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MutilatingGender

DeanSpade
Spring2000

Howdoyouknowyouwantrhinoplasty,anosejob?heinquires,fixingmewithapenetratingstare.
Because,Ireply,suddenlyunabletoraisemyeyesabovehisbrownwingtips,Ivealwaysfeltlikea
smallnosedwomantrappedinalargenosedbody.
Andhowlonghaveyoufeltthisway?Heleansforward,soundingasifheknowstheanswerand
needsonlytohearthewords.
Oh,sinceIwasfiveorsix,doctor,practicallyallmylife.
Thenyouhaverhinoidentitydisorder,theshoetopsstateflatly.Mybodysagsinrelief.Butfirst,
hegoeson,wewantyoutogetlettersfromtwopsychiatristsandliveasasmallnosedwomanforthree
years...justtobesure.[1]

In1958,awomannamedAgnespresentedherselftodoctorsattheDepartmentofPsychiatryofthe
UniversityofCalfornia,LosAngelesseekingplasticsurgerytoremedyanapparentendocrineabnormality.[2]
Thedoctorswereengagedinastudyofintersexedpatients,andwereinterestedtofindthatAgnesappeareda
femininewoman,withfemalesecondarysexcharacteristics,butalsohadafullydevelopedpenisandatrophic
scrotum.Agnesexplainedthatshehadbeenbroughtupasaboy,buthadalwaysfeltshewasagirlandhad
developedfemalecharacteristicsatpuberty.ThemedicalteamdiagnosedAgneswithtesticularfeminization
syndrome,speculatingthatherfemininecharacteristicscamefromestrogensproducedbyhertestes.[3]They
performedsurgerytoremoveherpenisandtestesinordertocorrectthisnaturalmistake.

FiveyearsafterAgnesobtainedsurgery,andeightyearsafterfirstcametotheUCLAclinic,sherevealed
tothedoctorsthatshehadnotspontaneouslydevelopedfemalesecondarysexcharacteristics,buthadengineered
afeminineappearancebytakinghermothersestrogenbeginningattheageoftwelve.Hausmancomments,
Agnesspassingfrommantowomanturnsouttohavebeenbasedonanotherkindofpassingaltogether.[4]
Agnesachievedhersurgicalgoalsbyfoolingthedoctorsintobelievingthatshewasintersexedthecriteriafor
receivingsuchsurgeryintheirprogram.
WhatisthesignificanceofthenecessityforandexecutionofAgnessdeceptionofthedoctors?How
shouldgendertheorists,feminists,andtranspeopleunderstandthelongstandingpracticeamongstgendervariant
peopleofstrategicallydeployingmedicallyapprovednarrativesinordertoobtainbodyalterationgoals?
Thisessayexaminestherelationshipbetweenindividualsseekingsexreassignmentsurgery(SRS)[5]and
themedicalestablishmentswithwhichtheymustcontendinordertofulfilltheirgoals.Mystartingpointforthis
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analysisisFoucaultsunderstandingofpowerasproductiveratherthanrepressive,andofgovernanceasoccurring
notprimarilythroughrepressivelawbutthroughdisciplinaryforceswhichexistindiverse,uncoordinated
agencies.[6]UsingFoucaultsmodelsofpowerandgovernance,Ilookcarefullyatthediagnosisandtreatment
ofGenderIdentityDisorder(GID)fromtheperspectiveofpersonsseekingSRS,examininghowthecreationof
thesubjectpositiontranssexualbythemedicalestablishmentrestrictsindividualsseekingbodyalterationand
promotesthecreationofnormabidinggenderedsubjects.
Throughoutthisessay,Idrawonmyownexperienceofattemptingtofindlowcostorfreecounselingin
ordertobegintheprocessofgettingadoublemastectomy.Thechoicetousepersonalnarrativeinthispiece
comesfromabeliefthatjustsuchacombinationoftheoreticalworkabouttherelationshipsoftranspeopleto
medicalestablishmentsandgendernormsandtheexperienceoftranspeopleistoorarelyfound.RikiAnne
Wilchinsdescribeshowtransexperiencehasbeenusedbypsychiatrists,culturalfeminists,anthropologists,and
sociologiststravel[ling]throughourlivesandproblemsliketourists...[p]icnickingonouridentities...
select[ing]thetastiesttidbitswithwhichtoillustrateatheoryorpushabook.[7]Inmostwritingabouttrans
people,ourgenderperformanceisputunderamicroscopetoprovetheoriesorbuildexpertisewhilethegender
performancesoftheauthorsremainunexaminedandnaturalized.Iwanttoavoideventheappearanceof
participationinsuchatradition,justasIwanttousemyownexperiencetoillustratehowtherequirementsfor
diagnosisandtreatmentplayoutonindividualbodies.Therecentproliferationofacademicandactivistworkon
transissueshascreatedtheimpressioninmanypeople(mostlynontrans)thatproblemswithaccesstoservicesfor
transpeoplearebeingalleviated,andthattheeducationofmanyspecialistswhoprovideservicestotranspeople
hasmadeavailablesensitivetherapeuticenvironmentsfortranspeoplelivinginlargemetropolitanareaswhocan
availthemselvesofsuchservices.Myunsuccessfulyearlongquestforbasiclowcostrespectfulcounseling
servicesinLosAngeles,whichincludedseekingservicesattheLosAngelesGenderCenter,theLosAngeles
GayandLesbianServicesCenterandChildrensHospitalLosAngelesisatestamenttotheproblemsthatstill
remain.[8]Thisfailuresuggeststhelargerproblemswiththeproductionofthetranssexualinmedicalpractice,
andwiththediagnosticandtreatmentcriteriathatmadeitimpossiblefortheprofessionalsfromwhomIsought
caretorespectfullyengagemyrequestforgenderrelatedbodyalteration.
Ihopethattheuseofmyexperienceinthispaperwillprovideagroundingillustrationoftheregulatory
effectsofthecurrentdiagnosistreatmentschemeforGIDandresistthetraditionalframingoftranssexual
experiencewhichpositstranspeopleasvictimsorvillains,insaneorfascinating.Instead,Ihopetobepartofa

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projectalreadytakenupbyRikiAnneWilchins,KateBornstein,LeslieFeinberg,andmanyotherswhichopensa
positionfortranspeopleasselfcritical,feminist,intellectualsubjectsofknowledgeratherthansimplycasestudies.
I.Governance:PassingasaTranssexual
HereswhatImafter:asurgicallyconstructedmaleappearingchest,nohormones(fornowmaybe
forever),nofirstnamechange,anypronouns(exceptit)areokay,althoughwhenitcomestogendered
genericsIhappentoreallylikeUnclebetterthanAunt,anddefinitelyMr.Spade.[9]Hausmanwrites,
transsexualsmustseekandobtainmedicaltreatmentinordertoberecognizedastranssexuals.Theirsubject
positiondependsuponanecessaryrelationtothemedicalestablishmentanditsdiscourses.[10]Ivequickly
learnedthattheconverseisalsotrue,inordertoobtainthemedicalinterventionIamseeking,Ineedtoprovemy
membershipinthecategorytranssexualprovethatIhaveGIDtotheproperauthorities.Unfortunately,
statingmytrueobjectivesisnotconvincingthem.

Intheiressay,TheSocioMedicalConstructionofTranssexualism:AnInterpretationandCritique,
BillingsandUrbanexaminethedevelopmentoftranssexualismasadisease,andsexchangesurgeryasits
treatment.Theyarguethattranssexualismissociallyconstructedbymedicalpractice,andismaintainedby
profiteerdoctorswhogainwealth,fame,andsurgicalexpertisethroughthediagnosisandtreatment(whichthe
authorscallmutilation)ofavarietyofsexualdeviantsincorrectlylabeledtranssexuals.[11]Manyofthe
conclusionsoftheiressaycontradictthebasicpremisesofthispaper:thatsexualandgenderselfdeterminationand
theexpressionofvariantgenderidentitieswithoutpunishment(andwithcelebration)shouldbethegoalsofany
medical,legal,orpoliticalexaminationoforinterventionintothegenderexpressionofindividualsandgroups.
However,manyoftheirtheoreticalunderstandingsoftheoperationofmedicalauthoritywithregardtogender
reassignmentarevaluable.[12]
BillingsandUrbanareconcernedwiththedominationofdailylifeandconsciousnessbyprofessional
authority...[and]theextenttowhichmanyformsofdevianceareincreasinglylabeledillnessaswellthe
possibilitythat[s]exchangesurgeryprivatizesanddepoliticizesindividualexperiencesofgenderrole
distress.[13]Theyarguethattranssexualismisconstructedbyandonlyexiststhroughmedicalpractice,which
hasinventeditasapsychologicalentity,aprobleminthemindsofpatients.Instead,BillingsandUrbansuggest
thattranssexualismisarelationalprocesssustainedinmedicalpracticeandmarketedinpublictestimony.[14]
BillingsandUrbanscritiqueoftheinventionofthetranssexualasamedicalanomaly,amentallyill
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personrequiringtreatment,offersausefulpointofdepartureforananalysisofthetreatmentanddiagnosisofGID
thatquestionsthetermsuponwhichindividualsseekingbodyalterationmayreceivesuchcare.Understanding
physicalandmentalhealthcareassocialprocesseswithregulatoryeffects,wecanexaminethestandardsby
whichsuchalterationisrestricted.[15]
Foucaultdescribesanotionofproductivepowerthatinstructsacriticalanalysisoftheregulatoryeffectsof
medicaldiagnosisandtreatment.Foucaultrejectswhathetermstherepressivehypothesisasawayofviewing
thehistoryofsexualitysincethe16thcentury.[16]Hearguesthatthehistoryofsexualityisnotcharacterizedby
repression,butbyanincitementtospeakaboutsex.[17]Hedescribeshowtheimperativehasbeentospeak
aboutsex,toaccumulatedetailedknowledgeofit,toidentifyandclassifyit,andtoseekouttheoriginsofsexual
behavioranddesire.Sexualityhasbecomethelocusofthetrueselftoknowtheselfistoknowonessex,
sexuality,anddesire.Inthismodel,sexisfigurednotasthethingthatmustnotbespoken,butasapublic
problemneedingtobemanagedbyanincreasinglylargegroupofmedical,psychiatric,andcriminaljustice
specialists.[18]
Foucaultdemandsthattheprojectofaskingwhetherapproachestosexarerepressiveorpermissivebe
replacedbyaprojectofexamininghowsexisputintodiscourse.Hismodelofpowerasproductiverequiresthat
powerdoesnotjustsaynoandenslavefreesubjects,butratherproducesknowledge,categoriesandidentities
thatmanageandregulatebehavior.Foucaultsfavoredexampleistheinventionofhomosexuality.Hearguesthat
thesexologistswhofirstdiscussedhomosexualitywerenotidentifyingapreexistingidentity,butratherwere
inventingthehomosexual.[19]
Foucaultstheoryofpowerrequiresaconceptionofgovernancewhichgoesbeyondtheajuridico
discursivemodelwherepowerexistsinlaw,whichrepressesandforbids.[20]InsteadFoucaultdemonstrateshow
governanceoccursthroughdisciplinarypower,locatedindiverse,uncoordinatedagencies,includingeducational,
medical,andpsychiatricinstitutions.HuntandWickhamdescribedisciplinarypower:
Discipline,ratherthanbeingconstitutedbyminoroffences,ischaracteristicallyassociatedwith
norms,thatis,withstandards,thatthesubjectofadisciplinecomestointernaliseormanifestin
behaviour,forexamplestandardsoftidiness,punctuality,respectfulness,etc....Thesestandards
ofproperconductputintoplaceamodeofregulationcharacterisedbyinterventionsdesignedto
correctdeviationsandtosecurecomplianceandconformity...Itisthroughtherepetitionof
normativerequirementsthatthenormalisconstructedandthusdisciplineresultsinthesecuring
ofnormalisationbyembeddingapatternofnormsdisseminatedthroughoutdailylifeandsecured
throughsurveillance...[E]xercisesandtherepetitionoftaskscharacterisethedisciplinarymodel
of[]power.[21]

