The myths versus the reality.
Transmedicalism is the recognition of gender dysphoria – and thus being trans – as a medical condition (which may or may not carry with it a trans identity). The transmedicalist (transmed) community is primarily made up of trans people whose awareness of the reality of gender and transsexualism comes from medical research, interactions with medical professionals, and our own life experiences with gender dysphoria and its medical implications. We are joined by cis allies who are aware of how the problematic beliefs espoused by trans-identified cis people are negatively affecting trans and cis people alike. Included among them is an increasing number of detransitioned cis people; those who initially believed the social identity-based narratives that are promoted by mainstream “trans” communities, pursued a medical transition as a result of those narratives, then experienced first-hand the harm caused by “identifying” as trans without having genuine gender dysphoria. They are the people who believed the myths about transmedicalism and discovered the reality too late.
My experience of the transmed community has been infinitely more positive than my experience in the trans-identity community. The latter made me feel alienated, ashamed, and ultimately unsafe; for asking questions in a genuine attempt to understand beliefs about non-binarism/genderfluidity/non-dysphoric “trans” people , for – later in my transition – advising non-dysphoric “trans” (i.e. cis) people (who later detransitioned with the complaint that no one told them they might regret transitioning) to reconsider proceeding with a medical transition, for pointing out the logical flaws and potential harm in the beliefs that gender is a social construct or that being trans is solely about identity and expressing the fact that many of those beliefs did not align with my experience, for seeking support and discovering that so few people in the community truly understood what I was going through.
I discovered the transmedicalist community while trying to gain an understanding of how someone can identify as trans without having dysphoria and without relying on patriarchal gender stereotypes (e.g. “I don’t ‘fit in’ with other girls”) or thought-terminating platitudes (e.g. “Gender is a social construct”) to explain their trans identity. It was one of many relentless searches for information in a bid to help me feel some connection to what I was being told was my community. I found an LGBT forum where another trans guy had asked many of the questions I wanted answered as he too felt alienated from the mainstream “trans” community. The responses he received were either dismissive or abusive, and the few that answered genuinely still relied on patriarchal gender stereotypes and/or nebulous descriptions of their emotions to explain their trans identities. Among the responses was the suggestion that he might find better support from a specific transmed group.
When I browsed the site, I found a huge group of logically-minded, empathetic people who simply want to support each other with valuable, informed, practical advice, create a safe space for the most vulnerable in our community where their experience is not dismissed or belittled by misinformation, improve understanding of what being trans really means, improve access to trans healthcare for those who really need in order to give trans people the best chance of survival , and prevent cis people from inducing dysphoria in themselves via a medical transition.
It is, I’ve found, a calmer community where open, honest discussions about alternative opinions are welcomed rather than – as in most mainstream “trans” communities – shut down or dismissed. It is a community that emphasises honest communication between each other and between patients and doctors, encourages people to explore the possibility that they may not be trans (which is never seen in mainstream “trans” spaces), and provides practical, meaningful support and understanding for those who need it. As with all communities, it is imperfect and has some problematic members, but it is at its core a safer place for trans people to receive support and understanding.
I had always been told that transmeds are the bad guys, but having gone from mainstream “trans” spaces to transmed spaces, the disparity between what people thought about transmedicalism versus what was actually happening in transmed communities became very apparent. I searched a few different mainstream “trans” spaces online and collated the most common myths about transmedicalism, contrasting them against my experience of the transmedical community.
Myth: Transmedicalism is all about gatekeeping.
Reality: Like a lot of the narratives and conversations coming from the “trans” (i.e. cis-dominated) community, “gatekeeping” is one of those handy thought-terminating words that helps end a conversation. Its negative connotations mean those who hear it immediately dislike and prefer to disassociate from whatever it becomes attached to (including transmedicalism). The reality is that gatekeeping and medical regulation are very different things. For example, if I were to go to my doctor and say, “I identify as diabetic and I think insulin would make me feel better,” it would not be an act of gatekeeping for my doctor to want to ask more questions, do some tests and, when it becomes clear that my only basis for believing I have diabetes is misinformation from social media and a lack of clarity about the difference between identity/desire versus biology/need, refuse to prescribe insulin. That would be case of good medical regulation and would prevent me from causing harm to myself by taking a medication that I don’t need. If I were to go to a support group for people with schizophrenia on the basis that I’m a bit quirky so identify as schizophrenic, it would not be an act of gatekeeping for the group’s organisers or members to refuse me access to that group; it would be an act of safeguarding vulnerable people from harmful, reductionist beliefs about their medical condition.
