Transkeptuality: Gatekeeping and The Value of Critical Thought


(note: this was originally intended as a guest post, but then timing got all crazy. I think it will work nicely as an introduction instead, though.)

An important, interesting, and increasingly common question in the contemporary skeptical community is to what extent should social concerns like sexism, misogyny, racism, homophobia, etc. be incorporated into the overall agenda of skepticism. Are these things really the domain of skeptics? Are these kinds of issues something that skepticism should be addressing, or even can address, or are our energies better invested into “traditional” issues like theism, Bigfoot, psychics, natural medicine, homeopathy, creationism, and all that nutty goodness?  The connections between these different sorts of issues and why skepticism can be valuable to addressing them aren’t too hard to make. After all, the same pining for a golden age that never was and belief in the inherent value of tradition for tradition’s sake that often justifies belief in the value of “traditional medicine” can also lead to steadfastly defending the sanctity of marriage, or nostalgia for the good ol’ days when men were men, women were women, and strict gender roles were brutally enforced. But there’s still a widespread hesitancy in our community to take such issues on directly.

Perhaps the desire to shy away from these more complicated and perhaps more subtle assumptions, misunderstandings and biases about gender, race, sexuality and so on is because they’re harder to unpack, harder to prove false with tests and scientific fact. But I’d imagine a large part of it is also that these assumptions are more intrinsically tied into our culture. They’re closer to us, more inherent, harder to identify because we’ve lived with them for so long, and perhaps most importantly, they’re harder to challenge because so much more of our society (and our own identities!) hinges on them. The woo is harder to see when it’s right in front of your nose, and gets harder to pull away the more is leaning on it. The social costs of accepting uncomfortable truths about race and gender are a bit higher than the social costs of accepting there’s no Loch Ness Monster. Some assumptions become so ingrained in a culture that even our science and medicine can get caught up in attempting to maintain them… so close that even people who are genuinely committed to the value of objective truth can miss their influence. That’s why not only is skepticism valuable to addressing these issues, but addressing them is valuable to skepticism. It’s hard to be an unbiased thinker when you’re immersed in a biased culture.

And that, after my long and rambly introductory paragraphs, brings us to my actual topic: the history of bias and assumptions about gender in the medical treatment of transgenderism.

It can be more than a little tricky to talk to skeptics about being skeptical of established science. That’s the MO of creationists, climate change skeptics, 9/11 truthers and homeopaths, after all. Science is our buddy, not the bad guy, right? Science welcomes doubt and questions and critique. And besides, we’re not in the 19th century anymore! Scientists aren’t measuring skulls to determine our predispositions for benevolence, melancholy or vice. We don’t compare racial phenotypes to animals and make claims about them representing “lower” evolutionary traits. Science isn’t biased anymore! It’s all good science now! …right?

The tricky part is that science and medicine is made up of human beings. Silly, irrational, gullible, wonderful human beings, possessed of exactly the same failings that make skepticism and the scientific method necessary in the first place. That’s as true today as it ever was. And as mentioned, the more ingrained an assumption is, and the more is dependent on it, the harder it becomes to exercise that skepticism.

Gender is something VERY close to us, and upon which a great deal rests. Not just socially, but for each of us, as individuals. We all want to feel secure in our gender, that it’s stable and unwavering. It’s one of the core aspects of our identity. You might even say it’s the first aspect of our identity. Before anything else about who we are has been established, the question gets asked: is it a boy or a girl? Doctors want to maintain the stability of that aspect of our identity as much as anyone else, and have just as much at stake, and that can get in the way of maintaining a truly objective approach to the times that it isn’t quite stable, binary and fixed. And on top of that, considering your patient’s quality of life also means considering how they’re going to fit into the world and live in it.

Intersexuality and transgenderism pose a strong threat to the stability of gender. They’re the loose threads in the comfy sweater of gender binaries. The existence of such people makes it clear that we can’t treat the concepts of “male” and “female” as binary, mutually exclusive opposites that stay fixed and stable. They overlap, bleed into one another, are mutable and composed of all kinds of different things that can occur in all kinds of different combinations… chromosomes, hormones, primary sexual characteristics, secondary sexual characteristics, gender identity, gender expression, sexual orientation, the ability to tell “eggshell” from “beige”, etc. Trans women also pose an additional cultural threat to the assumption that maleness and masculinity are naturally superior and preferable to femaleness and femininity. So an interesting problem comes up: how do you deal with these patients, meet their needs, address the realities they represent but still maintain the ideas of gender upon which so much of our society and identities are based?

From the moment it became a medical possibility, gender transition had to be treated not as a fundamental right or choice, but only as an extreme, last ditch, no-other-choice kind of thing to be employed only when all other options had been exhausted and the patient was on the brink of self-destruction. A system had to be arranged to weed out the “true transsexuals” who were “really” members of their identified sex from anyone who might simply “want” to change sex, or be merely “confused”.  At the same time, such a system would make sure that the boundary between genders wasn’t compromised, that there was still a clear division with men on the one side and women on the other.

