When Medical Providers Give Sex to Trans and Intersex People

By Georgiann Davis

In this post Georgiann Davis writes about her recent article co-authored with Jodie Dewey and Erin Murphy.

What does my life have to do with Caitlyn Jenner’s life, a former Olympic athlete turned reality TV star, who became a worldwide household name after a public gender transition?

Well, for one, our sexed embodiment has similarities. We both defy stereotypical thinking that assumes everyone’s body is either male or female, and that such male or female distinction is neatly correlated with our gender identity as either masculine for males or feminine for females.

Second, Jenner is trans, and I am intersex. And while trans and intersex are different despite often being conflated and confused throughout public discourse and even some academic research, as my mother recently and astutely noted, Jenner and I are in “the same family.”

Despite our similarities with embodiment, shared experience, defying binary sex, gender, and sexuality essentialist logic, there is an interesting paradox in how we are treated by the medical profession. This paradox is what inspired my colleagues and I to ask why and how providers are quick to surgically “fix” intersex but respond at a much slower pace to trans people who desire gender-transitioning services. We hope our attempt at uncovering these questions will reveal a crucial step in better understanding how trans and intersex embodiments are problematically seen in the medical world.

Through a comparative analysis of interviews with medical providers from various specialties—10 who treat intersex people and 20 who serve trans people, we argue many providers like much of the rest of society, believe in binary ideologies about sex, gender, and sexuality. That is, that healthy people are naturally either heterosexual masculine males or heterosexual feminine females. While providers may not be unique in holding these beliefs, they are in fact positioned (because of their trans and intersex expertise) to disrupt these stereotypes through medical certainty and credibility. However, the accounts our providers gave lead us to conclude that it is far too common for providers to perpetuate, rather than disrupt, faulty and problematic beliefs about our bodies and identities.

We suggest providers give their patients sex by withholding (in the case of trans) or enforcing (in the case of intersex) their medical services, especially surgical procedures. Providers tend to approach trans and intersex embodiments as problems that need to be solved, not healthy human variations. They slow down trans people’s request for transitioning services, citing that such requests are often irreversible and medically unnecessary and therefore need to be carefully thought about before enacted, whereas they are quick to use their scalpels in the case of intersex despite such interventions also being irreversible and almost always medically unnecessary. What’s remarkable here is that trans people have likely been contemplating any requested transitioning services for a great deal of time before even approaching a provider with their requests. Intersex people, on the other hand, are often immediately, and in an urgent manner, subjected to these similar medical services, especially the scalpel, when they are babies or young children even though intersex activists have for decades now pleaded with providers to wait on performing any medically unnecessary and irreversible interventions until intersex people are mature enough to make their own bodily decisions.

We also found that many providers assess the success of their interventions by looking for signs that their patients are living heteronormative gendered lives. We claim it’s rare for providers to accept their role in perpetuating the belief that trans and intersex embodiments are problematic. They also like to speak of themselves as facilitators of health care rather than decision-makers and gatekeepers, yet they control when trans people can have access to the interventions they are requesting, and they force intersex people to undergo unnecessary procedures in order to better fit into either a male or female sex box.

The good news is providers could make very different choices, and with changes in the new Medical College Admission Test (MCAT), approved in 2012, future generations of doctors might be better equipped to approach trans and intersex embodiments as healthy differences rather than pathologies. In addition to testing one’s knowledge in the natural sciences, the new MCAT also assesses one’s familiarity with the social and behavioral sciences, which will hopefully result in fewer providers problematizing trans and intersex embodiments. In the case of trans, providers could just listen to their patients and the urgency they express, accepting that trans adults have likely given considerable thought about transitioning before seeking medical assistance. In the case of intersex, providers could listen to the loud and clear critiques about medicine from the intersex community and simply stop framing intersex as a medical emergency that needs to be quickly, and surgically, corrected. If providers acted in these ways rather than the ways we uncovered in our comparative analysis, they would be creating a welcoming and supportive space for trans and intersex people. In doing so, providers would be approaching their trans and intersex patients as healthy people who have the right to make autonomous decisions about their bodies.

Georgiann Davis is assistant professor of sociology at the University of Nevada, Las Vegas. She has written numerous articles on intersex in various venues ranging from Ms. Magazine to the American Journal of Bioethics.Her book, Contesting Intersex: The Dubious Diagnosis, is available at New York University Press. Listen to her YouTube.com mini-lecture here

Article co-authors: Jodie M. Dewey is associate professor of sociology and director of the criminal justice program at Concordia University-Chicago. She has published several articles on trans-identified patients’ impact on the health care process. Her work focuses on medicalization and psycho-pathologization in transgender health. Erin L. Murphy is an independent scholar and graduate of the Sociology Doctoral Program at the University of Illinois at Urbana-Champaign. Her work has previously appeared in Gender and Society, Feminist Formations, Critical Sociology, and the Journal of Historical Sociology. She is working on a book tentatively titled, Exceptions of Empire: Anti-Imperialist Protests During the Philippine-American War. 

This blog entry is based on a June 2016 30 (3) Gender & Society article titled, “Giving Sex: Deconstructing Intersex and Trans Medicalization Practices.” To view the article, click here





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