SO71089A - Gender, Media & Culture Dissertation

Student number: 33304956

word count: 14540

Are you a girl or a boy? A study into the reinforcement of

gender binary through medical transition and the NHS.

An in-depth critique and discussion into the medicalization

of the transgendered person in both historical and current
contexts, and the normalization of transsexuality through
the implementation of the gender binary model in terms of
language and medical intervention.

Introduction

This dissertation will be looking into the ways trans people must
conform to specific gender binaries in order to be legitimized as a
Transgender person and to receive and gain access to surgery and
hormone treatments, specifically through the national healthcare
system.
I wish to explore the way stereotypical gender roles are encouraged
in order to legitimize medical transition, and how access to gender
reassignment serves as a reward for fulfilling the quota of
'masculine male' and 'feminine female.
I will look into the effect this has on non-binary identified trans
people and the extent to which medical conceptions of sexed
identity associated medical practice have a detrimental effect to the
encompassing of all trans people with varying gender identities
within society and with access to medical care.

I will do this by firstly looking into the history of medicalization of

trans and gender variant people in both historic and current
contexts. This will include a look into corrective surgery on Intersex
people and the way ambiguous gender is perceived as abnormal
within medical practice. I will also be looking into the initial
conception of trans into medical discourse and the changes and
progression made over time with replacement of terms such as
gender identity disorder to gender dysphoria within the DSM-V

manual. Do these changes in medical terminology reflect a change

in attitude and a new understanding of gender identity?

I will address issues of Gender binary as a system of oppression by

looking at texts such as; Kate Bornsteins Gender Outlaw (1994)
and Alison Rookes Telling Trans Stories, (2010) which focuses on a
project involving debates between young Trans people and medical
professionals involved in their care as well as Oral History taken
from literature by Zowie Davy. (2010)

In the final part of this dissertation I will be drawing upon my small

scale research study of non-binary identified trans interview
participants, and an online survey that asked questions relating to
the medical interactions and care they had received as a non-binary
person. With this approach and by drawing upon each individuals
experience, I hope to illustrate the ways in which the healthcare
system is failing non-binary trans people.

Background

2014 has been a good year in regards to raising visibility of Trans

people and putting issues of Transgender rights into the spotlight.
From Laverne Cox making history as both the first transgender actor
to be nominated for an Emmy (Cullen, 2014) and for being the first
Trans person to feature on the front cover of Time Magazine. (Hach,
2014)
However, increased visibility has meant that mainstream media and
society have constructed their own ideas and ideals of what trans
signifies to them based on potentially outdated ideologies and
definitions of transgender. BBC Online for example, defines a
transgender person as, Someone who has a conviction that they're
trapped in the wrong body. (bbc.co.uk)

There have been many criticisms of the wrong-body model such as

Talia Bettchers Trapped in the Wrong Theory, in which she states,

The wrong-body narrative is deeply connected to genital

reconstruction

technologies,

the

narrative,

just

as

the

technologies, is open to worries about class and racedifferentiated access. The wrong-body narrative outlines a
standard genital reconstruction surgery, and any identity that
fails to desire that is ruled ineligible. It thereby attempts to
restrict access to womanhood or manhood itself through
hegemonic class-, race-, and culture-inflected modalities.
(Bettcher, 2014:402)

Bettcher outlines how limiting Trans identity to a wrong-body

narrative dictates the authenticity of a trans persons identity that
must follow the guidelines of an oppressive medical definition, such
as: the desire for corrective genital surgery which I will discuss
further, in the section The problem with Corrective surgery.

Context Part I: Clarifying Trans Terminology

To ensure clarity of the subject, I feel it necessary to define what I

mean by trans people throughout the context of this essay. The
term trans can usually be incorporated within many levels of
gender ambiguity. In fact one of the first problems I encountered
was giving it a narrow definition as it is utilized as such an extensive
umbrella term.

This notion of a term that encompasses gender variance on such a

huge scale is emphasized in Vanessa Sheridans Complete Guide To
Transgender In The Workplace. As Sheridan explains,

Transgender is a very big tent that covers a lot of territory,

with much of it difficult to categorize. A useful understanding

of the term is this: transgender includes everything not

covered by our cultures narrow terms for man and
woman. (Sheridan 2009:1)

In this dissertation, I will use the term trans to describe those who
do not identify with the biological gender they were assigned at
birth. One important factor that Sheridan (2009) fails to mention is
that the medicalization of trans people does not seemingly
acknowledge this vast spectrum of alternative gender identities that
the term trans covers.

This way of viewing gender has been debated by many queer

theorists (Whittle, 2000; 2006) who argue that gender is very
complex, is a social construct (Phillips, 2006; Kessler and McKenna,
2006) and even a performance, which is not based on your genitalia
or your internal organs (Butler, 1999; 2004).

A good example on the issue of defining gender on the distinction of

ones physical anatomy is illustrated in an article by Geertje Mak
appropriately entitled, So we must go beyond what the microscope
can reveal. Mak focuses her attention on late 19th century studies
into genitalia and gender identity, critiquing the work of Alice
Dregers Hermaphrodites,

Most physicians agreed that the true sex had to be defined

by the structure of his/her gonadal tissue. Dreger labeled this
period The age of gonads. Arguing that no matter how an
individual lived in a gender role- they would be labeled male
or female by their anatomical gonads. (Mak 2005:69)

As Mak (2005) explains, the belief was held that the construction
and appearance of your genitalia ultimately defined ones gender
identity. Whilst Mak argues there had been queries and disputes
regarding the concept of sex/gender long beforehand, Dreger
argued that Blair Bell, a surgeon in Liverpool (1915), was one of the
first to publicly question this practice by asking Whether we are
justified in branding patients with a sex that is often foreign not
only to their appearance but also to their instincts and social
happiness (Mak, 2005: 69).
We can conclude that Bell was advocating the idea that anatomy
should not necessarily reflect gender identity, and by drawing upon
the social happiness of individuals, Bell recognizes the adverse
affects that branding patients can have on ones emotional
wellbeing.

With this in mind, Mak (2005) states how a new understanding of

biological sex began to influence the language used to define
gender. Mak writes, Other kinds of biological sex were being
discovered, e.g. hormonal sex and chromosomal sex. A shift in

conceptualization

also

attributed

shift

in

name,

from

hermaphrodite to intersex. (Mak, 2005:69)

Context Part II: The Issue with corrective and Intersex

surgery

In this section I will look into the concept that Intersex surgery as
corrective is a Westernized cultural idea influenced by a belief
system that considers gender ambiguity abnormal and in need of
medical intervention by way of surgical normalizing (in this case)
sexual organs to make them appear more male or female. In

10

other words; enforcing a binary gender identity on an otherwise

gender-neutral individual.
To illustrate this, I am going to focus on Nancy Ehrenreichs essay
Intersex surgery, FGC and the selective condemnation of cultural
practices (2005) In which she compares criticisms of African cultural
practices of Female circumcision more commonly known as
Female Genital Mutilation (FGM), and looks into why these same
criticisms are not applied to the practice of intersex surgery.

Ehrenreich states that much of the argument for Intersex surgery is

based around the way it is represented as respected practice purely
within a medical context, The Western medical community has
represented its genital cutting as modern, scientific and above
reproach. (Ehrenreich, 2005:71) By the same token, African genital
cutting is presented as a barbaric, irrational and harmful practice
due to it being considered uneccessary (Ehrenreich, 2005:71) due
to there being no scientific or medical explanation for the practice.
Ehrenreich argues that playing FGC under in the category of the
other

means

that

Western

feminist

scholars

(and

medical

practitioners alike) fail to acknowledge the similarities between the

two practices.
One such procedure, she argues, that of surgical genital cutting
once considered necessary to be performed on intersex infants
carried far greater risks than African genital cutting, Eisenreich
comments that these procedures are medically uneccessary

11

(Eisenreich, 2005:74) which is one factor upheld in arguments

against African FGC. The important point is made over the use of
medical terminology and acceptable language that harbor positive
and harmless connotations such as circumcision over the use of
terminology used to describe FGC such as mutilation and cutting.
(Eisenreich, 2005:72)
The difference in how these surgeries are referred shows how one
type of genital surgery is considered acceptable over the other due
to the belief that one is necessary and scientifically justified
because the medical professional sees the surgery as corrective,
even if the procedure itself holds more health risk and is more
invasive than FGC. Eisenreich argues that it is the construction of
African societies and practices being presented as primitive,
patriarchal and barbaric (Eisenreich, 2005:75) essentially implying
that African understandings of the body are merely cultural that
serves as justification to condemn such practices.

Considering the similarities between to the two surgeries in that

they both run the risk of infection, are medically unnecessary, can
affect sexual function and can cause problems later in life, how is
surgery on Intersex infants justified?
One explanation as illustrated in an article from The Independent
argues that it is due to the medical professionals refusal to allow for
the existence of those babies who do not fall neatly into the
category of male or female. (Morrison, 2013)

12

Sarah Morrison reports that,

[Intersex people] argue that their very existence has been

eradicated by British society. Generations of children have
been operated upon to normalize their genitals while
official documentation from birth certificates to passports
requires a male or female box to be ticked. (Morrison, 2013,
my emphasis)

Morrison not only highlights the fact that Intersex people are being
forced into a gender binary by way of having their genitals
normalized and their intersex identity subsequently eradicated, but
also introduces the concept of being forced into a gender binary by
default due to lack of appropriate documentation such as: having to
tick a male or female box on a passport.

In the 1960s it became the norm to operate on children with

atypical sexual anatomy at a young age. Doctors assigned the
childs gender and operated to reinforce it. (Morrison, 2013) This
concept of surgical intervention on sex organs/anatomy enforces the
idea that genitalia/sex equates to gender identity and the two
become indistinct from one another.

13

Context Part III: Assigning gender The case of David

Reimer

This section will be looking into the issues of medical professionals

assigning gender markers and gender identity.
One of the earliest and well-known cases ever recorded involving a
doctor assigning a childs gender was that of David Reimer, whose
penis

had

been

burned

beyond

surgical

repair

during

circumcision attempt. (Woo, LA Times, 2004)

In an LA Times article Elaine Woo reports that At 8 months of age
Reimer became the unwitting subject of sex reassignment The
American doctor whose advice they sought recommended that their
son be castrated, given hormone treatments and raised as a girl.
(Woo, 2004) The prospect of a child without a penis was
immediately equated with the idea that he could be raised a girl
regardless of the childs gender presentation and gender identity.
Dr Money the Doctor involved in the experiment and acclaimed
sex researcher argued that sex roles were largely the product of
social conditioning, essentially gender was nurture over nature.

