Why Transmedicalists are Wrong

Rori Porter
Oct 17, 2019 · 20 min read

I am a binary-ish trans woman. About the most visible of the trans identities, people like me receive a lot of airtime, for better or for worse. Our struggles are more well known than most others under the trans umbrella, and the most frequently traveled path of our ranks is often framed as a guideline or common narrative for the trans experience. We (binary trans women) often seek particular changes to our body, tend to have gender dysphoria, and we are seen and represented in media through actresses and activists like Laverne Cox, Janet Mock, Jazz Jennings, Carmen Carerra, Amanda LePore, Andreja Pejić, Chelsea Manning, and a number of other high profile trans women. That said, these women all have something in common: their experience is binary and tends to make more sense to the general population than non-binary trans experiences. The narrative surrounding trans feminine people is abundant and readily accessible by the masses through shows like Orange is the New Black, Sense8, Euphoria, and Pose, while other demographics of the trans community are quite overlooked.

To get to the core of the anti-non-binary methodology, you need to first understand three tenets of trans representation:

First — Increased visibility/representation correlates to increased public scrutiny

This visibility for trans woman is hard-fought, and visibility for one group cannot be seen as a bad thing in light of another community being overlooked. With increased visibility often comes increased scrutiny, so the representation afforded to trans women can often seem like a double-edged sword. We are more in danger of being taunted and attacked. Trans women of color are particularly at risk for being on the receiving end of hate crimes and face one of the most statistically disturbing demographical murder rates on the planet. We don’t always assimilate well or blend into society’s expectation of what a woman should look like, while trans men often do with the ability to grow a beard and the deepening of their voices when on testosterone.

That said, trans men receive far less news coverage than their trans femme counterparts, and their celebrity rankings are far less prolific. Chaz Bono, Ian Harvey from Transparent, and porn star Buck Angel are some of the only trans men that most people know, if they even know those few. I don’t intend to pass judgment on Buck Angel — quite the contrary. He is highly involved in the transmasc community, and has headlined trans events that I’ve been to. Buck does a lot of good work for the trans community with his advocacy and outreach, and I only mention him because a porn star being one of the most prominent representations of trans men in our culture is truthfully not great for cultural perceptions and is ultimately a microcosm of the rampant fetishization of the trans community.

Buck Angel should always have a place in the community, but his place of prominence is due to a lack of similar role models with a platform. Buck uses his platform to benefit his own community, the trans men under-represented in our world, and that is honestly an amazing thing. Trans men are often invisible in our society, blending in in a way that trans women don’t necessarily share.

To be very very clear, Buck is a hugely problematic figure and his support of the transmasc community doesn’t erase the damage he causes to nonbinary people with his platform. That subject will take a lot to get into, but let’s be clear that Buck is no guardian angel to most of our community, just the ones he approves of. I would get into that here, but I have about two densely packed pages of notes on the subject, so I’m going to reserve condemnation of Buck for another time.

Point being, he is both a transmedicalist and a major part of transmasc representation in a world where that is exceedingly lacking.

For the price of a lack of representation, trans men are less at risk in our society that allows and celebrates masculinity in many forms, but punishes femininity in all forms. Our experiences as trans people are incredibly varied, and so we face different problems. Trans men lack representation, and trans women are generally more at risk in public. It is not something to lament, but rather to simply be aware of.

In general, trans people of all genders and walks of life face unique challenges that cisgender people will never face and we must find solidarity in that.

Second — Non-binary representation is almost non-existent

Non-binary representation falls even shorter, with most enby celebrities being mislabeled as cisgender and gay/bi/lesbian, or sometimes cisgender and straight. Asexual non-binary people are a level of unrepresented that feels like I just tried dividing by zero in my effort to find anybody with a platform who fits that descriptor.

While non-binary folk are often completely overlooked and disregarded, they face an inversely enormous level of scrutiny for falling outside of the prescribed gender binary. While I can personally name several non-binary stars like Miley Cyrus, potentially Gerard Way, Courtney Act, Valentina, and lots of other Drag Race alumni, their identities are largely invisible to the public eye. Non-binary drag queens are often just thought of as cisgender gay men, though there is a distinct intersection of gay and enby/trans culture when it comes to drag queens and how they straddle both labels. In the case of Miley, people have chalked up their non-binary identity to them trying to be “fashionable,” and a statement like this came from their own godmother, Dolly Parton herself.

