Medical Understanding of Transgender Identities
Medical knowledge about gender and sexuality have changed dramatically since ancient Greece. Hippocrates believed that male was superior to female, due to his theory of four humours: men had more heat than women, resulting in better physical strength and mental capacity. This belief led him to believe that women were inherently inferior, and should be treated as such.
Galen's teachings suggested that there was little difference between males and females, beyond their reproductive organs.
In the middle ages, medical texts used Christian scriptures to describe sexuality. They taught that God created man and woman separately, with different roles and functions. Medieval physicians believed that the clitoris was "the source of all feminine evil" because it resembled the penis. It was considered harmful to cut off the clitoris during childbirth, but doctors did it anyway. Physician Jean Astruc wrote in 1694 that castration could reverse gender identity, an idea still believed today.
Modern medicine has rejected these medieval ideas. In the late 20th century, scientists recognized that transgenderism is a natural variation in human biology. The Diagnostic and Statistical Manual of Mental Disorders (DSM) classified transgender people as mentally ill until 2013, when it removed them from its list of diagnoses. Now, modern science recognizes gender dysphoria as a valid condition, and provides treatment options for those who suffer from it.
Pathologization
Pathologizing transgender identities has raised ethical questions about autonomy, respect for diversity, and recognition. Some doctors have argued that transgender people are not sick, but simply need to adjust to society's expectations for what men and women should look like.
Pathologizing transgender identities can lead to disrespect for individuals who may feel uncomfortable in their bodies. It also suggests that there is something wrong with being non-binary or intersex, which contradicts current knowledge about genetics.
Even if some believe that pathologizing transgender identities is harmless, doing so creates barriers to accessing medical care. Many insurance companies won't cover procedures related to transitioning unless they are necessary for mental health reasons. This means that people must pay out-of-pocket for hormone therapy, surgery, or other treatments that cisgender people receive without question. Some employers refuse to hire transgender people, or require them to use the bathroom matching their birth sex rather than chosen identity. These actions show that non-normative genders aren't socially accepted, leading to further stigma and discrimination against transgender people.
Transitioning requires time, patience, and self-discovery. For many, hormone therapy takes years to complete, and surgeries often require multiple operations. Transgender people deserve the same rights as everyone else, including access to medical services without discrimination based on their identity.
Social Recognition
Social recognition of gender diversity has improved over the past decade, but remains limited in most places. Many countries lack laws prohibiting discrimination against LGBTQ+ individuals, and few countries allow same-sex marriage. In the US, state governments can deny birth certificates to transgender parents who don't match their children's biological sex. In addition, some states forbid gender confirmation surgeries, even though they are medically necessary.
These policies create a hostile environment for transgender individuals, making it difficult for them to live openly and safely. They may face violence, discrimination, and harassment because they express themselves differently from what society expects. To improve social recognition of transgender identities, we must advocate for anti-discrimination laws, promote understanding, and support equal opportunity for all genders.
Medical knowledge about transgender identities has evolved dramatically since ancient Greece, but there is still much progress to be made. Pathologizing transgenderism hurts those seeking medical care, and creates barriers to transitioning. We must recognize that non-normative genders are valid expressions of human sexuality, and provide equal access to medical treatments regardless of identity. Only then will societies become more inclusive and welcoming to diverse sexual orientations and gender identities.
How has medical understanding of transgender identities evolved, and what philosophical and ethical questions arise regarding autonomy, pathologization, and social recognition?
Medical understanding of transgender identities has significantly changed over time. Before 2013, there was no consensus on how to define and classify gender dysphoria (GD), which is now recognized as a key diagnostic criterion for those who experience distress because their physical sex does not match their gender identity.