14

Money argued that through surgeries and hormone treatments he

could turn a child into whichever sex seemed most appropriate.
(Woo, 2004) In the case of Reimer however, the sex that was
deemed appropriate was purely based on the failed circumcision
attempt as opposed to the childs gender identity and expression.

Importantly, Money is also quoted as stating he had experienced

success changing the sex of babies born with incomplete or
ambiguous genitalia. (Woo, 2004)

Ambiguous genitalia implies

that it does not correspond what would medically be considered

normative, i.e. male or female genitalia.
We can subsequently presume that Dr Money performed what would
thus be considered corrective surgery on intersex infants.

Dr Moneys experiment was unsuccessful as David was rejecting his

feminized self,

David had steadily rejected (his) assignment

from male to female, at 15 he refused to continue living as a girl.

(Woo, 2004, my emphasis) David eventually committed suicide due
to bouts of depression namely brought about by his traumatic
childhood. (Daily mail reporter, 2010) This shows how gender is
intrinsic to the individual. Surgery cannot be performed to dictate
whether a child is one binary gender or the other.

In Judith Butlers Undoing Gender, she illustrates how the failure of

Dr Moneys experiment gained him many critics within the medical

15

field including sex researcher Milton Diamond, who according to

Butler believes in the hormonal basis of gender identity. (Butler,
2004:60) Butler states that those critical of Dr Moneys theories
believed that Davids failure to be accept his socialized role as a girl
shows us that there was some deep-seated sense of gender one
that is linked to his original set of genitals... as an internal truth and
necessity, which no amount of socialization could reverse. (Butler,
2004:62)
Butler comments that the Brenda/David case was now being used in
order to provide evidence for the reversal of Moneys thesis.
As such, these new arguments were, supporting the notion of
essential gender core, one that is tied in some irreversible way to
anatomy and to a deterministic sense of biology. (Butler, 2004:62)
Butler draws upon Gender studies professor Anne Fausto-Sterling to
question this ideology stating,

Her (Annes) view is that although a child should be given a

sex assignment for the purposes of establishing a stable social
identity, it does not follow that society should engage in
coercive surgery to remake the body in the social imagine of
that gender. Such efforts at correction not only violate the
child, but lend support to the idea that gender has to be borne
out in singular and normative ways at the level of anatomy.
(Butler, 2004:63, my emphasis)

16

It could be argued that by suggesting a child should be assigned a

sex, this puts the focus back onto the biological and medicalized
aspect of sex rather than the childs own gender identity. Although
Anne

strongly

criticizes

the

idea

of

corrective

surgery

and

normative ideas of gender and the anatomy, it seems hypocritical

to critique social norms of gender while implying the necessity of
sex assignment, especially on a child whose gender identity may
not fit into a male/female binary.

Alice Dreger illustrates the problems of Dr Money Concealmentcentred approach of intersex patients in her paper Shifting The
Paradigm of Intersex Treatment, which directly compares the
concealment-centred model (such as the one utilized on David) with
a patient-centred approach.

The paper was prepared for the Intersex society of North America
(ISNA). Dregers comparisons drew attention to the way being
Intersex

was

interpreted

within

medical

discourse

within

concealment centered model as being a rare abnormality which is

highly likely to lead to great distress, to the patient-centered model
of Intersex which states that it is merely an anatomical variation
from the standard male and female types; just as skin and hair
color vary along a wide spectrum. (Dreger, ISNA, 2014) The

17

Concealment approach regards Intersex as an abnormality whereas

the Patient approach rightfully understands gender ambiguity as
merely a variation of what is considered the norm.

In the section Are Intersexed genitals a medical problem? The

concealment approach argues that if untreated, it is highly likely to
result in depression and suicide. Intersexed genitals must be
normalized to whatever extent possible if these problems are to be
avoided. (Dreger, 2014) There is a direct connotation with Intersex
and abnormality as well as an implication of mental health issues in
the Concealment approach. The Patient-centered approach argues
that Intersexed genitals are not a medical problems and that there
are no evidence for the concealment paradigm. (Dreger, 2014)
Arguably the belief that an Intersex person will grow up to be
depressed or suicidal due to not having normal genitalia are
merely preconceived ideas of the medical professionals as opposed
to the lived reality of the Intersex person.

18

Medicalizing Trans: The Problem with Medicalizing bodies

and Medical Terminologies

In the book Transgender Nation (1994), Gordene Mackenzie

discusses this notion of the damaging effects of medicalization,

Often

we

lose

sight

of

the

individual

with

clinical

categorizations and rigid definition As Foucault and Planner

suggest, they have stigmatized, dehumanized, condemned
and justified the barbaric torture of whole groups of people as

19

sick and deviant, simply because they did not conform to the
status quo. (Mackenzie 1994:55)

Mackenzie (1994) continues: Much of the medical and legal

pressure for sex reassignment surgery is based on the persistent
American belief that somehow, gender emanates from the genitals
(Mackenzie, 1994: 56). Similar to the critique of the Age Of Gonads,
it is apparent that there is a lack of separation between gender
identity and biological sex. Mackenzie (1994) notes;

This idea of trans people born in the wrong body. Common

sense dictates that the idea of wrong bodies assumes the
existence

of

right

bodies.

Right

bodies,

according

to

transsexual ideology must match the gender of the individual

accordingly.
reinforcing

Masculine-male,
sex

and

gender

feminine-female,
congruence

thereby

demanded

by

contemporary American society. (Mackenzie, 1994:61, 62)

Here we can argue that trans peoples gender identities are dictated
by societal presumptions on gender binaries; male and female. This,
once again, shows the reinforcement of gender dialectics and
binaries.

In Kate Bornsteins Gender Outlaw (1994) she discusses how these

binary ideologies on gender influenced her decision to have surgery,

20

I never hated my penis; I hated that it made me a man in

my own eyes and in the eyes of others. For my comfort, I
needed a vagina I was convinced that the only way I could
live out what I thought to be my true gender was to have
genital surgery to construct a vagina (Bornstein, 1994:47)

Bornsteins desire for surgery was born out of her desire to conform
to what she believed at the time would make her more of a
woman, and this was directly equating genitals (sex) to gender.

This next section will be focusing on the Parliamentary Guidelines

for the commissioning of healthcare treatment services for trans
people, and some of the issues this brings up in regards to the
language used and the definitions put forward within the guidelines.

The guidelines define gender dysphoria as,

(The) experience of oneself as male or female that is a

gender identity which is incongruent with the phenotype (the
external sexual characteristics of the body). The personal

21

experience of this incongruence is termed gender dysphoria.

(GIRES, 2009:3, my emphasis)

From the outset, gender dysphoria is defined as experiencing

oneself as male or female outside the biological sex. It
immediately presumes the dysphoria will be experienced as one
binary gender or the other as opposed to merely an experience of
incongruence which deviates from the normative gender role.
The guidelines go on to state, The individual may need medical
assistance to facilitate a transition of status to live in accordance
with his or her gender identity rather than with the phenotype.
(GIRES, 2009:3) Again, the guidelines presume the trans person to
be identifying as male or female and that they would also require
medical assistance to live adequately in this role. What then of
gender ambiguous trans people requiring or desiring surgery and/or
hormones to facilitate their feelings of gender dysphoria? The
guidelines fail to take non-binary trans people into consideration
and presume all dysphoria must equate to a desire of transitioning
to male or female.

The next section in the guidelines become confusing as it states,

The services should be flexible and patient-led, taking into account
their particular needs and circumstances the aim of the treatment
services is to achieve lasting personal comfort with the gender role.
(GIRES, 2009:3)

22

How can a service be flexible when it denotes how one must feel to
legitimately be experiencing gender dysphoria? On the one hand it
emphasizes the fact that treatment should be patient-led implying
it must accommodate to a patient-centred treatment approach to
ensure each individuals personal needs. This gives a sense that
there is some acknowledgement that each case will be different to
each trans person, but again, failing to acknowledge how each trans
persons dysphoria and gender identity may not reflect the rigid
definition of what gender dysphoria encompasses since there is no
mention of anything outside of the male female binary.

In the section marked terminology the guidelines illustrate the

extent

to

which

the

definition

of

gender

dysphoria

and

transsexualism still utilize gender binaries to dictate how the trans

person will identify. Interestingly, they also acknowledge the ways in
which many of the terms are evolving. The language used in the
fields of gender dysphoria is constantly evolving as understandings
and perceptions of these conditions change. (GIRES, 2009:4)
If it is understood that perceptions are changing, why is it not
necessarily reflected within the medical terminology?

A person who is transitioning should be addressed according to

the name and title (Mr, Mrs, Miss or Ms). (GIRES, 2009:4) The
guidelines once again only foresee binary gender titles as applicable
to the trans individual.

23

The gender-neutral title Mx of example, has not been included

within the guidelines. The reason why this is important is due to the
fact Mx has been implemented by many major organisations and
corporations as a legitimate title choice, reflecting a change in
attitude regarding gender identity and the freedom and right to
express oneself outside of the binary.

An article taken from polyinpictures online magazine entitled The

Growing Use of Mx as a Gender-Inclusive Title in the UK (2014)
illustrates this by listing various companies and organizations of
which Mx is an accepted or offered title form. These include the
DVLA, DWP, NHS, HMRC, Post Office Ltd, and most of the major
banks including Barclays, HSBC, RBS Santander, Halifax and Co-Op.
(polyinpictures, 2014, online article)
It is puzzling therefore, that in-depth guidelines set about to educate
and inform medical professionals and organizations regarding
treatment of trans people do not encompass this. If the guidelines
state that the terminology is evolving, then this should be reflected
within the literature.

Other aspects of terminology evolving in regards to understandings

of Trans and gender identities is in the teachings of Transgender
issues, as illustrated in Laurel Westbrooks Becoming Knowably

24

Gendered.

Westbrook

comments,

In

challenging

dominant

understandings of gender, teaching transgender articles promote an

idea of gender as a continuum as diverse and as fluid. These
understandings explicitly argue against a belief that the world is
comprised of two mutually exclusive genders.