“There are only two genders!” is a common refrain used to discredit and invalidate non-binary individuals, as well as tired phrases like “I identify as an Apache attack helicopter,” as if the idea of not being a man or a woman, being both, some combination therein, or lack thereof, is as absurd as being a conscious, sentient machine of war. Like, “Oh, if someone can identify as agender, I can identify as a potato salad.” The idea that gender is immutable, binary, and solely dependant upon sex characteristics is pervasive, and the burden of change is laid squarely upon the shoulders of those whom this misconception hurts most.

& Third — Non-binary people face a steeper climb than binary trans folks in the path to mainstream cultural acceptance

It can be said that many (certainly not all) binary trans folks are effectively assimilating into binary culture, going from a 1 to a 0 or visa versa, trying to blend in as the opposite sex and/or gender. Non-binary trans folks, conversely, are functionally trying to create the society that allows for them to exist and thrive. Not that we’re playing Oppression Olympics here, but I personally think that nonbinary is a harder path, as when I tell someone I’m a trans woman it’s generally understood, while non-binary folks often have to shoulder the entire burden of educating almost everyone they care about or have to spend any significant amount of time around.

What perhaps troubles me most about the invalidation of the non-binary community is that very often that invalidation comes from within the trans community itself. People are expected to fall into one category or the other, male or female, innie or outie, and any variance is frequently infantilized, discredited, and chalked up to liberal theology gone mad, and often trans people are just as guilty as cis folks of perpetuating anti-nonbinary mentalities. These are very much the same slights that binary trans folks face, but with the added dynamic of binary trans folks gatekeeping nonbinary trans folks for living an experience they don’t understand. Functionally, anti-non-binary gatekeeping is an external manifestation of internalized transphobia.

The fact that biological variance exists outside of the trans community in the form of intersex individuals is also widely ignored in favor of a rigid social construct that simply doesn’t work for all of us or even make much scientific sense. Everyone thinks they’re an expert on gender while very few people actually are.

And that’s the thing — anti-trans + anti-non-binary stances fall apart with the slightest pressure of logical and scientific scrutiny, but bigotry does not abide by the same rules as science and logic. Hateful people seek out only the facts that confirm their bias and use whatever twisted knowledge they come by as justification for treating an oppressed minority as less than human.

Okay, so now we’re up to speed, right?

Okay, I’m mostly kidding, I don’t expect the cisgender people reading this to be totally up to speed yet. Some of that takes personal effort, and I can only explain so much in the confines of this medium (hah.) You will need to take what you learn here and build upon it using resources like Trans101.org.au, HRC, and GenderSpectrum.org. If anybody has better resources, please shoot me a comment. TransStudent.org is back online, and is probably my favorite resource to educate cisgender people about the trans community. Check it out, bookmark it, share the hell out of it.

I started this piece by explaining the most commonly understood paths of binary transness because that is the prescript by which non-binary folk are judged. A foundational understanding of this reality is necessary for understanding the uphill battle we face in unlearning non-binary-specific anti-transness.

Now that you‘re up to speed on these three basic starting points — that visibility = scrutiny, that non-binary folks lack representation, and that non-binary trans people face some different trials and tribulations than binary trans people, let’s continue on, shall we?

So, what are we talking about here?

Over-generalizing Medical Definitions Gatekeeps & Holds Non-binary People Back

The expectation that trans people wish to transition to the opposite gender/sex, have gender dysphoria, and seek specific surgeries is down to the pathologization of transness as laid out by the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM sees transness as a physical and mental disorder that can only be corrected medically with hormones, surgery, and therapy. In my case, this is 100% true, but it isn’t for so many others. There is no single way to be trans — we are diverse human beings with unique needs and wants, and the one-size-fits-all mentality that used to be applied to our community is being slowly dismantled. It is only recently that non-binary was accepted into the DSM 5 (The Diagnostic and Statistical Manual of Mental Disorders), before which non-binary people faced much higher levels of scrutiny in seeking methods of medical transition due to their “in-between” status, often labeled as gender confusion.

For a long time, non-binary identities have been considered a bridge to figuring out one’s “true” identity, in much the same way that many bisexual folks are considered to be gay-in-training rather than legitimately bisexual. Thus many non-binary folks have had to adjust their narratives to accommodate the medical system. For instance, my electrolysis is covered under LA Care/Medical because I have been diagnosed with gender dysphoria and I’m on hormone replacement therapy (HRT), but a non-binary transfemme friend of mine with the very same healthcare faces unique troubles in attaining their electrolysis covered by insurance because they experience more isolated dysphoria and are not on HRT.

