Earlier this year the British Medical Journal tweeted asking why there has been no “constructive dialogue” about gender dysphoria. Abigail Thorn, a well-known trans woman, actor, and writer, responded saying “Probably cause ‘gender dysphoria’ was made up based on unreliable data by a bunch of cis doctors, multiple of whom have since been disgraced. We shouldn’t need some cis person’s fantasy diagnosis to transition; the fact that we want to is enough.” (Emphasis my own). Her response generated a swift backlash—from trans people! Thorn’s replies were filled with people accusing her of perpetuating the harmful myth that being trans is just a “fad” or “mere cosmetic choice.” Some crossed the line into attacking Thorn with those very myths. Many asked Thorn, seemingly derisively, “do you have gender dysphoria? Or did you transition because you wanted to?”
Some trans people uncharitably read Thorn as denying the reality of their feelings. While trans people’s defensiveness is understandable given this transphobic world, and the feelings labelled as “gender dysphoria” are very real, Thorn is attacking the idea that these feelings constitute a distinctive medical and diagnostic kind. Moreover, Thorn is right—“gender dysphoria” was made up by cis doctors based on unreliable data drawn from deeply flawed clinical practices. Yet trans people’s responses to Thorn suggest that the concept of gender dysphoria plays some important role. I want to explore two such roles the concept currently plays, and show why it is imperative trans people move past them.
Gender dysphoria is defined as a manifested incongruence between one’s experienced gender and one’s natal gender that is associated with clinically significant distress or impairment in important areas of functioning. Getting this diagnosis into the Diagnostic and Statistical Manual (DSM) was a genuine victory for trans rights. Medical organizations are tools of social legitimization, and this gave advocates for trans rights something “backed by science” to cite to governments and other powerful institutions in arguing for those rights. Moreover, gender dysphoria is conceptualized as involuntary, as something that happens to trans people. In this respect it functions like the “gay gene” and locates the source of a socially maligned identity outside of the will of the people who express it. These factors together mean the concept of gender dysphoria plays an institutional role of providing a reason for the state to accommodate trans people.
As such, it is reasonable for trans people to worry that undermining the diagnostic category will undermine the perceived need for the state to provide care. Moreover, this worry is becoming true. As lawmakers attempt to strip away trans people’s rights, they are attempting to redefine being trans as a kind of fetish, something that people tend to think individuals have control over whether they express, and thus something the state should not support.
It is true that abolishing the category of gender dysphoria immediately would create a hole in the political, legal, and bureaucratic apparatus that currently secures some trans people some rights. But the social security that gender dysphoria provides is a false one, and as Thorn also later pointed out, the diagnosis of gender dysphoria is a key tool in the system that disempowers trans people.
I am not the first to point out that makeup, dietary supplements, and cosmetic surgery are all gender-affirming procedures, and that cis people engage in them to alleviate feelings that can be labelled “gender dysphoria.” When a cis woman feels disgusted by hair on her upper lip and gets electrolysis to remove it, she is seeking a gender-affirming procedure to alleviate her dysphoria. When a cis man feels emasculated by his height and has his legs surgically lengthened, he is seeking a gender-affirming procedure to alleviate his dysphoria. A cis man might feel anxious because he is persistently perceived as “unmanly,” and a cis woman might feel grief over how she was denied femininity as a child. In other words, cis people experience the feelings that trans people feel, and they engage in procedures to change themselves to be more aligned with who they feel they really are.
Yet we do not call cis people’s feelings “gender dysphoria”—that label is reserved for trans people. Why? There is nothing distinctive about trans people’s feelings. Cis people experience them as intensely as trans people do. Cis people often become depressed if they are unable to affirm their gender, and will engage in risky behaviors to get the gender affirmation they want—both notable signs of someone suffering from gender dysphoria.
Ultimately, the reason we don’t say cis people suffer from gender dysphoria is because they are cis and not trans. Gender dysphoria is the thing that trans people have. To borrow from Thorn, for all its mention of “distress” and “incongruence” the definition of gender dysphoria is effectively “mad tr***y disease.”
The diagnosis of gender dysphoria perpetuates the idea that trans people are dysfunctional and cannot be permitted to make choices about ourselves and our bodies that cis people make about theirs. If a cis woman wants breast implants, she can get a referral from her doctor. If a trans woman wants the same procedure, she will likely have to pass months or years of invasive psychiatric evaluation—and, as Thorn said, cis people have control over the criteria of evaluation. Trans people are thus at risk of those criteria being changed without our consent or input. For example, in states like Florida, politicians trying to ban access to transition-related healthcare falsely argue that the “affirmative approach” to trans identities—wherein a trans person’s claims about their identity are affirmed and respected—is harmful, and that people should instead be “encouraged” to feel comfortable in the sex they were assigned. This is conversion therapy, a form of torture, and without the political power to fight this trans people are fleeing these states in huge numbers.
