Trans health care is an evolving practice, and as such, the assumptions which drive decision making and access to, or withholding of medical options for transition must be scrutinized. The current model of restricted access, psychiatrization of gender identity, and some aspects of protocols for assessing readiness for trans health care are laden with the following cis-normative assumptions:
1. That all trans people feel they were “born in the wrong body.”
2. That there are two genders: male and female, man and woman.
3. That man/male/masculine and woman/female/feminine must go together.
4. That trans women will necessarily id as feminine.
5. That trans men will necessarily id as masculine.
6. That each trans person “knew something was wrong” from birth.
7. That trans people have a coherent, linear narrative in terms of discovering and exploring their gender id: ie) “born in the wrong body” -> desire to “cross dress” from an early age -> “play” preferences appropriate to “opposite” gender -> heterosexual identity (ie. Trans men attracted to women and trans women attracted to men) -> experience largely of suffering and suicidality -> unbearable dysphoria -> transition to “opposite” gender.
8. That dysphoria is an inherent disconnect between the body and mind (spirit), and is entirely separate from societal notions imposing meaning on bodies.
9. That meaning imposed societally on bodies and how they are seen (*read) is an invalid reason for seeking changes.
10. That Trans ppl must display no ambivalence in the transition process.
11. That Trans ppl must have successfully reconciled their ambivalence prior to transitioning.
12. That transition means a desire to “become a woman” or “become a man” and cross over to an “opposite” gender.
13. That all trans people seek medical transition.
14. That medical transition is the only way to legitimate a trans identity and that individuals must be seeking ALL surgical options as well as hormonal options in order to be approved/seen as their chosen gender.
15. That trans or gender variant identities are “disordered” and in need of “treatment.”
16. That the psychiatrization of trans and gender variant experience is not a significant cause of mental health issues, depression, anxiety, systemic trauma and suicidality.
17. That the gender assessment process is not a magnified microcosm of societal transphobia.
18. That trans women must be able to “pass” as cis women.
19. That trans men don’t wear dresses or makeup.
20. That active substance use must be dealt with prior to starting hormones or approving surgery.
21. That homelessness should rule out approval for hormones or surgery.
22. That mental illness should rule out approval for hormones or surgery.
23. That individuals must *out* themselves in their chosen gender prior to accessing hormones or surgery.
24. That individuals must *out* themselves to their families prior to accessing hormones or surgery.
25. That family members will provide support. That this support is necessary to be approved for hormones or surgery.
26. That children are “too young” to give informed consent.
27. That children are “too young” to know who they are.
28. That cross gender play is a necessary determinant of trans identity.
I'm sure we can come up with many more examples of the various assumptions which infuse medical gatekeeping. Let's keep the discussion going and push for expanded discussions on these topics with service providers tasked with assessing who is suitably ready to receive appropriate healthcare.
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