I won’t go into the DSM-V Gender Dysphoria criteria. The involvement of Kenneth Zucker was enough to keep Gender Dysphoria under mental conditions, and people keep weaponizing that decision. They keep doing so even though a lesser known statement by the American Psychiatric Association that clears up that transgender identity is not per se the mental illness, BUT xyz. They screwed us over on purpose and then it was revealed Zucker had vested interest in continuing his own thing.
I am talking about the WHO’s ICD-11 Gender Incongruence which is outside mental illnesses but it is still under Sexual Health related conditions. I find this odd, because I don’t think being transgender is a sexual thing, despite overlapping with sexual health a lot, but I still think is a misclassification and our enemies gleefully take the chance to weaponize this as well. In fact, reducing transness to a “sex thing” is a main line of attack for right-wing strategies, for instance saying “trans stripper” for drag queen story hour, or Project 2025 equating LGBTQ people with “pornography”, especially trans people. Using this argument for book bans etc.
So I got myself thinking, it is not the mind that is wrong it is the endocrine system. After all the gonads are operators for the endocrine system. The intervention is at the endocrine system. So why not start thinking of transness as an endocrine condition primarily?
Now, I start thinking I might be on the asexual spectrum, so I put the fact on the table. But this is not to undermine my proposal, I just think many people might not be seeing that because for most people sex is an important part of life and the overlap between “who you are”, “who are you going to bet with”, and “who you are going to bed as” is bigger. But of the three, I only see “Who you are” relating to gender identity, “Who you are going to bed” as sexual orientation, I don’t see much theory in the latter “going to bed as sth”.
So I think that the classification is in error, and it is motivated by erroneous constructs we tried to shake away by replacing “Transexual” with “Transgender” to focus more on identity and biosocial aspects of gender identity. So I don’t think that gender incongruence belongs in Sexual Health organically, I believe it is primarily and inherently an endocrine condition (your system does not produce the right hormones for you) treated with endocrine interventions (suppress the production of, or remove the organs that are the producers of the wrong hormones, or correct the results of exposure to wrong hormones). Sex hormones for sure, but hormones. The important thing here is the Self. We agreed against conversion; we preserve the Self, fix the hormones, not the other way round. It is an endocrine condition.
You make some good points, that perhaps should be better explored on a more sound activist and philosophical basis.
Variation for example is a relatively statistical term. “Disorder” is a normative term. It sets some level above which it is considered pathological. This is like an age-old discussion about what is pathological in psychiatry and even medicine more general. The term “disorder” itself was chosen as less stigmatizing from the previous “disease”, but now it is considered itself stigmatizing. We are also talking about “mental health stigma” which is one of the intersectional oppressions that quietly affects trans people (another invisible one is whorephobia for example).
Intersex conditions are now called, if memory serves, differences of sex development. There is a reason for that, which is to reduce stigma. This is why we moved from Gender Identity Disorder, to Gender Dysphoria, to Gender Incongruence. Why should we go back to a stigmatizing term again? Because some people experience high-levels of biochemical dysphoria. Sure, the latter two terms make that point without bringing back the problematic term. After all cis people seeking similar treatments are not considered disordered. But the latter is classed outside mental health altogether. Also, assigned sex at birth is an established and meaningful term derived from intersex activism, since intersex people are literally assigned to a gender with lifelong consequences. In that light I think the shorthand “natal” sex is still problematic.
What are we left with? The disorder is that the gendered self is incongruent with the embodied aspects of sexual maturation. So I think the response misses the point because nobody seeked to invalidate high or even low levels of biochemical dysphoria. I think perhaps the majority of trans people do seek hormonal treatment, so I don’t see merit in highlight the emergence of a separate term like “biochemical dysphoria” other than “voice dysphoria”, “bottom dysphoria” and other stuff we say to communicate with each other without them being separate diagnostic categories.
Another issue that arises is that much of the legal advancement (and societal discussion surrounding it) leans more heavily to a gender expression civil liberty and its reduction on AGAB. Perhaps the point you are trying to make is the permanence and innateness of the gendered self, but I could do without the biological reductionism of it. I do believe gender identity is permanent and it has a component in the brain and other organs, but I want to make a point that we talk about a self, and it is not bad or mutable if it has an acquired or psychological side. There are plenty acquired traits that are immutable, such as the mother tongue. So far among trans activist I have seen two ends regarding this. Contrapoints evades defining gender identity altogether (Trans people are just this way.) Serano prefers to reduce it to innate sex roles, but even in animals sex-related behaviors are sometimes learned. Either way, this is just a “soft” argument, as I don’t say that there isn’t a biological aspect to transness, but I am not willing to say that it is the only aspect. I prefer the approach of it being a permanent biosocial developmental trait.
This is extremely important for legal recognition, and activists have pushed for explicit recognition of discrimination on the basis of gender identity, and not reducing it to “opposite to AGAB gender expression”, as this reduces it to existing protections of sex discrimination.
So, I don’t think that the argument which is essentially “some people experience extremely high levels of gender dysphoria because their brain was trans since the womb” means we should have a stigmatizing term for it. I think this approach sets apart a special class among trans people for which a medical term should be reserved, and I think it is unintentionally problematic. To sum up, I believe that existing activism in depathologization and legal recognition is in the right direction, and I don’t think that the argument of intensity of gender dysphoria for a subset of trans people is sufficient to grant the use of the stigmatizing term “disorder”. People who experience dysphoria, most of which might want endocrinological treatment, can use the established vocabulary regardless of levels, and don’t see how the proposal to move Gender Incongruence to endocrine conditions is affected by these arguments.