Gatekeeping is more a case of, for example, “You’re not a true fan of [band/artist] unless you can name all of their albums.” That is; setting arbitrary rules for something that anyone can enjoy or be a part of. Diagnostic criteria are not arbitrary, given their root in medical research, and transsexualism is not an experience that anyone can opt in to.
Myth: Transmedicalism excludes non-passing trans people.
Reality: As trans people, we have all been “non-passing” at some point (although the term “passing”, while commonly used in trans communities, is problematic in and of itself as it implies we are in some way pretending to be the gender we are). Whether or not a person is perceived as male or female is down to so many different factors that to say a person isn’t trans specifically because they’re not perceived as their true gender 100% of the time is ludicrous and has never been present in any of the many transmed spaces I’ve been in.
The myth stems from the fact that many trans trenders (trans-identified cis people) simply don’t care about being perceived as the gender they claim to be, which means that there is no dysphoria present. Of course, as trans people trying to have our dysphoria – and thus need for medical transition – taken seriously, we are inevitably going to be bothered by people who claim to represent us while being comfortable presenting entirely as their birth sex; those who feel no need to “pass”. That kind of comfort in pre-transition gender nonconformity is a luxury that people with dysphoria (trans people) don’t have. Which brings us on to…
Myth: Transmeds hate gender non-conforming people.
Reality: Surprise! Many of us are gender nonconforming! After all, we’re the people who are most critically aware of the fact that fashion and hairstyles do not equal gender. After coming out but prior to our medical transition, many of us are forced in to gender conformity by our dysphoria. The social gender roles that are reinforced by trans trenders (e.g. “I was born biologically male and am comfortable with my male sex characteristics, but I wear dresses/make-up/am not stereotypically masculine, so therefore I’m not really a man”) are ones that trap gender nonconforming people (trans and cis alike) in to performative stereotypes.
While many of us don’t like performing gender stereotypes, prior to medical transition (and sometimes even after), we have to protect ourselves from dysphoria by making sure we are seen as our true gender as much as possible. For example, trans women may find that they are perceived as their true gender more frequently/consistently if they wear dresses or make-up, whether they want to wear dresses/make-up or not. For trans men, it could mean that they cut their hair short, or wear traditionally masculine clothing, even if it’s not their preference. We don’t support these gender stereotypes, but they offer a silver lining in that they allow us to signal our true gender to the outside world.
I remember one gender nonconforming trans man speaking of the problem with the “gender nonconformity = trans” belief that is perpetuated by trans-identified cis people; he explained that, despite having dysphoria, gender stereotypes made him question whether or not he should transition. He thought – much like a lot of trans-identified cis men – that because he liked wearing make-up, he couldn’t truly be male. Long story short, he ended up being hospitalised due to dysphoria-related mental illness and realised that he needed to transition and that his enjoyment of make-up did not make him any less male. While socially transitioning, he knew that wearing make-up would mean people perceived him as female (because combining stereotypically “female” fashion with female sex characteristics generally indicates that a person is female) and so he only wore make-up in private or in trans spaces. Once he started hormones, his voice dropped and his beard started growing, meaning that he could wear make-up knowing that people would just see him as he is; a man wearing make-up.
However, the trans trend came along and perpetuated the false “gender non-conformity = trans” narrative. This particular trans guy was wearing make-up in public when someone excitedly asked, “Are you trans? I have loads of trans friends!” Of course, the person asking whether he was trans was seeing him as someone who was born male but who identifies as trans because he doesn’t conform to gender stereotypes. But to a genuine trans person, suddenly having the trauma of your dysphoria brought up by a total stranger is jarring, unpleasant, and panic-inducing, especially if you’re not publicly out as trans. The guy said that the experience was so unpleasant that he’s stopped wearing make-up in public so as to reduce the risk of overly-keen “allies” and trans-identified cis people inadvertently triggering his dysphoria-related distress, outing him, or treating his past pain as some kind of exciting fashion or social statement. It also made him realise that to be gender nonconforming is to be associated with a trend that is contributing to the prolonging of pain and trauma to trans people. Ironically, by associating stereotypes of gender presentation with gender itself, trans trenders have boxed genuine trans people in to performative gender roles that we do not want.
Myth: Transmeds hate people who can’t medically transition.
Reality: Once again; nope! Many of us are in a position where we can’t medically transition, whether that’s due to finance, family, health, lack of access, or any other reason that could put a barrier between a person and their healthcare. To say that trans people hate those among us who are unable to medically transition would be like saying diabetics hate other diabetics who cannot afford insulin; patently untrue and reductionist in its equation between lack of access and lack of need to access.
