a simple pro or anti stance. The perspectives involve a nuanced interplay between medical and non-medical elements in defining and validating transgender experiences.

History

It is believed that the concept of medicalisation began with late 18th century Age of Enlightenment philosophy which was one of the first developments of pathologisation in Western society. The three hallmarks of medicalisation are mind-body dualism, individualism and naturalism (philosophy).

In 1897 a physician and sexologist, Magnus Hirschfeld, founded the Scientific Humanitarian Committee. The motto of the committee, "Justice through science".

Hirschfeld's theories about a spectrum of sexuality existing in all of the world's cultures implicitly undercut the binary theories about the differences between various races that was the basis of the claim of white supremacy.

Under the more liberal atmosphere of the newly founded Weimar Republic, Hirschfeld purchased a villa in Berlin for his new Institut für Sexualwissenschaft ('Institute of Sexual Research'), which opened on 6 July 1919.

Hirschfeld had coined the term transvestite in 1910 to describe what today would be called transgender people, and the institution became a haven for transgender people, where Hirschfeld offered them shelter from abuse and performed surgeries. Among the residents were one of the first transgender patients to receive sex reassignment surgery at the institute, and Lili Elbe.

In 1922, Dora Richter underwent an orchiectomy, a surgical removal of the testicles, performed by Berlin surgeon Erwin Gohrbandt at the Charité Universitatsmedizin.

Various endocrinologic and surgical services were offered, including an early modern sex reassignment surgery in 1931. Hirschfeld originally advised against sexual reassignment surgeries, but came to support them as a means of preventing suicide among transsexual patients.

In early 1931, Richter had a penectomy performed by Institute physician Ludwig Levy-Lenz, and in June that year an artificial vagina was surgically grafted by Gohrbandt, making her the first transgender woman of whom records remain to undergo vaginoplasty.

Hirschfeld himself was not happy with the term transvestite: He believed that clothing was only an outward symbol chosen on the basis of various internal psychological situations. In fact, Hirschfeld helped people to achieve the first name changes (legal given names were required to be gender-specific in Germany) and performed the first reported sexual reassignment surgery. Hirschfeld's transvestites therefore were, in today's terms, not only transvestites, but a variety of people from the transgender spectrum.

Hirschfeld also noticed that sexual arousal was often associated with transvestism. In more recent terminology, this is sometimes called transvestic fetishism. Hirschfeld also clearly distinguished between transvestism as an expression of a person's "contra-sexual" (transgender) feelings and fetishistic behavior, even if the latter involved wearing clothes of the other sex.

Today, the term transvestite is commonly considered outdated and derogatory This is because the term transvestite was historically used to diagnose medical disorders, including mental health disorders, and transvestism was viewed as a disorder.

Magnus Hirschfeld coined the term transsexual in a 1923 essay, Die Intersexuelle Konstitution. This identified the clinical category which his colleague Harry Benjamin would later develop in the United States. Hirschfeld sometimes used the term "extreme transvestites" or "total transvestites" to refer to transsexuals. Benjamin was asked by Alfred Kinsey, a fellow sexologist, to see a young patient who was anatomically male but insisted on being female. Kinsey had encountered the child as a result of his interviews for Sexual Behavior in the Human Male.

After World War II forensic psychology became the new approach, unlike the more sexological that had been employed in the lost German research.

Despite the psychiatrists with whom Benjamin involved in the case not agreeing on a path of treatment, Benjamin eventually decided to treat the child with estrogen (Premarin, introduced in 1941), which had a "calming effect", and helped arrange for the mother and child to go to Germany, where surgery to assist the child could be performed but, from there, they ceased to maintain contact, to Benjamin's regret. However, Benjamin continued to refine his understanding and went on to treat several hundred patients with similar needs in a similar manner, often without accepting any payment.

Many of his patients were referred by David Cauldwell, Robert Stoller, and doctors in Denmark. These doctors received hundreds of requests from individuals who had read about their work connected with changing sex, as it was then largely described.

However, due to the personal political opinions of the American doctors and a Danish law prohibiting sex reassignment surgery on noncitizens, these doctors referred the letter-writers to the one doctor of the era who would aid transsexual individuals, Harry Benjamin. Benjamin conducted treatment with the assistance of carefully selected colleagues of various disciplines (such as psychiatrists C. L. Ihlenfeld and John Alden, electrologist Martha Foss, and surgeons Jose Jesus Barbosa, Roberto C. Granato, and Georges Burou).

Benjamin's patients regarded him as a man of immense caring, respect and kindness, and many kept in touch with him until his death. He was a prolific and assiduous correspondent, in both English and German, and many letters are archived at the Magnus Hirschfeld Archive for Sexology, Humboldt University, Berlin.

The legal, social and medical background to this in the United States, as in many other countries, was often a stark contrast, since wearing items of clothing associated with the opposite sex in public was often illegal, castration of a male was often illegal, anything seen as homosexuality was often persecuted or illegal, and many doctors considered all such people (including children) at best denied any affirmation of their gender identity, or involuntarily subjected to treatments such as drugged detention, electroconvulsive therapy or lobotomy.

Though he had already published papers and lectured to professional audiences extensively, Benjamin's 1966 book, The Transsexual Phenomenon, was immensely important as the first large work describing and explaining the affirmative treatment path he pioneered.