What even are transmedicalists?

This is where transmedicalist ideology comes into play. Transmeds are trans people who believe that the DSM’s definition of trans identity is law, a Bible through which we must derive our paths to truth, and anybody who falls short of the DSM definition is not trans enough at best, or faking it at worst.

Transmeds often call non-binary folks and their supporters “transtrenders” and “tucutes,” both of which we will get to later on in this article.

There is a common belief, particularly held tight by transmeds, that transness is defined by dysphoria or a great feeling of incongruence in one’s own body. Gender dysphoria is experienced by many trans people, non-binary and binary alike, though the idea that it is the sole expression of trans identity is absurd.

Uh… what the hell are transtrenders?

Yes, that feels like the logical next question. With that first misconception / blatant lie out of the way, let’s tackle the term “transtrender.”

The term “transtrender” has arisen as a result of anti-enby mentality and is used to define all non-binary as attention seekers, heavily mirroring society’s view and infantilization of non-binary people as confused or seeking attention. Put politely, “transtrender” is a bullshit term that causes detrimental harm to young people, and deprives them of the right to explore their gender identity free from scrutiny or backlash.

I appreciate a good portmanteau as much as the next girl, but the idea that anybody would identify as trans to follow a trend is laughable, or at least would be laughable if people weren’t completely serious when they lob this slur at non-binary folk and any trans person who doesn’t wish to medically transition. There is little to no social currency in transness. Moreover, people deserve the right to explore their gender without being labeled a “trender.” Gender is complex, often very confusing, and we do our community no favors when we attack others for being who they are.

What’s the opposite of transmedicalist though? I need labels, gimme gimme gimme!

Glad you asked! Really, it’s simple — there’s transmeds on one side and those of us who don’t gatekeep our siblings on the other. Sure, there’s a third thing, but the discourse around this issue tends to play out in a predicably “us vs. them” manner.

That said, transmeds like to call their opponents “tucutes.” As in “2 cute 2 b cis, lolz.” This language is a method of infantilizing those who disagree with them.

Inversely, sometimes transmedicalists are called “truscum,” and I rather suspect that “tucute” is a derogatory response to “truscum” being interpreted as a slur.

Non-binary trans folks face quite as much transphobia as binary trans folks, but the difference is that the behavior often coms from within a community that should be embracing our non-binary siblings. Every time I witness transmeds tearing down someone for “not being trans enough” or being a “transtrender” it hits me like a punch to the stomach.

The breakdown of what a tucute believes, as defined by transmeds, is as follows: (stolen from Urban Dictionary, so you know it’s legit)

“Tucutes believe that gender is a way of thinking and that being transgender is your choice. They believe that if you feel like you would function better in society as the opposite gender (due to you being ‘too masculine’ or ‘too feminine’ for your birth gender according to society) then you are trans.”

First of all, non-binary folk and their supporters do not believe that being trans is a choice, and this argument rather feels like a page torn out of a transphobe’s handbook. I have never seen any non-binary person arguing that gender is something anybody chooses. One chooses to come out and chooses a label to identify with, but the being trans/non-binary part is nobody’s choice, it is merely how we and they are.

The second part of that definition, insisting that non-binary folk believe that being AFAB and masculine, or AMAB and feminine, inherently constitutes transness, is categorically false. The non-binary community is not likely to cast labels upon others, let alone transness, and the idea that they do is absurd and damaging. While, yes, gender is a social construct, literally nobody is arguing that all gender non-conforming folk are trans, and I have never once met a non-binary person who would be at all comfortable with assigning a gender to any other person, trans or cis, based solely on their gender presentation. The accusation is practically unthinkable and does not gel with my understanding of enby folks and the social change that many of them are advocating for.

In the sense that one chooses their own labels, yes, identifying as trans is a choice, in the same way that self-labeling as asexual, gay, straight, bisexual, lesbian, pansexual, or otherwise is a choice one makes. The label that we inform our identity with is a choice — the identity itself is not. People don’t choose the nature of their attraction, they merely choose a label that best defines their experience. We aren’t born with our labels, we pick them.

If someone read any of that as “being trans is a choice!” I would posit that they are being intentionally obtuse,. Literally no non-binary person is arguing that being trans is a choice, and insisting this is merely a means of justifying hatred against a community that needs our love and acceptance.

