Trans Segment #43: Myth: Transsexuality is an invention of the medical establishment.
Myth: Transsexuality is an invention of the medical establishment.
Reality: Yeah, no. Throughout history in every culture, there have always been some people who significantly didn’t conform to sex/gender expectations, engaged in cross-gender behaviors, and had long-term, stable cross-gender identities. There have always been people that we might call proto-transsexuals.
Although we have no conclusive evidence as to the etiology—assuming there is only a singular cause—of transsexuality, the strongest evidence points toward biological predispositions. From my personal experience, this is also what makes sense for me. I don’t believe the entirety of our sex/gender is located in the brain, and so neither can they be “determined” by it, but neurology doesn’t get nearly the amount of credit that it should. We forget that our brains *are* parts our bodies; you can’t therefore separate the mind and the body. This is why I maintain that I have always been male in some respect.
So while I might have chosen to undergo social and medical transition, I didn’t “choose” to instinctively feel myself to be male any more than a cis man “chooses” to instinctively feel male. I also couldn’t consciously affect my hormone levels without the benefit of medicine, and sometimes it makes me wonder why my estradiol levels appear to have always been in the same range as a cis man’s. Suffice it to say, I am pretty sure a lot of this is hard-wired. I suppose my way of looking at it is that there *is* a normal level of natural deviations; nature loves variety. I don’t think transsexuality has emerged inorganically. It has simply come to be named (the German sexologist, Magnus Hirschfeld, used the word and described the concept in the 1920s and 1930s), recognized, and treated.
What medicine has done is to develop and provide us, cis and trans, with the ability to produce exogenous hormones, which can be used for any number of reasons. Remember that we aren’t talking strictly about steroid hormones like estradiol and testosterone here. The insulin that diabetics take is also a hormone, and it is also available by way of modern medicine. Yet how many people, outside of certain religious sects, do you hear condemning diabetics for supporting an evil, corrupted medical establishment by taking insulin or for going against the “laws of nature” by taking a hormone their body doesn’t produce enough of or even at all?
Surgeries have been developed that are beneficial to transsexual people, but all of these surgeries, including ones specifically operating on the genitals, have their origins in being used to treat cis and intersex people. It was only later that they were applied to the process of medically transitioning for transsexual people. If we are sympathetic toward a cis male soldier having a phalloplasty after losing his penis in a traumatic war injury and understand his need for undergoing this procedure, then why begrudge a trans man this same surgery?
Again, remember that since the cause of our transsexuality cannot be readily seen, we historically have been assumed to be insane and delusional. Most doctors refused to work with transsexual patients and referred them to the same cruel “reparative therapies” (a bitter misnomer if there ever was one!) that cis GLB people have been subjected to: psychotherapy aimed at changing one’s orientation, institutionalization, electroshock, and aversion therapy. These pseudo-therapies are still performed on trans and gender non-conforming children by people like Ken Zucker.
In the United States, it wasn’t until the German-born and German-trained endocrinologist, Harry Benjamin, began to treat these patients medically in the 1950s with hormone therapy congruent with their identified sexes that the tide slowly began to change. What Benjamin and eventually the other doctors who followed him found was that they had no shortage of patients requesting, many times desperately so, this treatment. They also didn’t have to work very hard to find the patients, who came to them after having located their names through word of mouth. People like Dr. Benjamin clearly didn’t invent this condition; they merely provided us with a technological and personal path we hadn’t had before.
An especially conspiracy-theory variation on this myth that you sometimes hear, usually from a small number of second-wave feminists, is that transsexuality was invented as a way to make cis GLB/gender-nonconforming people into straight, gender-normative people. This idea, which originated with Janice Raymond and her book, The Transsexual Empire: The Making of the She-male, and is repeated in things like the writings of the Stonewall vet gay activist Jim Fouratt and the movie The Gendercator, is patently false.