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Disciplinary,productivepowerconstitutesgovernanceinthesensethatitstructuresthepossiblefieldofactions
ofothers.[22]Acentralelementofthisgovernanceistheproduction,dissemination,andutilizationof
knowledge.[23]Inthisunderstandingoftheworkingsofdomination,lawisreplacedorsupplementedby
psychiatry,psychologyandmedicine,whichcreatecategoriesofdangerousindividuals,subjectpositionsthat
operateasregulatoryinstruments.
Foucaultsmodelofpowerlendstoacritiqueofthecreationofcategoriesofillnessthatserve,through
diagnosisandtreatment,toregulategenderexpression.Whensuchananalysisisappliedtotranssexuality,we
mustaskwhatwillbethemediatingprinciplebehindtheanalysis.ForBillingsandUrban,theprincipleisthatthe
treatmentofdistressingenderrolesthroughsurgeryisfundamentallyopposedtoaliberatingandpoliticized
projectofgenderequality.Theytracetheinventionofthecategorytranssexualbydoctors,examininghow
medicalpracticehasestablishedachildhood,asexuality,adetailedlifenarrativeforthetranssexualthatsexual
deviantsofmanytypeshavemimickedand/orinternalized[24]asnormsinordertorelieveorexplaingender
distress.Theycorrectlyassertthatthisnarrativeshoresuptraditionalnotionsofgenderdichotomyand
compulsoryheterosexuality.[25]However,becausetheirmediatingprincipleisthatbodyalterationisalwaysa
privatizinganddepoliticizingresponsetogenderroledistress,theypainttranssexualsasbrainwashedvictimswho
havefailedtofigureoutthattheyareonlyunderminingarevolutionthatseekstosavethemBillingsandUrban
arriveatthisprinciplebycreatinganarbitrarylinebetweentechnologyandthebodythattheyplaceatsexchange
procedures.Theyfailtoincludeintheiranalysisthefactthatpeople(transsexualsandnontranssexuals)change
theirgenderpresentationtoconformtonormswithmultipleothertechnologiesaswell,includingclothing,make
up,cosmeticsurgerynotlabeledSRS,trainingingenderspecificmanners,bodybuilding,dieting,andcountless
otherpractices.Likeothertheoristspicknickingontranssexualidentity,theirworktounderminetransalteration
stabilizesexercisesofnormativegenderproduction,evenwhiletheysuggestthatgenderdestabilizationistheir
goal.
Anapproachthatrecognizesthepossibilityofanormresistant,politicized,andfeministdesireforgender
relatedbodyalterationneednotrejectthecritiqueofmedicalpracticeregardingtranssexualitynorembracethe
normalizingregulationsofthediagnosticandtreatmentprocesses.Analternatemediatingprincipleforacritical
analysisispossible.Suchananalysisrequiresseeingtheproblemnotasfundamentallylyingintheprojectof
genderchangeorbodyalteration,butinhowthemedicalregimepermitsonlytheproductionofgendernormative
alteredbodies,andseekstoscreenoutalterationsthatareresistanttoadichotomized,naturalizedviewofgender.
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Analternativestartingpointforacritiqueoftheinventionandregulationoftranssexualismisadesirefora
deregulationofgenderexpressionandthepromotionofselfdeterminationofgenderandsexualexpression,
includingtheeliminationofinstitutionalincentivestoperformnormativegenderandsexualidentitiesand
behaviors.Thisunderstandingsuggeststhattheproblemwiththeinventionoftranssexualismisthelimitsitplaces
onbodyalteration,notitsparticipationintheperformanceofbodyalteration.[26]
Startingfromthispresumption,aFoucauldiancritiqueofthediagnosisandtreatmentoftranssexualism
exposeshowtheinventionofthisdisorderanditspurportedtherapydo,indeed,functiontoregulategender
performance.Containinggenderdistresswithintranssexualismfunctionstonaturalizeandmakehealthy
dichotomized,birthassignedgenderperformance.Itcaststhecriticaleyeonthegenderperformanceofthose
transgressinggenderboundaries,andproducesanormthatneednotbecriticized.Similarly,thismodelestablishes
astructureforaddressingviolationsofgenderrulesthatindividualizes,privatizesanddepoliticizesthemeaningof
thosetransgressions.Itisinthemindsoftheillthatgenderproblemsexist,notintheconstructionofwhatis
healthy.
Similarly,thedisciplinarypowerexercisedbythegatekeepers(doctors,surgeons,psychiatrists,therapists)
ofSRSrequirestherepetitive,normproducingexercisestowhichFoucaultrefers.Thesuccessfuldaily
performanceofnormativegenderisarequirementforreceivingauthorizationforbodyalteration.[27]Similarly,
thesuccessfulrecitationofthetranssexualnarrativeinmeetingaftermeetingwithmedicalprofessionals,andin
sessionaftersessionwithcounselorsandpsychiatrists,isessentialtoobtainingsuchauthorization.Thenext
sectionswilldealspecificallywiththesepractices.
ThenexttwosectionslookindetailathowsomeoftheprerequisitesforSRSservetomaintainnormative
genderperformanceandcontaingenderdysphoriaintherealmoftranssexuality.Thefinalsectionswillexamine
thecostsandbenefitsofstrategicuseofthetranssexualsubjectpositionbypersonsseekingSRS,andquestionthe
meaningsfrequentlyassignedbynontranstheoristsandmedicalpractitionerstosuchstrategicperformances.
II.TheTranssexualChildhood
Whendidyoufirstknowyouweredifferent?[28]thecounselorattheL.A.FreeClinicasked.Well,I
said,IknewIwaspoorandonwelfare,andthatwasdifferentfromlotsofkidsatschool,andIhadasingle
mom,whichwasreallyuncommonthere,andwewerentChristian,whichisterriblynoticeableintheSouth.
ThenlaterIknewIwasafosterchild,andinhighschool,IknewIwasafeministandthatcausedmeallkindsof
trouble,soIguessIalwaysknewIwasdifferent.Hisfacialexpressiontellsmethisisntwhathewantedtohear,

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butwhyshouldIengagethisideathatmygenderperformancehasbeenmymostimportantdifferenceinmylife?
Ithasnt,andIcantseparateitfromtheclass,race,andparentagevariablesthroughwhichitwasmediated.
DoesthismeanImnotrealenoughforsurgery?
IveworkedhardtonotengagethegaychildhoodnarrativeInevertalkabouttomboyishbehaviorasan
antecedenttomylesbianidentity,Idonttellstoriesaboutcrossdressingorcrushesongirls,andIintentionally
fuckwiththeassumptionofitbytellingpeoplehowIusedtobestraightandhavesexwithboyslikeanysweet
trashyruralgirlandsomeofitwasfun.Iseethesenarrativesasstrategic,andIvealwaysrejectedthestrategy
thatadoptssometheoryofinnatesexualityandforeclosesthepossibilitythatanyone,gendertroubledchildhood
ornot,couldtransgresssexualandgendernormsatanytime.Idontwanttoparticipateinanideathatonly
somepeoplehavetoengageastruggleoflearninggendernormsinchildhoodeither.Sonow,facedwiththese
questions,howdoIdecidewhethertolookbackonmylifethroughthetrannychildhoodlens,tellthestories
aboutbeingaboyforHalloween,notplayingwithdolls?Whatisthecostofparticipationinthisselective
recitation?Whatisthecostofnotparticipating?
RachelPollackwrites:
Whatsensedoesitmaketolabelsomepeopleastruetranssexuals,andothersassecondary,orconfused,
orimitation?Whomdoessuchanattitudeserve?Icanthinkofnoonebutthegatekeepers,thosewho
wouldseizethepoweroflifeanddeathbydemandingthattranssexualssatisfyanarbitrarystandard.To
acceptsuchstandards,torankourselvesandothersaccordingtoahierarchyoftruetranssexuality,totry
torecastourownhistoriestomakesuretheyfittheapprovedmodel,canonlytearusdown,allofus,even
theonesluckyenoughtomatchthatmodel.[29]

AnneBolinquotesanMTFshespokewith:[Psychiatristsandtherapists]...useyou,suckyoudry,andtellyou
theirpitifulopinions,andmyresponseis:WhatrightdoyouhavetodeterminewhetherIliveordie?Ultimately
thepersonyouhavetoanswertoisyourselfandIthinkImtooimportanttoleavemyfateuptoanyoneelse.Ill
liemyassofftogetwhatIhaveto.[30]