And there’s a huge part of the problem — transmedicalists often know they’re wrong and do not come to debate in good faith. They are not just pushing an ideology because they believe it, they are pushing it because they are angry at the world and non-binary people are the easiest targets.

But what exactly is gender dysphoria?

From my personal perspective, dysphoria is an intensely negative feeling associated with being misgendered or perceived as male. For me, dysphoria often manifests in instances in which my internal sense of self comes into stark contrast with how I am treated by others. When someone calls me “He” or by my old name I feel a spike of intense anxiety that, depending on the nature of the issue, can sit with me for many hours. Dysphoria has the power to ruin my day, throwing me into a tailspin of depression and self-loathing that can be hard to dig oneself out of.

Dysphoria is a hugely uncomfortable experience and it’s a large part of my personal trans experience, but dysphoria by no means defines my trans experience. I am trans because I was assigned male at birth and I am a woman, not solely because I am uncomfortable in my body.

Dysphoria doesn’t define transness any more than PTSD defines what it means to be a veteran. PTSD is often a part of people's experiences, but not all soldiers experience PTSD, and the ones who do aren’t more soldiery than other soldiers. PTSD is a mental illness that is commonly associated with trauma and war, but it is by no means a mandatory requirement for identifying as a soldier.

Similarly, forcing trans people to identify with a mental health diagnosis only serves to further pathologize trans people, and in doing so robs trans people of their right to exist outside of a diagnosis. You should consider the idea that all trans people have a common mental illness (dysphoria) with the same level of scrutiny that you would if someone told you such a thing about any other demographic.

What’s the DSM 5 again?

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, is the latest iteration of a tome used like a bible by most mental health practitioners in America. It is a largely necessary resource, as without it trans people would have a hard time accessing medically necessary services like mental health treatment, hormone therapy, or gender confirmation surgeries.

The DSM 5, while better than previous versions, applies appealing answers to why trans people exist. It gives trans people problems they can solve, and many of us cling onto that because solvable problems are comfortable. The stark reality of it is that trans people are trans because they are trans.

Many of us share a common narrative, but the hallmarks of that narrative are neither standard nor judicious toward trans people who have a different lived experience, and it’s not necessarily comforting to accept that nobody in the medical field or otherwise truly understands what actually causes transness. I’ve heard that it’s due to hormonal imbalance in-utero. I’ve heard that it’s social conditioning gone awry. And those explanations may be somehow comforting, but they’re probably not true.

Accepting that transness just is doesn’t make for a satisfying conclusion to that research, so many trans folks end up defaulting to that most strict and respected of definitions as laid out in the DSM, and their personal experience reflects it, so they dig into the “them vs. us” mentality because hating others as much as others have hated us can feel like justice, or even cathartic despite the mentality being ultimately self-destructive.

It’s comfortable to draw firm lines between “them and us”, but the reality of the matter is that the definitions found in the DSM 5 were written by cisgender people who can’t understand the trans experience the way that trans people do. But as trans people, we are often so ready to accept any answers that ring true about our struggles that it’s not hard to see how some trans people fall into the trap of following the DSM as a bible that justifies our right to exist.

“I have a medical condition!!” is something that many trans people take comfort in because it can quickly down scrutiny when it comes. But this mentality is ultimately harmful to the trans community, and painting everybody in our community with our own pain and using it as a litmus test for who is or isn’t “really trans” is an act of violence against our own.

But what’s wrong with transmedicalists? Aren’t they just following the common science outlined in the DSM 5?

That’s not an unreasonable conclusion — the DSM 5 exists for a reason. It is a tool for mental health practitioners and it’s often spot on, so tons of professionals swear by it. The problem comes when a hammer is used in an attempt to fix a problem that would be better suited by a wrench. The fact is that the current version of the DSM is less of a utility belt than a screwdriver with swappable crosshead and flathead attachments. Super nice to have, often very necessary, but not exactly helpful when you’re trying to sand a table.

Trans people are bound by no common experiences. We are not bound together by mental illness, our bodies, our interests, or anything like that. We are simply bound by the fact that our culture assigned us incorrectly at birth based on a rigid set of cultural standards that projects an identity upon us based solely upon our genitals. That is our common ground — not dysphoria, or mental illness, or any other narratives that are commonly used to explain the trans experience.

