Jan Bergstra & Laurens Buijs
Amsterdam Gender Theory Research Team
We previously reported on the confusion the World Health Organization (WHO) is sowing with their definition of transgender (see AGTRT-BF83). But there is more unclear medical jargon about gender. For example, on the Youth Aid Knowledge Platform site we find the following text:
“Gender affirming trajectories and their impact.
A gender affirming course includes various medical steps, such as puberty inhibition, hormone therapy and surgical procedures, to bring the body more in line with the adolescent’s gender identity and deal with gender dysphoria.”
We believe that gender dysphoria is used here where gender incongruence should have been. The medical steps are related to a medical diagnosis (for a problem that is named in the ICD) but which is precisely not in the DSM5-TR because gender incongruence is no longer considered a primary psychiatric problem. This does not rule out the possibility that resolving gender incongruence along medical steps can also reduce gender dysphoria, a possible symptom of gender incongruence.
Gender dysphoria is still referred to in the DSM-5TR but then sometimes, but not always, involves consequences of gender incongruence. Gender dysphoria can occur without experiencing gender incongruence, and conversely, gender incongruence can occur without experiencing gender dysphoria.
Finally, gender identity (as determined by the person) may differ from the legal gender (usually the gender assigned at birth) without gender dysphoria and without gender incongruence.
In the latter case, opinions are divided on the application of gender classification. Co-essentialism indicates to follow the (self-identification of the) gender identity and essentialism indicates not to. A MotR approach takes a middle ground that may vary from case to case.
These issues are directly related to the primary FGT argument (1 and 2 below) for the correctness of enabling legal gender transition:
- P’s legal transition from gender G1 to gender G2 may be a useful tool in the treatment of gender dysphoria (as a psychiatric problem).
- The interest that P may have in legal transition from G1 to G2 is so great (as part of the solution to gender dysphoria) that this interest itself justifies the law allowing legal gender transition.
Critical to this primary argument is that gender dysphoria is considered a mental health problem (DSM5-TR). Replacing gender dysphoria with the medical problem of gender incongruence knocks the bottom out of the argument: it is not clear that a medical problem can find a solution through a legal step (whereas for a psychological problem it is conceivable).
The primary FGT argument is what can be argued from FGT against the TERF ideology (see AGTRT-BF43) and against the TEFC ideology (see AGTRT-BF44). The primary FGT argument is thus also what can be argued from FGT against the extremely negative attitude about gender transition in Dignitas Infinita (see AGTRT-BF77).
For completeness, we also mention a secondary FGT argument for the correctness of enabling legal gender transition: if bodily gender is seen as morphological gender (still perfectly common until say 1950), then gender transition is also possible from an essentialist perspective. Working along that line has created an acquired right to gender transition that endures even after the notion of physical gender has migrated to a more fundamentally biological interpretation of it (which would make gender transition in technical terms precisely implausible, the TERF argument, “once a man always a man”).
Finally, we note that the primary and secondary FGT arguments are of a different order than further arguments for utility and reasonableness of the possibility of gender transition. These other arguments come into play only when the possibility of legal gender transition has been accepted in principle.
Primary and secondary FGT arguments are intended for use in discussion with essentialist opponents of legal gender transition. We explicitly do not see the co-essentialist argument that formal gender is simply determined by gender identity and that legal transition (in terms of regulation) must formally follow gender (a matter of human rights) as a decisive argument and certainly not as an argument that is usable with the opponents from essentialist quarters.