SymptomsofGIDintheDiagnosticandStatisticalManual(DSMIV)[31]describeatlengththesymptom
ofchildhoodparticipationinstereotypicallygenderinappropriatebehavior.BoyswithGIDparticularlyenjoy
playinghouse,drawingpicturesofbeautifulgirlsandprincesses,andwatchingtelevisionorvideosoftheir
favoritefemalecharacters....Theyavoidroughandtumbleplayandcompetitivesportsandhavelittleinterestin
carsandtrucks.GirlswithGIDdonotwanttoweardresses,preferboysclothingandshorthair,are
interestedincontactsports,[and]roughandtumbleplay.[32]Despitethedisclaimerinthediagnosis
descriptionthatthisisnottobeconfusedwithnormalgendernonconformityfoundintomboysandsissies,no
reallineisdrawnbetweennormalgendernonconformityandgendernonconformitywhichconstitutesGID.
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[33]Theeffectistwofold.First,normativechildhoodgenderisproducednormalkidsdotheoppositeofwhat
kidswithGIDaredoing.NonGIDkidscanbeexpectedto:playwithchildrenoftheownsex,playwithgender
appropriatetoys(trucksforboys,dollsforgirls),enjoyfictionalcharactersoftheirownsex(girls,specifically,
mighthaveGIDiftheylikeBatmanorSuperman),playgenderappropriatecharactersingamesofhouse,etc.
Secondly,aregulatorymechanismisputintoplace.Becausegendernonconformityisestablishedasabasisfor
illness,parentsnowhaveamillofspeech,[34]speculation,anddiagnosistofeedtheirchildrensgenderthrough
shoulditcrosstheline.AsFoucaultdescribes,theinventionofacategoryofdeviation,thedescriptionoftheill
behaviorthatneedberesistedorcured,createsnotaprohibitivesilenceaboutsuchbehaviorbutanopportunityfor
increasedsurveillanceandspeculation,[35]whathewouldcallinformalgovernance.[36]
TheDiagnosticCriteriaforGenderIdentityDisordernames,asageneralcategoryofsymptom,[a]strong
andpersistentcrossgenderidentification(notmerelyadesireforanyperceivedculturaladvantagesofbeingthe
othersex).[37]Thiscriterionsuggeststhepossibilityofagendercategorizationnotreadthroughthecultural
genderhierarchy.Thisrequiresanimaginationofachildwantingtobeagenderdifferentfromtheoneassigned
tohir[38]withouthavingthatdesirestemfromaculturalunderstandingofgenderdifferencedefinedbythe
advantagingofcertaingenderbehaviorsandidentitiesoverothers.Touseanillustrativeexamplefromthe
descriptionofchildhoodGIDsymptoms,ifachildassignedfemalewantstowearpantsandhatesdresses,and
hasbeentoldthatthisisinappropriateforgirls,isthatdecisionfreefromarecognitionofculturaladvantages
associatedwithgender?SinceadiagnosisofGIDdoesnotrequireachildtostatethedesiretochangegenders,
andtheprimaryindicatorsaregenderinappropriatetastesandbehaviors,howcanthisbeseparatedfromcultural
understandingsofwhatconstitutesgenderdifferenceandgenderappropriateness?Ifwestartfroman
understandingthatgenderbehaviorislearned,andthatchildrenarenotbornwithsomeinnatesensethatgirls
shouldweardressesandboysshouldntlikeBarbieoranythingpink,thenhowcanadesiretotransgressan
assignedgendercategorybereadoutsideofculturalmeaning?Suchastandarddoes,asBillingsandUrbanargue,
privatizeanddepoliticizegenderroledistress.Itcreatesafictionaltranssexualwhojustknowsinhirgutwhat
manisandwhatwomanis,andknowsthatsieistrappedinthewrongbody.Itproducesanaturalized,innate
genderdifferenceoutsidepower,afictionalbinarythatdoesnotprivilegeoneterm.
ThediagnosticcriteriaforGIDproducesafictionofnaturalgender,inwhichnormal,nontranssexual
peoplegrowupwithminimaltonogendertroubleorexploration,donotcrossdressaschildren,donotplaywith
thewronggenderedkids,anddonotlikethewrongkindsoftoysorcharacters.Thisstoryisntbelievable,but
becauseMedicineproducesitnotthroughadescriptionofthenorm,butthroughageneralizedaccountofthe
transgression,andinstructsthedoctor/parent/teachertofocusonthetransgressivebehavior,itestablishesa
surveillanceandregulationeffectiveforkeepingbothnontranssexualsandtranssexualsinadherencetotheir
roles.Inordertogetauthorizationforbodyalteration,thischildhoodmustbeproduced,andtheGIDdiagnosis
accepted,maintaininganideaoftwodiscretegendercategoriesthatnormallycontaineveryonebutoccasionally
arewronglyassigned,requiringcorrectiontoreestablishthenorm.
Itsalwaysbeenfuntorejectthegaychildhoodstory,totellpeopleIchoselesbianism,ortoover
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articulateastraightchildhoodnarrativetosuggestthatlesbianismcouldhappentoanyone.Butnotengaginga
transchildhoodnarrativeisterrifyingwhatifitmeansImnotreal?EventhoughIdontbelieveinreal,it
mattersifotherpeopleseemeasrealifnotImamutilator,animitator,andworstofall,Icantaccesssurgery.
TranssexualwriterClaudineGriggsbooktakesforgrantedthattranssexualityisanillness,an
unfortunatepredicament,somethingfortunate,normalpeopledonthavetogothrough.Shewrites:
Fortunately,mostpeople,thoughtheystrivetobecomeacertainkindofwomanorman,neverquestiontheir
foundationalgender....Apersonwithgenderdysphoriaiscrippledemotionallyandsocially,whichaccountsfor
partofthetranssexualcompulsionforbodyalteration.[39]Onthefirstpageoftheprefaceshewrites,
Iamnotanadvocateofsexchangeprocedures.Iknowthatsexreassignmentisnecessaryforsome
individualswithgenderdysphoriainmuchthesamewayasaradicalmastectomyisnecessaryforsome
individualswithbreastcancer,butIhopethatsuchtreatmentisundertakenonlywhennoothereffective
prescriptionexists.Thebestrecommendation,thoughpointless,isdontgetcanceranddontbea
transsexual.[40]

ThisispreciselytheapproachIwanttoavoidasIrejectthenarrativeofagendertroubledchildhood.Myproject
wouldbetopromotesexreassignment,genderalteration,temporarygenderadventure,andthemutilationof
gendercategories,viasurgery,hormones,clothing,politicallobbying,civildisobedience,oranyothermeans
available.Butthatpoliticalcommitmentitself,ifrevealedtothegatekeepersofmysurgery,disqualifiesme.One
therapistsaidtome,Yourereallyintellectualizingthis,weneedtogettotherootofwhyyoufeelyoushouldget
yourbreastsremoved,howlonghaveyoufeltthisway?Doesrealnessresideinthelengthoftimeadesire
exists?Arewomenwhoseekbreastenhancementrequiredtoanswerthesequestions?AmIsupposedtobeable
toseparatemypoliticalconvictionsaboutgender,myknowledgeoftheviolenceofgenderrigiditythathasbeen
apartofmylifeandthelivesofeveryoneIcareabout,frommyrealfeelingsaboutwhatitmeanstooccupy
mygenderedbody?HowcouldIbegintothinkaboutmychestwithoutthinkingaboutculturaladvantage?
III.ChoosingPerspective:PassingFullTime
FromwhatIvegatheredinmyvariouscounselingsessions,inordertobedeemedrealIneedtowantto
passasmaleallthetime,andnotfeelambivalentaboutthis.Ineedtobewillingtomakethecommitmentto
fulltimemaleness,ortheycantbesurethatIwontregretmysurgery.ThefactthatIdontwanttochange
myfirstname,thatIhaventsoughtouttheuseofthepronounhe,thatIdontthinkthatlesbianisthewrong
wordforme,or,worseyet,thatIrecognizethattheuseofanywordformyselflesbian,transperson,transgender
butch,boy,mister,FTMfag,butchhasalwaysbeen/willalwaysbestrategicismyundoingintheireyes.They
arewaitingforabetterjustificationofmydesireforsurgerysomethinglessintellectual,morereal.
ImsupposedtobewhollyjoyouswhenIgetcalledsirorboy.HowcouldIeverhavesuchan
uncomplicatedrelationshiptothatmoment?EachtimeImsirredIknowboththatmylookisdoingwhatIwant
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ittodo,andthatthereasonpeoplecanassignmalegendertomeeasilyisbecausetheydontbelievewomen
haveshorthair,andbecause,asGarberhasasserted,theexistenceofmalenessasthegenericmeansthatfewer
visualcluesofmalenessarerequiredtoachievemalegenderattribution.[41]Thistherapeuticprocess
demandsofmethatItossoutallmyfeministmisgivingsaboutthewaysthatgenderrigidityinformspeoples
perceptionofme.
LeslieFeinbergwritesaboutthestrategicuseofgendercategories,Outsidethetranscommunities,many
peoplerefertomeasshe,whichisalsocorrect.Usingthatpronountodescribemechallengesgeneralizations
abouthowallwomenactandexpressthemselves.Inanontranssetting,callingmeherendersmy
transgenderinvisible.[42]Similarly,Idonotwanttoforfeittheabilitytoutilizegendercategoriestopromote
socialchange.Iwanttokeepopenmyabilitytorejecttheuseofsomecategoriesinsomecontextsbecauseofthe
presumptionsthatunderlietheirdefinitions.
InACritiqueofOurConstitutionisColorblind,NeilGotandawritesabouthowthetermsof
Americandialoguesaboutracearesetbyracism.Hedescribesracialdifferenceisunderstoodthroughtherule
ofhypodescent,whichdictatesthatanypersonwithaknowntraceofAfricanancestryisblack.
[H]ypodescentimposesracialsubordinationthroughitsimpliedvalidationofwhiteracialpurity.Asaresult,
theuncriticalproclamationIamwhiteisaraciststatement,becauseitreaffirmsthedefinitionofwhitethatis
groundedinadichotomyofracialpurityandimpurity.[43]Thetermsofgenderdifferenceoperatedifferently,
butaresimilarlyproblematictodeclaremembershipinastaticgendercategoryaffirmsaregulatorysystemof
dichotomousgender.Whatkindofhealthdoessuchtreatmentrestoremeto,ifitcompelsmetomakesuch
adeclaration?