If someone says they’re trans but have no clinical need to access medical transition, it’s an incredibly strong indicator that they don’t have genuine dysphoria and thus are not trans. But if someone knows they need to access transition but are unable due to external circumstances, they are no less trans than those of us who are mid- or post-transition. If you have dysphoria but cannot access transition for any reason, you are still trans. If you claim to have dysphoria but don’t “want” to medically transition, that dysphoria is probably just discomfort rather than true brain-body disconnection and thus you are cis.
Myth: Being trans isn’t medical.
Reality: Being trans is the state of having gender dysphoria, i.e. a brain with a cross-sex map of its body. The neurobiological differences in trans brains that have been observed in various studies 1 2 3 (to list but a few) means that dysphoria – and thus being trans – can only fall in to the category of medical condition by virtue of it being a biological difference that requires medical treatment. Similar to the diabetes analogy above, when something is built in to your biology and will require medical intervention to keep you alive and healthy, there can be no argument for it not being a medical condition. That’s not to say that someone with diabetes can’t also identify in some way as being diabetic – it’s just saying that someone cannot identify as being diabetic if they don’t meet the biological/diagnostic criteria for diabetes (and those who do meet the medical criteria for diabetes are unlikely to consider that one biological difference a major part of their identity in the way that trans trenders do with their trans identities).
Gender dysphoria is, of course, less easily tested for than diabetes (that’s not to say it can’t be tested for; some tests and scans can indicate whether a person is genuinely trans or not, but they prohibitively expensive, especially to underfunded gender care services), but it is still present purely as a result of a specific neurobiological make up that causes a very specific kind of distress. That distress – gender dysphoria – can be eased and eventually cured through medical intervention. To say that medical transition isn’t medical is to say that it’s cosmetic (because invasive use of medication and surgical intervention can only fall in to one of two categories; medical and cosmetic) – and to say it’s cosmetic (or social, if you will, since all cosmetic treatment is inherently tied to social constructs) is to say it’s a choice. Of course, to say it’s a choice is to perpetuate ignorance of what it’s like to have dysphoria.
Myth: Transmeds are right-wing.
Reality: In a poll conducted in a transmed group to which I belong, ~49% held left-wing political views, ~29% centre-left, ~6% centre, and only ~11% held centre-right or right wing views. The more diverse political range than mainstream “trans” spaces helps counter the echo chamber effect of most online communities, but we are still a heavily left-leaning community, likely due to our negative experiences of conservative gender roles (gender roles which, ironically, are reinforced by left-leaning trans-identified cis people).
This erroneous claim that transmeds are right-wing is often made by the cis people who hijacked transsexualism for socio-political reasons and want to steer the community away from medical support and towards social change. And, to be fair, that social change is very much needed – gender roles and stereotypes are repressive, toxic, and do far more harm than good, for cis and trans people alike. However, using trans people as pawns to highlight the different expectations of men and women and the imbalance in power and privilege between the two genders is not an act of support or allyship for trans people; it’s exploitation. It ignores our most basic needs and silences our voices so that a different cause can take precedence.
I myself am a staunch feminist who believes that no one should feel tied to a rigid set of behaviours, hobbies, clothes, hairstyles, etc. simply based on their gender or sex, which I part of the reason why I’m speaking out; it is impossible to be a feminist while letting nothing other than gender stereotypes dictate your identity (because, without dysphoria, a trans identity can only exist in relation to the patriarchally right-wing gender stereotypes to which it gives power). In fact, I’ve yet to talk to a transmed who doesn’t believe this, because the current trans trend exists almost entirely as a reinforcement of traditional conservative gender stereotypes and age-old transphobia.
To give an example, trans-identified cis male drag queen, Bimini Bon Boulash, explained his non-binary “identity” as a result of gravitating towards “things society deems as feminine” but also being “comfortable… In my [male] body“, which only promotes the conservative, patriarchal idea that a man who is comfortable with his male sex characteristics but not interested in stereotypically masculine things is inherently not male. Combined with the (often unconscious) social stereotype that trans = man in a dress, a non-dysphoric trans identity can only serve to reinforce right-wing views about gender and trans people. In the same interview, Bon Boulash said, “A young girl should never be prevented from wearing a football shirt and playing in mud if she wants. A young boy should never be humiliated for wanting to wear a dress or play with a doll.” This is, of course, entirely at odds with his earlier reinforcement of those stereotypes; he gravitates towards stereotypically feminine things and thus believes he is not male, but also tries to argue that a boy who gravitates towards stereotypically feminine things is still a boy.
