Transmedicalists and the Cult of Self-Exclusion
By: Rori Porter
Tags: Inclusion, Transgender, Nonbinary, LGBTQ, Human Rights

I came out about three years ago as a transgender woman and have learned a lot about my community in that time. Before coming out, I was largely isolated from trans issues and knew little of the battle between transmedicalists and nonbinary trans folks until I found myself caught in the thick of it. I have encountered much ire from folks who identify as “old-school transsexuals” in response to my assertions that nonbinary people fall under the trans umbrella. I find the main personality trait in these folks is a desire to remove themselves from the greater trans community to align themselves as “transier than thou.”

For those uninitiated, transmedicalism is a belief that being transgender requires medical transition, and that anybody who seeks alternative paths to their truth is invalid and not part of the trans community.

Despite some thoughts I’ve seen to the contrary, “transmedicalist” and “transsexual” are not at all synonymous. Transmedicalism is an ideology, and transsexuality is an identity.

A piece that I keep coming across on this website is penned by a transsexual-identified woman who feels left out of the “trans*” community, despite the trans community being largely accommodating binary trans folks’ experiences over those of nonbinary experience. I find this desire to form an isolated transsexual community to be curious, as your average nonbinary person has no issue with other people identifying as transsexual, nor do they exclude transsexual-identified folks from their spaces. I often see “old-school transsexuals” intentionally and vehemently refusing to accept nonbinary people as part of their own community due to a, apparent misunderstanding that transsexuality and nonbinary are mutually exclusive. (Spoiler alert: they’re not.)

Just because the transsexual-identified experience and label are no longer being held as the golden standard of transness does not mean that we’re being left out of the trans community. Rather, our experience of binary medically-driven transness is accepted as a norm and is more easily digested by the general cishet public.

Personally, I identify as a nonbinary transsexual/transfemme woman. I do not often use the middle part of that identity out loud very often because it invites too much scrutiny into the path of my medical transition. The surgeries and medical interventions I wish to undertake are ultimately nobody’s business but mine and the people I share those details with like significant others and medical professionals. While I do not publically call myself a transsexual, this is most definitely a part of my identity.

This is largely why the term “transsexual” has fallen out of favor — not because it is invalid, but because it’s a term that focuses far too heavily on our parts for the comfort of many trans folks. Of course, medical transition is of great importance to many of us, but it is not something that many of us feel defines our whole trans experience or something that we wish to openly broadcast or invite scrutiny upon. My own nonbinary identity feels in no way at odds with my transsexual identity because my desire to physically transition ultimately has little to do with my gender identity. If I were assigned female at birth (AFAB), I would still identify as nonbinary; I would just not have to undergo much or any medical transition. The dysphoria of being born in what some consider a “male body” drives me toward a medical path to transition, but my gender identity and presentation as a woman neither exist in a vacuum. They are not at all contingent upon following a stereotypical path to fixing the parts of my body that cause me pain. I think that gender is a rigid social construct that ultimately serves more harm than good, and therefore I identify as nonbinary.

The fact that many nonbinary people experience dysphoria and often wish to medically transition seems to be conveniently glossed over by transmedicalists, and that *literally nobody* is excluding transsexual-identified trans people from trans spaces is also ignored in favor of a self-isolationist model that sees “old-school transsexuals” refusing to accept that the trans umbrella has grown. This is rather akin to the phenomenon of cis gays and lesbians being averse to accepting bi/pansexual (and trans people, for that matter) into the umbrella that has become our LGBTQIA+ alphabet soup.

The mentality seems to be that if the umbrella grows larger, they will become lost in the shuffle, when, in actuality, LGBTQIA+ spaces are largely more accommodating to people of binary sexual and gender experience in terms of access to medical care and accommodating mental health services like individual and/or group therapy. Equality isn’t pie — if there are more services and inclusion of nonbinary folks, that doesn’t equate to less for transsexuals. My own health center has group therapy for transfemmes and transmascs, but nothing of the sort for nonbinary-identified individuals. In my personal experience, increased visibility has not yet equated to increased services — we are still divided by gender assigned at birth — so I am not totally sure what transmedicalists are getting at when they insist that nonbinary people are interloping upon much-needed services for transsexual-identified trans folks.

Moreover, transsexual-identified trans folks trying to separate themselves from nonbinary folks ignore people's lived experiences like me, who are definitively both transsexual and nonbinary. My intersecting identities cannot be isolated from each other as they are manifestly intertwined. I am not transsexual one day and nonbinary the other, and I am both at the same time because these identities are merely labels that I use to explain my experience, not to shove myself in a box.

And that’s the whole point we’ve been trying to explain about gender for decades, right? Gender and sex are two separate things. You can be a transsexual AND nonbinary because gender does not always have to do with one’s genitalia or body features. The “old-school transsexuals” I know align that way because their dysphoria matches their binary gender identity — it doesn’t make them more trans or more valid than people who are nonbinary.

I find this self-isolationist old-school transsexual model interesting, as I personally straddle nonbinary and transsexual labels and don’t quite understand this inclination to separate oneself from the greater trans community. I don’t really know any nonbinary people who take issue with transsexual-identified trans folks, except in the case where “old-school transsexual” becomes a dog whistle for the “actually trans club.” Furthermore, I don’t know of any nonbinary people who would disagree that transsexual folks are valid and deserve reverence and space within the community. The exclusion of the “other” is reserved primarily for transmedicalists, who seek to leave nonbinary people in the rain, constricting the umbrella to a singular trans experience in which transness is the sole property of those who wish to or have the means to transition medically.