This state of affairs is profoundly disempowering, and the diagnosis of gender dysphoria is a vital part of how it is maintained. Thus, although getting gender dysphoria into the DSM was an important victory, it can only be a stop-gap solution. Gender dysphoria puts the reins of trans people’s lives in other, usually cis, people’s hands, and trans people should be fighting for a system where we don’t need another person’s authority to access the care we want.
As the replies to Thorn’s tweet show, however, some trans people object to this political vision. According to them, simply wanting to transition is not enough. This view is known as transmedicalism and purports that transness is a medical condition, namely the mental disorder of having gender dysphoria. According to transmedicalism, a person needs to suffer from gender dysphoria to be trans. “Suffer” is the operative word. Transmedicalists— that is, the trans people who affirm this narrative—frequently describe being trans as awful, as a horrendous condition that they wouldn’t wish on their worst enemy. Many say that they don’t want to be trans or to transition—they are doing it because they have to.
While I strongly disagree with transmedicalism, I have no interest in denying trans people’s reports of their experiences. What I am interested in is how interpreting their identities around the concept of gender dysphoria performs a personal function for transmedicalists, and the role this serves in their lives.
Trans people suffer widespread and persistent hermeneutical injustices, the injustice of lacking the conceptual resources people need to understand their own experiences due to widespread prejudices about them. Because mainstream society lacks positive or accurate representations of them, trans people are frequently misinterpreted and left unable to communicate their experiences to others. These communicative failures prop up transphobic social practices. As Miranda Fricker emphasizes, one of the central harms of persistent hermeneutical injustice is undermining people’s abilities to maintain their identities. Being persistently unable to make sense of their experiences undermines a person’s confidence in themselves, and makes them vulnerable to prejudicial interpretations of who they are. For example, women who suffered sexual harassment but who lacked the concept needed to make sense of their experiences instead saw themselves as “boring” and “overly sensitive” people who couldn’t “take a joke.”
Trans people face exactly this vulnerability. Transphobia invalidates trans people’s feelings towards their genders on the basis of their supposed “real bodies.” Sexed bodies are not only defined by their physical parts but also their “expected subjectivities,” i.e., the desires and other mental states they are supposed to have. Bodies coded as male are not supposed to desire being feminine, having breasts, or being called a “girl’s name.” Trans people misalign these expectations, and transphobia codes this as either deception or delusion, depicting trans people as “really men/women” who are only pretending to be women/men. These depictions saturate the process of figuring out one is trans—e.g., if I am a trans woman who still thinks of herself as a man, then I will likely interpret my feelings as evidence that I am delusional, or that I want to pretend to be a woman for some perhaps fetishistic reason. This gives me a reason to suppress my feelings of “cross sex desire,” much like how experiencing oneself as “boring” can provide a reason to ignore one’s feelings of discomfort about workplace harassment.
This is where gender dysphoria plays its role in transmedicalist narratives by bolstering the idea that being trans is a concrete reality that happens to trans people. Transmedicalism is one example of an approach that, as Gayle Salamon puts it, attempts to locate a substance that grounds trans identities in a real material difference between cis and trans bodies. When a trans person believes this narrative they cede their responsibility for their own identity, as gender dysphoria enables them to put the responsibility for their transness outside of their will and onto their body. They are not trying to pretend to anyone—they are not trying to do anything. This isn’t something they want; it is something they must submit to. Interpreting themselves as having gender dysphoria thereby provides the trans person with a first-personally intelligible reason to take their feelings seriously, as actionable, and thus vindicates the decision to transition.
However, like its institutional role, this personal role can only be a stopgap solution. Gender dysphoria perpetuates its own hermeneutical injustice. The functional definition of gender dysphoria as the thing that trans people have impedes people from realizing that they are experiencing gender dysphoria, because for them to even consider that their feelings might be gender dysphoria they must already consider that they might be trans. I distinctly recall this period of my life. I was depressed, disassociated from my body, and jealous of trans women, and I would think “why do I feel this way? I’m not trans, so it can’t be gender dysphoria…” What the concept gives with one hand it takes away with the other.