(Westbrook,

2008:49)
It is interesting to see that in teaching transgender articles, it
promotes the ideology that there are more than two binary genders,
since much of the information based on medical knowledge of
transgendered people does the opposite.

Besides challenging current gender norms. These teaching

transgender articles dispute dominant understandings of
gender by arguing that all people should be allowed to choose
their gender and that gender should not be determined by
sex. (Westbrook, 2008:49)

Westbrook argues that it is the individual who should choose their

gender

identity,

directly

opposing

the

idea

that

medical

professionals are the ones who get to dictate an individuals gender

identity or a Transgender persons status by way of legitimizing the
Trans status based on a diagnosis of gender dysphoria.
In Holly Boswells The Transgender Alternative she states,

25

Many confuse sex with gender. Sex is biological, gender is

psycho/social. If biology does not truly dictate gender or
personality, then dichotomies of masculinity and feminity may
only serve to coerce or restrict the potential variety of ways of
being human. (Boswell, 1991:31)

Boswell is essentially implying that masculinity and femininity do

not represent or coincide with either gender identity, and are in fact
social constructs that work against a notion of gender fluidity.

The guidelines go on to state, It is important to note that many

people. After receiving the appropriate medical care do not identify
as trans, but simply as men and women. (GIRES, 2009:4) The
concept of trans people simply identifying as men or women give a
notion of normalization, and the implementation of the word simply
implies that identifying in this way is a far less complex identity than
it is to identify as transgender. Remove the trans status and
underneath they are just regular men and women like everyone
else.
By stating that Trans people identify in this way after receiving the
appropriate medical care suggests that trans people could only
really identify as men or women post surgery or hormones.

When a trans person discounts their trans identity, this is what is

known within literature and trans communities as living in stealth.

26

Opinions on stealth vary drastically with some advocates of trans

people denouncing it as having negative consequences on the
community.
An article in The Transadvocate for example, stated how it is only
when transpeople are out and open about their gender identity, that
change within societal opinion and policy happen. Only being out
and proud of being trans has led to the major gains weve made in
the public policy realm the last few years. (Roberts, 2013)

Roberts argues that being stealth perpetuates the narrative of trans

people being forced to hide their trans identity, arguably associating
being transgender with an innate sense of shame.
How are they helping the trans community by NOT being out
at the two large gay inclusive organisations? They will be
more concerned about hiding their trans status at all costs
than being fierce advocates for our community alongside
these organisations. (Roberts, 2013)

This statement is in regards to the 6 alleged stealth trans people

working at HRC and GLAAD. It could be argued that social and
medical reinforcements on acceptable gender identities have an
impact

on

trans

persons

willingness

to

disclose

certain

information about themselves.

27

Another way of interpreting this is by looking at it from a

perspective of Naturalizing Transgendered people, and instead of
considering

being

transgendered

outside

of

the

normative,

understanding it as something that has merely been considered as

such by years of social conditioning.
Laurel Westbrook discusses this idea by looking into Transgender
articles that address issues of Naturalising Transgender.

Through their tone and formatting, as well as explicit claims

that transgender practices come from nature, these teaching
transgender articles naturalise the concept of transgender
Authors frequently argue that transgender is natural and
biological. For example, Holly Boswell writes It is our culture
that has brainwashed us and our families and friends, who
might otherwise be able to love us and embrace our diversity
as desirable and natural something to be celebrated.
(Westbrook, 1991:31)

For Boswell, it is culture and society that has made transgender

identity or gender ambiguity abnormal as opposed to the identity
itself, which she states is natural. It could be argued, that medical
diagnosis of Gender Dysphoria and medical literature have also
contributed to an ideology of Transgendered people not necessarily
fitting in with the norm. It is also important to note, that for those
Trans people who do not identify into either binary gender, fail to

28

have the opportunity to be granted normalisation due to the fact

that their identity is not considered legitimate.

Legitimizing Trans Identities Part I: Gender Recognition Act

and Acceptable vs. Unacceptable Trans Identities

This section will be focusing on what kinds of trans people qualify for
legal citizenship and are recognized within the legal system and
society and importantly- those who dont. It will also look into
legislative changes such as the Gender Recognition Act (2005) and
whether this has been beneficial for trans people and if not, why,

29

and if it has been beneficial- for who? To aid the discussion I will be
focusing on Sally Hines Transforming Gender: Social change and
Transgender Citizenship. (2006)

The Gender Recognition Act came into force in April 2005 allowing
trans people to become the acquired gender by way of applying for
a Gender Recognition Certificate that had to be approved by a
Gender Recognition Panel. The Certificate would allow the trans
person to have their birth certificate and passport altered so that
the gender would match their lived gender.
In Sheila McLeans First Do No Harm (2013) she comments that the
acquiring of a GRC is:

Subject to certain expectations. (Mclean, 2013:563) The

applicant (must have) have gender dysphoria, has lived in the
acquired gender for at least two years, and intends to
continue to do so for the rest of his or her life. As such, the
Panels decision is one of fact rather than judgment. (McLean,
2013:563)

McLean highlights the fact that the GRC can only be obtained by
fulfilling certain quotas such as the diagnosis of gender dysphoria,
and living in role for two years.

30

As previously established, the quota needed to fulfill a diagnosis of

gender dysphoria rests quite firmly on a notion of identifying oneself
male or female that differs from biological sex. This would make it
increasingly difficult for a trans person who does not identify within
a binary to be eligible for a Gender Recognition Certificate. But why
does this matter? It matters because the GRA was considered a shift
in

changing

attitudes

towards

transgender

people

and

in

encompassing them as legal citizens as illustrated by Sally Hines.

(2013)
Hines commented that the Gender Recognition Act represented the
civil recognition of gender transition and marked an important
change in attitudes towards transgender people. (Hines. S, 2013:2)
This specific change in attitudes was in reference to the fact the
legislation no longer required surgical intervention as a requirement
to obtain a GRC. Hines states that this brings a new framework
for understand sex and gender, and the relationship between these
concepts. (Hines, 2013:2)

Whilst it is positive that shifts in understandings of gender and sex

have progressed so far as to not dictate gender via genitalia, in her
paper Transforming Gender, Hines argues that the GRA is still
rooted in medicalised ways of thinking that marginalize practices of
gender diversity. (Hines. S, 2007:1) In other words- the GRA still
limits what is acceptable and legitimized gender diversity and what

31

isnt. Normative binary understandings of gender underpin recent

social and legislative shifts. (Hines, 2007:1)
This is evident in the fact the GRA only accommodates those trans
people looking to change the gender on their birth certificate from M
to F or vice versa, and the right to marry in their new gender.

One of Hines interviewees Christie highlighted the fact that the

rights the GRA granted were not extended to non-gendered people
commenting,

I could only successfully apply for gender recognition if I were

to identify within the gendered societal construct. The law
does not recognize human existence outside the gendered
societal structure. (Hines, 2010:100)

The legislation only serves those trans people who have the desire
to change from one binary gender marker to the other.

In Stephen Whittle and Taryn Wittens The greying of Transgender

and the Law, they discuss these exact issues in relation to the GRA
commenting, It is both medically incorrect and ethically wrong to
assume

that

trans

peoples

needs

only

relate

to

gender

reassignment therapies and surgeries. (Whittle, Witten, 2004:511)

This acknowledges the fact that the needs of Trans people go
beyond medical intervention. Whittle and Witten highlight the fact

32

that the pathologising of Trans bodies can be extremely damaging

to individuals.
This is illustrated in the case of Trans man James who at 71 and
with early stages of Alzheimers was placed within a local authority
where every other client was female. (Whittle, Witten, 2004:513)
The staff at the care home were very uncomfortable with meeting
his bodily needs and were very unhappy with his constant removal
of his incontinence pads. (Whittle, Witten 2004:513) Incidentally,
James had undergone chest reconstruction surgery, but not genital
surgery.

local

volunteer

contacted

support

group

after

discovering James very distressed. A Trans man met up with James

to discover he was very distressed with the use of incontinence pads
used, and regarded them as womens aids. (Whittle, Witten,
2004:513) After a threat to invoke Disability Discrimination James
was eventually moved into a Mens home and became much
happier. Whittle and Witten comment,

The

Western

biomedical

healthcare

system,

with

few

exceptions, pathologises trans-behaviours and intersexed

bodies right mind/right body vs. wrong mind/right body or
right mind/ambiguous body Trans is invisibilised as well as
pathologised, through a classification of mental pathology.
(Whittle, Witten, 2004:513-514)

33

The emphasis on marriage highlights an idea of acceptability that

is rooted in heteronormative ideals, such as marriage and binary
gender.

Hines

comments,

Notions

of

citizenship

are

heterosexualised, such boundaries of tolerance depend upon rights

based claims (such as the right to marry) which fit with a
heterosexual model of the good citizen. (Hines, 2007:7) It could
be argued that the same can be applied to notions of acceptable
trans person vs. unacceptable. For example: a binary identifying
trans person vs. non-binary trans person. Hines utilizes the fight for
lesbian and gay rights as an example of the way articulating the
rights of lesbian and gays through the concept of citizenship.
(Hines, 2007:7)

In Michael Warners The trouble with Normal, he comments that

Marriage, in short, would make for good gays the kind who would
not challenge the norms of straight culture, who would not flaunt
sexuality, and who would not insist on living differently from
ordinary folk. (Warner, 2000:113)
Warner makes an important point; the concept of not living
differently from ordinary folk. This notion could definitely be
applied to Transgender people in the sense that those who comply
with medical transition in order to present as a binary gender are
ordinary folk compared to those who dont.

34

Warner goes on to illustrate the fact that marriage is not just about
two people taking a vow; marriage is much more to do with having
that relationship acknowledged by the state. (On this occasion,
those marriage privileges tied to marriage in the United States.) Let
us begin with the menu of privileges directly tied by the state to
marriage. Marriage is nothing if not a program for privilege.
(Warner, 2000:117)

Warner mentions how marriage as a social institution is constructed

and

the

stereotypical

ideologies

surrounding

marriage

are

perpetuated,

Advocates of gay marriage assume that marriage as a

social institution is, in the words of Bishop John Shelby Spong,
marked by integrity and caring and filled with grace and
beauty; that it will modify behaviour (that) is desperately in
need of virtue. (Warner, 2000:113)

Essentially, Warner implies that advocates of gay marriage believe

affording marriage to gay people will, in a sense normalize them
and eradicate the idea of bad queers. Marriage will allow gays to

35

be accepted within heteronormative society by following the alleged

sanctity of marriage.

