On Transmedicalism

Earlier this week, an Instagram post seemingly blaming Florida’s new Medicaid ban on funding gender affirming care on non-binary people went viral after Euphoria star Hunter Schafer commented on it.

Leaving aside the trans celebrity engagement, the post itself was somewhat bizarre as it rehashed some common transmedicalist talking points. I’ve always been somewhat sympathetic to the transmedicalist argument. After all, I had to get a gender dysphoria diagnosis before being able to transition, so the medical model is one that feels like the common trans experience to me.

But I’m not the dictator of the trans experience, and it’s okay if other people have different ways of describing their own trans lives, though it took awhile for me to get to that point. I was part of a friend group awhile back that was pretty heavily transmed. They were some of my first trans friends, so I stuck with them through a sense of nostalgia and comfort. But their political views sometimes really bothered me.

The strongest transmed argument to me is that keeping the medical model of transness makes it easier to sell cis people on the idea that gender affirming care is medically necessary. It’s enticing to cling to this, especially as conservatives and gender crits are beginning to succeed in restricting our care once again.

But where they go wrong is misplacing the blame for these bans. Instead of attacking those who actually restrict care, transmeds instead blame non-binary people who claim you don’t need dysphoria to be trans, as if Ron DeSantis is closely consulting with non-binary people before pushing a ban on transition care.

Florida’s Medicaid ban depends on a claim that transition care is not medically necessary. Of course, conservative Florida politicians don’t really care about non-binary people, who they regard as just as deluded as binary trans people.

But a quick scan of the history behind transition care bans should reveal just how futile the trans med position really is. In the early 80’s, ultra conservative Senator Jesse Helms succeeded in banning transition care from federal Medicare coverage, deeming it never medically necessary. This was, of course, long before the existence of non-binary people was as widely known as it is now (meaning that non-binary people definitely existed back then, but a lot of people weren’t aware of them).

Helms succeeded in this without even knowing of non-binary people and this was at the height of power for the transmedicalist model. Back then, trans people were completely at the mercy of their doctors, and transition was not only limited to those who experienced dysphoria, but trans women in particular had to be straight and physically attractive in order to access their care.

The Helms ban came shortly after a Johns Hopkins doctor, Paul McHugh, succeeded in shutting off gender affirming surgeries at the nation’s leading hospital system, again arguing that gender affirming care was not medically necessary.

Wherever you see a ban on trans care in history, there’s a claim that it’s not medically necessary. So it’s a bit stupid to blame the most recent spate of trans care bans on non-binary people.

Do we really want to return to an era where doctors can dictate our lives and make us into their own personal dancing monkeys in order to access care? In the old days, doctors required trans women to pick up their lives, “disappear,” and pop up in a new town far away from friends and family to start a new life. They required you to start out somewhat passing before allowing a medical transition.

I for one am not eager to return to this model, and yet that would definitely be a risk to going the transmedicalist route. I don’t know, I think we need all the solidarity we can get right now. Ron DeSantis and company win when we fight amongst ourselves instead of fighting them. It’s fine if we disagree on things, but we don’t need headass takes like “non-binary people enable trans care bans.”