So… enter the World Professional Association for Transgender Health (WPATH) and their Standards of Care. This organization created a protocol for doctors and caregivers to follow when diagnosing and treating transgender patients. This served a dual purpose. The cuddly, friendly, totally reasonable purpose was providing functional diagnostic criteria, a system for making sure the patient was well-informed and able to manage the huge stress of transition, ensuring that their decision was genuine and not affected by other mental health issues, protecting the patient’s safety and well-being, and making sure they understood what treatment entailed and took the decision seriously, carefully and unhurriedly. The other, creepier, un-cuddly purpose was making sure that the patient conformed to the social expectations of gender and challenged them as little as possible. The WPATH standards of care were largely about protecting the patient, but also were about protecting everyone else from what the patient implied.

An excellent example of the kind of thing the standards of care entailed was the requirement for Real Life Experience (RLE for short, also known as the Real Life Test). This is a requirement that the patient live full-time as a member of the sex to which they are transitioning for a certain period of time before being eligible for certain treatments. This is ostensibly about ensuring that the patient can function in the new role, can adapt to the change, and will be genuinely happier and more comfortable in the new identity. There is, however, an un-cuddly aspect, of course: making sure the patient can properly conform to their new gender role and all the expectations that go with it. A notably problematic version of the RLE requirement was that in early days, it was necessary even before being eligible for hormone replacement therapy. This was hugely dangerous for the patient as very few trans people, even those who would be fully able to “pass” during and after transition, are able to do so prior to taking hormones. The consequence is a sort of “weeding out” (by proxy; through intolerance, discrimination and social enforcement of the binary) of those patients most likely to end up being visibly gender variant and therefore threatening to cisgender assumptions. It protected the cultural institutions of gender at the expense of posing a risk to the patient’s wellbeing, and potentially their life. While this particular requirement (RLE before hormones, that is) has been eased in most developed nations, it’s still in effect in some places, such as in the UK under the NHS (though I understand that it can be bypassed if you’re able to afford a private practice, like Dr. John Curtis in London). RLE requirements are still widely in effect for SRS, though…this can pose problems for those patients who have non-binary, genderqueer or androgyne identities, those who are only interested in SRS but not interested in social transition, and for butch or tomboy-ish trans women and effeminate trans men who may be considered to not “really” be living or presenting as the target sex.

What, exactly, does it even mean to live and function as female or male? It’s important to note that the standards of femininity and masculinity trans people were expected to live up to were typically outdated and far more stringent than the standards cis people were expected to meet. A cis woman doesn’t have to wear make-up every day in order to be considered living-as-female, does she? This disparity in gender role expectations has eased over time, but it’s still very much in play.

Another notable issue with the gatekeeping system was that patients were usually strongly encouraged to cut all ties with their past, take a new job, move to a new town, etc. This was justified as being about protecting the patient’s safety while helping consolidate the new identity. In actuality it would often be a humiliating, traumatic and emotionally devastating process that left the patient isolated, cut off from their support networks and often times unemployed (or forced into sex work). But no worries! The payoff is that no cis person ends up having to deal with the discomfort of knowing someone is trans, and our community gets quietly shuffled off into invisibility. This was perhaps the most clear-cut example of placing the gender binary ahead of the needs of the patient.

Where it gets cool and skepticky and a little more fun, though, is how the gatekeeping system ended up playing out amongst the researchers and doctors themselves. In order to be eligible for treatment, a trans person had to present with a very specific narrative and meet a specific set of criteria. Trans women, for instance, had to be sexually attracted to men but to have never identified as gay or been sexually active as such or ever have strongly participated in that “lifestyle”. They had to desire genital surgery without reservation, they had to present with a very conventionally femme personality and style (like notoriously being expected to wear heels to all their psych appointments), and they had to present with absolutely no co-morbid disorders. But the trans community is small and tight-knit …we may squabble a bit, but we try to look out for one another and we love to share information. It didn’t take long at all for trans people to learn the “expected” narrative and presentation, and learn that their treatment depended on telling the doctors what they wanted to hear. So when various research and surveys were conducted trying to understand transgenderism, their distrust of the medical establishment came into play, and the subjects responded with the answers they’d been taught to give rather than their actual experiences and feelings. The distorted data came back to the doctors and ended up being used as proof that their initial assumptions were correct, and as further justification for maintaining the gatekeeping system that produced those answers in the first place.

They approached the subject of gender and transsexuality with a certain set of assumptions in mind, created a system that distorted the reality into a reflection of those assumptions and forced any individuals whose narratives would contradict the assumptions out of the data, and then took the results that system produced as evidence that the assumptions were correct all along. Rather not unlike someone going to visit a psychic with the assumption that it works, offering verbal and body language cues to the psychic to work their cold read, ignoring the misses while paying exaggerated attention to the hits, and then walking away from the experience taking it as evidence that their belief in psychic powers was correct all along. THAT is why skepticism is of huge importance to social issues like cissexism, and that is why these issues are valid concerns for skeptics to address.