Professor of history Robert M. Beachy stated that, "Although experimental and, ultimately, dangerous, these sex-reassignment procedures were developed largely in response to the ardent requests of patients." Ludwig Levy-Lenz commented, "[N]ever have I operated upon more grateful patients."

In 1939, Michael Dillon sought treatment from the doctor George Foss, who had been experimenting with testosterone to treat excessive menstrual bleeding; at the time, the hormone's masculinizing effects were poorly understood. Foss provided Dillon with testosterone pills but insisted that Dillon consult a psychiatrist first, and the psychiatrist he consulted gossiped about Dillon's desire to express a male gender identity, resulting in the story becoming widely known. The hormones soon made it possible for him to pass as male, and eventually the his manager insisted that other employees refer to Dillon as "he" in order to avoid confusing customers. In 1946, Harold Gillies and a colleague carried out one of the first sex reassignment surgeries from female to male on Michael Dillon. In 1951 he and colleagues carried out one of the first modern sex reassignment surgeries, from male to female, on Roberta Cowell, using a flap technique, which became the standard for 40 years.

Robert Stoller developed theories concerning gender identity, which he is credited as having coined in 1964.

The use of the biopsychosocial model and 'weak sciences' like social science to explain human behavior lost significant popularity in 1960s and 1970s against 'hard sciences' like biomedicine, which can be attributed to a combination of deregulation and market factors pressuring economic growth in the political climate of the United States at the time.

In 1979 the Harry Benjamin International Gender Dysphoria Association was formed, using Benjamin's name by permission. The group consists of therapists and psychologists who devised a set of Standards of Care (SOC) for the treatment of gender dysphoria, largely based on Benjamin's cases, and studies. It later changed its name to The World Professional Association for Transgender Health (WPATH).

John Money was a psychologist, sexologist and professor at Johns Hopkins University known for his research on human sexual behavior and gender. Believing that gender identity was malleable within the first two years of life, Money advocated for the surgical "normalization" of the genitalia of intersex infants. Money advanced the use of more accurate terminology in sex research, coining the terms gender role and sexual orientation.

Money believed that transgender people had an idée fixe, and established the Johns Hopkins Gender Identity Clinic in 1965. He screened adult patients for two years prior to granting them a medical transition, and believed sex roles should be de-stereotyped, so that masculine women would be less likely to desire transition. Money is generally viewed as a negative figure by the transgender community.

In 2013, a notable cluster of “truscum” bloggers surfaced on the popular microblogging website Tumblr. This digital space became a focal point for individuals who identified with truscum ideology, emphasizing specific criteria for transgender identity, particularly related to medical transition. Transmedicalists have been referred to as transmeds and truscum, a term coined by a user on Tumblr, meaning "true transsexual scum", which has since been reappropriated. The counter term tucute, meaning "too cute to be cisgender", emerged for those who believed that gender dysphoria was not required to be transgender.

During the early days of truscum ideology, a prevalent perspective emerged, suggesting that many proponents were individuals facing challenging circumstances in their transgender journeys. This viewpoint asserts that truscum ideology was often driven by trans people in unfortunate situations, and their desperate medical transition needs. These individuals found themselves in desperate need of medical transition, facing significant obstacles and barriers in accessing the necessary treatments.

In the ICD-11, the terms "transgenderism" and "gender dysphoria" were replaced by "Gender incongruence." This change reflected evolving perspectives on gender identity and marked an the recognition and classification of diverse gender experiences within the international healthcare community.

Critisism and movements

Medicalisation also has the potential to lend credibility to less socially acceptable illnesses, and has been argued to in some cases improve quality of life. Regarding harmful effects, medicalisation can be used as a form of social control or result in social stigma.

Despite efforts to adopt a more inclusive approach to transgender healthcare, existing policies often create obstacles in accessing gender-affirming medical support. Research indicates that healthcare practitioners still rely on criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, fostering an environment where accessing gender-affirming care is perceived as a test. This approach can be particularly challenging for non-binary individuals, who may feel compelled to conform to traditional gender expectations to receive necessary care.

A common belief in transmedicalist online communities is that individuals who identify as transgender without experiencing gender dysphoria or desiring to undergo a medical transition are not genuinely transgender. Radical transmedicalists may also exclude those who identify themselves as non-binary or genderqueer from the trans label. There are divides and debates within the transmedicalist community on the exact definition of who is or is not transgender. Transmedicalists sometimes refer to those who identify as transgender without medicalized criteria as transtrenders.

Critics argue that transmedicalism pathologizes gender experience. Transmedicalism is critiqued for being akin to the medical model of disability in that it medicalizes an attribute that contains both medical and broader social components. The social components might consist of social transitioning and legal acknowledgement. Since medicalization is the social process through which a condition becomes a medical disorder in need of treatment, medicalization may be viewed as a benefit for trans people who feel they require treatment. Another less pathological perspective might be the biopsychosocial model, which considers a broader spectrum of factors, including biological, psychological, and social elements, in understanding and addressing transgender experiences. Other ways to understand gender might be through bioessentialism or performativity from queer theory.

See also

• Medicalisation of sexuality
• Causes of gender incongruence
• Psychopathology
• Neurosexism
• Phenomenology (psychology)
• Mind–body problem
• Psychogenic pain
• Suffering
• Compulsory heterosexuality
• Social construction of gender