Gender Identity, the Sexed Body, and the Medical Making of Transgender

Abstract

In this article, I argue that the medical conceptualization of gender identity in the United States has entered a “new regime of truth.” Drawing from a mixed-methods analysis of medical journals, I illuminate a shift in the locus of gender identity from external genitalia and pathologization of families to genes and brain structure and individualized self-conception. The sexed body itself has also undergone a transformation: Sex no longer resides solely in genitalia but has traveled to more visible parts of the body, implicating racialized aesthetic ideals in its new formulation. The re-imagining of gender identity as genetically and neurologically inscribed and the expanding locus of sex correspond to an inversion of the relationship between gender identity and the sexed body as well as shifts in medical jurisdiction. Whereas psychiatrists in the 1960s, ’70s, and ’80s understood gender as stemming from genital sex, the less popular idea that gender identity precedes the sexed body has gained traction in recent decades. If gender identity once derived from the sexed body, the sexed body must now be brought into alignment with gender identity. The increasing legitimacy of self-defined gender identity, the expanding definition of racialized sex, and the inversion of the sex–gender identity relationship elevates the role of surgeons in producing racialized and sexed bodies.

Queering Doing Gender: The Curious Absence of Ethnomethodology in Gender Studies and in Sociology

“…Acts of categorizing refuse recognition of the vast permutations of differences typically lumped together as “sex.” Attributing “typical” patterns of chromosomes, hormones, and appearances of genitals as maleness and femaleness is typification—gender attribution (Crawley, Foley, and Shehan 2008; Friedman 2006; Kessler and McKenna 1978). Basing this typification on the singular criterion of presumptions of reproductive capacity—not actual reproductive practice or capacity or a wide variety of other kinds of identifying criteria—makes the same assumption as homophobic claims to the biological primacy of heteronormativity (Gonsalves 2020)—the very basis of queer criticism.…”

“…The bifurcation into two categories of male and female is an invention of science, and its stability is maintained by scientific and legal attribution (Davis 2015; Fausto-Sterling 1992, 2000, 2005; Friedman 2006; Karkazis 2018; Kessler 1998; Roughgarden 2004) as much as routine attribution (similarly, see Somerville’s [2000] queer, anti-racist analysis of the connection of scientific racism and homophobia). Indeed, the science of reproduction, with claims to the “nature” of bodies, has changed significantly over time, with notions of male and female being variously understood (Elson 2004; Gonsalves 2020; Happe 2013; Laqueur 1990; Richardson 2013; Shiebinger 1993). Furthermore, the science of reproduction has invoked racism and homophobia (Gonsalves 2020; Happe 2013; Somerville 2000) as much as being mired in productions of binary gender.…”

“…Indeed, the science of reproduction, with claims to the “nature” of bodies, has changed significantly over time, with notions of male and female being variously understood (Elson 2004; Gonsalves 2020; Happe 2013; Laqueur 1990; Richardson 2013; Shiebinger 1993). Furthermore, the science of reproduction has invoked racism and homophobia (Gonsalves 2020; Happe 2013; Somerville 2000) as much as being mired in productions of binary gender. Scientists and bureaucrats often attempt to confirm that gender is sex—personifying and shaping the physical body as already masculine or feminine (Butler 1990; Kessler 1998; Lorber 1996; Martin 1991).…”

Cultivated co-production: Sexual health, human rights, and the revision of the ICD

“…Specifically, transgender people may need to be assigned a diagnosis in order to qualify for gender-affirming procedures (or be reimbursed for them, in cases where health insurance covers such procedures) or in order to amend birth certificates and passports or defend legal rights (Spade, 2006;Stryker, 2008). Therefore, transgender people have had to engage strategically with medical categorization (Gonsalves, 2020;Hanssmann, 2017;Johnson, 2019, Psihopaidas, 2016Zuiderent-Jerak and Jerak-Zuiderent, 2016) − often acquiescing to, yet also resenting, a characterization of themselves as having a medical or mental health condition (Ashley, 2019a;Stone, 1991). In ICD-10, this characterization took the specific form of a grouping within the chapter on mental and behavioral disorders called 'gender identity disorders', and within it a category called 'transsexualism': 'a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex'.…”

“Pee in Peace” or “Make Everyone Uncomfortable”: Public Perceptions of Transgender Rights

“…Westbrook and Schilt (2014) introduce the concept "determining gender" to illustrate the process by which transgender people are placed into sex/gender categories. Analyzing instances of conflict and resolution over "who counts as a man and who counts as a woman," Westbrook and Schilt (2014:32) find that in gender-segregated spaces, such as bathrooms and sports teams, biology-based accounts, such as surgical and hormonal criteria, are premiere in determining gender (see also G. Davis et al 2016;Gonsalves 2020;Lampe et al 2019). They describe how gender-segregated spaces, like bathrooms, are justified through rhetoric they name "penis panics," which situate bodies with penises as a threat and women as potential victims (Schilt and Westbrook 2015).…”