Over the past decade or so, the gatekeeping system has finally begun to erode. While that’s partly due to the efforts of feminism and the gradual broadening of the way we understand and treat gender, and partly due to the hard work of LGBT activism and awareness, it’s also due to many good, skeptically-minded doctors and scientists recognizing that the realities didn’t match the narrative, recognizing that their patients histories needed to be recognized rather than stifled or treated as conditional for potentially life-saving treatment, and placing the importance of good science, critical thinking, and their patients’ well-being above the assumed realities of sex and gender. As the standards of care began to loosen, the predicted epidemic of regretful accidental transitioners never happened, the satisfaction patients expressed with transition improved, and overall cultural attitudes began shifting in the direction of tolerance rather than hostility. The horrible consequences the gatekeeping model sought to prevent never came to pass. Hurray!

So… I guess, when the question of how social issues like trans-feminism and skepticism are important to one another, or when people wonder about the connections between my being a skeptic, a feminist and an advocate for trans rights, I just reflect upon the fact that I was able to transition without ever once having to lie to my doctor or distort the truth. And I can go to my appointments in a t-shirt and jeans, rather than dressing up like I’m going to a cocktail party or trying to seduce the poor guy. Honestly, I don’t know how I could possibly be a skeptic, a feminist or a trans-rights advocate without the other two.


Natalie Reed now writes at http://www.freethoughtblogs.com/nataliereed

Related Articles


  1. I love you Natalie, I have to say that. *hug*

    I am at work right now and don’t have time to give a long response but I need to thank you. You have given me a lot to think about and I need to formulate my thoughts to better express everything I am feeling but suffice it to say that only a few short months ago I didn’t know the difference between sexuality, sexual orientation, and gender, I couldn’t identify transphobia if it happened right in front of me (or even if I perpetrated it), and I had to look up what a cis-gendered person was.

    With outreach and understanding-without-judgement like you have shown it will get better. I promise. :)

    A longer respond will follow later.

  2. Hi Natalie!

    Thanks for this. I have to say, I’m really excited to hear from transfolk in the skeptical community. I understand the trans experience of the medical system is at odds with the way it’s often promoted in skeptical circles, which ignores some of the system’s flaws and non-science-based practices.

    Er – not to say I’m not valuing what you have to say as yourself. But it’s cool to get another perspective that hasn’t had much of a visible presence.

  3. Wow. I had no idea that makeup and heels (really guys? Heels?) were (and still are) a requirement for trans people to meet doctors’ approval for SRS. This was really eye-opening. It’s heartening to see that there were enough skeptical doctors who looked for facts rather than looking for confirmation of their own bias.

    1. It’s not really the case anymore. Things have gotten much better over time. But back in the 70s and 80s, and probably into the 90s, yeah, it was definitely an unwritten rule that if you weren’t going all-out femme you weren’t “really” presenting as female, and that included make-up and heels.

      It can still be the case if you get the wrong doctor, though. They’re always in control whether or not you get your approval letters or your scripts. If you’re in a big city, or in the right parts of the world, you can find a different doctor, or go to an Informed Consent Clinic, but if you’re not…. you could easily get stuck with a stubborn gatekeeper who will make your transition as difficult as conceivably possible, and keep gender expectations as narrow as possible.

      People in those situations often have not choice but to “DIY” by ordering meds off the internet. Which is highly dangerous… so, yeah, I don’t have a lot of respect for doctors whose decisions directly lead to their patients endangering their health.

      1. Even for people who’ve gotten HRT and some surgery, finding trans-friendly medical care for other stuff can be a huge problem.

        I have a friend who came to Montreal from the UK, and while they’ve had one or two good experiences, they’ve also had a bunch of doctors who’ve been physically intrusive, and nurses who insist on calling them “it” or using female grammar when speaking of them in French.

        So even after getting past that gate, it’s still an uphill struggle.

  4. Awesome Natalie, think you covered all the important things there :)

    To illustrate how strong the gender binary is/was in medicine: In the 20s and 30s it was so surprising to discover that so-called male hormones were important in female development and so-called female hormones important for male development. That did not at all fit with the neat picture of sex-hormones maintaining the binary. It was met with skepticism. Not even skepticism is immune to the goggles of socio-cultural bias.

    Medical advancement had developed to the point where the inconvenience of hermaphrodites—as they were called—was as good as eliminated. Western society quickly forgot that gender wasn’t always either/or. Surgery—often at great personal cost to the child—was used by doctors to enforce the binary, and parents often kept in the dark about the reality of their child’s condition. It was even in the guidelines to inform parents as little as possible in order not to upset them unnecessarily. Unethical I’d say.

    I’m glad to see things are changing for the better …

    1. Yep. The unnecessary and non-consentual surgical modification of intersex infants (which still sometimes goes on today) is a PERFECT example of the medical establishment violating ethics and playing fast and loose with the well-being of the patient in favour of maintaining a gender binary. Thanks for pointing that out!

