The slippery slope of Transmedicalism

11 Jun, 2025

Heya! So, you might have read my recent rant on this topic. In this post, I want to cover exactly why I think transmedicalism (or whatever you wanna call it) is actually really really fucking bad while being slightly less incendiary than I was last time. Because, for some reason this stuff is like, worryingly popular on bear and I have not really seen anyone else talk about it?

Some quick definitions so we're all on the same page:
Transmedicalism - the belief that you are only transgender if you experience dysphoria or want to have gender confirmation surgery.
^ this is the thing I'm arguing is really bad and harmful.

Transgender -
Not identifying with the gender you were assigned at birth.
^ this is the "less strict" definition, and the one I'm going to be arguing for.

This would be a bad idea even if you were right about it...

Alright, so first things first: even if, the core ideas here are correct, (they aren't), spreading this kind of rhetoric would still be massively damaging to everyone involved and fuck over a lot of people that do meet the transmedicalism criteria for being a "real" trans person. Because, and i feel like this is something any trans person should know already, gender identity is complicated. Emotions are complicated. It is very much possible to have gender dysphoria and not know about it. Because our brains are very good at justifying this sort of stuff to ourselves. It's easy to misinterpet dysphoria as any number of things. Like just being attracted to a person. Or thinking it's "just a fetish". Or learning to live with it and never really questioning why it's there, assuming it's just something everyone else feels. You know what's the easiest way to figure out if you're trans? Just trying it out and exloring your gender identity in some sort of safe space. It's how I figured out I was trans. (thanks, ff14)

You know what all this transmedicalist rhetoric is saying you shouldn't do? Identifying as trans if you don't have dysphoria or aren't planning on medically transitioning. You know what the kind of people unsure about their gender identity also aren't sure about? So, imagine what happens when someone who isn't sure about their gender identity finds a post saying that you're "not actually trans" unless you're dysphoric and get surgery? There's a good chance that pushes them back in the closet. In these beginning stages, youre often really unsure about your identity, about if this is who you are. It makes sense. For most of your life, you've been conditioned to see your assigned gender as the "correct" and only option. So, for many people, things go like this:

1. Oh shit, I'm trans
2. Now that I know that, I start thinking about my own gender identity more
3. Wait, that thing I thought was normal turned out to be gender dysphoria all along
4. Now that I've sorted out those feelings i realize i want to get top/bottom surgery/whatever

If you're not going to let people do that first part of exploring your gender identity, trying stuff to see what works, and instead tell them they're not actually trans if they don't want or feel x, y and z (they often do, they just don't know it yet) then you'll end up pushing a lot of people that do actually fit those arbitrary criteria you've set back into the closet. Because realizing you're trans is a lot harder than justifying to yourself why you aren't.

...Thing is, you're also not right about it.

Alright. So let's say we're in some sort of perfect utopia where the aforementioned stuff isn't a problem. How does gatekeeping trans identity help anyone? What good does this actually do? One "argument" I see a lot is about being trans becoming commoditized, becoming an aesthetic. And like.... That's good, actually? That's the whole point?¹ Being trans should be normalized. It should not be some grand political statement, some dramatic gesture. I want to live in the world where being trans is normalized to the point it's just like... A thing people happen to be. It should be mundane. You should not have to fear for your life to qualify as trans. The trans experience should not be defined by how much misery you're willing to endure. I for one would very much like to be happy and for people to just respect me for who I am. I can somewhat see where the people saying this stuff come from, right? If you had to fight to get where you are and you see other people suddenly having it much easier, that can seem unfair. But this is just kind of... How we make progress as a society. If we don't try to make things easier for the people that come after us, then what the fuck are we doing, right? What's the point? Why should we strive to maintain the status quo just so you can feel slightly cooler. People being more easily accepted doesn't invalidate your suffering, it doesn't make it meaningless. It's a result of that effort. Yes, your lived experience might be very different, but that doesn't invalidate others identity as being trans. It just means you had different lives. Trying to exclude people, making being trans some secret club you only get to participate in once you've received enough death threats - that doesn't help anyone.

You're using the same reasoning used to oppress trans people

Alright, so. Placing requirements on gender identity. This can really easily lead to things becoming far worse than "just" transmedicalism. Once we've started accepting the idea of your gender identity being conditional, on having it be recognized by other people being a privilege, something you earn - then we've fucked up. Because when we start treating it as a privilege and not a fundamental right, it's very very easy to begin moving goalposts. "Hey, you can legally change your gender if you get surgery. If you can afford the surgery. If you live somewhere you're allowed to get it." ...And so on. Placing conditions on identity will very quickly end up going very very wrong because it can quite easily get co-opted by powerful people with far worse motives than just wanting to feel better than some other trans person on the Internet. This is how the right gets people - it's by using flawed assumptions that sound "reasonable enough" at first glance and then slowly turning up the temperature until suddenly trans kids can no longer go outside without the fear of getting shot. I'm not saying that you're alt-right if you're transmedicalist or whatever the fuck. Im just saying that the transmed line of reasoning is just a few steps removed from a lot of the reasoning being used to oppress trans people in places like the U.S., and that maybe that should make you think about who you're agreeing with here and what consequences that might end up having.

So, yeah. If you are transmedicalist and you've read this far... I hope I've at least given you something to think about.