The idea of acceptable vs. unacceptable in regards to alternative

sexual identities can also be noted in Kath Brownes Geographies of
Sexualities, in which it is argued that success if granted by the
state always lead to negotiations and a burden of compromise that
results in an agreed to acceptable mode of being a sexual citizen.
(Browne K, 2007:162)
State and gay and lesbian acceptance of certain forms of
homosexuality forms of homonormativity reflect forms of
discipline and constraint that effectively close off spaces that
support various forms of alternative erotic citizenship (Bell
and Binnie 2000:19) Alternative sexual practices and identities
are pushed into the private and invisible sphere, causing a
division between good gays and (disreputable) bad queers.
(Browne. K, 2007:162)
If we can come to an understanding that those minority groups who
follow the heternormative ideal tend to fare better within state
protection and acceptance, then the same argument could be
applied to transgender people. Specifically those who do not fit in
with social normative gender roles.

36

Legitimizing Trans Identities Part II: Medical Treatment

Narratives and Gendered Citizenship

This section will look into the medical narratives a Trans person
must usually follow in order to be seen as a legitimate case for
medical intervention and treatment. I will also be looking into the
ways Trans people are afforded Citizenship by looking into the
concept of what is seen as acceptable and unacceptable in

37

regards to identities that are situated outside the norm, and the
pattern of acceptability one must follow in order to attain
citizenship.

Hines

comments

that,

Whilst

some

new

forms

of

trans

femininities and masculinities are benefitting from recent policy

developments,

other

experiences

and

practices

of

gender

transformation remain marginalized. (Hines, 2007:2)

It could be argued, that there is a real lack of research on the topic
of marginalized trans people due to a lack of representation and
acknowledgement of these trans peoples existence. In many cases,
a non-binary trans person will follow a medical narrative of a binary
trans person purely in order to move through the healthcare system.
Providing these trans people identify as one binary gender or the
other and present themselves in a satisfactory way that proves they
can conform to a specific gender role, they are able to fulfill the
medical professionals expectations and thus receive access to
medical care and access to certain legislation and rights to
citizenship. Other trans people are excluded because they do not
conform to the rules set out by the heteronormative state.
This idea is illustrated in Zowie Davys Transsexual Agents (2010)
in which she interviewed various self-defining Trans people and their
experiences within the health care system. One such participant
named Benjamin responding when asked about the positives from
the NHS stated, The positives are only that you get what you need

38

from. The negatives were very generalized and out of date

questioning

which resulted

in

standard

answers. (Benjamin,

transman from Davy. Z, 2010:115)

Davy states that this response follows a standard narrative, (Davy,
2010:115) and the responses are therefore not truthful accounts of
the trans persons identity per se, but rather obligatory responses
rooted in preconceived knowledge of what requirements are
necessary to access medical care.

As with the majority of participants in this research Benjamin

understood that taxonomic legitimacy and a diagnosis are required
to actualize transformation of (his) body. (Davy, 2010:115, my
emphasis) Davy highlights the fact that Benjamin had prior
knowledge

that

the

condition

(in

medical

terms)

of

Transsexualism (Davy, 2010) had to be legitimized by a medical

professional, and subsequently persuading the gatekeeper to allow
for access to the treatment.

Most participants demanded medical services even though

some were skeptical about the psychiatric process within the
NHS. The processes involved in persuading their psychiatrist
(gatekeeper)
hormonal

that

and

they

surgical

were

legitimate

intervention

candidates

were

viewed

for
as

ritualistic (Davy, 2010:11)

39

The concept of medical Transition as ritualistic is a notion

suggested

in

Whitney

Barnes

paper

The

Medicalization

of

Transgenderism. Barnes states that Trans people are fully aware of

the procedures that need to be followed and are not passive agents
in the medicalization of their existence. (Barnes, 2001)

The evidence that transgendered individuals find it necessary

to circumvent the rules governing their access to legitimate
and adequate health care, often through means of dishonesty
and/or embellishments brings one to question the very
existence of those regulations they must work within and
against. Any institutional structure which causes people to
provide their health care providers with less than entirely
honest information is subject to scrutiny. (Barnes, 2001)

Here, Barnes criticizes the medical institution by suggesting that the

rules that are put in place to decide who gets access to healthcare
and who doesnt forces Trans people to lie and give dishonest
accounts in order to receive the healthcare they need. This is not a
negative reflection on the Trans person, but a reflection of the rigid
regulations set out by the medical professionals.
This is a notion reflected by Scholars such as Califia and Namaste,
who suggest that, Transgendered people read what psychiatrists
write about them so that they can enter the clinical setting,
present the classic transsexual narrative, and receive the health

40

care and medical technology they desire. (Califia, 1997:192) And

that The gender community has at this point accumulated a lot of
folk wisdom about what you need to tell the doctors to get admitted
to a gender-reassignment program. (Califa, 1997:224)
The idea of medical professionals acting as Gatekeepers for
treatment and the pathologised treatment of Trans individuals is
also reflected in Juliet Jacques article published in The Guardian
(2010) in which she documents her experiences as a Transgender
patient of the NHS going through gender transition.
Jacques comments,

Charing Cross (Londons Gender Clinic) struggles to shake

a reputation for being cold and overly demanding. This is not
always diminished by the experiences posted online by
patients, some of whom have reservations about gender
services being pathologised under mental health. (Jacques,
my emphasis, 2010)

Jacques

addresses

the

issue

that

the

gender

clinic

has

reputation, arguably fuelled by online discourse of peoples

experiences at the clinic who are dissatisfied with the pathologised
approach of treatment and services.
Jacques comments, If you arrive prepared to work with the
clinicians, you shouldnt have many problems I had plenty going
for me having changed my name and begun living in role.

41

(Jacques, 2010)

Here, Jacques illustrates the ways in which it is

possible to get through the system more efficiently providing you

work with the clinicians. She mentions having changed her name
and lived in her desired gender role, implying these are factors
taken into consideration by the Gender Clinic.

What exactly is meant by living in role? (Sometimes called Real Life

Experience)
In a document taken from Ontario Human Rights Comission (OHRC,
2014) entitled Medicalisation of Identity, it discusses the issue of
real life experience (or living in role) and the problems this can
encompass.

The real life experience requires the pre-operative individual

to live in their felt gender for a prolonged period of about one
to two years There is significant controversy within the
transgendered

community

about

RLE

and

its

medical

necessity. One individual with a medical background stated

that RLE does not provide useful information to the patient it
is rather a period of compliance with a rigid set of criteria.
(OHRC, 2014)

This is an important point, as it addresses the fact that living in

role does not serve to inform the Transgendered person about what

42

should be expected in sex reassignment or indeed any kind of

medical intervention that Trans person may choose to undertake,
but instead is merely a medical requirement one must comply with
in order to gain medical services.

Concepts of living in role and real life experience also bring about
the concept of Passing. According to Lori Girshick (2009)
The word as it is used today generally refers to fitting into the
gender binary as a man or a woman. In order to pass in this
sense it is not enough to be who you are you have to alter
your gender appearance and behaviors to fit notions of
masculinity and femininity. (Girshick, 2009:108)
Girshick highlights the fact that to pass within society means living
up to societys expectations of male and female.

Leslie Feinberg

stated that Passing was a product of oppression, (Feinberg,

1996:89) whilst Kate Bornstein comments that Passing becomes
silence. Passing becomes invisibility. Passing becomes lies. Passing
becomes self-denial. (Bornstein, 1994:125)
However, what is failing to be acknowledged is the way in which
Passing can also prove extremely positive for the Trans person by
way of having their gender identity taken seriously within society,
and also furthering their chances for medical treatment.

43

In Josephine Hos Transgender body/subject formations in Taiwan

(2006) she explores the ways in which passing often allows for
easier integration within society for the Trans person.

The concept of passing along with its connotations of

deception entails profound knowledge/power maneuvers for
Trans subjects. For passing presupposes the unchallengeable
naturalness and truthfulness or evidentially of the physical
body, and affirms the meaning and status assigned to such a
body by the social culture. (Ho. J, 2006:230)

Ho

suggests

that

passing

as

their

chosen

gender

grants

acceptability and status of the Trans person within the society in

which they move.

The operation of such as truth regime thus serves to

reduce/stigmatize the trans subjects bodily self realization as
nothing but scams and deceit, not to mention creating a
profound sense of shame and insecurity in the subjects in
regard to the clear discrepancy between ones body and ones
chosen identity. (Ho, 2006:230)

44

Ho argues that the negative connotations and criticisms of passing

encourage the idea that a Trans persons body (post surgery) and
the living in role of that gender identity or passing is nothing more
than a scam.
Ho suggests that bodies are not given, fixed materials and instead
comments that they are physical embodiments of the self (Ho,
2006:230).

Trans subjects differ from other subjects only in that they have
formed a very different feeling of at-homeness as their endowed
body completely fails to provide that feeling. (Ho, 2006:230-231)

It could be argued that a Trans persons body post surgery or

hormones is no different from any other gendered individual and is
not an attempt at passing as one specific gender or another. The
need for medical intervention is separate from the need to be
accepted within society, and is merely a way of feeling at home
within a body. However, Hos paper mainly focuses on those Trans
people who wish to Pass within society and she fails to address
issues of gender ambiguity within the Trans community in which her
paper is based.

Concepts of medical intervention and Trans Bodies have always

been a topic of debate and disagreement between medical
professionals and Trans people themselves.

45

In Alison Rookes Telling Trans Stories, (2008) she brings together a

paper in which both Medical Professionals and Transgendered people
are able to put their opinions on medical services and the treatment
of Trans bodies together in the same forum. Rooke focuses on the
Scidentity Project which was a workshop/panel discussion bringing
together academics, arts practitioners, medical professionals and a
group of 18 young transgendered and transsexual people between
the ages of 15-22 who were living their sex and gender with a
degree of complexity. (Rooke, 2008:65)

By bringing together both medical professionals and Transgender

people and allowing a dialogue to initiate between the two parties, it
allows the Trans person to voice their experiences. Rooke suggests
that

their

trans

identity

may

allow

for

more

complex

understanding of sex and gender that say a medical professional

would not have. In light of this, it brings about the question, who has
the right to diagnose? If we separate gender dysphoria from a
medical definition and understand it as more of an identity that is
individual to each person as opposed to a medical condition who
holds the right to give the go ahead for surgery over someone elses
body?