  5. Incredible post! Posts like this are EXACTLY why I love skepchick soooo much. And to your point “to what extent should social concerns…be incorporated into the overall agenda of skepticism,” I say they absolutely should be part of skeptic dialogue. I can’t think of a single subject area that can’t benefit from science and rational thinking. No topic should be off limits in the skeptic community. In fact, as a long time skeptic, I’m getting to the point that I barely skim over UFO and big foot stories. Let’s talk politics. Let’s talk social issues. When we get into these complicated areas, not all skeptics are going to agree on everything, but that’s ok. In fact, that’s great! That’s what living in a democracy is all about. And for skeptics to shy away from controversial, socially relevant issues would be terrible indeed.

  6. Natalie, thank you SO MUCH for writing this. I’ve only really come out as trans to myself and others in the last couple of years, and am at the beginning of my transition. And the thing is, being trans has made me feel somewhat alienated from the skeptic movement, which had previously been something I was invested in. It’s not that I’ve experienced direct transphobia (although I do have a memory of one of the Novella brothers saying some really unfortunate things about the “pregnant man” in an episode of SGU), but I have frequently felt like the movement as a whole doesn’t care if we exist or not, and regards social and sexual issues as frivolous (and implicitly feminized).

    A post like this, though, makes me feel welcomed back in a very specific way, and for that matter so does the realization that Skepchick now has a transwoman blogger. On that note, I should also offer some props to Rebecca, who has always been a progressive force in skepticism (and was also the only one really arguing against transphobia in the aforementioned SGU episode). It was her twitter that led me here today, but now I think I’m back.

    1. This comment makes me really, really happy. I even got a bit watery eyed. Thank you so much!

      If there’s one thing I’d most like to accomplish by being involved with Skepchick, it’s to help other trans people, and other LGBTQ folk in general, feel more welcome in the skeptic community.

  7. I’d call my gender androgynous. I don’t identify enough with either of The Big Two and even then I find those gender proscriptions akin to astrology, general assertions that most people would relate to. If you do identify with a Big Two descriptively, that’s great; it’s who you are, no matter why. I just don’t think possible minor biological differences between XYs and XXs (lest no one forget, these aren’t the only two) mean people HAVE TO BE a certain gender or HAVE TO HAVE these fleshy bits attached in a specific configuration.

    It’s interesting that the most “masculine” tomboy and “feminine” lady girl with vastly contrasting interests and skills can both say they’re women. It’s a gigantic overlapping spectrum. Why not a gender for both and one in between, et cetera? Even if they do have differences from men in quantifiable ways? I dunno why hypothetical spatial rotation abilities are deciding what gender is. So yeah, trans folk are awesomesauce and are a really great addition to the philosophical discussion of personal indentity, though, admittedly, most people have identities and it’s interesting anyway, but I digress.

  8. This post is awesome! I’m so excited to see more!

    To be honest, I find the sex/gender concept kind of confusing. I really dislike the gender binary, but I think I’ve been confusing it with gender stereotypes. If you break down gender stereotypes, what is left of the binary?

    If someone could link to a transgender version of feminism101 I’d really appreciate it!

    1. http://nnhs-gsa.org/transwhat/confused/

      This is a pretty good start.

      I would argue (and have argued) that the binary doesn’t really exist, and certainly not in any scientific sense. It’s a false dichotomy imposed upon humanity that glosses over a far more diverse variety of identities and bodies.

    2. Trans What? is a great overview, and happens to be done by a kinda-sorta e-friend of mine.

      I think the main problem people tend to have in understanding this kind of thing is confusing “gender expression” and “gender identity”. This confusion is what leads to the erroneous “if we didn’t have any gender roles, we wouldn’t need transition” or “transgenderism reinforces the idea of an essential ‘male’ and ‘female’ role” kinds of thinking.

      Gender IDENTITY is an inherent, immutable sense of self. Gender EXPRESSION is the degree to which someone tends towards “masculine” or “feminine” modes of behaviour, presentation, whatever. It’s the former that distinguishes transsexual people from others. Our gender identity clashes with our physical sex, so we alter our physical sex to bring them into a more comfortable harmony. Our gender expression can be anything: femme, butch, tomboy, androgynous, effeminate, macho, whatever. Same as with any cis person.

      This is another good link:


      I’m not too fond of the “spectrum” model as it leads too quickly to hierarchy (“I’m more female than you!”), but it’s a good starting place for understanding these important distinctions.

      1. As a better description than the spectrum where male and female are opposites, an orthogonal version have been suggested. In that model how female you are does not affect how ,male you are and vice versa. It accounts better for the variety than the linear model.

      2. Oh. Ok, yeah, I didn’t consider that the concept of gender was split in two.
        I actually never heard the term “gender expression” before, but the chart cleared that up – even if the continuums may be too linear. Thanks yo.

  9. What an excellent post.

    My brother transitioned about 5 years ago and the process has been packed with unexpected situations, things nobody ever thought of.

    Thanks for showing me a few more.

  10. Awesome post!

    Some people really have a problem being skeptical about the assumptions they hold as exceptionally normal, like the gender binary, what people of a certain gender look/act like and what constitutes “really” identifying as whatever gender.