What transmedicalists (sometimes called truscum) do is use their own experience, their own pain, as a barometer for the validity of every other trans person. To a transmed the idea that a trans person might not want or need to undergo medical transition is absurd. That there is more than one way to be trans is often seen as downright appropriation by people who are jumping on a bandwagon. However, there is little to no social currency in being trans. There is no benefit to pretending to be non-binary for cool points. Non-binary people face a level of scrutiny over their identity that binary trans people usually do not. Not to say that our identities aren’t scrutinized, but enby folk are taken to task constantly over their identities, pronouns, and the validity of their very being.

But what does that all mean?!

The simple fact is, transmedicalists are harming some of our most vulnerable trans siblings.

I can be sympathetic to the people and how transmedicalist radicalization happens, but nobody gets a pass on treating other people like shit. Being abused by society does not give anybody a free pass to abuse others.

Binary trans people face transphobia, yes. We are often told that we are not our gender, our pronouns are ignored, and many of us are frequently deadnamed by our friends and family. Yes, binary trans people are oppressed, but playing Oppression Olympics as a gatekeeping method boils our experiences down to pain, when ultimately we are transitioning for internal congruence, contentedness, the euphoria that comes with being seen for who we are.

This article is long… what’s the conclusion, sis?!

Gender is not immutable or defined by what’s in your pants, it’s a social construct. That statement, for at least as long as I’ve been out as trans, has been hardly controversial. Most people understand that the way men and women behave is in some part dictated by society. Gender roles are embedded deeply within our culture, and that people are now ignoring those roles is an integral piece in progress and moving toward the society that accepts all people, trans or cis, for who they are. Even if you believe that men and women are defined by their parts, a spectrum of feminine, masculine, and androgyny is not usually combatted due to, well, people having eyes and ears to perceive others with.

Transness is no different. Gender is a spectrum, not an inflexible 2D monolith of which you must choose one side or the other. Gender is not a binary, it is a quantum unit, a mobius strip that curves in over itself. Trying to define gender as rigid and immovable is to not understand what gender is and how people functionally operate within its constructs.

Gender is not sex. Gender does not necessarily correlate to how you are born. Gender is not necessarily something you need to even define. Gender is an intensely personal experience, and no amount of gatekeeping will make another’s gender anybody’s task to define other than the individual who is working to figure out how gender works, or doesn’t work, for them.

I believe that transmedicalists are afraid that the acceptance of non-binary folk will invalidate their own gender and choices they’ve made to confirm and affirm who they are. The idea that someone else might have an experience that is less difficult, less painful, fills them with rage, so they project that rage upon people whose experience do not match their own.

Many binary trans people specifically seek to blend in, to assimilate into the culture that currently exists, to be accepted into the cisgender world and accepted as “normal.” Non-binary people, however, are seeking to create the society that accepts them, and transmeds are terrified that the acceptance of non-binary folk will create a world in which they are accepted even less; that dismantling the social dynamics and roles around gender will leave them still othered, still unable to assimilate, unable to seek the safety they so crave. I think, above all, transmedicalists fear that if non-binary people are accepted, it will permanently brand them as trans, when all they want is to be cis.

I am not saying any of this as an attack. As a binary(ish) trans person I want to be accepted, I want to be integrated and assimilated into the culture as myself, without an asterisk, without “TRANS” scrawled out across my forehead. I get that need, that want, and it is entirely valid. But, so is the desire to tear down the construct of gender so we can rebuild it to include all people, all people who exist outside the binary, all people who need to transition medically or socially.

Our movements are not hurt by each other, but rather strengthened, and a world where we must disappear to be accepted is no world I want to live in. Trans people are not benefitted from a culture in which appearing trans is a liability, and non-binary trans people are the leading voices in creating that world for us.

Non-binary struggles are real, and they are not at odds with the struggles and needs of binary trans people. The fact of the matter is that breaking down barriers and gates around gender can only serve to allow binary and nonbinary trans people to better integrate into society without having to erase part of who we are. We are stronger together than we are apart, and as a whole, our community is bright and diverse. The binary medical path to transition is only one chapter in a great tome about the human experience. It is made no less valid, no lesser than, because there are other chapters that follow.


TransFocus: A Collection of Trans Experiences

Rori Porter

Written by

Autistic Queer Transfemme writer & designer based out of Los Angeles. She/Her/They/Their. Editor of TransFoc.us Anthology. RoriPorter.com


TransFocus: A Collection of Trans Experiences

Rori Porter

Written by

Autistic Queer Transfemme writer & designer based out of Los Angeles. She/Her/They/Their. Editor of TransFoc.us Anthology. RoriPorter.com


TransFocus: A Collection of Trans Experiences

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