Sculpting trans bodies

A constant note of the human experience is that we all have bodily autonomy to do with our bodies as we wish within the bounds of the law. This is as subjective as the societies we live in, with notions of bodily autonomy ranging from abortion to euthanasia, with things like tattoos, piercings, body mods, and plastic surgery falling into a spectrum ranging from small through to extreme. Our bodies are not the prisons of our mind, and bodily autonomy as a fundamental right of the human condition is always in tension with wider society, especially when it comes to how we medically intervene with ourselves. Trans bodies have long been sites of medical intervention based the idea that alleviating gender dysphoria through medicine is a holistic good. However, while sculpting bodies through scalpel and medication provides lifelong relief, it also opens up questions of how ethical it is to assume that the medicalisation of trans bodies is the dominant solution for gender dysphoria.

As someone who has sculpted their body to affirm my gender identity it is easy for me to say that medicalised intervention is laudable and worthy. I have been on hormones since 2000, had gender confirmation surgery in 2008, and then a tracheotomy in 2009. Hormones have given me curves and a traditionally assumed female bone structure. Yet, none of this alone has affirmed my gender, it is the holistic approach to moving through the world as a woman that provided the salve for my personal gender dysphoria. I have no personal critique for the way that medicalised intervention has alleviated my gender dysphoria.

However, this does not mean that we can simply assume that medicalised intervention is a pure concept that is virtuous at every level. Ever since Magnus Hirschfeld and the early trans medicine pioneers began to medically intervene in the 1910s and 20s there has been an ongoing conversation to the efficacy of trans healthcare through medical science. Much of the reasoning behind trans medical science is rooted in the ethics of bodily autonomy, that regardless of the feelings of cisnormative society at large it is down to the individual trans person to make the final decision as to what happens to their body. All healthcare is based on providing the best holistic approach to alleviate a set of symptoms, so to decry trans healthcare just because you may feel squeamish about it ignores the fact that all healthcare is inherently personal without recourse to the needs of society. Yet, the law regularly intervenes to limit personal autonomy based on the feelings of the wider whole.

Trans healthcare by its nature is unique to the individual trans person, one of the most gatekept areas of global medicine. To be trans and seeking medical intervention is to enter a world where your personal autonomy is judged at every turn. You become part of a system that judges you based on cisnormative understandings of gender and sex, where to access medical intervention is to be assumed that your body with conform to societal expectations. To subvert that is to risk access to insured medication, to fall foul of medical industrial practices that assume bodies should be a certain way. The efficacy of being trans falls short when it is compromised by this gatekeeping process, as whatever desires you may have to affirm your gendered self are tempered by the understanding of others. To be a medicalised trans person is to be compromised in your vision of self.

Or, is this simply the nature of the human condition, where every person alive lives in a state of compromised understanding of self. Each of use desires to remould ourselves at various points in our lives, and being a medicalised trans person takes most people’s idle musings to affirm a gendered self that exists in the mind’s eye. We are all essentially compromised versions of ourselves, which can be frustrating for trans people who depend of fulfilled medical intervention to exist safely in societies that harass and harm trans folk. When the ethics of trans identities are tested in the court of public opinion, it is this conjunction of bodily autonomy and societal safety that drives trans medicine forwards.

By making trans healthcare contentious matters that should be left between patient and doctor are made a matter of public discourse. That trans healthcare is called mutilating ignores every procedure that leaves a patient sterile, assuming that the pinnacle of the human condition is reproduction. In ignoring the bodily autonomy of trans folk those who attack our decisions also ignore the gender affirming care that cis people undertake globally. No trans medicine is unique to trans people, so to gatekeep it in such a way that treats trans people as mentally ill and not of sound mind is wildly patronising and hypocritical. Policing trans bodies is a power play designed to relegate trans people to a lesser citizenship, to legally infantilise them and make them wards of a gatekeeping state if they wish to exercise their personal bodily autonomy.

While it is easy to treat this as an abstraction, in reality this impacts trans people in ways that are hard to articulate other than frustration and rage. Trans people are left with a lesser citizenship based on false assumptions about our bodies and minds. Medical intervention to alleviate gender dysphoria is not something given away like condoms, it is gatekept within an inch of our lives. What should be a liberating experience of affirming our gendered selves becomes a marathon of navigating gatekeeping and society whims that deny our bodily autonomy. Cisnormative healthcare does not label the vast majority of cis gender affirming healthcare such as breast enlargement or reduction as mental illness, allowing cis bodily autonomy unfettered. All of this leaves trans patients infantilised before the law, in a philosophical limbo where sculpting our bodies through medical science is suspect and demeaned. Yet, none of this stops us from exercising our bodily autonomy to affirm our gendered selves.