46

Rooke comments,

Young trans people could form their questions, explore,

deepen and express their understandings of gender and sex,
interrogate

scientific

discourses

of

sex,

gender

and

transsexuality and respond to the authority and apparent

certainties of science (Rooke, 2008:65)

By using the term interrogate Rooke suggests that the trans people
in the project may disagree or have issues with the scientific
discourses of Transsexuality subsequently utilizing their own
experiences to directly challenge the medical discourse. Placing the
word authority in quotations also suggests that Rooke has her own
doubts on the authoritarian stance placed on medical discourses.

The two phases of the project featured a creative engagement, and

outreach workshops aimed at a variety of audiences such as
teachers, youth workers, activists etc. The workshops served to
inform and educate those who worked in the private sector so they
would be better equipped in dealing with trans youth.
There was space where the participants could relate with other
young trans people and explore their own identities through the
relations with others. (Rooke, 2008:66) Rooke outlines the fact that
the creative segment was made interactive in the hope that non
trans participants would be better able to understand gender non

47

conformity, by finding and relating to similarities through the stories

and experiences of trans people.

This implies that it is possible to educate and inform cis-gendered

people (non trans people) of gender ambiguity and gender variance
through Trans narratives. It also brings medical definitions of what it
is to be Transgender/Transsexual under scrutiny and medicalization
of Trans people into question. How can one truly comprehend and
define what makes a legitimate trans person unless they have
experienced the feelings of trans-ness themselves?
Group discussions allowed transpeople to discuss their experiences,
worries and feelings about their identity in a safe space. The
presence of medical professionals also gave them the opportunity to
challenge the status quo.
The participants own histories and experiences were transformed
through challenging the authority of the science of sex and gender.
(Rooke, 2008:68)
They developed critiques of the scientific and medical practices that
reproduce the coherence of sex and gender in the figure of the
man or woman.

We could argue that the practice of telling trans stories and

narrative means the medical professional will hear the trans
persons individual experience and own relationship with their
gender identity as opposed to basing treatment of all trans people

48

on

one

specific

protocol

or

structure

according

to

medical

guidelines.
If all trans people are not the same, then the treatment model to
which they are ascribed should not be the same for all trans people.

One Trans participant in the project named Shannon brings up quite

an important point regarding cosmetic surgery.

To get your tits enlarged you need money, but to get them
cut off you need a gender shrink. Thats bloody weird! .Why
is one more of a problem for society than the other? Why does
society require that we have an either/or gender? (Rooke,
2008:69)

Shannon makes and extremely valid point. If one experiences

body/gender dysphoria, why does the desire for a specific body
modification surgery require someone to jump through medical and
gender binary hoops in order to access one specific type of surgery.

49

Citizenship

Bell

and

Binnie

propose

queering

citizenship

to

acknowledge and celebrate the ways in which normative

practices and arrangements (e.g. non monogamy) challenge
the

institution

of

heterosexuality

and

traditional

conceptualizations of citizenship. (Hines, 2007:7)

It could be argued that if queering citizenship can challenge

normative ideology of the regulations one must follow in order to be
accepted as a legitimate citizen, there is space to queer gender in
the same way, so that those who do not fulfill the correct regulations
of gender ambiguity as set out by heteronormative ideals and
medical practitioners may too be accepted.

Can citizenship be Gender Neutral? This is a question posed by Mark

Rix.

50

Rix looks into social citizenship and asks whether its possible to
have gender-neutral citizenship incorporated into the citizenship
system when it has long been burdened with the issues of gender
inequality. (Rix, 2006:1)
Rix suggests that because legal citizenship focuses on the idea that
all citizens are equal before the law it is able to escape the gender
inequality embedded within social citizenship. (Rix, 2006:1) This, Rix
argues is due to social citizenships focus on paid employment as
an eligibility requirement to the public sphere and the rights of
cizenship. This meant that womens traditional roles of child bearer,
caregiver

and

homemaker

were

usually

regarded

as

being

inconsistent with social citizenship and full participation in the public

sphere. (Rix, 2006:1)
From the outset Rix paints a picture of citizenship being fully
grounded in ideologies of binary gender and traditional gender roles
based around inequalities of citizenship through gendered work.
This is an important point, because it reinstates a notion of
citizenship encompassing binary gender, reinforcing the fact that
non-binary gendered people may not be valid candidates for this
specific citizenship model.

But it can be done. Germany is the first country in Europe to legally

recognize a third gender, while several other nations have already
taken similar steps. (BBC News, 2013) German passports now have
a

third

designation

for

intersex

holders.

Allowing

legal

51

recognition of its intersex citizens is a huge first step. For one, it

acknowledges the existence of a third gender, and also indirectly
acts as a deterrent for any social and medical ideas revolving
around corrective surgeries and the need to make an individual
one gender or the other. It encompasses a gender identity that it
previously denied existed.
Silvan Agius of IGLA-Europe which campaigns for the rights of LGBTI
people said the law needed to go further. While on the one hand it
has provided a lot of visibility about intersex issues it does not
address the surgeries and the medicalization of intersex people and
thats not good. That has to change. (BBC News, 2013)

Silvan highlights the important issue that although a third gender

option is available, the issues of medicalization still exist and are
failing to be addressed. Could it be argued that gender-variant
bodies are so heavily associated with medical interventions and
surgeries, that it is hard to separate the two even when legal
recognition and citizenship is granted?

Another aspect of citizenship, specifically when we think of how it is

associated with binary gender is by looking at gender as a system of
its own, in this case Gender as a system of Oppression. (Bornstein,

52

1994:105) In Kate Bornsteins Gender Outlaw (1994) she looks at

binary gender as a form of oppression made all the more dangerous
by the belief that it is an entirely natural state of affairs. (Bornstein,
1994:105) By presenting the gender binary as natural (I previously
discussed concepts of naturalising trans) non-binary gender
becomes unnatural and the other.

Bornstein looks into gender binaries as a system of class and power,

and how one cannot exist (or indeed, oppress) without the other.
Bornstein comments,

In the either/or gender class system that we call male and

female, the structure of one up, one down fulfills the requisite
for a power imbalance Its an arena in which roughly half the
people in the world can have power over the other half.
Without the structure of the bi-polar gender system, the power
dynamic between men and women shatters. (Bornstein,
1994:107)

Bornstein is essentially stating that the gender binary exists purely

to enforce the oppression of women and ensure that men retain
their position as the dominant class. Without gender binaries, there
would be no division of power. And without the division of power,
one half of the population would not be better off than the other.

53

Does the separation of medicalization and gender identity help to

eliminate gender binaries? In what ways, if any, is the move away
from medicalization detrimental to the rights and healthcare of
Trans people?

Issues with the De-Medicalization Of Transgendered People

The demedicalization of transsexualism is a dilemma. There

is a demand for genital surgery, largely as a result of the
cultural genital imperative Transsexuals, especially middleclass pre-operative transsexuals are heavily invested in
maintaining

their

status

as

diseased

people.

The

demedicalization of transsexuality would further limit surgery

in this culture, as it would remove the label of illness and so
prohibit

insurance

companies

from

footing

the

bill.

(Bornstein, 1994:119)

This section deals with the potential problems that arise from
arguments that call for the moving away from a medicalized view
and treatment of Transgender people. I believe it is important to
address this issue as the bulk of this dissertation has explored the

54

negative

aspects

of

medicalizing

trans

people

without

acknowledging the ways in which Medicalization also protects and

allows for the treatment of Trans people.

Bornstein

(1994)

highlights

the

fact

that

maintaining

Transsexualism as a medical issue or a disease means that Trans

people maintain an access to medical intervention if they need it.
They are protected in the sense that with a diagnosis comes medical
assistance. Transsexuality is a medicalized phenomenon. The term
was invented by a doctor. The system is perpetuated by doctors.
(Bornstein, 1994:119)

If we are to acknowledge the Transsexual or Trans identity of an

individual, we must acknowledge the term and identity was
constructed

by

medical

professionals

utilizing

medical

terminologies. Subsequently, can it ever be possible to demedicalize

the Trans person and Transgender identity?
Barnes (2001) comments;

Transgender identity is claimed by the psychiatric community

as a disorder or condition. These regulatory functions
include the necessity for transsexuals to claim illness before
being considered for sex re-assignment hormones and/or
surgery. This illness is itself transsexuality, and unless one
accepts transsexuality as an illness and as a component of

55

their own personality, they will be excluded from most sexreassignment programmes. (Barnes, 2001)

Barnes illustrates the way that a Trans person as a patient seeking

medical help has to conform to the rules and regulations laid out by
(in this instance) the psychiatric community who have given
Transgender identity the label of a disorder or a condition. To qualify
for medical attention and to have their Trans identity legitimized the
Trans individual must accept, whether they feel it is the case or not
that they have the illness of Transsexuality. They must ascribe to
the condition already set in place by the Medical professional which
in turn enforces Transgender identity as a medical condition as
there is no other choice for the Trans person if they want to receive
treatment.
It could be argued that de-medicalizing Transgender would run the
risk of removing regulations that the medical professional deems
necessary in order to treat patients.

However many theorists argue that Transsexualisms place within

medicine and psychiatry will continue for a long time to come
(Barnes, 2001) as Barnes comments the two have grown together
and become intertwined.
In Janice Raymonds 1979 publication The Transsexual Empire she
controversially argues that transsexuals are created through
medicine and that psychiatric evaluation as well as the availability

56

of surgery function to produce transsexuals. (Namaste, 2000:33)

This is a highly problematic statement since it presumes that one
cannot identify or be Transgender without being a post-operative
Transperson.

It

implies

that

one

becomes

Transgender

or

Transsexual through medical intervention. In essence, it claims

Transgender is not a legitimate gender identity. Raymond fails to
recognize the distinction between biological sex and gender identity.
Barnes (2001) argues that the problem with this concept lies in the
medical definition and terminology surrounding the Trans identity.
This definition presupposes the need for medical intervention.