There is no harm in a trans umbrella that includes all people who don’t align with their gender assigned at birth. The harm is solely in “old-school transsexuals” who wish to keep the umbrella small. The problem with that is that constricting the umbrella to a singular experience leaves vulnerable people out in the rain, left to fend for themselves against a world that fails to protect them.

So, to be clear, not all nonbinary people are transsexual, just as not all trans people are nonbinary, but I know a fair amount who are. And here’s the thing — transsexual is a term that focuses heavily on our sex parts, so while many of us align with a medical path to transition, not all of us want to use a word that reduces us to our genitalia.

I find transsexual isolationists / transmedicalists to be quite as ridiculous as those who reject the reality of bisexuality. To close the umbrella to a binary experience is to ignore that bisexual people experience discrimination and that nonbinary people face scrutiny larger than that of “old-school transsexuals.” The binary experience of gender and sexuality is seen as a default setting. Anyone outside of it is seen as an interloper, forcing the umbrella to grow to unstable proportions. But as a community, I believe that we are stronger together, and I believe that we have more in common than we have differences.

Nobody rejects transsexuality from the trans umbrella, just as nobody rejects cis gays and lesbians from the LGBTQIA+ community in favor of bi/pansexuality. This self-victimization is baffling to me. If they would only open their minds, they would see that inclusion of those who defy the gender binary does not equate to the exclusion of those who align with it. Yes, transsexual is considered outdated as an umbrella these days, just as “homosexual” is considered cold and clinical, but that’s because that identity and experience do not apply to all of us. Where people start to take offense is when “old-school transsexual” becomes a dog whistle for, “I’m trans, and you’re not — get out from under my fucking umbrella.”

In my experience, non-transitioning trans folks often face a lot of scrutiny for their desire not to transition, often causing severe mental health issues and sometimes end up making choices to get surgeries they didn’t actually want or need and only got as a means of being accepted into the community. Of course, the need for surgeries and hormones are serious needs for those who require those things, but I hardly see how the needs of those who wish to transition are more important or more valid than that of those who do not (or wish for minimal medical transition.)

Further, those who use non-binary pronouns tend to get misgendered much more than those who use binary pronouns (not that any particular pronoun is the sole domain of either party.) The idea that neopronouns are less acute of a concern is a matter of opinion that I respectfully disagree with. For those who need them, they are a matter of great need, as being misgendered causes those who use them quite as much distress as those who are misgendered in a binary way. The difference is, the nonbinary folks I know are misgendered more or less always, even when using “they” instead of neopronouns like “ze/zir.”

Again, equality is not pie. More for others does not mean less for anybody else. A focus on neopronouns, genderless bathrooms, and social transition is not superfluous but hugely necessary and quite as important as making sure all trans people can access proper healthcare. These struggles exist simultaneously, and it is entirely possible to focus on all of them without leaving either party in the dust.

As one reader pointed out and commented, the move toward transmedicalism is often subconscious in those who experience a binary and more “traditional” form of transition. Especially with older generations, “old-school transsexuality” was all there was when they were coming up and out, and newer generations having more options can seem like an assault on their way of being. I do think this viewpoint is self-centered and myopic, regardless, however earnestly one comes by this mode of thinking. How we solve that problem is a curious issue, as I’m not sure how much I can reach those who hold to those views strongly. I can write pieces like this, but there will always be knee-jerk reactions, even to well-reasoned concern.

Inclusion is the wave of the future. As a community, we are all marginalized in ways that see us needing to band together in radical acceptance. Transsexuality is not at odds with nonbinary identities, and it has never been. Rather, modern transness is at odds with gatekeeping.

Queer liberation will be fought for by those who radically embrace the nonbinary experience, regardless of whether they personally align with it. I don’t identify much with gender fluidity. Still, I respect it as an experience that sits adjacent to my own and therefore under the umbrella in which I seek refuge and community. Bi/pansexuality and nonbinary experiences are moving toward creating a society in which we are not forced into boxes for others' convenience. Binary gender and sexual experiences will never stop being the majority, but our community will continue to grow as everyone understands that gender and sexuality exist on a spectrum. It is not a line from here to there, but a Mobius strip that wraps in and over before meeting back at the beginning and end of itself.

Fellow transsexual-identified trans folks, particularly those who identify as transmedicalist, I invite you to come out and experience the full beauty of our growing queer/trans community. I invite you to live your best life, whether you align with a binary gender or a nonbinary one. You are not being excluded; you are being embraced as among those who took the first steps toward queer liberation. Look no further than the reverence for figures like Marsha P. Johnson, Silvia Rivera, Lavern Cox, Janet Mock, Chaz Bono, Lynn Conway, and Renee Richards, who all forged the path so that nonbinary people to live their truths as well. Transsexuals were the ground-breakers, the trail-blazers who made the rise of nonbinary identity, which could be digested by the culture at large. The move away from the term “transsexual” is merely a side-effect of most of us not wanting to be reduced to an “innie” or an “outie.”

As those in the majority under the trans umbrella, we must stop this self-isolating and gatekeeping. It serves no purpose other than to divide us in a world where we need unity and radical acceptance of all people under the trans umbrella. I call myself a nonbinary transsexual both as an accurate representation of my identity and as an act of defiance against those who would seek to put up walls between these states of being. The old-school ways are holding you back from seeing that the community is greater than your own experience.

Nobody will take your transsexual identity from you. All who do not align with their gender assigned at birth are trans if they wish to claim the label. As a trans advocate, I insist that we hold the umbrella open for anybody who needs it. Otherwise, we are doing to nonbinary folks exactly what cis gays have done to trans folks since that first brick was thrown at Stonewall.