    I’m a genderqueer androgyne myself, and I love how excellent Skepchick is for LGBTQ skeptics. :)

    1. I’d like to reinforce to BeccaTC’s comment as another in the skeptic community who identifies as a genderqueer androgyne — but moreover as someone who has had feelings of gender identity and body dysmorphia for what seems like all of my adult life, and have only recently decided to take the first hesitant steps at transitioning, I cannot thank you enough, Natalie, for adding an articulate and compassionate trans* voice to the community here at Skepchick. What a great first post.

  11. A) Fantastic introductory post. I’m sharing this all over the place. I’m lucky enough to live in a large city with an active community caring for trans folks, and gatekeeping has been minimal. I still remember how much more depressed I was at the beginning, though, when I thought transition meant ending my old life. I never could have done it that way.

    B) I love your description of having kicked your Y chromosome’s ass. Brilliant.

  12. Great first post! I found it very interesting and enlightening, and I found myself agreeing with what you were saying, even though I’m cissexual, because I’ve seen this pervasive “status quo” mentality all throughout science.

    I, myself, rejected the gender binary a long time ago, and don’t understand why people have the need to put people in boxes. In terms of gender expression, I identify as neither male nor female, and I resent people’s attempts to put me into either box.

    Looking forward to hearing more!

  13. Nice to see you here Natalie. I thought about you today at work. One of my co-workers said she needed a man’s assistance in something. I got confused and thought about the conversations over at the SGU about gender roles. When she started talking about her car I felt sad for a second. What does having testicles have to do with knowledge about cars? What would lacking a Y chromosome inform someone about fashion? Why do we, as a culture, insist on these pre-built roles based on nothing more than what sexual bits you happen to own?

    I’m glad to know and read from the trans community. That was a hole in my experience, living in an rural part of the U.S. Not only am I glad for the knowledge of trans issues…but on how it informs gender roles even amongst us cis-type folks.

  14. Great introductory article! I absolutely love you self description too! Gender issues have been on my mind a lot recently, so great timing

    1. I just had to say that I love your icon. GWS is awesome, and that frame in particular melts my heart every time I see it. The closer in you look at it the better it gets.

  15. Yay! I’m so glad you’re here! I had been seeing more trans-related discussions cropping up all over the skeptic blogosphere, and when Skepchick put out the call for submissions I thought it would be great if we could find a trans voice.

    Even better is that what you’ve written about here is something that I’ve been thinking about myself recently. Just finished reading Delusions of Gender, and only recently came to terms with my own gender-related anxiety. and you’ve given me new words to describe something I had been feeling myself (Identity vs expression!).

    So, thanks! I look forward to your further writing!

  16. Great read! Glad to have you here.

    On the topic of what and what isn’t in the domain of skepticism: Honestly, whenever I hear somebody say, “skeptics shouldn’t be commenting about ____” they’ve completely lost me. Nothing is exempt from science, critical thinking, and rational inquiry. Especially these days when there are plenty of sex researchers who aren’t evo. psychologists ;)


    P.S. At the risk of sounding like a company mouthpiece, this year’s World Science Festival had a great discussion on the science of sexuality and one of the focuses was the idea that our binary system of gender is a cultural construct rather than a biological “norm.” http://worldsciencefestival.com/search/tag/group-The+Origins+of+Orientation

  17. Wonderful first post Natalie!

    As a skeptic and a trans-woman, I am thrilled to see a post like this.

    I am happy to say that I haven’t encountered any gatekeeping to this point (granted, I’m only a month and a half in on hormones).

  18. Great post, Natalie!

    I recently read a medical article – and I don’t know if it was posted here on Skepchick – where doctors admitted with sort of an amazed tone that some people with XXY chromosomes may identify as female or as androgynous, and may not identify as having Klinefelter’s syndrome. It was fascinating to me because, as a ‘gender skeptic’, this sort of seems like a “no duh” (since there are XX folks who identify as male, female, or somewhere in between/neither, why wouldn’t there be XXY folks who identify as female, male, or between/neither?) – but the tone of the article was just so precious, like, “Uh… guys? We didn’t expect this… what’s going on here???” It was very cute, in an incredibly depressing way. We’ve got a long way to go.

  19. Whoops – I edited my last post too much – I meant to explain that they may not identify as having Klinefelter’s because the shorthand term is “XXY Male”, and treatment often involves taking testosterone.

  20. What an enlightening and fascinating article. I hope this world continues to move towards acceptance that gender and sexuality are subtle and varied, unique to each being. It’s amazing how hetero/cis biased the world is when you really look. I’m really glad you’re at Skepchick, Natalie. I look forward to more of your contributions :)

  21. Fantastic 1st post, Natalie! I always feel like my brain has had a workout when I read something you have written. Like others here, your insights into the world of trans-folk have really opened my eyes to a whole new way of seeing humanity, in all its many forms. How could I be less than eternally grateful for that?

  22. @Muddgirl

    Speaking as someone in science, unless you’re specifically studying hormones, you’re usually taught that XX = female and XY = male. Some people get a bit more info and learn that XO = female, XXY = male-ish, and XYY = male.