Identifying as having the mental condition of gender dysphoria is a form of internalized oppression. Feminists and others have described how oppressive conditions lead to existentially and agentially restricted subjects who are diminished in their capacities compared to non-oppressed subjects. There are disempowering ways of identifying oneself that put people at risk of personal harm and of perpetuating conditions that harm their oppressed group. Gender dysphoria is one such way. It locks trans people into dependence on the abusive medical system, and forces them to accept the degrading forms of gatekeeping imposed as conditions for accessing care. Moreover, transmedicalists often ally with those seeking to abolish trans rights and trans people altogether. Blaire White and Buck Angel, two prominent transmedicalists, have both publicly allied themselves with far-right and openly fascistic political figures, and have used their platforms to promote claims that the transfeminist movement has “gone too far” and that transitioning has become “trendy.”
Given the problems with gender dysphoria as a diagnostic category, it is vital that transfeminists and trans people move past its description of trans identities and the narrative it provides for the legitimacy of transition. I agree with Thorn. The best place to look for legitimacy is our own wills. Wanting it is enough.
The idea that wanting it is enough can be scary. The fact that it centers trans people’s agency means there is a worry that shifting to this approach will create difficulties that approaches using concepts like gender dysphoria and the “gay gene” avoid.
But I think there are significant benefits, too. Shifting to this approach demystifies trans people. Constructing narratives of transness and transitioning that center trans people’s agency and our understanding of the meanings of our choices brings trans people’s behaviour under the same framework of evaluation as cis people’s. Trans people’s choices are just like cis people’s—they don’t exude some special dysphoria juice, and can be understood in terms of the reasons why individuals make them.
This approach also provides a richer scaffolding upon which trans people can overcome the aforementioned hermeneutical injustice. A key part of moving past the diagnosis of dysphoria is providing a replacement for the role it plays for some trans people making sense of their identities, and good places to look for these narratives are trans people who have already figured it out. Trans people choose to transition for many different reasons, and have different experiences of e.g., how anger and grief have impacted their lives, how they have eradicated their shame, as well as how they find joy and experience their bodies as pleasurable. By centering their reasons for their choices in an understanding of trans identities, trans people and transfeminists can provide more pathways for people to realize they are trans.
Finally, I think this approach has significant radical potential. Laws that prohibit abortion and no-fault divorce, that restrict or ban women’s access to birth control, and that criminalize trans people are all part of a state system of restricting bodily autonomy. These restrictions are justified on the grounds that a person’s body takes priority over what they want to do with it because there is something that their body is for, a function that it has and that it is the role of the state to “protect.” Trans people disrupt the foundation of this system of control.
If wanting it is enough then it is not true that our bodies are for something. Pre-transition, a trans person’s body may be able to do things it cannot do post-transition. But to assume those things should define the parameters of the person’s life is a deeply anti-feminist, anti-trans idea. The goal of transfeminism is not to “fine-tune” the state’s ability to control who gets to do what with their bodies. The goal is to create a system that’s responsive to people’s needs, that accommodates and enables their assertions of their identities, and that provides them the resources to live the lives they wish.
This is a trans political vision of radical bodily autonomy. My body is not a predefined reality that provides a divine or natural mandate for how my life must go and which the state must “ensure.” There is just the physical material of my body, my will, and my desires, and the social and other resources I can access to make the former align better with the latter. While my body of course sets the limits of many of my capacities, it does not have authority over me—and nor do I have authority over it. I am not master over my body; we are in this together, and I, with my body, am what I am able to make of me.
As such, I think wanting it has to be enough, because wanting to be one gender for some reasons, or not wanting to be another gender for some reasons, is really all there is to trans identities, and to any other person’s gender identity, too.
The Women in Philosophy series publishes posts on those excluded in the history of philosophy on the basis of gender injustice, issues of gender injustice in the field of philosophy, and issues of gender injustice in the wider world that philosophy can be useful in addressing. If you are interested in writing for the series, please contact the Series Editor Alida Liberman or the Associate Editor Elisabeth Paquette.
Jas Heaton
Jas (sometimes “Jasper”) is a doctoral candidate in philosophy at the University of British Columbia. Their research is in feminist and transfeminist philosophy with a focus on social ontology and social epistemology, and they are currently working on a series of papers about the utility of theories of gender identity in feminist and transfeminist politics. Jas is also interested in issues of equity, diversity and inclusivity within academic philosophy, and she is an active member of the Philosophy Exception project.
Thank you for this post. J.
“Desire is the womb from which all things have their birth or beginning” (Hermes Trismegestus)