Perhapsthemostovertrequirementfortranssexualdiagnosisistheabilitytoinhabitandperform
successfully[44]thenewgendercategory.Throughmyowninteractionswithmedicalprofessionals,accounts
ofothertranspeople,andmedicalscholarshipontranssexuality,Ihavegatheredthatthefavoredindicationof
suchsuccessseemstobethegenderattributionofnontranspeople.Becausetheabilitytobeperceivedbynon
transpeopleasanontranspersonisvalorized,normativeexpressionsofgenderwithinasingularcategoryare
mandated.
Griggsnarrativeexemplifiesthisparadigmofgenderlegibility.Herstoriesassumethatgenderidentityis
fundamentallyaboutgenderattribution:yourrealgenderistheonethatpeoplecanseeonyou.Shearguesthat
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thereisnoperceptualmiddlegroundbetweenmaleandfemalewhichmeansthattranssexualscannotfade
gentlybetweengenders.[45]ForGriggs,theprojectofchanginggendersfundamentallyconcernstheperception
ofnontranspeoplethatsheisabornwoman.Shewrites,
Ihavealwayshadafemininegender,yetIbecameawomannotbecauseIchangedmydriverslicense,
tookestrogens,appliedmakeup,grewlonghair,orhadgenitalsurgery,butbecauseon1July1974,aman
openedthedoorformeasIenteredmy8:00a.m.class....Societymustseeawomanotherwise,sex
changesurgeryornot,onecannotbeawoman.[46]

Griggsfailestoengageanyfeministanalysisoftheactofaccepting,uncritically,theentiretyofthesubject
positionwoman(includingthepremiseswhichunderlieactsofchivalry).Indooropeningstory,the
performanceofcoherentoppositionalgendernormssecuresGriggsownselfperceptionoffemaleness.Griggs
alsotellsastoryaboutmeetingamanatabarwhoassumedhertobeamanduringalongconversation,andthen
discoveredthatshewasawomanafterthebartenderaddressedher.Shedescribesthattherestoftheirinteraction
includedhimbuyingherdrinksandsayingthingslike
Gee,Imsorry...Ifeelterrible.NowthatIseeyou,IdontknowhowIcouldpossiblyhavethought..
.Butmaybeyoushouldntsitsorough,like.Youhaveabeautifulfigure...Andifyoudidntputyour
elbowsonthebar,aguycouldsee....Andmaybe,...alittlemakeupwouldsoftenyouup...You
couldfixyourhair.[47]

Inresponsetothisovertpolicingofherperformanceoffemininity,Griggswrites,Afterawhile,evenIbeganto
wonderifIhadcarriedthebutchthingtoofar.[48]Justlikemanymedicalpractitioners,Griggsacceptsthata
successfultransitionhingesuponfullparticipationinthenormative,sexist,oppressiveperformanceofwoman.
JudithHalberstampointsoutasimilaroperationinthedesireofsomefemaletomaletranssexuals(FTMs)
and,Iwouldadd,ofprofessionalstreatingFTMs,todistinguishFTMsfrombutchlesbiansatanycost.[49]
HalberstamdescribesthatbutchandFTMbodiesarealwaysreadagainstandthrougheachothercommonly
throughacontinuummodelthatseekstofindadefiningdifferencebetweenthetwo.[50]Sheassertsthatsucha
constructionstabilizesbutchlesbiansaswomenanderasesthedisruptiveworkthatbutchidentityengageson
dichotomousgendercategorization.Shepointstothelistsofpassingtipsthatarecommonlysharedbetween
FTMsontheinternetandatconferences.[51]Manysuchtipsfocusonanadherencetotraditionalaestheticsof
masculinity,warningFTMstoavoidpunkyhaircutsthatmaymakeyoulooklikeabutchlesbian,andtoavoid
blackleatherjacketsandothertrappingsassociatedwithbutchlesbians.Apreppy,cleancutlookisoften
suggestedasthebestaestheticforpassing.Again,thisestablishestherequirementofbeingevenmorenormal
thannormalpeoplewhenitcomestogenderpresentation,anddiscouraginggenderdisruptivebehavior.The
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resultingimage,withthemostsuccessfulFTMsexitingaskhakicladfratboyclones,leavesfeministgender
queertrannieswiththequestion,whybother?
Thepassingimperative,whichbeginsfromthemomentaSRSseekerentersamedicalofficeandis
sizedupbyaprofessionalwhowilldecidehirrealnessandseriousnessatleastinpartbasedonthesuccessof
thepresentationofagendernorm,isanessentialregulatingaspectoftheprocessoftranssexual(andnon
transsexual)production.Wilchinsnotes:
Currentpracticeinsexchangesurgeryassumes,evenrequires,reallookinggenitals....Thatiswhyso
manydoctors,whileproudlyshowingoffhowtheirvaginacanevenfoolOB/gyns,arereducedto
mutteringnoguaranteesandwecantbecertainwhenaskedaboutthepleasurepotentialoftheir
work.Itsalsopartofwhymanytranswomendonthavealotoferoticsensationaftersurgery.[52]

Thisframeworkerasesthepossibilitythatsomeonemightnotprioritizehowtheirgenitalswilllooktoothers,or
mightevenwishforgenitalsthatdonotconform,aesthetically,totheculturallyspecifiednorms,isnoteven
imaginedinthisframework.AsWilchinspointsout,anadmissionthatapatientmightwantintersexgenitals
wouldfallonthedeafearsofdoctorswhoonlyseektoproducegenitalsthatfitintooneoftwonarrowlydefined
options.
Whatifthesuccessoftransitionwasnotmeasuredby(nontrans)normativeperceptionsoftruefeminity
andmasculinityintranspeople?Iimaginethat,likeme,somepeoplehaveamultitudeofgoalswhentheyseek
genderrelatedbodyalteration,suchasaccesstodifferentsexualpractices,abilitytolookdifferentinclothing,
enhancementofaselfunderstandingaboutonesgenderthatisnotentirelyreliantonpublicrecognition,public
disruptionoffemaleandmalecodes,oranynumberofotherthings.[53]Somebirthassignedmenmightwant
toembodywomanasbutchlesbiansinawaythatmeanttheyenjoyedoccasionallybeingsirredandonly
sometimescorrectedthespeaker.Somebirthassignedwomenmightwanttotakehormonesandbecome
sexybeardedladieswhoareinterpretedavarietyofwaysbutfeelgreatabouthowtheylook.Whenthe
gatekeepersemploydichotomousgenderstandards,theyforeclosesuchnormresistantpossibilities.
MarjorieGarbertalksabouthowtranssexualsseeourbodiestheoretically.ShedescribeshowtheFTM
withachestscarredbyreconstructionseesamalechest.
Inspiteof...unaestheticresultstranssexualpatientsoftengobarechested,displayingwhatdoctorscalla
poorrealitysensealongwiththeirflattenedchests.Anotherwayofdescribingthis,andaless
condemnatoryone,mightbetosaythatthepatientisregardinghisnewbodytheoreticallyitis,heis,
male,howeverattractiveorunattractivetheappearance.[54]

WhileIwouldarguethateveryoneseestheirbodytheoretically,andeveryonesselfimageismediatedthrough
genderfictionsandexpectations,Garberspointdescribesapleasurelostinthepassingimperative.Mostofthe
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transpeopleIhavetalkedtodonotimaginethemselvesenteringarealmofrealmannessorrealwomanness,
eveniftheypassasnontransallthetime,butratherrecognizetheabsenceofmeaninginsuchtermsandregard
theirtransformationsasfreeingthemtoexpressmoreofthemselves,andenablingmorecomfortableandexciting
selfunderstandingsandimages.However,recognizingthattranspeoplemakefinepleasuresandbenefitsapart
fromtheabilitytoconformtogendernormsraisesthethreatdiscussedearlierthat,indeed,transpeoplemightbe
engineeringourselves.
Thetherapistaskedmeaboutcomingouttomyfamilyaboutmysurgery/GID.Shewasdisconcerted
whenIdescribedthatmysisterknew,butIdoubtedIwouldtellmyfosterparentsanytimetoosoon,andmight
notevertellthem,sinceitwouldlikelybebetterforourrelationshipandtheywerenotmyintendedaudience.I
felttherewasnothingtogainbyenteringthisconversationwiththem,andmuchtolose,andthatanyeducational
workthatdisclosurecouldachievewasbestleftwiththeirunderstandingofmeasalesbian.Imskilledin
dressingtodownplaychestnoticeability,soIimaginedthatforthetimebeing,evenaftersurgery,Iwould
continuesuchastrategywhenIsawthemunlessIdecideditwasntworththebenefits,orunlessIdecidedtotake
hormoneswhichwouldsignificantlychangemyappearance.Thisonlyfurtherconvincedher(wedalready
coveredmygoingbyJane)thatIlackedthepropercommitmenttothistransition.HowcouldIreallyneedthis
surgeryifIcouldstandtobeperceived,forevenaminute,tonothavehadit?Howdoyouknowyouwantto
dothis?Whydoyouwanttodothisifitsnottopassasaman?[Igivesomeresponses.]Stopintellectualizing
andtellmehowyoufeel.
IV.MaybeImNotaTranssexual.
ThecounselorattheL.A.FreeClinicdecidedIwasnttranssexualduringthefirst(andonly)session.
WhenItoldhimwhatIwanted,andhowIwasstartingcounselingbecauseIwastryingtogetsomelettersthatI
couldgivetoasurgeonsothattheywouldaltermychest,hesaidYoushouldjustgogetbreastreduction.Of
course,hedidntknowthatmostcosmeticsurgeonswontreducebreastsbelowaCcup(Iwouldntevenqualify
forreduction),andthatbreastreductionisadifferentprocedurethantheconstructionofamalelookingchest.I
alsosupposethathewasntthinkingaboutwhathappenstogenderdeviantswhentheyendupinthehandsof
medicalprofessionalswhodonthaveexperiencewithtranspeople.
Somesurgeonshavestrongreactionstotranssexualpatients,andoften,ifthesurgeryisdoneina
teachinghospital,thesurgeonturnsouttobearesidentorstaffmemberwhoisoffendedbythe
procedure.Inonecase,withwhichIamfamiliar,writesadoctor,thepatientsmassivescarswere
probablytheresultofthesurgeonsunconscioussadismandwishtoscarthepatientforgoingagainst
nature.[55]