The term transsexual mandates some desire to attain

attributes of the opposite sex. Western medicine holds a
firm monopoly over the various possible means with which to
achieve those ends. (Barnes, 2001)

In essence, Transsexual cannot exist without Medical intervention

because Medicine and Psychiatry created the term.

It is difficult to imagine that people existing in cultures

without modern Western medicine could have conceived of
surgically and/or hormonally altering their sex in the methods
now practiced by modern Western medicine. (Barnes, 2001)

57

Arguably, the desire for these changes may have existed, but
Barnes does not address the fact that these desires and needs for
surgical intervention presuppose the existence of Western medicine.
The fact Western medicine began to incorporate such surgeries and
medical options for Trans people must have been born out of a need
for it.

Leslie Feinberg (1998) addresses this point:

Its true that the development of anesthesia, and the

commercial

synthesis

of

hormones,

opened

up

new

opportunities for sex reassignment. However, the argument

doesnt take into account ancient surgical techniques of sexchange developed in communal societies that offered more
flexible sex and gender choices. (Feinberg, 1998:105)

Feinberg agrees that advances and development within medical

treatment meant that sex reassignment was made further possible
by way of surgeries and hormones. However, Feinberg makes the
important point that these Western medical interventions are
restrictive and limited since they perpetuate the notion of binary
gender by offering surgery and hormones in order to change from
one sex to the other. Feinberg also states that surgical techniques
to assist Trans people existed prior to Western medicine, and in fact

58

accommodated gender fluidity as opposed to enforcing gender

binaries.

Descriptions of Native Americans fluid perceptions of sex and

gender poignantly illustrate that transgendered individuals accessed
recognition of their gender identities without the aid of modern
Western medicine or technology. (Barnes, 2001)

It could be argued, that because perceptions of gender identity

within these communities embraced notions of gender ambiguity (or
in the case of tribal communities within Native American societies Two-Spirit people) (Barnes, 2001) there was less of a need for sex
reassignment surgery since fluid gender identities were accepted
without the Western social expectations of fulfilling a specific binary
gender quota.

Therefore, we could argue that modern Western social expectations

of gender have an influence on not only the kind of surgeries and
medical services a Transgender person is able to access, but also
the kind of surgeries and medical services a Trans person desires.

At what point does

Medicalization of Trans

people become

beneficial? One major argument in favour of medicalizing Trans

59

identities is the fact that through medical terminology and the

articulation of Transsexuality through medical diagnosis, comes
legislation,

rights,

and

medical

implementation

in

order

to

accommodate those who have been diagnosed with the condition.

One example of how medical diagnosis serves to protect and
accommodate Trans individuals are in cases such as; where a
Transgendered person has been incarcerated.

Alvin Lee (2008) recounts the incident of Donna Konitzer, a trans

woman diagnosed with Gender Identity Disorder (GID) incarcerated
in Wisconsis until 2026.

Recognizing their Eighth Amendment obligation to provide

inmates with healthcare Wisconsis prison officials enacted a
policy in 2002 stating that those diagnosed with GID should be
given access to hormone therapy while incarcerated. (Lee,
2008:448)

In this instance, it is evident that the law ensures Transgender

people are able to access the medical services, in this case the
hormones that they require.

Identity is legitimized through the

medical definition of Gender Identity Disorder, and without that

60

definition or diagnosis, there would be no foreseeable reason to

allow medical treatment for the Trans person.

Lee acknowledges the controversy with medicalization and asks,

Does the use of medical evidence create or perpetuate an image of
trans people as mentally diseased does the use of medical
evidence actually do more to harm than help the trans community?
(Lee, 2008:448)
Whilst it has been established throughout the duration of this paper
that medicalization retains focus on maintaining binary gender, it
also brings about issues of reinforcing Transgender identity. This is a
notion discussed in Mary Burkes GID and the contested terrain of
diagnosis (2011)

Through medicalization and diagnosis in particular, patients

are also able to form collective identities, which foster the
creation

of

support

networks

and

advocacy

groups

institutional recognition, access to services and resource

allocation. (Burke, 2011:188)

However, as previously discussed in this paper, diagnosis of Gender

Identity Disorder or Gender Dysphoria - whilst positive in the sense
it subsequently opens gateways to treatments and legislative
measures for those successfully diagnosed; reinstates notions of
femininity and masculinity and denies Transgendered people who

61

do not conform to a particular, narrowly defined set of standards.

(Burke, 2011:189)

My data collection deals with Trans peoples perceptions and

experiences within the NHS and medical healthcare system, and
offers a view of medicalization of Transgender people from the Trans
persons perspective.

Methodology

My research draws upon 1) A qualitative study based on 77

participants who completed an online survey that asked Four main
questions, these included multiple choice, stating their agreement
or disagreement with certain statements and also the opportunity to
add their own input and opinion on certain question topics.

62

2) Two Skype interviews. I had conducted many more interviews

over Skype and in person, but hadnt specified that I needed nonbinary Transgender people, thus the majority of my interviewees
experiences did not reflect the issues a non-binary Transgender
person faced and had to be omitted. I also had not left enough time
to transcribe the interviews conducted.

Ethics
My ethics form was approved by Goldsmiths University Of London.
The research has been conducted in a way to prevent any harm to
participants. This entails a full briefing of the research, its purposes
and the way in which it will be utilized so the interviewees can
provide fully informed consent to take part. No questions required
the participants to identify themselves and there was no way to
trace

participants

identity

so

the survey

was

automatically

anonymous. The terms and conditions are stated on the first page of
the survey (see appendix 1) including advising participants that
they must be 18 or over.

1) Online Survey

The survey can be viewed in full at:

https://www.surveymonkey.com/s/HQZQ8YL

63

The only demographic that was asked was gender identity. I felt that
this was the only demographic relevant to the research since this
dissertation focuses on the complexities of binary gender and I
wished to illustrate that in my results.
I promoted the survey via Internet links on my own personal
Facebook page as well as multiple Transgender/Gender variant
Facebook group pages. I also attended a Queer club night and made
an announcement in regards to my survey to try and encourage
more people to take it. I focused on the Trans community since the
questions would be revolving around their own experiences as a
Trans person dealing with the NHS and medical healthcare
professionals.

The survey was constructed online using a web-based survey

creator called Survey Monkey, which was free of charge to use and
allows the creator to analyze the results online. I felt this was the
best method of data collection due to it being anonymous and
online-based. I opted for a method I knew would be easily accessible
to people and reach a far higher number.

64

Online Survey Results

I will firstly address the demographic result regarding the gender

identity of participants. Question 1 asked: How would you describe
your gender identity?
I gave a total of 18 different gender identities for participants to
choose from and importantly allowed them to tick as many of the
options as they felt applied. There was also the option to add a
comment to state their own gender identity if they felt it wasnt one
of the choices offered. (See appendix 2)
I will focus on the most relevant results. 52% of respondents
identified with Transgender, 50% identified with Genderqueer, 31%
identified

with

Trans*

and

24%

identified

as

Androgynous.

Importantly, only 9% identified as Transsexual, which is a term

heavily associated with medical terminology and practice.
I took into consideration the fact that many of these people may
identify themselves as gender variant, the results indicate that this
is the case. We could argue that these people hold greater
understanding of the issue due to their own personal experience of
gender variant bodies. It also shows just how broad and varied
Transgender peoples gender identities can be.

Question 2 asked, When consulting a medical professional (GP or

Gender Clinic) about transition, did you have any prior knowledge of

65

the process? (This can be anything from researching online, to

talking with Trans friends)
Respondents were only able to tick Yes No or Unsure. This
question was posed because I wanted to illustrate the way in which
preconceived knowledge or direct knowledge regarding medical
practice has an impact on the way Transgender people access
medical services, specifically the NHS.

A massive 87% of respondents stated that they did have prior

knowledge regarding the process of Transitioning. (see appendix 3)
This result is important as it goes on to show how this knowledge
perhaps had an impact on their experience with the medical
professional in later questions.

Question 3 asked respondents to look at statements and decide

whether they agreed or disagreed. Response options were on a
sliding scale of Strongly Agree to Strongly Disagree.

(see

appendix 4)
The question posed was: "During my appointments with the medical
professional I... followed by nine different statements applicable to
experiences within the NHS/medical care as a Trans person.
83% of respondents Strongly agreed or agreed that they felt like
they had to present a certain way (i.e. binary gendered) to be taken
seriously, and 80% Agreed or Strongly Agreed that they Knew that
if they acted a certain way they would get treated more promptly.

66

These two finding are of key importance as it reflects a notion of

having to legitimize ones Transgender self in a binary gender in the
presence

of

medical

professionals.

It

is

also

important

to

acknowledge the fact that the majority of the Survey participants

already had prior knowledge of the way the medical system worked
in order to treat Transgender people and that this must have been a
factor in the way they prepared for appointments.

80% of respondents Agreed or Strongly Agreed that they Felt they

had to prove their Trans identity. It could be argued that this
pressure to prove their Trans identity is a major factor in the way
Trans patients approach and deal with their appointments with the
medical professional.
76% of respondents Agreed or Strongly Agreed that they left out
certain aspects of their history/lifestyle when talking to the medical
professional. It could be argued that this supports Barnes (2001)
comment that institutional structures cause people to provide their
health care providers with less than entirely honest information
should be subject to scrutiny. (2001)
78% Agreed or Strongly Agreed that there was a specific Trans
Narrative they could follow in order to get treated more efficiently.
This supports the notion that Transgendered people have an
understanding the medical healthcare system and realize that by
following a narrative, it is easier to access treatment.

67

A majority of 54% Agreed or Strongly agreed that they Acted in a

more masculine or feminine way during appointments, arguably
reflecting the way gender stereotypes and expectations of gender
dysphoria by the medical professional perhaps enforce binary
gender presentation.

Question 4 asked: How do you think the NHS/Healthcare could be

more accommodating towards non-binary gendered Trans people?
(See appendix 5)
This was another multiple-choice question where participants were
advised to tick as many answers they felt applied, there were 13
options as well as an other box where participants could add their
own response.
I asked this question because I felt it was important to gain insight
and feedback from Trans people of whom had experienced being
treated by the NHS.

