My autistic ass is wondering if truscum realize medicalization and gatekeeping are the first two stops on the “How do we make people like this stop existing?” train.
Hello, trans truscum here.
Medicalization doesn’t mean that trans people don’t exist. It lets people who really need HRT have it, rather than letting every single person who wants it have it. If anyone could have HRT, and it was demedicalized, prices would skyrocket, and incurrence wouldn’t help pay for it, meaning less access for the people who need it.
“Gatekeeping” is us saying that you need dysphoria to be trans. We are telling people fact, and that does not mean that trans people don’t exist. We want people to know what being trans means, versus being cis, GNC, or NB. A lot of cis, GNC, and NB people identify as trans, when they simply aren’t, and there are other lables that could better fit them.
All truscum have to believe that trans people exist, and none of us want trans people to just disappear, or think that being trans isn’t real. We are clarifying the definition of being trans, so that the trans community can help actual trans people, rather than cis, GNC, and NB folk.
“Medicalization doesn’t mean trans people stop existing.”
That’s cool. So what do you think the follow-up question to all the “why are people trans?” research is?
“[Gatekeeping] lets people who really need HRT have it” Hahahahaha, that’s a good one.
Oh, you were serious. Let me laugh harder.
It does literally the opposite of that. It delays and restricts access, on the basis that trans people are somehow less capable of knowing ourselves than cis people.
@emotional-karuma, you wanna weigh in here, as someone who desperately needs HRT but has been denied it by the system these folks are trying to support?
“If HRT is demedicalized…” Nobody here is remotely suggesting that. That’s your idea, not ours. What we’re arguing for is for it to be treated like every other prescription medication, without special barriers or the regressive idea that trans people are inherently wrong or bad or crazy.
“You need dysphoria to be trans…” [citation needed]
“… So that the trans community can help actual trans people, rather than cis, GNC, and NB people.”
One: You… You realize that you literally just admitted that you’re throwing trans people under the bus, right? And not even in the sense that we disagree on the definition. Like… You know there are NB people with dysphoria and a need for HRT, right?
Two: If you think that we can actually solve trans issues without also helping GNC people, you clearly haven’t thought about what exactly our issues are.
Look, here’s the thing: Any filter you care to apply is going to have false positives (in this case, people for whom HRT is not the right answer being prescribed it) and false negatives (people who need HRT being denied access.) Accepting that these are going to happen and having a plan for dealing with these cases is part of good system design, and a critical component of that is asking “would we rather design this system to throw more false positives or false negatives?”
In this case, false positives result in cosmetic issues, and more medical and psychological support. False negatives result in dead trans people.
The people who built this system have decided that preventing even one false positive is worth any number of false negatives.
You are not helping trans people by supporting that. You are helping the people who literally *did* what you’re scared of, within my and probably your lifetime. You’re helping the people who kept me from accessing hormones for literal decades, and would still be denying me access to surgery if I hadn’t done an end run around them.
Why would you do that?
I’ll gladly weigh in!
Trans healthcare in my country isn’t the worst in the world for gatekeeping, but I’d argue it’s among the worst. Officially the steps that must be completed to receive just hormones are:
Name change
2 years “real life experience”
Employment
Now that’s already more than you get for LITTERALLY ANY OTHER MEDICAL TREATMENT. Now I’ve had abortions, you’d think they’d be as gatekept, right? Even they aren’t. Never before seeking treatment for dysphoria have I been denied treatment for anything because I don’t have a fucking job.
Their are no allowances if changing your name would put you at risk (though thankfully it is free here). Their are no allowances if spending 2 years living openly as your correct gender without HRT puts you at risk. Their are no allowances if you cannot work for whatever reason.
And that’s just the “official” requirements. Things that can cause you to be denied hormones in practice are (and this is not an exhaustive list, this is just what I or people I know have experienced):
Having a job that doesn’t require you to deal with the public
Being routinely misgendered (you just aren’t trying hard enough!)
Any organisation refusing to change any of your details (which is against the law but it’s still your fault)
Attending GIC appointments in trousers when it’s snowing (in this case it was a threat to remove hormones the person had already been on for years)
Having sex
Having a child (wether that was a free choice or not)
Wearing “women’s” clothes that were actually “mens” clothes but the shitty ass doctor refused to believe me even though they were my closeted GFs clothes
Wearing pastel shoes even if they are the only pair you own
Dying your hair purple (Its too close to pink, which is apparently a girls colour)
Being a “trap”
Cosplaying
Being non binary, even if you have dysphoria (at least one clinic now refuses to take nb patients)
Being willing to shave if hypothetically you didn’t like body hair as a result of HRT
Being willing to wear a wig if you went bald and it ended up bothering you
Dating
Dating after the clinic has attempted to forbid you from dating
Liking anything that is masculine if you’re on the transfem side/feminine if you’re on the transmasc side
Not binding (no allowances for health problems)
Not shaving (even if you are still in the closet)
Looking too naturally feminine while pre-T
Dressing in a manner to avoid violence
Being “unstable” (which is highly fucking subjective)
Self harming (ever. People have been threatened with having their hormones removed because they self harmed in the past)
Being suicidal over dysphoria
Not making “fast enough progress” (this specifically was in reference to me not magically curing myself of disability and them not giving me HRT, all of which are my fault of course)
And that’s all I can remember right now. That’s what gatekeeping is. I’ve been attempting to get hormones for 5 years now. I already did my soul searching and decided what I needed before I went to them. I’ve had eating disorders and addictions because of my dysphoria. They know this, and they decided I don’t deserve hormones.