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Tothiscounselor,myfailuretoconformtothetranssexualityhewasexpectingrequiredmyimmediateexpulsion
fromthatworldofmeaningatanycost.MydesirecouldntbeforSRSbecauseIwasntatranssexual,soitmust
beforcosmeticsurgery,somethingnormalpeopleget.
Allmyattemptsatcounseling,andallthoseexperienceofbeingeyedsuspiciouslywhenIsuggestedthatI
wastrans,ortoldoutrightIwasnotbynontranscounselors,mademeexpectthatIwouldgetasimilarreception
fromtranspeopleinactivistorsupportcontexts.Thishasnotbeenthecase.Ivefoundthatintranscontexts,a
muchbroaderconceptionoftransexperienceexists.ThetranspeopleIvemethave,shockingly,believedwhatI
sayaboutmygender.Somehaveaselfnarrativeresemblingthemedicalmodeloftranssexuality,somedonot.
However,thepeopleIvemetsharewithmewhatmycounselorsdonot:acommitmenttogenderself
determinationandrespectforallexpressionsofgender.Certainlynotalltranspeoplewouldidentifywiththis
principle,butIthinkitmakesbettersenseasabasisforidentitythantheabilitytopassfulltimeortheamount
ofcrossdressingonedidasachild.Wilchinspositsanideaofidentityasaneffectofpoliticalactivisminsteadof
acause.Iseethisnotionreflectedintransactivism,writing,anddiscussion,despiteitsabsenceinthemedical
institutionsthroughwhichtranspeoplemustnegotiateouridentities.
Feinbergwrites:

OnceIfiguredoutthattransgenderedwassomeonewhotranscendedtraditionalstereotypesofman
andwoman,IsawthatIwassuchaperson.Ithenbeganaquestforfindingwordsthatdescribed
myself,anddiscoveredthatwhilepsychiatricjargondominatedthediscourse,thereweremanyother
words,botholderandnewer,thataddressedtheseissues.WhileIacceptedthelabeloftranssexualin
ordertoobtainaccesstothehormonesandchestsurgerynecessarytomanifestmyspiritinthematerial
world,Ihavealwayshadaprofounddisagreementwiththedefinitionoftranssexualismasapsychiatric
conditionandtranssexualsasdisorderedpeople.[56]

IV.TellingStories:StrategicDeploymentoftheTranssexualNarrative
BillingsandUrban,whentracingthehistoryoftheinventionoftranssexualismanditsdiagnosisand
treatment,describehowphysiciansinthe1970sbeganrecognizingthattranssexualshadroutinelyand
systematicallylied.[57]Oneexpertintreatingtranssexualitycomplained,Thoseofusfacedwiththetaskof
diagnosingtranssexualismhaveanadditionalburdenthesedays,formostpatientswhorequestsexreassignment
areincompletecommandoftheliteratureandknowtheanswersbeforethequestionsareasked.[58]Billingsand
Urbandescribe:
Sincethereputableclinicstreatedonlytextbookcasesoftranssexualism,patientsdesiringsurgery,for
whateverpersonalreasons,hadnootherrecoursebuttomeetthisevaluationstandard.Theconstructionof
anappropriatebiographybecamenecessary.Physiciansreinforcedthisdemandbyrewardingcompliance
withsurgeryandpunishinghonestywithanunfavorableevaluation.[59]

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Apatientgrapevineemerged,throughwhichpatientsinformedeachotherofthebestwaystopassthenecessary
requirementstosurgery.Therewereevenstoriesbeingpassedbetweendoctorsofpostoperativetranssexuals
posingasmothersofpreopsinordertoaddcredibilitytothetestimonyofthepatientsintheeyesofthedoctors.
[60]Patientsomittedinformationwhichwoulddisrupttheversionofnormativefemininityormasculinitythat
theywerepresentingtothedoctors,includinghomosexualityandenjoymentofsexpracticesintheunaltered
body.[61]
BillingsandUrbandescribethatinresponsetotheoutbreakofstoriesofpeoplelyingtogetSRS,the
diagnosticstructurewaschanged,sothatthetermtranssexualwasreplacedwithgenderdysphoriasyndrome.
However,theypointoutthatthischangewasinconsequential,becausebehavioralcriteriaisstillstressedby
doctors.Indeed,forprognosis,itisprobablethatthediagnosticcategoryisofmuchlessimportancethanthe
patientspreoperativeperformanceinaonetothreeyeartherapeutictrialoflivinginthegenderofhis
choice.[62]BillingsandUrbanincludeananecdotefromadoctorwhohadperformedover100sexchange
operations,describinghismethodofverifyingtherealnessofapatientstranssexuality.[He]toldushe
diagnosedmaletofemaletranssexualsbybullyingthem.Thegirlscrythegaysgetaggressive.Theyfollow
thisupwiththeassertionthat,basedoninformationfromtheirparticipantinformantatagenderclinic,diagnosis
inthepostBenjamineraremainsasubtlenegotiationprocessbetweenpatientsandphysicians,inwhichthe
patientstroublesaredefined,legitimated,andregulatedasillness.[63]
BillingsandUrbanarguethatthescreeningandinterviewingprocessesforSRSstillfunctionasaformof
patientsocialization,wherediagnosisandtreatmentarelinkedtotheperformanceofnormativegender.Patients
areawareofthis,andutilize,totheextentthattheycan,theirpriorknowledgeofthediagnosticcriteriato
convincedoctorsoftheirsuitabilitytothetreatmenttheyseek.[64]ForBillingsandUrban,thisisevidenceof
theevilofSRSpatientswhoaregenderdeviantaresocializedbydoctorstoconformtogendernorms.
Idonotdoubtthattheexistenceofthetranssexualnarrativeinformstheselfunderstandingsofmany
people,asitispartofanoverallconstructionofnormativegenderthatnaturalizesdichotomousgendercategories
andlabelstransgressionofsuchcategoriesasillness.Itlikelyleadssomegendervariantpeopletoseetheirgender
deviancethroughadepoliticizedandprivatizedlens,asanindividualillnessratherthanacommentaryonthe
inhabitabilityofdichotomousgender.Italsolikelyleadssomepeoplewhounderstandthemselvesasnot
transsexualtothinkthattheiradherencetogendernormsisnaturalandhealthy.Everyoneisimplicatedinthis
narrative,notonlytranspeople.However,IthinkthattheimageofSRSseekersassolelyvictimsoffalse
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consciousnessisseverelyincomplete.Areviewofliteraturewrittenbytranspeople,particularlytheworksless
oftencitedbynontranswriters,[65]suggestsaselfconsciousstrategyofdeploymentofthetranssexualnarrative
bypeoplewhodonotbelieveinthegenderfictionsproducedbysuchanarrative,andwhoseektooccupy
ambiguousgenderpositionsinresistancetonormsofgenderrigidity.

Afterattendingonlythreediscussiongroupmeetingswithothertranspeople,Iamstruckbythenaivet
withwhichIapproachedthesearchforcounselingtogetmysurgeryauthorizingletters.Nooneatthesegroups
seemstoseetherapyastheplacewheretheyvoicetheirdoubtsabouttheirtransitions,wheretheywrestlewith
thepoliticalimplicationsoftheirchanges,wheretheyspeakaboutfearsoflosingmembershipinvarious
communitiesorintheirfamilies.Noonetruststhedoctorsastheplacetoworkthingsout.WhenImentionthe
placesIvegoneforhelp,placesthataresupposedtosupportqueerandtranspeople,everyonenodsknowingly,
havingheardcountlessstorieslikemineabouttheseveryplacesbefore.Somehavesuggestionsoftherapistswho
arebetter,butnonecostlessthan$50/hr.Mostly,though,peoplesuggestdifferentwaystogetaroundthe
requirements.Igetnamesofsurgeonswhodonotalwaysaskfortheletters.SomeonesuggeststhatsinceIwont
beonhormones,IcangoinandpretendImawomanwithahistoryofbreastcancerinmyfamilyandthatI
wantadoublemastectomytopreventit.Ihavethesegreat,sad,conversationswiththesepeoplewhoknowall
aboutwhatitmeanstolieandcheattheirwaythroughthemedicalroadblockstogettheopportunitytooccupy
theirbodiesinthewaytheywant.Iunderstand,now,thattheplacethatissafetotalkaboutthisisinhere,with
otherpeoplewhounderstandtheslipperinessofgenderandthepoliticsoftransition,andwhobelievemewithout
questionwhenIsaywhatIthinkIamandhowthatneedstolook.
VI.TranssexualsAsTheExemplaryAdherentstoGenderNorms
Garberwritesabouthowtranspeoplearemoreinvestedin[thegenderbinary]thaneveryoneelse.[66]
Thetranssexualbodyisnotanabsoluteinsigniaofanything.Yetitmakesthereferent(manor
woman)seemknowable.Paradoxically,itistotranssexualsandtransvestitesthatweneedtolookifwe
wanttounderstandwhatgendercategoriesmeanforpersonswhoareneithertransvestitenortranssexual.
Theyareemphaticallynotinterestedinunisexorandrogynyaseroticstyles,butratheringender
markedandgendercodedidentitystructures.Thosewhoproblematizethebinaryarethosewhohavea
greatdealinvestedinit.