The fact that he relies so heavily on Western gender stereotypes goes to show not only the distinct lack of understanding that trans-identified cis people have about gender and transsexualism, but also the inherently right-wing, anti-feminist, and colonialist views they perpetuate; that women are not women if they don’t conform to restrictive Western patriarchal gender roles and men aren’t men if they are in any kind of alignment with a Western view of femininity. It is offensive, dangerous, and reductionist in the extreme.
Myth: Transmeds don’t believe non-binary people exist.
Once again, not true! Transmedicalism is about dysphoria being a core part of the trans experience and, as I mentioned in my first post, dysphoria can be non-binary. Not all trans people need to access lower surgeries and many are content with just changing their secondary sex characteristics. While there haven’t been any studies in to why non-binary dysphoria only exists as secondary sex dysphoria, in nearly two decades of being in the trans community, I’ve never known a trans person to only need lower surgery without any HRT/top surgery. The one woman I followed who did pursue lower surgery (phalloplasty) without hormones or top surgery expressed regret within two months of having surgery, stating she was suicidal, could not stop crying, and felt she had ruined her life.
In my experience, it’s pretty rare for someone with non-binary dysphoria to identify as anything other than male or female, as the term ‘non-binary’ is simply a classification of a type of dysphoria, rather than a gender in and of itself. People with non-binary dysphoria are no less trans, nor less male or female than people with binary dysphoria. However, there are a few transmeds who experience non-binary dysphoria and consider themselves to be more in-between genders as a result of having a post-transition dual-sex body, but again, that feeling of being placed in a space outside of male or female is a socially-led one. I have also encountered a relatively small number of transmeds who don’t believe in non-binary dysphoria at all, but they are almost always younger trans people who haven’t been in the trans community very long. I believe their lack of experience with people who have non-binary dysphoria and have happily transitioned without lower surgery contributes to this, along with the negative experiences they’ve had of cis people who misappropriate transsexualism through a non-binary identity.
The main perceived issue between transmeds and non-binary people is the fact that non-binary identities have become the easiest route for cis people to misidentify themselves as trans, which in turn creates misinformation and has led to the removal of trans healthcare and safe, supportive trans spaces. On top of that, non-binary-identified cis people are often the loudest and most visible part of our newly-colonised community, meaning that those of us who are not only genuinely trans but most in need of a voice often get drowned out and excluded from trans spaces, particularly if we call out our “non-binary” oppressors’ ignorance.
Myth: Transmeds are “truscum.”
Reality: To those who are unaware, “truscum” is the word given derogatorily to trans people who speak openly about their experience of gender dysphoria as a medical condition. It’s exactly what it sounds like – true scum. It is, at its core, a transphobic slur designed to shut down outspoken trans people. If trans people suggest that we’re being negatively affected by cis-created narratives that “gender is a social construct” or “you don’t need dysphoria to be trans” (and to deny that we’ve been negatively affected by that misinformation is wilful ignorance), we are labelled “scum”.
I’ve never quite understood how the people who say that trans people deserve respect and deserve to be listened to are so willing to disrespectfully silence a trans person by calling them scum, but that’s just one of the many hypocrisies of the cis-dominated “trans” community. I think it’s worth noting that in my near-twenty years in trans spaces, one of the patterns I’ve noticed in those who detransitioned is that they were the ones quickest to use the word “truscum” (or indeed “gatekeeper”, “cis bootlicker”, “fascist”, etc.) to shut down any suggestion that they may be making a mistake in transitioning. Of course, when they inevitably detransition, they rarely reflect on their dismissal of those who tried to help them; we are still, in their transphobic eyes, scum.
Much like the word “feminazi” before it, “truscum” is a handy word for oppressors to deny their victims a voice and dismiss them as somehow undesirable and therefore unworthy of being listened to. Just as Nazi has (obviously) negative connotations, so too does scum. To say a person is scum is to say they are less than human – which I think says more about how the ostensibly “trans” people and “allies” who use the word really see trans people. It belies a latent transphobia that they are unwilling to face in themselves. It’s also worth noting that they don’t call cis people who support transmedicalism “truscum” – they call them transphobes. One could argue that calling a person a transphobe is decidedly less demeaning than calling them scum (i.e. sub-human), which again shows that their issue is primarily with trans people – we are placed lower down on the spectrum of humanity than cis people who say the same things.