Their reasoning? Because I don’t have dysphoria. Because all that irrelevant bullshit apparently “proves” I don’t have dysphoria. Under this model, they get to decide if I have dysphoria, they get to decide how they want dysphoria to manifest in trans people, and since dysphoria is in their eyes the be all and end all of the trans identity, I’m a fake.
See what’s wild to me is alongside this we actually have guidelines for prescribing to patients not under GIC care if they need it, because HRT is not made from the tears of unicorns or as dangerous as fucking anthrax. Their is already a limited model for informed consent based prescriptions that is successful when used. (Just no fucker uses it, because trans people have no rights and refusing to use guidelines intended to save lives and let trans patients die instead is apparently perfectly fucking legal)
And informed consent models do exist in some places in America, and I’ve yet to hear of HRT costs going through the roof there. HRT shortages are pretty much unrelated to demand, its a manufacturing issue
I fail to see how any of this actually helps trans people. Most of us, when we ask for help, we know what we need. We should be trusted. Being trans is highly stigmatized so people ain’t running out for hormones just for the fuck of it. Anyone who is asking needs it. And anyone who is unsure has the option of therapy before making a choice. But no one should be forced through minimum 2 years of therapy to be told no because they wore the wrong shoes one time if they need hormones.
I’m struggling for a way to phrase this without something typically used to dismiss, but I can’t think of anything so bare with me. The thing with stuff like this is “Its all in our heads”. There is no test to prove who experiences dysphoria. Their is no adequate questionairre or checklist that can determine for sure if we are telling the truth. But the number of people fucking up and making poor choices does not compare to the number of dead trans people. There’s one that I know of in my country who died earlier this year I think? I almost did in October.
No cis person is held to this standard while seeking healthcare. Because it’s not about helping us, its about controlling us, and controlling which trans people are allowed to live. Which apparently doesn’t include anyone who isn’t a feminine trans woman or masculine trans man.
Also y’know what, fuck making being trans a requirement anyway. I’ve known cis people self med for their own reasons, it made them happy, they’re fine. Let people have what hormones they feel is best for them, gender be damned.
Tag: gatekeeping
HRT does change your appearance but so does getting full body tattooing and you can get a full body tattoo at 18 without proving to a doctor that you won’t regret it so like…
…maybe HRT being hard to access is actually about transphobia…
*foaming at the mouth while reblogging*
Cis women can get a boob job at 18 without two notes from a therapist
I see all the notes on this with people being all “it’s a serious medication, of course you need to get doctor approval for your own health”; no guys, this is specifically about the psych eval requirement that many doctors with outdated info and mindsets still stand by. That’s not the same thing as the medical eval. Stop with the damn “well your tattoo artist needs to make sure you aren’t allergic to the inks”, that’s not what this is about.
This. Making sure that HRT won’t trigger or aggravate some kind of preexisting condition – just the way a responsible doctor would check known risk factors before ANY major medical treatment – is a very different thing from “you have to prove that you really REALLY want this, and that you want it for the RIGHT REASONS (as determined by us), and that no matter what life pulls on you in the next 60 years or what changes you go through, this is the one decision you will never regret.”
Anyone in those notes wanna tell me the last time getting a prescription required you to go to your GP, who referred you to a social worker, who referred you to a therapist, who made you read (out loud!) and sign off on every single paragraph of a five-page document, mostly phrased in the most alarmist and scary way possible and then referred you to a psychiatrist who made you read (out loud!) and sign off on every single paragraph of the same document, and then gave you a referral to a specialist who wanted a complete medical history and full-body exam, in a process taking about a week of actual work and a year of calendar time?
Because that’s what I had to do for HRT, and my case was an easy one in a place that’s actively trying to eliminate gatekeeping.
doctor: you need this thing
insurance: no you don’t
Just reminded of the time I also got sent to a guy at some Christian counseling place for an SSI reevaluation. I didn’t even know there were any practices like that in the area, but it turned out there was at least one–and they were apparently seeking out disability assessment contracts! I also didn’t know I could try to get that changed.
(The only review ever, after I got a new case manager at the local Social Security office who took it upon herself to repeatedly call people up to harass and threaten them over supposedly faking. That was fun. Probably not the only one to get a review out of it, either.)
At least nobody was sounding aggressively Evangelical at me or anything, but the fact that openly ideologically motivated professionals were getting federal contracts for disability assessments struck me as hideously inappropriate at the time. That was also fairly early during the GWB administration, so yeah. So much dodgy shit was not as normalized yet.
The waiting room also had brochures for some type of bedwetting alarm system including the option of a shock aversive. (Not vibration, definitely shock.) I had no idea that existed. The only mentions I can easily find right now refer to one model which has apparently not been on the market for a while (thank goodness), but something similar was definitely getting pushed in the US ca. 2000. So yeah, seeing that didn’t make me any more comfortable about whoever the assessment had been contracted out to.
In that case, they did at least behave professionally dealing with me, but I still felt put even more on the spot. When the evaluations are already stressful enough. Having someone in that kind of position of power over you, with multiple ideological reasons to possibly consider you Undeserving–besides very possibly an investment in the idea of praying disabilities away–is really not reassuring.
Not everyone is going to behave professionally (by most standards) and even try keep their own religious beliefs off other people. To state the obvious. Especially if they’re feeling a need to set themselves up as Professional Explicitly Ideological Counselors. Seems too likely that this might help shape their ideas of what even constitutes professional behavior, on top of the basic worldview filtering and bias concerns.
That time I did manage to keep access to SSI and the connected Medicaid. Still felt like that was an even closer call, and nobody should be placed in a position like that.
Urocyon's Jaunts 2.0 