Priortothispointinthechapter,GarberreferstothebiographiesoffamoustranssexualsReneeRichards,Jan
Morris,and,tosomedegree,ChristineJorgensen.[67]WhileGarberdoesstoptoquestionwhyallthebestknown
transsexualsareMTFsandnotFTMs,shedoesnotquestionwhythenarrativesofthetranssexualssheusesas

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evidencearewellknown,norwhetherthetruthsabouthowtranssexualsunderstandthemselvesandtheir
genderidentitiesthatshecollectsfromthesebiographiesareatallstrategicallydeployed.Sheassertsthattrans
peoplearemoreinvestedindichotomousgendercategoriesandarenotinterestedintheinbetweenspacesof
genderbasedonafewstorieswhich1)arelikelythemostpopularstoriesoftranssexualismamongnon
transsexualsbecausetheyaffirmatranssexualnarrativethatreifiesthenaturalnessofnormativegender
performance,and2)maywellhavebeenstrategicallycraftedbytheirnarratorstoachievesocial
acceptance/tolerancefortranssexuals,whichmanypeopleunderstandtobebestsoughtthroughamodelofinnate
transsexualitysimilartotheonedeployedbyGriggs.Herarrivalattheconclusionthattranspeoplearemore
investedinnormativegendercategoriesthannontranspeopleisfacilitatedbyherfailuretoquestionthestrategic
valuefortranspeopleofadherencetogendernormativenotionsoftranssexuality.Absentfromheranalysisare
thestoriesoftranspeoplewhoworkandliveonthestreet,transpeopleofcolor,transpeoplewhoneverstriveto
orneversucceedinfittingintoavisionofsuccessfulgenderperformance,withallofitsracialandeconomic
implications.Usinganarrowsetoffamousexamples,shecomfortablyarrivesatanunderstandingofhowtrans
peopleviewgenderthatsupportsthewaythatnontranspeopleseetranspeople.
AsimilarmoveismadeinElsieShorescasestudyofaformertranssexual,abirthassignedmalewho
soughtSRS,wasdiagnosedwithtranssexuality,livedasawomanforaconsiderableperiod,andthendecided
daysbeforesurgerytoreturntomaleidentity.[68]TheauthordescribesthatwhenshemetMickey,shehad
beenonfemalehormonesfor21monthsand...livingexclusivelyinthefemalerolefor14months.Ofmedium
heightandbuild,dressedandmadeupinarealisticandnonflamboyantmanner,Mickeypresentedasaconvincing
female.She[was]shy,lonely,andwantingtobelovedandcaredfor.[69]
ShoreattributesMickeyschangeofheartaboutSRSandcontinuinglifeasawomantohisrealizationthat
hisprioradherencetostrictbeliefsaboutwhatmenneededtoactlikewasnottrue.ShesaysthatwhenMickey
joinedachurchandmetmenwhowerewarmandcaringwithoutlosingmasculinityhefoundoutthatoneis
notrequiredtobefemaletobekindandloving.[70]Additionally,Mickeyfellinlovewithawomaninhisnew
religion,andfeltadesiretoprotectandtopossessherandconceptualizedthesefeelingsasthosethataman
experienceswheninlovewithawoman.[71]Shorerecognizes,also,thataninfluenceonhisdecisionmight
havebeenthatthepossibilityofhisfeelingsforthiswomanbeingunderstoodashomosexualmayhavefrightened
him.
AsShoresortsthroughwhatMickeysdecisiontoreturntothemalerolemeans,sherulesoutthe
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possibilityofanoriginalmisdiagnosisoftranssexuality.Shebelievesthediagnosiswascorrectbecausethe
historyMickeypresentedtothegenderclinicthatadmittedhimwasconsistentwiththegenerallyaccepted
pictureoftranssexualdevelopment.[72]Secondly,shebelievesthathissuccessatlivingfortwoandahalfyears
asafemaleatteststothefactthathewasatruetranssexual,becauseanindividualwithshallowercrosssexual
identificationwillnotsucceedatlastingayearinthenewrole.[73]ShorebelievesthatMickeywas,indeed,a
truetranssexual,butthathisconditionwasinlargepartaresultofthefactthathewasaverynonaggressive
personandhadahighlystereotypeddefinitionofmanwhichledhimtobelievethathemustbeawoman.
Shorecitesotherexpertsintranssexualitywhohavefoundthattranssexualshaverigidnotionsofwhatmasculinity
is,andconfusedependencyfeelingsandlackofaggressivenessinsocialinteractionswithfemininityandsexual
behavior.[74]Sheconcludesthattherapeuticinterventiondirectedatlooseningrigidgenderrolestereotyping
mightbeawaytotreattranssexualitywithoutSRS.
SomecontradictorypresumptionsunderlieShoresanalysis.First,similartoGriggs,Shoreseesthe
avoidanceofSRSasagoaloftreatment,andwantstokeepSRSasalastresortoption.Second,Shoreacceptsthe
diagnosticcriteriaanddefinitionoftranssexuality.Sheacceptsthatthereissomethingabouttranssexualitythat
requirestreatmentoftheindividualtranssexualtobringhirintoamaleorfemalerole.Thesepresumptionsallow
Shoretoarriveattheconclusionthatwhatrequirestreatmentintranssexualsistheiroveradherencetogender
normsorstereotypes.Ironically,itisjustthisadherencethatthediagnosisandtreatmentcriteriarequireinorder
forpeopleseekingSRStoachievetheirgoals.Shoresfailuretocritiquethediagnosticcriteriaoftranssexuality
beforecomingtoherconclusionscreatesasituationwhereSRSwouldbehardertogetthanever:ifthepatient
adoptedthenormbasednarrativeofgenderrequiredbythediagnosticcriteria,siemightstillberefusedtreatment
forpreciselythat.
GarberandShorebothassertthattranssexualsaremoredeeplyinvestedingendernormsthannon
transsexualswithoutrecognizingthatthemedicaldefinitionoftranssexualityrequirestheperformanceofsuch
aninvestment.Transsexualsareinadoublebinditispathologicalnottoadheretogendernorms,justasitisto
adheretothem.Thecreationoftheimageoftranssexualsasexemplaryadherentstogenderstereotypesrequires
anunderstandingoftranssexualitythatbothfullyacceptsthemedicaldefinitionoftranssexualandignoresthe
multiplenonnormadheringnarrativesthattranspeopleproduceoutsideofmedicalcontexts.
VII.Conclusion
Personalnarrativeisalwaysstrategicallyemployed.Itisalwaysmediatedthroughcultural

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understandings,throughideology.Itisalwaysafunctionofselectivememoryandnarration.HaveIlearnedthat
Ishouldlietoobtainsurgery,asothershavebeforeme?DoesthatlessonrequireanacceptancethatIcannot
successfullyadvocateonbehalfofadifferentapproachtomydesirefortransformation?
Anexaminationofhowmedicinegovernsgendervariantbodiesthroughtheregulationofbodyalteration
bymeansoftheinventionoftheillnessoftranssexualitybringsupthequestionofwhetherillnessisthe
appropriateinterpretivemodelforgendervariance.Thebenefitsofsuchanunderstandingfortranspeopleare
noteworthy.[75]AslongasSRSremainsatreatmentforanillness,thepossibilityofMedicaidcoverageforit
remainsviable.[76]Similarly,courtsexaminingthequestionofwhatqualifiesatranssexualtohavelegal
membershipinthenewgendercategoryhavereliedheavilyonthemedicalmodeloftranssexualitywhenthey
havedecidedfavorablyfortranssexuals.[77]Amodelpremisedonadisabilityordiseasebasedunderstandingof
deviantbehaviorisbelievedbymanytobethebeststrategyforachievingtolerancebynormadherentpeoplefor
thosenotadheringtonorms.Suchargumentsarepresentintherealmofillicitdruguseandinthequestfor
biologicaloriginsofhomosexualityjustastheyareintheportrayaloftranssexualityasanillnessordisability.
However,itisvitalthatthecostsofsuchanapproachalsobeconsidered.First,themedicalapproachto
gendervariance,andthecreationoftranssexuality,hasresultedinagovernanceoftransbodiesthatrestrictsour
abilitytomakegendertransitionswhichdonotyieldmembershipinanormativegenderrole.Theself
determinationoftranspeopleincraftingourgenderexpressioniscompromisedbytherigidityofthediagnostic
andtreatmentcriteria.Atthesametime,thiscriteriaandtheversionoftranssexualitythatitpositsproduceand
reifyafictionofnormal,healthygenderthatworksasaregulatorymeasureforthegenderexpressionofall
people.ToadoptthemedicalunderstandingoftranssexualityistoagreethatSRSistheunfortunatetreatmentof
anunfortunatecondition,toacceptthatgendernormadherenceisfortunateandhealthy,andtounderminethe
threattoadichotomousgendersystemwhichtransexperiencecanpose.Thereificationoftheviolenceof
compulsorygendernormadherence,andthesubmissionoftransbodiestoanormproducingmedicaldiscipline,is
toohighapriceforasmallhopeofconditionaltolerance.