    Getting over that sort of chromosomal essentialism, even just by learning about CAIS/PAIS and other hormonal differences, has been a learning experience for me, and that’s discounting social mediation of gender, gender identity, etc.

    So scientists usually get a pretty simplistic view of gender, unless it’s their field of study. And even then, it’s still pretty simplistic for a lot of people.

    1. XY can also be female in the event of CAIS, PAIS, and…well… transsexuality.

      Also, a great many people with Klinefelter’s don’t even realize they have it, and diagnosis is quite often not made until they notice that they’re infertile. The symptoms can be very subtle.

      I’m not by any means an expert on intersex conditions or identity, but I wouldn’t be surprised if they’d feel a bit insulted by being described as “male-ish”.

        1. No no. I was trying to give an impression of what we’re taught as science undergrads, so that people who might expect more nuance from scientists will understand that most of us are coming from chromosomal essentialism.

          I like to think I’ve come a fair ways since.

          1. Just an FYI, I was taught about sex chromosome disorders during genetics, mostly as examples of nondisjunction. But, it wasn’t really a major aspect of the class and that is pretty much the closest I’ve came to an explicit questioning of the sex dichotomy.

            Although I really like something my ecology/plant bio prof has said, ‘everything in biology has an exception.’ Which fits well with this. XY means male, except when it doesn’t. Vagina means female, except with it doesn’t. High levels of testosterone mean facial hair development and other secondary sex characteristics, except when it doesn’t happen.

  23. Great post!
    I love it when skepticism crosses over into other areas of interest for me, and LGBTQ+ issues definitely fits the bill.
    Looking forward to more!

  24. Enjoyable post! It’s precisely this kind of thing which makes me despair about the UK NHS sidelining NICE – relying instead on general practitioners being well informed (they aren’t) and administrator’s being rational (they aren’t) to supply critical healthcare at the national level.

    I’ve experienced the gatekeeper effect firsthand, having to undergo RLE without any hormones – and only hair removal because I can afford to go private for that. Also the regional board made me wait 2 years – TWO YEARS – to talk to a f***ing specialist. My personal opinion is that they were hoping I’d top myself so that they wouldn’t have to spend even a small amount of money on my health.

    Erratum: Dr John Curtis -> Dr Richard Curtis (see http://www.transhealth.co.uk).

  25. I agree with the overall theme of this article. Gender and Sex binaries are harmful and oppressive, and the medical establishment as certainly been one of the worst offenders.

    However I feel a need to point out that many of the people who are now remembered as gatekeepers were once cutting edge skeptics in their own right. The psychiatrists that ended up playing gatekeepers ended up doing so because they were the ones that sought out and persuaded surgeons and endocrinologists to offer procedures that were simply never available before.

    While “Gatekeepers” were offering surgery in the “only” most stereotypical of cases, mainstream psychiatrists were laughing at them for coddling people who were considered at that time to be “confused homosexuals”. The standard mainstream treatment of that era was “Aversion Therapy”. Patients would be asked to provide several photographs of themselves – 50% photos of them in “normal” clothing, and 50% of them dressed in the “deviant” fashion. The patient would then be asked to sit in a comfortable chair where an electrode would be fitted to a finger on the left hand. Then the photos would be shown to the patient in random order, interspersed with stock photos of neutral imagery; Whenever a photo displaying “deviant” behaviour was shown to the patient they would receive an electric shock. The sad part isn’t that the treatment was offered, but that tolerance of gender variance was so poor in the mainstream community, and so few alternatives existed that many transgendered people were willing to give aversion therapy a try.

    Don’t get me wrong. The gatekeepers fell off the cutting edge. The standards that they set became entrenched, and in hind-sight, were arbitrary and unfair. However they weren’t conspiring to preserve gender norms — they didn’t have to — everyone was in on it. Schools taught home economics to girls and woodwork to boys, parents beat their effeminate sons to toughen them up, police detained cross-dressers and threatened to send them to the asylum, employers got rid of suspected employees….

    Having been through the system myself, I understand why so many people rail against it. However nothing’s ever black and white, not even the “bad guys”.

  26. ZOMG! I’m totally a Natalie hipster. I knew her back before it was the cool thing to do! You make a great addition to the skepchicks Natalie. Great first post!

  27. Medics, as a whole, are a-holes – I hate ’em! Along with lawyers and used car salesmen.

    It is ironic that some of my dearest friends and family are in these categories.

    Nevertheless, why do so many of them have to be so judgemental? – and this based on what is too often a very narrow experience of life.

    I have enough material for a book on this topic – but I’m sure a book written by Natalie would be much better and more interesting!