Over

80%

of

Encompassing

respondents
non-binary

ticked

gender

the

identities

following
on

the

options,
"gender

dysphoria" spectrum, Providing Nurses/GP's/Doctors/Psychiatrists

with updated information on gender identity and Trans people,
Offering treatment to non-binary individuals, Updating medical
terminologies/information on Transgender people to include nonbinary individuals, and Updating language used within medical
establishments/databases to encompass gender neutral pronouns

68

and gender ambiguity. These were the most popular response

choices and interestingly, they all incorporate a notion of better
medical services and acknowledgement of non-binary Trans people.
This reflects that the majority of participants held an understanding
that non-binary Trans people are failing to be accommodated by the
healthcare system, and hold a desire to see more done in order to
accommodate them.

Over 70% of participants agreed with: Treating Trans patients on a

case by case basis, and Moving away from the 'Trapped in wrong
body' medical narrative. This implies that Trans people wish to have
less of a medicalized emphasis on their treatment and desire a
move away from the traditional medical narratives.
69% of participants agreed that Surgery should be offered without
having to be on hormones. This too deviates from the medical
requirement and treatment narrative of having to be on hormones
before surgery and would subsequently accommodate those Trans
people who did not feel they needed or wanted to begin hormone
treatment.
A minority of 42% agreed with Looking at treatment for Trans
people as more of a need for comfort as opposed to medical
intervention. In the Other response, one participant stated,

While I agree with the de-pathologisation of Trans people, I

think it's still important to recognize that care pathways are

69

commissioned on medical terms. If chest reconstruction

doesn't

fall

under

medical

pathway

specific

to

the

'treatment' of gender dysphoria, then it becomes perceived as

a purely elective cosmetic surgery, and then there's a danger
that that care could be taken away from people who really
need it and can't afford private treatment. (Anonymous,
2014, see appendix 5.1)

This participant re-iterates the fact that whilst it is positive to resist

the pathologization of Trans bodies if surgery and medical
intervention is reduced to cosmetic needs, then it will no longer be
covered by health services. This would put those Trans people who
desire medical transition and cannot afford it, at risk.

The final question was another multiple choice where participants

could tick as many statements they agreed with and asked How do
you

think

the

Government/Society

could

accommodate

non-

gendered people? (See appendix 6)

Over 90% agreed that there should be better education on nonbinary gender identities and differences between sex and gender
identity in schools and the workplace. Over 90% also agreed that
there should be acknowledgement and the offering of genderneutral titles and pronouns in all application forms (such as Mx).

70

This shows that the vast majority of Trans people would like to see
the option of gender-neutral inclusivity in documentation. It also
highlights the desire to have better information within education
system and the work place in regards to Trans and non-binary
gender identities, suggesting that the information out there already
is potentially inadequate and outdated. Or that it does not represent
non-binary gendered people.

Over 80% of respondents agreed to Allowing citizens to self-define

as gender-neutral/third gender without a medical diagnosis. This is
important as it illustrates the belief that Gender Identity shouldnt
necessarily need a medical diagnosis in order to legitimize ones
Trans status. It also reinstates the fact that people should be able to
self-define as third gender (not just male or female)

2) Skype Interviews

71

The Skype interviews were conducted via Skype text chat. The two
interviews utilized in my research were conducted utilizing the text
chat method as this made the transcribing far easier. The Skype
interviewees were also informed of the terms and conditions prior to
the interview and had to state I Agree to signify they had
understood the terms of the interview and that their responses
would be utilized in my dissertation. (see appendix 7)
All names have been altered to protect anonymity.
All quotes taken from the interviews have been directly cited from
the Skype text chat interviews. The full transcription from which the
interviews are quoted can be located in Appendix Part II.

In order for me to be reflexive it is important to recognize that my

own gender identity is similarly aligned with those whom I am
studying; I am also a trans person highly active within LGBT issues.
This in itself enabled me to gain access to a potentially hard to
reach social network of people. By using my own identity to gain
participants in this research through social capital it has enabled me
to access my sample more easily and I acknowledge this fact.

72

Skype Interview Results

My two interviews were conducted using Skypes online Text Chat

feature. The interviews followed a very loose structure of 9 preset
questions (See appendix 8) based around the interviewees gender
identity and experiences as a non-binary Trans person with the
healthcare system. However due to the nature of interviews, topics
would occasionally branch off into more personalized areas of the
participants

life

and

experience

and

my

questioning

would

subsequently reflect this.

My first interviewee was a 27-year-old non-binary Trans identified

person named Edward. I will utilize male pronouns, as these are
what Edward had requested. Edward explained his understanding of
the term Transgender to me,

I think transgender is a really complicated term that can

mean really different things to different people... I found out
about the term pretty late, only really properly in my last year
of my undergrad degree from what I can remember. So it was
through

academic

texts

and

through

course

on

feminism.(Edward, 2014)

Edwards understanding of the term hadnt been influenced by

medical ideologies of Transgender(ism) and had instead he had

73

come to an understanding of Trans identity through Trans literature

and academia and also through feminism.
It could be argued that learning about the term in this context may
have helped in understanding Trans identity in a more varied
spectrum than if he had learnt about Trans identities through
medical discourse that tend to utilize more narrow

and binary

definitions.

When

asked

about

his

experiences

with

the

NHS,

Edward

emphasized that he didnt feel like what he was doing was

Transitioning, ...Straight away I don't feel like I fit what the NHS
system would want me to say to them. (Edward, 2014)
Edward noted that some of the things he had heard through other
Trans friends of whom had been through the NHS system that had
made him apprehensive about appointments at the (in this instance)
Charing Cross Gender clinic,

I had heard complete horror stories about gender policing,

about trans women who weren't taken seriously because they
turned up to appointments wearing trousers. I knew about the
requirement to take T (testosterone) and the phrasing used
such as 'living in role'. Basically I knew a lot of people who
were way more binary identified than me, who already were
getting a hard time from doctors. (Edward, 2014, my
emphasis)

74

Here, Edward illustrates how more binary identified people had

experienced negative issues with medical professionals, and this
subsequently led him to believe that he too would be given a hard
time as a non-binary identifying individual.

I felt I had to lie because I didn't trust them to be able to help me if

I was honest with them. I started to see it more as 'what do I want
and how can I get that'. (Edward, 2014)
The information Edward had access to enabled him to have a firm
understanding of the kind of Trans-Narrative he would have to follow
in order to receive the treatment he needed. Acknowledging that
the medical professional could not accommodate him due to his
non-binary identity, he would have to lie in order to obtain the
treatment he needed.

My next set of questions posed to Edward addressed issues of

proving trans identity, honesty with the medical professional and
whether there were feelings of having to give socially acceptable or
normalized responses.

I felt I had to present a certain way - as male/masculine as

possible, so they would take me seriously. I definitely felt I was
trying to prove that I was trans, or that I was trying to
convince them or make a case for it. This affected the answers

75

I gave (not necessarily lying, but selecting what anecdotes to

tell about my childhood and presenting one particular
narrative. (Edward, 2014)

Edward connotes presenting in a binary gender and stereotypically

masculine way to being taken more seriously by the medical
professional. He also emphasized the need to prove his trans
identity affected what he felt he could and couldnt disclose.

My second interviewee was a 36-year-old non-gendered Trans

person called Aiden. (See Appendix Part II.2) I will use the genderneutral pronoun they since that is the one Aiden utilized to
describe themself.
Aiden emphasised the issues they had experienced with their GP in
regards to getting documents changed,

I had a Statutory Declaration drawn up and signed by a

solicitor changing my title to MX and my GP refused to amend
my records, he also refused to do anything for me from that
point unless as he put it he had a green light from CHX,
(Aiden, 2014)

What is important to note is the refusal to amend Aidens records

even though they had provided the medical professional with legal
documentation.

76

By law, the records should have been changed. It could be argued

that the issue lay in the fact the title was attempted to be changed
to

Mx.

As

previously

discussed

in

the

dissertation,

many

documents and applications fail to have or even acknowledge this

as a legitimate title so the issue may lie more in the lack of
accommodation or acknowledgement for non-binary titles in legal
documents.
Aiden also emphasizes the fact the GP would not help in any way
until they had received a green light from Charing Cross (gender
clinic.)
This implies the GP was waiting for Aidens Trans status to be
confirmed and/or diagnosed by the Gender specialists or
subsequently have Aidens Trans Status legitimized at Charing Cross
before accepting Aiden as a treatable Trans patient.

At my first GIC appointment I was told... We see a handful of

people like you every year and we never know what to do with
them. (Aiden, 2014)
Arguably, this illustrates the way in which the NHS do not have the
knowledge or experience to treat non-binary Trans people as their
service only caters to binary-identified Trans patients.

I did feel I needed to 'prove' that my identity was legitimate

in some sense. My understanding of how trans healthcare
services worked was that they were set up to assist those

77

people they could diagnose as 'Transsexual' according to their

definition of that term. At my third appointment at CHX GIC I
was informed quite explicitly that the clinician would not
consider endorsing me for any treatment at all unless I was
living "as a woman. (Aiden, 2014)

Aiden comments that due to not identifying in a way that meant

they could receive a medical diagnosis, the clinician openly stated
that they would not be eligible for treatment unless they were living
as a woman. This shows the way in which non-binary Trans people
are unable to access healthcare due to falling outside of the
conditions of treatment.

It could be argued that updating medical literature and diagnosis to

include non-binary Trans people would better allow and encompass
a variety of different gender identities and Trans people who are in
need of medical treatment.

I had to attend a panel meeting early last year, there were about 78 clinicians present, the general consensus was that non-binary
identity was not stable or permanent. (Aiden, 2014)
This illustrates the way in which clinicians do not consider nonbinary gender a stable or permanent gender identity, or even a
legitimate identity.

78

Aiden also outlined the way in which it was impossible to follow

through with the clinicians guidelines due to their being no way to
live in role as a non-gendered person.

They (medical professional) state in the letter that in order for

them to endorse me for surgery they require me to go
through the usual Real Life Experience, including 1 year of
substantial occuptation of some sort... as evidence of stable
functioning in the desired gender role (whether male, female
or gender neutral) - despite me having repeatedly pointed out
to them that there is no social or legal recognition of nongendered identity. (Aiden, my emphasis, 2013)

Aiden points out the fact that even if a non-binary gendered person
were to try and abide by the Gender Clinic guidelines in order to
receive treatment it would currently be impossible. Requirements
such as living in role prevent a non-binary gendered individual
from qualifying or being eligible for treatment since there is no way
to legally live in their chosen gender role.