The same can be said, again, of ‘feminazi’; if a woman called out misogyny, she was a feminazi. If a man called out misogyny, he was “pussy-whipped” or a “cuck.” That is, an outspoken women = the worst of humanity, an outspoken man = unmanly according to patriarchal standards of manliness. Men and women alike use the word feminazi to describe outspoken feminists (although, let’s be honest, it’s usually men), just as trans and cis people alike use the word truscum. When dehumanising language is normalised, many people who – were they to speak out – would be branded with such terms by their oppressors would rather follow the “if you can’t beat ’em, join ’em” mentality and adopt the language of their oppressors.
A quick diversion for a truscum/feminazi anecdote
I used to be friends with someone who, in his own words, is “deciding to be genderqueer” because “men are oppressors and I don’t want to be seen as unsafe to women and queer people”. Rather than choose to be living proof that men don’t have to be oppressors (because everyone has a choice about their actions and beliefs) and that men can be safe to women and queer people if they choose to be, he decided to reinforce the belief that male = oppressor and he literally decided to opt out of cisness and into transness.
When I next spoke to him, I explained the issues with what he’d said – that “deciding” to be trans is not only impossible, but insulting to those of us who were born with dysphoria and had no choice in whether we are trans or not, that many of us wish we could just “decide” to be cis, that framing himself as a trans voice in an attempt to not be oppressive to women and queer people only makes him an oppressor to trans people, and that sometimes wearing skirts and make-up doesn’t make him any less of a man. He epitomised the worst part of the trans trend and its problematic views about gender and trans people.
However, this escalated when he said (direct quote here); “diagnosing transness is literally like asking trans people to wear a yellow star”. I’m not going to clarify how deeply insulting this is to both trans people and Jewish people because it’s blindingly obvious, but it goes to show the level of privilege, arrogance, and ignorance that many trans trenders have without even realising it. To him, this was a perfectly reasonable comment to make because he has no true knowledge of the medical reality of gender and, being a straight, cis, able-bodied, white man in an opposite-sex relationship, would never be a target for the kind of fascism that Nazism embodied/embodies.
The sad thing is, he’s not an outlier; while his words would likely shock a lot of trans-identified cis people, his careless use of language and ignorant willingness to dismiss education about transsexualism and gender as fascism is so prevalent among trans-identified cis people that most actual trans people choose not to speak out. To face that kind of ignorance in people who tell you they are your friends and allies can be heartbreaking.
What trans allies need to know.
Whether people like it or not, the fact is that transmeds are trans people. You can’t call yourself a trans ally and reject transmedicalism; for one, to do so is a denial of and disrespect for millions of trans people’s experience. Secondly, it’s a rejection of science and logic in favour of the feelings of people who are unaware of their own privilege (a hallmark of oppression). Thirdly, it would be a cherry-picking exercise of the narratives that make most sense to you as a cis person.
In order to truly understand transsexualism and trans people, you have to understand where our community began; in people with dysphoria and the doctors who saved our lives. You have to be willing to trust that medical science knows more than social media. You have to recognise that you may have some unconscious bias towards cis narratives simply because a cis narrative is more relatable to your limited experience of gender. You have to accept that, if you believe gender is a “social construct” or a “fluid identity”, you are buying in to misinformation that reinforces gender stereotypes and harms trans people.
If you want to be a true ally to trans people – if you want to do the right thing – you have to sit with the discomfort of considering that you might be holding on to some transphobic opinions without even knowing that what you believe is transphobic. More importantly, you have to accept that that’s okay; unpicking harmful thought patterns is how we make progress. No trans person will begrudge a cis person whose well-meaning but ultimately transphobic beliefs were born of ignorance, so long as – when made aware of that ignorance – they choose to acknowledge that ignorance and educate themselves. We know the misinformation is coming from a well-meaning place, but that doesn’t make it okay.
- https://www.ese-hormones.org/media/ei0psrhz/transgender-brains-are-more-like-their-desired-gender-from-an-early-age.pdf ↩︎
- Carme Uribe, Carme Junque, Esther Gómez-Gil, Alexandra Abos, Sven C. Mueller, Antonio Guillamon,
Brain network interactions in transgender individuals with gender incongruence, NeuroImage, Volume 211, 2020, 116613,ISSN 1053-8119,
https://doi.org/10.1016/j.neuroimage.2020.116613. ↩︎ - Feusner, J.D., Lidström, A., Moody, T.D. et al. Intrinsic network connectivity and own body perception in gender dysphoria. Brain Imaging and Behavior 11, 964–976 (2017). https://doi.org/10.1007/s11682-016-9578-6 ↩︎
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