  28. I guess I was lucky that all the “Gatekeepers” I met didn’t give the HBIGDA (at the time) guidelines much consideration. Every one I met realized that I was informed and of sound mind, and that they had to give recognition to the barriers only in order to surmount them. It was really a formality more than anything. I mostly used the shrink time to talk about how horrible my mother was being. :\

    I’m really excited to see this post and your addition, Natalie! It’s been kind of a silent subject in the skeptical community, mostly rolled up in the LGBTQ Katamari when it’s mentioned at all. I’m interested to see more of what you have to say. :D

    PS: I just celebrated the 10th anniversary of my surgery. Now I’m feeling old. :P

  29. Wonderful post! I’m so happy to have you here and so happy to see more trans women and men coming out of the woodwork. Skepticism fits naturally with feminism AND transfeminism, for pretty much the exact same reasons: they expose deeply held prejudices and the irrationality spawned by the attachments to those prejudices. I’ve never understood the older feminists who claim that trans women aren’t real women; to choose to live as a woman in a world that is so hostile to femininity and femaleness is a deeply feminist act, in my opinion, one that takes courage. I have nothing but respect and appreciation for trans women. It seems obvious to me that prejudice for things like gender binaries is just the kissing cousin of superstitious beliefs in psychic phenomena, and it’s even more interesting because it’s more difficult to nail down, factually, than things like ghosts or telekinesis. This is where the truly interesting skeptic investigation can take place: where our irrationality is so closely related to our personal identity. It’s a real challenge, unlike Bigfoot or UFOs or homeopathy. I love this article and will be returning to it in the future. Brava Natalie!

  30. Just an aside…

    I think that having a cause is not inconsistent with skepticism. However, having a dogma is.

    To be a true skeptic, one must be willing to question (or at least listen to counterarguments about) one’s most cherished beliefs or ideas and the things one is most certain about. Even the facts.

    We often hear about people being entitled to their own opinions, but not their own facts. That is a myth. The facts are precisely what are always in dispute, in science and in everything else.

    Climate science deniers aren’t bad because they are being skeptical of science. They are bad because they affirmatively hold a belief DESPITE the evidence and in the face of the evidence. They not only draw incorrect conclusions based on faulty evidence, they claim to be skeptics by acting decidedly unskeptically. They refuse to be skeptical of their own position – their own firmly held and cherished belief or idea.

    To be a skeptic ought to involve a willingness to question all of science – even things like evolution and the Big Bang theory. Scientists do it all the time. The real test is HOW that is done. A skeptic questions using evidence – a “denier” denies in spite of any counterevidence.

  31. Looking forward to reading more Natalie! Thank you for this incredibly well written article. So glad trans issues are being included in the Skepchick universe!

  32. Fascinating read. And it gave me some insight into an experience that always confounded me:

    Years ago, I was a regular participant on the forum for a webcomic; the comic was written by a fairly extreme conservative, but the forum had a fairly decent blend of the political spectrum, and furthermore, had a lot of thoughtful individuals who would at least reconsider their opinions (within limits, usually, but you could win a few arguments if you were occasionally willing to lose a few, as well).

    One of the regular participants was absolutely dead-set against any notion of gay rights or equality for homosexuals; because Democrats generally (if tepidly) supported gay rights, the poster was a die-hard Republican. During conversations on the subject, it came out that this individual was a happily married post-op MtF living in Texas. It astounded me that a transsexual would be such a staunch social conservative, given that so many of the folks they were allied with would regard them as nothing but a freak of nature.

    And I got the impression at the time that it boiled down to identity–she was so strongly affixed to the notion of set gender roles that she couldn’t accept something (homosexuality) that seemed to her to undermine those roles.

    I’m now wondering how much of that stemmed from being… indoctrinated, I guess you could call it, during the transition process. If she went through the more extreme end of things that Natalie describes here, it could be easy to understand how she might develop hostility to the notion that one does NOT have to be a 1950s TV housewife to be a ‘woman’.

    It always struck me as a little sad.

    1. Interesting, freemage.

      The power of indoctrination is not to be trifled with.

      One theory that I have seen for why Hitler was such a megalomaniac was the psychiatric treatment he received after he was gassed and blinded in WW1. (The blindness was thought to be psychosomatic.)

      The treatment was hypnotism, something along the lines of “You are powerful, more powerful than you know, you can do anything”…!!

      Then again, not all the patients treated turned into dictators.

      To get back on topic, I would like to ask Natalie what she considers the ideal preparation regime for gender transition? (I mean for both “sides”, the doctor and the patient?)

      Should there be any exclusion criteria at all? Should there be for instance a mentor who has sucsessfully undergone the transition?

      I am curious but I hope none of these questions cause any offence.

      1. I’m not sure I entirely understand what you mean by “preperation regime”… do you mean precautions should be placed in regards to who does and doesn’t transition?