First, transsexuality was considered aberrant, taboo, weird, disgusting, and undesirable by most of the medical establishment. Transitioning was definitely not recommended as a first line of treatment for anyone, even the so-called “primary” or “true” transsexuals who were thought to be the only ones who “really” needed it. The Standards of Care (SOC) were written in such a way that intentionally *prevented* the vast majority of people from ever transitioning, no matter how much they begged to be treated.
The goal was explicitly to keep as few people from doing it as possible and to “protect” cis people from either transitioning wrongly or from having to know that transsexual people lived among them. Those who did successfully receive treatment were forced to go stealth even if they didn’t want to, relocate, leave their jobs *lest it cause embarrassment to the employer*, divorce their spouses and leave their children even if they didn’t want to. Doctors even believed that it was preferable to tell children that their parents had died or simply went away and weren’t coming back than to tell them that their parents had transitioned. And after obliterating people’s support systems and isolating them, the doctors then wondered why and jeered transsexual people for being at such a high risk of suicide even after medical transition. Transsexual people were to never tell anyone that they were transsexual, and in fact, it was recommended BY DOCTORS that they actively *make up* childhood memories that they had never had in order to “pass.” They were also told to avoid other transsexual people, so peer support was out of the question.
Doctors were much quicker to recommend psychological treatments than physical ones. Outside of a handful of doctors and a dozen or so university-affiliated gender clinics in the 1960s and 1970s, this was never considered an acceptable treatment, and the doctors who facilitated this process were often looked upon by their peers as quacks and snake oil salesmen. That is why trans people have been and many times still are asked to swear themselves to secrecy about who their doctors were/are. These doctors don’t want to become the mecca, the “transsexual doctor,” lest it ruin their credibility and reputation. This myth greatly overestimates the ease with which people could acquire this treatment.
Second, it is interesting to me that people talk about “forced sex changes” when it comes to transsexual people, those who really want the treatment, but they don’t generally discuss the cases of actual forced sex changes, which happen mostly to intersex children but have also been known to occur in very rare cases with cis people, such as David Reimer, who I mentioned in a previous segment, and Alan Turing, one of the fathers of computer science, code-breaking, and artificial intelligence.
After Turing was arrested for homosexuality, which was still illegal in the UK in 1952, he was given estrogen treatments as an alternative to prison. Made terribly miserable by the effects of these treatments, he committed suicide 2 years later. The goal in administering estrogen to Turing was not exactly to make him straight, though. It was to reduce his libido and make him impotent, which did happen. We can see then that Reimer and Turing both experienced *dysphoria* upon having these treatments. That is, transitioning will make a cis person just as miserable as not transitioning will make a trans person. That is why I keep hammering on the theme of consent. This is all about whether the individual in question wants and needs the treatment.
Third, this completely disregards those of us who transition but are not heterosexual and/or gender-normative in our identified sexes/genders. We cannot be accounted for in this myth, and yet we certainly exist.
What strikes me as being most ironic about those feminists who believe this myth is that they don’t hesitate to claim that trans people are in alliance with the religious right to eliminate cis GLB people (sometimes by pointing to the situation in Iran, which is another matter altogether…I also recommend the film Facing Mirrors for the perspective of trans Iranians to give it a different light), yet they use the religious right’s tactics to discredit and harass trans people.
In case you thought that Raymond’s book was just theory and didn’t have an effect in the real world, think again. Not only do I continue to see this book cited unironically and without thoughtful analysis in social sciences texts even today, but in the 1970s, Janice Raymond successfully united with religious fundamentalist activists and lobbied the insurance industry to exclude genital reconstructive surgery under their plans because it was an “experimental, cosmetic” technique when in fact it is neither; its therapeutic benefits are well-established and it is cosmetic only insomuch as the appearances of body parts change. Nonetheless, the insurance industry bought this argument and to this day it is still an uphill battle, even with recommendations from the American Medical Association and theWorld Professional Association for Transgender Health (WPATH), to get them to cover our medical care. Raymond is also credited with the dissolution of the university gender clinics in this same time period.
Image credit: Barry Deutsch of Amptoons