[1]RIKIANNEWILCHINS,READMYLIPS:SEXUALSUBVERSIONANDTHEENDOFGENDER63(1997).
[2]BERNICEL.HAUSMAN,CHANGINGSEX:TRANSSEXUALISM,TECHNOLOGY,ANDTHEIDEAOFGENDER1(1995).
[3]Id.
[4]Id.at2.
[5]Iusethisterminthebroadsense,notjusttosignifythegenitalsurgerywhichisoftenthelegalcriteriaforachievinglegalgender
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change.Specifically,Iwanttoexaminethetypesofsurgerythatarecurrentlyassociatedwithtranssexualismandthereforesubject
thepersonseekingthemtotherequirementsoftheHarryBenjaminstandardsofcare.However,Ialsowanttosuggestacritical
approachtothelabelingofcertainsurgeries,suchasmastectomyforpeopleassignedfemaleatbirthorbreastenlargementfor
peopleassignedmaleatbirth,assurgerythatchangesgenderexpressionorperformancewhileothersurgeriessuchasbreast
enlargementforpeopleassignedfemaleatbirthorpectoralimplantsforpeopleassignedmaleatbirthareunderstoodas
innocuouscosmeticsurgery.
[6]ALANHUNT&GARYWICKHAM,FOUCAULTANDLAW:TOWARDSASOCIOLOGYOFLAWASGOVERNANCE28
(1994).
[7]Wilchins,supranote1,at22.
[8]Iwasabletopay$1020weekly.Iwasqualifiedforservices(storiesofwhichareincludedinthispaper)attheChildrens
HospitalbecauseIwas2122throughouttheyear.
[9]MypositiononthesequestionshaschangedsinceIoriginallywrotethispiece.InowgobyDeanandhe.However,myaim
istocapturethesetofdesiresIhadintheyearinwhichIwasseekingservicesinL.A.andfindingmyselfoutsideofmedical
professionalsunderstandingsofwhatitmeanttobetrans.Itwasmyfailuretoprovideagenderedpicturethattheycould
recognizeascohesiveandconsistentthatdisabledthemfromprovidingmetheservicesIsought.
[10]Hausman,supranote2,at3(emphasisinoriginal).
[11]DwightB.BillingsandThomasUrban,TheSocioMedicalConstructionofTranssexualism:AnInterpretationandCritique,29
SOCIALPROBLEMS266,276(1982).
[12]Asmentionedabove,BillingsandUrbanunderstandSRSasmutilation.TheyappearentirelyopposedtoSRSofanykind.In
theirunderstanding,personswhogetsexchangesurgeryarejustsexualdeviantswhosepossibilityforapoliticalresponsetotheir
situationisbeingsquelchedbecausetheyarebeingsoldaquickfixanswertotheirdiscomfortingenderorsexnorms.
Amongthetranssexualpatientsweinterviewedwereministerswhoembracedthelabeltranssexualtoavoidbeinglabeled
homosexualsexualdeviantsdrivenbycriminallawsagainstcrossdressing,orbyrejectingparentsandspouses,tothe
shelterofthetherapeuticstateandenterprisingmaleprostitutescashinginontheprofitablemarketfortranssexual
prostituteswhichthrivesinsomelargecities.
Id.at276.BillingsandUrbanpaintapictureofthoseseekingorreceivingsexreassignmentsurgeryasapolitical,needingtobe
educatedratherthanmedicallytreated(mutilated)sothattheycanstartagenderrevolution.Therevolutiontheyimagine,however,
hasnoplaceforbodyalterationtochangegenderpresentation,andsuchactivitycanonlyrepresentforthem,disempowering
commodification,reification,andthereinforcementoftraditionalgenderroles.WhileIagreewiththeirassertionthatthe
operationofmedicalauthorityinthediagnosticandtreatmentprocessesfortranssexualityoftendoesworktoprivatizeand
depoliticizethepoliticsofgenderconformityanddeviance,Irejecttheirnarrowunderstandingofthepotentialpoliticalmeaningsof
SRS,theirignoranceofthepoliticizedactsandidentitiesoftranspeople,andthepaternalisticanddisrespectfulapproachtotrans
peopletheytakethroughoutthepaper,exemplifiedinmomentswhentheyrefertotranspeoplelikeChristineJorgensonusing
pronounsappropriatetotheirbirthassignedgender.Id.at267.
[13]Id.at266.
[14]Id.
[15]Formsofillnessarealwaysmorethatbiologicaldiseasetheyarealsometaphors,bearingexistential,moral,andsocial
meanings.AccordingtoTaussig,thesignsandsymptomsofdisease,asmuchasthetechnologiesofhealing,arenot
thingsinthemselves,arenotonlybiologicalandphysical,butarealsosignsofsocialrelationsdisguisedasnatural
things,concealingtheirrootsinhumanreciprocity.
Billings&Urban,supranote10,at276(emphasisinoriginal).
[16]MICHELFOUCAULT,THEHISTORYOFSEXUALITY,VOL.1:ANINTRODUCTION,313(1978).
[17]Id.at18.
[18]Id.at5354.
[19]Id.at43.Thenineteenthcenturyhomosexualbecameapersonage,apast,acasehistory,andachildhood....thehomosexual
wasnowaspecies.Id.
[20]Lawisneitherthetruthofpowernoritsalibi.Itisaninstrumentofpowerwhichisatoncecomplexandpartial.Theformof
lawwithitseffectsofprohibitionneedstoberesituatedamonganumberofother,nonjuridicalmechanisms.MICHEL
FOUCAULT,POWER/KNOWLEDGE:SELECTEDINTERVIEWSANDOTHERWRITINGS19721977,141(ed.ColinGordon,
1980).
[21]Hunt&Wickham,supranote6,at49.
[22]MichelFoucault,TheSubjectandPower,inMICHELFOUCAULT:BEYONDSTRUCTURALISMANDHERMENEUTICS208,
221(HerbertDreyfus&PaulRabinoweds.1982).
[23]Hunt&Wickham,supranote6,at27.
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[24]See,infra,sectionV,foradiscussionofthestrategicuseofthetranssexualnarrativetogainaccesstoSRS.
[25]ThesymptomsofGIDdescribedintheDiagnosticandStatisticalManual(DSMIV)primarilyfocusontwoelements:thefailure
toconformtogenderstereotypes(particularlyinchildren)orthedesireforgenderrelatedbodyalterationSRSandhormonetherapy
(particularlyinadults).Seeinfra,sectionII,foradiscussionoftheconstructionofthetranssexualchildhood.Suchafocuson
genderconformitysupportstheconclusionsoftheBillingsandUrbanthatthedoctorpatientrelationshipinthetranssexualsituation
isoneinwhichthedoctorisproducingadherencetogendernorms,andpathologizinggendernonconformity.However,the
questionarisesastowhethertheproblemliesinthesearchforgenderrelatedbodyalteration(mutilation,astheywouldcallit),or
intheprocessbywhichpermissionforsuchselfengineeringisobtained.
[26]Hausmanacknowledgestheresistantcontentpossibleinbodyalterationprojects,andthewaysthattranssexual
diagnosis/treatmentservestocontainthatthreat.[T]hecommonsenseunderstandingoftranssexualismasadisorderofgender
identityisacoverupforthepotentiallymorethreateningideathattranssexualsaresubjectswhochoosetoengineerthemselves.
Hausman,supranote2,at9.
[27]Onedoctordescribedtherequirement:Patientsareexpectedtoliveinthenewgenderrole...for1to2yearsinorderto
experiencelifeinthenewroleanddevelopappropriaterolebehaviors.ElsieR.Shore,TheFormerTranssexual:ACaseStudy,13
ARCHIVESOFSEXUALBEHAVIOR277(1984).
[28]Feinbergwritesaboutthesearchfororiginsofgendernonconformityaswell,andanswersthisquestion:
Whocares!Aslongasmyrighttoexplorethefullmeasureofmyownpotentialisbeingtrampledbydiscriminatorylaws,as
longasIambeingsociallyandeconomicallymarginalized,aslongasIambeingscapegoatedforthecrimescommittedby
thiseconomicsystem,myrighttoexistneedsnoexplanationorjustificationofanykind.
LESLIEFEINBERG,TRANSLIBERATION:BEYONDPINKORBLUE32(1998).
[29]RachelPollack,TheVarietiesofTranssexualExperience,7TranssexualNewsTelegraph18,20(1997).
[30]CLAUDINEGRIGGS,S/HE:CHANGINGSEXANDCHANGINGCLOTHES32(1998).SeesectionV,infra,formorediscussion
onstrategicuseofthetranssexualnarrative.
[31]AMERICANPSYCHOLOGICALASSOCIATION,DIAGNOSTICANDSTATISTICALMANUAL,4thEdition532(1994).
[32]Id.at533.
[33]Id.at536.Thedifferenceis,apparently,thatGIDgendertroublerepresentsaprofounddisturbanceoftheindividualssenseof
identitywithregardtomalenessorfemaleness.Personally,Ineverknewatomboyorsissywhomightnotqualifyasprofoundly
disturbed abouttheirgender,especiallyintheeyesoftheirparentsandteachers.Thedifferentialdiagnosisofthesekidsfromkids
withGIDseemslikeanafterthoughtinthewritingaquickwaytotryandmakeitnotappearthatallgendernonconformityisbeing
pathologizedbythegeneralizeddiagnosiswhichreliesonanimpossiblenormachildwithnocrossgenderplayhabitsor
transgressivegenderexplorations.SincealmostnochildwillstateImprofoundlydisturbedaboutmygender,thisdetermination
willalwaysbeleftforparents,doctors,andteachersthesurveillancesystemkicksin.
[34]Foucault,supranote15,at21.
[35]Foucaultusestheexampleofsexualdiscourseinthesecondaryschoolsofthe18thcentury.Whilethegeneralimpressionmay
bethatthesexualityofchildrenwashardlyspokenofattheseinstitutions,inrealityanelaboratediscourseaboutthedangerofthe
sexualityoftheschoolboydominated.Everyaspectofeducationwasdesignedtocontaintheimagineddanger.AsFoucault
describes,thediscourseoftheinstitutiontheoneitemployedtoaddressitselfwasconsumedwithconcern,speculation,and
attemptedregulationofschoolboysexuality.Id.at28.
[36]Hunt&Wickham,supranote6,at27.
[37]APA,supranote30,at537.
[38]Iusethegenderneutralpronounssie(pronouncedsee)andhir(pronouncedhere)topromotetherecognitionofsuch
pronouns,whichresisttheneedtocategorizeallsubjectsneatlyintomaleandfemalecategories,atthesuggestionofLeslieFeinberg.
Inthisessay,Iusethesepronounswhendiscussingahypotheticalperson,butwhenIamreferringtopeoplewhohavearticulateda
selfidenitificationinaparticulargender,Irespectthatchoicebyusingpronounswhichreflectit.Feinberg,supranote24,at1.
[39]Griggs,supranote29,at1013.
[40]Id.atix.Hausmanpositsasimilarlyhelplessandafflictedviewoftranssexuals.Ostensibly,thedemandforsexchange
representsthedesperationofthetranssexualcondition:afterall,whobutasufferingindividualwouldvoluntarilyrequestsuchsevere
physicaltransformation?Hausman,supranote2,at110.Thispresumptionisafundamentalpartofthemedicalapproachto
transsexualism.ThetherapistsIveseenhavewantedtohearthatIhatemybreasts,thatthedesireforsurgerycomesfrom
desperation.Whatwoulditmeantosuggestthatsuchdesireforsurgeryisajoyfulaffirmationofgenderselfdeterminationthata
SRScandidatewouldnotwishtogetcomfortableinastablegendercategory,butinsteadbedelightedtobetransformingtochoose
itoverresidingsafelyinmanorwoman?
Griggswritesthatthereisnoperceptualmiddlegroundbetweenmaleandfemaleandthattranssexualscannotfade
gentlybetweengenders.Griggs,supranote29,at1.TothisIwouldrespondwithaproverbthatFeinbergquotes:Thepersonwho
saysitcannotbedoneshouldnotinterruptthepersondoingit.Feinberg,supranote27,at61.
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[41]MARJORIEGARBER,VESTEDINTERESTS:CROSSDRESSINGANDCULTURALANXIETY102(1992).
[42]Feinberg,supranote27,at19.
[43]NeilGotanda,ACritiqueofOurConstitutionisColorblind,inCriticalRaceTheory:TheKeyWritingsThatFormedthe
Movement257(KimberleCrenshaw,etal.eds.1995).[U]ndertheAmericansystemofracialclassification,claimingawhiteracial
identityisadeclarationofracialpurityandanimplicitassertionofracialdomination.Id.at259.