        Well, to make it clear, I think of it as a fundamental right that everyone should have. It’s our bodies, our genders, our identities, and our decision. That said, I think there should be some basic level of screening for co-morbid pscyhiatric or neurological problems to make sure there isn’t anything affecting their decision or compromising their ability to provide consent, and patients should be provided access to psychiatric care and support during transition to help with the stress, but beyond that it’s an issue of informed consent. A psychiatrist would probably be needed to provide a GID diagnosis for insurance reasons or whatever, but really, I think it’s pretty much the patient’s decision. There should be no more hoops to jump through to access treatment than what is expected of anyone else suffering from any other medical condition. We don’t ask bipolar patients to “prove” they’re “really” bipolar before permitting them access to mood stabilizers, do we? HRT alone can create a HUGE improvement in a trans patients mental well-being and quality of life. I don’t see any legitimate reason to hold that back or act like it needs to be a “last resort”. I also think the possibility of “regret” tends to get MASSIVELY exaggerated, is actually extremely rare, and doesn’t warrant anywhere near the conspicuously high level of caution and number of pre-requisites imposed on trans patients.

        1. Thanks Natalie, that is exactly the answer I was looking for. I was totally ignorant before this excellent thread.

          My wife has for a long time been sought out by the LGBT+ community because of her reputation for being non-judgemental.

          She has had transgender patients in the past (although not involved with the actual transition) and her main worry was those who overdo the HRT to the detriment of their general health – a point that you yourself made earlier, I think.

        2. Natalie said: “We don’t ask bipolar patients to “prove” they’re “really” bipolar before permitting them access to mood stabilizers, do we? ”

          I agree with your point, but it seems to me that we do kind of have an ‘oh yeah? Prove it!’ attitude to mental health in a lot of cases. Especially when the negative symptoms mostly affect the person who has them, rather than everyone else.

          As for the question of what is ‘worthy’ of debate in skeptic circles, give me sexism, misogyny, racism, etc. issues over bigfoot and UFOs any day. They are worthy and interesting topics that are only made better by their inclusion in a skeptical context. And vice versa. For skepticism to matter, it has to tackle issues other than the low hanging fruit. I very much welcome your contributions to this site.

  33. wow holy shit i stop lurking on Skepchick for like a month, come back and they’ve added a trans blogger?

    freaking fantastic ^_^. Wonderful to see another trans lady skeptic!

  34. I’d really like to see a skeptical look at Julia Serano’s idea of intrinsic gender identity from her book Whipping Girl. I had some resistance to the idea because it’s so squishy and hard to pin down. I think it’s valuable, though.

  35. Thank you for the article. I’m a trans woman who has been following this website for a while, and glad to see I’m not alone.

    It’s sometimes very uncomfortable joining in on skeptic sites, because they tend to be heteronormative male oriented, duh, but I try to stand up and be heard. A lot of people bring their misconceptions to the table, and feel entitled to tell you that their thoughts on gender and sexuality are the correct ones.

    Sheena, amateur scientist, librarian, lesbian transsexual woman with a chip on her shoulder

  36. BTW: there is not any such thing as a “medical” gender transition. There is a “medical” sex transition. There is a social gender transition.

    I say this b/c, despite a generally good post, when we get careless with these, we reconfuse the very people we’re trying to unconfuse. I do know that some people actually believe that there’s no difference between sex and gender. But if you are going to say that there’s a difference between the two, you should really be consistent.

    Not to dis your work, just an encouragement to even better work in the future.

    1. Fair point. While transition certainly contains elements that are about gender, such as presentation, the medical, physiological aspects are associated with sex. The trouble is that I’ve never really seen the term “sex transition” used. And I find the terms “sex change” / “sex change operation” to be outdated, and lead to inaccurate assumptions about it being a single procedure that fundamentally changes your sex from one to the other, rather than a gradual, holistic process that may or may not involve lower surgery (which only modifies one particular aspect of one’s body / sex). While many people will well understand that “sex” pertains to more than just one’s genitals, there are many who don’t, and using it to refer to something like transition can end up creating other kinds of confusion. But you raise a definitely valid point about the fact that referring to HRT, SRS, FFS, etc. as being about one’s gender is much less accurate than to describe it as being about one’s sex.

      1. I’m not so sure that it is a fair point. I don’t know that you can necessarily separate the medical dimension of transition from the social aspect. Oh, I’m sure some people can, given the right bone structure and genetics, but if I choose to get a medical procedure like, say a breast augmentation or a tracheal shave, is there not a social dimension to that? I don’t NEED a breast augmentation to reaffirm the sex of my body, but I might choose to get one to reduce my chances of being read as trans in social situations, and that’s totally an intersection of medicine and social needs.

        For what it’s worth, I’ve never heard the phrase “sex transition” either.

  37. Hi, there was so much that I lied in this entry. Of course issues of bigotry and oppression are concerns for skeptics, after all, they are based in ignorance and fear. This is true of so many issues that skeptics confront.

    And with all due respect, I take exception to people who value “traditional medicine” being lumped together with bigots. Not only is that stereotyping, it flies in the face of the fact that one thing skeptics and believers in traditional medicine have in common is that they are usually quite progressive in social and political values. Although I often do not agree with non-scientific methods, I am well acquainted with the culture of “natural healing” and “traditional medicine.” The reason for this is that my radical socialist-feminist politics have brought me in contact with so many people who believe strongly in the effectiveness of “traditional” or alternative healing.

    Thank you for hearing my point of view.

    For peace and justice, Jim

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Back to top button