When I quizzed Aiden on what they thought needed to change in

regards to medical treatment for Trans people, they responded,

79

Healthcare services for trans people should be designed in

relation to easing the symptoms of gender dysphoria rather
than in relation to notions of disordered identity... They should
drop the idea of transition 'pathways' and instead offer a
range of services... they should offer a patient centred
approach to treatment based on informed consent.(Aiden,
2014)

Aiden emphasized the idea of treating Trans patients on a case by

case basis, and that treatment should be implemented in order to
relieve symptoms as opposed to corrective treatments and
surgeries which imply a more final and clear-cut approach. The
utilization of medical services to relieve gender dysphoria symptoms
would allow Gender Clinics and clinicians far more lee-way and
broader options in which to treat Trans patients, especially those
who do not identify as a binary gender.

Conclusion

80

This paper has looked into the history of Medicalization of Trans

people and the way in which these ideologies and medical texts are
still influencing the treatment of Trans patients in 2014.
I have addressed the way Trans narratives such as the Born in the
wrong body ideology perpetuate the pathologisation of Trans bodies
and an outdated focus on corrective surgeries and sex change that
proves

to

reinstate

notions

of

gender

binaries,

roles

and

stereotypes.

I have addressed legislation such as the Parliamentary Guidelines

for the commissioning of healthcare treatment services for Trans
people, and the way in which the wording of such documents
excludes non-binary Trans people by incorrectly re-instating that
Trans people identify as binary gendered. Also the issues associated
with the GRA and its failure to accommodate non-binary Trans
people. These normative binary understandings of gender have
influenced social and legislative shifts.

This led me to look into the way certain acceptable Trans bodies
are legitimized through medical, social and political movements,
and others are not, drawing upon arguments of acceptable
homonormativity versus deviant Queer people who, like non-binary
gendered folk, do not reflect the status quo.

81

I have addressed issues of gendered citizenship, and the ways in

which binary gender is heavily indebted within the system, so much
so it makes the concept of gender-neutral identity hard to
implement.
But I have also shown examples of certain countries and societies
where a third-gender has been successfully instated which proves it
can be done.
I have utilized actual experiences of Trans people through oral
histories from Rooke (2008), Davy (2011), and through my own
research and interviews with Trans participants to explore how the
medical system is failing them.

Through these findings, I hope to have sufficiently shown the way in

which the NHS and medical system are indirectly enforcing gender
binaries through rigid and exclusionary pathways in accessing Trans
healthcare.

82

BIBLIOGRAPHY
Bettcher. T, Trapped in the Wrong Theory: Rethinking Trans
Oppression and Resistance Signs Vol. 39, No. 2 (Winter 2014), pp.
383-406 Published by: The University of Chicago Press Article Stable
Bornstein. K, Gender Outlaw: On men, women, and the rest of us,
Routledge Publishing, New York, (1994)
Bornstein. K, My Gender Workbook, Psychology Press, (1998)
Bornstein. K, Gender Outlaws The Next Generation, Seal Press,
California, (2010)
Boswell, H, The transgender alternative, TV-TS Tapestry 58: 31-33,
(1991)
Browne, K, Jason Lim, Gavin Brown Geographies of sexualities,
Ashgate Publishing, Ltd., 1 Jan (2007)
Burke. M, GID and the Contested Terrain of Diagnosis, from
McGann. P, Sociology of Diagnosis, Emerald Group Publishing
(2011)
Butler, J. Undoing Gender, (2004), Abington: Routledge.
Butler. J, Undoing gender, Psychology Press, (2004)
Butler. J, Gender Trouble, Routledge Publishing UK, (1990)
Davy. Z, Recognizing Transsexuals: Personal, Political and
Medicolegal Embodiment, (2011) Ashgate Publishing Limited,
Surrey, England

83

Ehrenreich. N,with Mark Barr, Intersex Surgery, Female Genital

Cutting, and the Selective Condemnation of 'Cultural Practices,'
Harvard Civil RightsCivil Liberties Law Review, 40 (2005)
Feinberg. L, Transgender warriors: Making history from Joan of Arc
to Dennis Rodman, Boston: Beacon publishing, (1996)
Girshick. L, Transgender Voices: Beyond men and women, UPNE
publishing, Google eBook, (2009)
Hines. S, Recognising Diversity? The GRA and Transgender
Citizenship, from Transgender identities: towards a social analysis
of gender diversity, Hines. S, Sanger. T, Routledge Publishing, UK
(2010)
Hines. S, Gender Diversity, Recognition and Citizenship: Towards a
Politics of Difference, Palgrave Macmillan Publishing, (2013)
Kessler, S., J., and McKenna, W., Toward a Theory of Gender in
Stryker, S. and Whittle, S. (eds) The Transgender Studies Reader.
(2006) New York: Routledge pp. 165 182
Lee. A, Trans Models in Prison: The medicalization of gender identity
and the eighth amendment right to sex reassignment therapy,
Harvard Journal of Law & Gender, Vol. 31, p. 447-472, 2008, Harvard
Public Law Working Paper No. 08-51,
Mackenzie. G. O, Transgender Nation, (1994), Bowling Green State
University Popular Press, OH 43403
Mak. G, SO WE MUST GO BEHIND EVEN WHAT THE MICROSCOPE
CAN REVEAL: The Hermaphrodite's Self in Medical Discourse at
the Start of the Twentieth Century, GLQ: A Journal of Lesbian and
Gay Studies, (2005) Duke University Press
Mclean, S, First do no harm: Law, ethics and healthcare,; Ashgate
Publishing, Ltd, (2013)
Namaste. K, Invisible lives: The erasure of Transsexual and
Transgendered people, Chicago U of Chicago Press, (2000)
Raymond. J, The Transsexual Empire, Teachers College Press,
(1979)
Sheridan. V, The Complete Guide to Transgender in the
Workplace, (2009), ABC-CLIO Publishing,

84

Stryker, Whittle, Transgender Studies Reader, Routledge Publishing,

New York, (2006)
Warner. M, Fear Of a Queer Planet, University of Minnesota Press,
(1993)
Westbrook. L, Becoming Knowably Gendered, (Paper presented at
the annual meeting of the American Sociological Association Annual
Meeting, Sheraton Boston and the Boston Marriott Copley Place,
Boston, MA, Jul 31, 2008), taken from Hines. S, Sanger. T,
Transgender Identities, (2010) Routledge Publishing Ltd.
Whittle. S.,The Transgender Debate: The Crisis surrounding gender
identity, (2000) Reading, South Street Press
Whittle, S. Forward, in Stryker, S. and Whittle, S. (eds) The
Transgender Studies Reader, (2006) New York: Routledge pp. xi
xvi

BIBLIOGRAPHY ONLINE CITATIONS

BBC online, (2014) Gender dysphoria/transgender, cited at:
http://www.bbc.co.uk/radio1/advice/factfile_az/gender_dysphoria_tra
nsgender
Barnes. W, The Medicalization of Transgenderism, (2001) TransHealth.com and Trans Media Network, 2001-2014, online article
cited at: http://www.trans-health.com/2001/medicalization-oftransgenderism/
Cullen, C, Laverne Cox makes history as first transgender actor to
receive Emmy nod, cited
at:http://www.independent.ie/entertainment/television/tvnews/laverne-cox-makes-history-as-first-transgender-actor-toreceive-emmy-nod-30429295.html#sthash.MPMGUrp2.dpuf
Daily Mail Reporter, The tragic twin boy who was brought up as a
girl after horrific hospital blunder, (2010) Dailymail.co.uk, Article
cited at: http://www.dailymail.co.uk/news/article-1332396/BruceReimer-Tragic-twin-boy-brought-girl.html

85

Evans.S, BBC News Europe, Germany Allows indeterminate gender

at
birth,
November
(2013)
article
cited
at:
http://www.bbc.co.uk/news/world-europe-24767225
Hach. K, WHAT LAVERNE COX'S 'TIME' MAGAZINE COVER MEANS
TO ME AS A TRANSGENDER WOMAN, Bustle, (2014) cited at:
http://www.bustle.com/articles/26305-what-laverne-coxs-timemagazine-cover-means-to-me-as-a-transgender-woman
Hines. S, (Trans)forming Gender: Social Change and Transgender
Citizenship, Sociological Research Online, Vol 12, Issue 1, (2007)
cited at: http://www.socresonline.org.uk/12/1/hines.html
Jacques. J, They are the gatekeepers of my physical transition, The
Guardian Online (2010) cited at:
http://www.theguardian.com/lifeandstyle/2010/sep/22/transgendercharing-cross
Morrison. S, Special report: Intersex women speak out to protect
the next generation, (2013), The Independent, Independent.co.uk,
article cited at: http://www.independent.co.uk/news/uk/homenews/special-report-intersex-women-speak-out-to-protect-the-nextgeneration-8974892.html
OHRC, Current Issues: Medical Treatment and Medicalisation of
Identity, Ontario Human Rights Comission, Queens Printer for
Ontario, article cited at:
http://www.ohrc.on.ca/en/book/export/html/2825 (2014)
Polyinpictures (2014), The Growing Use of Mx as a Gender-inclusive
Title in the UK, Version 2.1 - 2014-04-09, (This work is licensed
under the
Creative Commons Attribution-NonCommercial-ShareAlike 3.0
Unported License.) cited at: http://www.polyinpictures.com/wpcontent/uploads/mxevidencelowres.pdf
Rix, M, Can Citizenship be Gender-neutral and -inclusive? Exploring
the possibilities of social and legal citizenship, Public Policy Network
Conference 2006, Perth, Western Australia, 23 February 2006, 1-13.
Cited at: http://ro.uow.edu.au/cgi/viewcontent.cgi?
article=1012&context=gsbpapers
Roberts. M, Stealth doesnt help the trans community,
Transadvocate TOS, (2013), cited at:

86

http://www.transadvocate.com/stealth-doesnt-help-the-transcommunity_n_9817.htm
Woo. E, David Reimer, 38; After Botched Surgery, He Was Raised as
a Girl in Gender Experiment, Los Angeles Times, (2004), article
cited at: http://articles.latimes.com/2004/may/13/local/me-reimer13

87