[44]ShaeferandWheeler,chroniclersofHarryBenjaminswork,describeasuccessfultranssexual:
WithBenjamin'sencouragementandtheinspirationofJorgensen'sstory,Janettookamorescientificandintelligent
pathtowardfulfillingherdream.AswithInez,despitehergenerallymasculineappearanceandthelateageatwhichshe
completedhersurgery(inherlate50s),Janet'sisagenuinesuccessstory.Freedfromherlifelonggenderstruggle,her
brillianttalentemerged.Janetandabusinesspartnerdevelopedaninventionsufficientlyvaluabletobesoldeventuallyfor
millionsofdollars.
Exceptforherclosestandmostintimatefriends,nooneinJanet'slifeknewthatthislovedandwonderfulwomanwas
notageneticfemale.Althoughshediedat72oflungcancer,Janetlivedherlast25yearsingreatwealthandcontentment.
LeahCahanSchaefer&ConnieChristineWheeler,HarryBenjamin'sFirstTenCases(19381953):AClinicalHistoricalNote,24
ArchivesofSexualBehavior73(1995)(individualpaginationnotavailable).Thestoryillustratesthemediationofpropergender
performancethroughcapitalistvalues.Iwouldassumethatapatientwhowentontohaveacareerinsexworkorfoodservicewould
notbeconsideredequallysuccessful.AsimilartrendwaspresentinthestorythatbeginssectionII,supra,whereIdescribethe
waysinwhichthetherapeuticapproachtomydesireforbodyalterationnecessitatesaprivilegingofsexualorgenderdifference
aboveallelse,andanerasureofotheraspectsofmypositionality.SuchanoccurrencefallsinlinewithFoucaultsanalysisthatthe
sexualselfhasbecomethetrueselftoconfessyoursexistoconfessyourself.
[45]Griggs,supranote29,at1.
[46]Id.at17.
[47]Id.at2122.
[48]Id.at22.
[49]JudithHalberstam,TransgenderButch:Butch/FTMBorderWarsandtheMasculineContinuum,4GLQ287(1998).
[50]Id.at292.
[51]Id.at298.[M]anyofthetipsfocusalmostobsessivelyonthecarethatmustbetakennottolooklikeabutchlesbian.Id.
[52]Wilchins,supranote1,at121.
[53]Insomeways,someofthesegoalsaresimilartothoseofpeoplewhoseekotherkindsofcosmeticsurgery.Perhapsthemost
notabledifferencebetweensomeinstancesofSRSand,say,breastenhancement,pectoralimplants,orlaservaginalreconstructionis
theferociousnesswithwhichmedicalpractitionersguardtechnologieswhichaidinenhancementofthefemininityofbirthassigned
menandthemasculinityofbirthassignedwomen,andtheeasypleasurewithwhichtheyperformprocedurestoenhancethe
femininityofbirthassignedwomenandthemasculinityofbirthassignedmen.SeePeterM.Warren,ACapandGownandNew
Breasts.Trends:InTimeforHighSchoolGraduation,MoreTeensAreGettingImplants.SurgeryontheYoungStirsControversy.,
L.A.TIMES,May21,1999,atE1.
[54]Garber,supranote40,at103(emphasisinoriginal).
[55]Id.at103.
[56]Feinberg,supranote27,at63.
[57]BillingsandUrban,supranote10,at273.
[58]Id.
[59]Id.
[60]Id.Doctorssharedexperiencesofhavingpatientslaterreveal,afterthecompletionofsurgery,thattheyhadtailor[ed]their
viewsofthemselvesandtheirpersonalhistoriestoprevailingscientificfashions.Id.ThedirectorofJohnsHopkinsUniversitys
genderclinicstatedhisconcern,in1973,aboutthepossibilitythatmanypeoplenotqualifiedforSRSwerereceivingsuch
treatmentthroughdeception.[T]helabeltranssexualhascometocoversuchamultitudeofsins.Meyeracknowledgedthat
amongthepatientswhohadrequestedandsometimesreceivedsurgery...weresadists,homosexuals,schizoids,masochists,
homosexualprostitutes,andpsychoticdepressives.Id.Doctorsaroundthecountrysharedafearthattheywerelosingcontrolofthe
maintenanceofthetranssexualcategoryasnumerousdeviantswhodidnotperfectlyconformtotheformulacrackedthecodeand
receivedsurgerythroughdeception.
[61]SuchastrategyispresentinAgnessstoryaswell.Infra,notes24andaccompanyingtext.ThesexualorientationofAgness
boyfriend,Bill,wasalocationofgreatspeculationandconcernforthedoctorstreatingAgnes.Theirobservationsfocusedon
whetherBillwashomosexualorheterosexual,andwhetherAgnesandBillhadengagedinanalintercourse.[T]hedoctors...were
constantlyonthealertforsignsofincipienthomosexualityintheirpatient.Agnessapparentheterosexualitywasanessential
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componentofherconvincingselfrepresentationasawoman.Hausman,supranote2,at6.Thedoctorswerenotwillingtoproduce
awomanwhowouldhaveanalsex,orahomosexualboyfriend.Agnessabilitytobethemostnormabidingheterosexualintersexed
personpossiblewasessentialtoherachievementofSRS.
[62]Id.at275,quotingDr.DonaldR.Laub&Dr.NormanM.Fisk,ARehabilitationProgramforGenderDysphoriaSyndromeby
SurgicalSexChange,53PLASTICANDRECONSTRUCTIONSURGERY388,401.
[63]Id.at275.
[64]Ofcourse,forsomepatients,thenarrativedoctorsseekisthenarrativetheybelieveaboutthemselves,andlyingisnotnecessary
forgainingaccesstoSRS.However,fornumerousothers,tailoringstoriesandproducingevidenceoftheexpectedsymptomsof
transsexualityisfundamentaltoachievingbodyalteration.
[65]SeesectionVIforadiscussionsometheoristsuseofthebiographiesoffamoustranssexualsasevidenceoftranssexual
adherencetogenderstereotypes.
[66]Garber,supranote40,at110.
[67]MarjorieGarber,SpareParts:TheSurgicalConstructionofGender,inGarber,supranote40,at93117.
[68]Shore,supranote26,at277.
[69]Id.Inthispassage,Mickeysrealnessislinkedtohernonflamboyantappearance.JustasFTMsarelegitimatedthrougha
differentiationfrombutchness,MTFsarelegitimatedthroughadifferentiationfromdragqueensandfags.Mickeyssuccessatfemale
identityistied,inthisdescription,tooccupationofastereotypicalfemaleidentitythatisseparablefromthefakefeminityof
femaleimpersonators.AsimilarbasisforAgnessrealnesswasusedbyherdoctors.
Themostremarkablethingaboutthepatientsappearancewhenshewasfirstseen...wasthatitwasnotpossibleforanyof
theobservers...toidentifyherasanythingbutayoungwoman....Herhair,whichwaslong,fine,andpulledbackfromher
faceacrossherears,wastouchedablondebrownfromitsnormalbrown....Hereyebrowsweresubtlyplucked.Shewas
dressedinamannerindistinguishablefromthatofanyothertypicalgirlofherageinthisculture.Therewasnothinggarish,
outstanding,orabnormallyexhibitionisticinherattire,norwasthereanyhintofpoortasteorthatthepatientwasillatease
inherclothes(asisseensofrequentlyintransvestitesandinwomenwithdisturbancesofsexualidentification).
Hausman,supranote2,at5.
[70]Id.at281.
[71]Id.
[72]Id.at282.
[73]Id.
[74]Id.at283.
[75]Manytranspeoplebelievethataviablepathtolegalprotectionagainstdiscriminationonthebasisofgenderidentityisthrough
disabilitystatutes.ThispossibilityappearedsomewhattruncatedwhentheAmericanswithDisabilitiesAct(ADA)waspassed
includinganexplicitbanoncoveragefortranssexuals.See,42U.S.C.A.12100etseq.(2000).However,recentstatedevelopments
suggestthathoperemainsforantidiscriminationprotectionthroughdisabilitystatues.Californiatransactivistsrecentlycelebrated
afterGovernorDavissignedA.B.2222.ThebillprovidesthattheCalifornialawmayprovidegreaterprotectionthantheADA.The
billextendsprotectiontotranssexualsandpeoplewithGID,whichmeansthattransgenderedpeoplewhomaybeperceivedtosuffer
frommaybeprotectedfromdiscriminationinemploymentandhousingonthebasisofthatperception.Additionally,thenewlaw
requiresemployerstoenterintogoodfaithnegotiationswithtransgenderemployeeswhoclaimtheirtranssexualityasadisability
regarding"reasonableaccommodations"fortheirdisability.
[76]CourtsthroughouttheUnitedStateshavearrivedatdifferentconclusionsastowhetherMedicaidcoverageshouldincludeSRS.
Foradetailedaccountofthedecisionsandtheirreasoning,seeEricB.Gordon,TranssexualHealing:MedicaidFundingofSex
ReassignmentSurgery,20ARCHIVESOFSEXUALBEHAVIOR61(1991).
[77]SeeRichardsv.U.S.TennisAssn,400N.Y.S.2d267(1977)R.v.Cogley,[1989]V.R.799M.T.v.J.T.,355A.2d204(1975).
However,itisimportanttonotethatunpopularconditionsoftenconsidereddisabilitiesassociatedwithsocialdeviance,including
transsexuality,drugaddiction,homosexuality,andvoyeurismwereintentionallyexcludedfromcoverageundertheAmericanswith
DisabilitiesAct.42U.S.C.12101,12213(1991).SeeAdrienneHiegel,SexualExclusions:TheAmericanswithDisabilitiesActAs
aMoralCode,94COLUM.L.REV.1451(1994).Thissuggeststhatthedisabilitymodelmaynotbereliableforachieving
improvedlegalstatusfortranspeople,becauseitdoesnotexcludethepossibilitythatlawmakerscanestablishdeservingand
undeservingclassesofdisabledpeople.

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