In 1966, Harry Benjamin published The Transsexual Phenomenon, one of the first works to address transness (Benjamin used the word “transsexualism”) as something other than a pathological mental disorder. Compared to modern queer theory this book got a lotttt of things wrong, but in 1966 it was a huge deal and it became the gold standard for medical professionals working with transgender patients. In The Empire Strikes Back: A Posttranssexual Manifesto, Sandy Stone discusses the effect the textbook had on transgender medical care:
“And when the first transsexuals were evaluated for their suitability for surgery, their behavior matched up gratifyingly with Benjamin’s criteria. The researchers produced papers which reported on this, and which were used as bases for funding. It took a surprisingly long time–several years–for the researchers to realize that the reason the candidates’ behavioral profiles matched Benjamin’s so well was that the candidates, too, had read Benjamin’s book, which was passed from hand to hand within the transsexual community, and they were only too happy to provide the behavior that led to acceptance for surgery.”
Those clever transsexuals realized pretty quickly that if they wanted to medically transition, they needed to fit the doctors’ ideas of what a trans person looked and acted like. So began a long history, which continues to this day, of trans people putting up with medical professionals. The medical model of disability treats impairment as a deviation from the norm that needs to be treated and prevented. While the medical establishment has, thankfully, moved away from this sentiment when it comes to trans people, medicalization is still alive and well and it affects how trans people access gender-related care.
In 2013, the DSM-5 was published, and the former diagnosis of “gender identity disorder” was replaced by “gender dysphoria,” which was supposed to de-pathologize transness and emphasize the distress experienced by trans individuals. Although it has a nicer name now, my identity can still be found in a big list of mental disorders, and I’m not sure how to feel about that.
I think medicalization is a double edged sword – Having an official diagnosis of gender dysphoria makes it “legit” to other people and it gives you access to medical care like hormones and surgery. On the other hand, it means that a trans person’s lived experience isn’t enough “proof” – You need an expert opinion, too. A lot of places still make you get a letter (or more!) from a psychologist before you can start hormones, and the process to get bottom surgery is even worse. Trans people have to pay medical professionals to tell them what they already know, and they have to jump through hoops to receive what is often necessary, life-saving care.
This June, I was able to make a virtual appointment with Planned Parenthood to start HRT. I talked with a doctor, told her my situation, and ended the call with an order for bloodwork and a plan to start weekly subcutaneous testosterone injections. This hour-long telehealth appointment didn’t even scratch the surface of the shit I’ve talked about with my trans friends, and I didn’t hear anything I didn’t already know. Thanks to medicalization and the American healthcare system, it cost $623. I only had to pay $60 out of that (thank you mom’s insurance), but it would have been a lot cooler if I could just pick up a vial of T at my local drugstore and be done with it.
Unruly Bodies 
I’m definitely of two minds on medicalization here.
On some levels I really do think it utterly fits. I use my control inhaler to essentially give myself a better body, a body that breathes easier and doesn’t have an asthma attack every day. My medication reshapes my body to a better more functional me. My rescue inhaler helps me breathe better in case of an asthma attack, thus essentially increasing the functionality of my body.
Similarly in parallel, my HRT is essentially used to reshape my body to better myself. It also at the same time time essentially stops me from having depression or anxiety, which I much prefer not having. HRT to me is fundamentally just another type of medication.
And in a medical sense, transgender care is just so easily justified as the evidence in favor of it is overwhelming. The case for informed consent is very easily made in the case of a medicalized model of transness simply due to the preponderance of the evidence of its effectiveness and the lack of regret most trans people have with HRT, and gender affirming surgeries.
Yet I feel uncomfortable for similar reasons. I do not feel that being transgender fits a mental disorder, and while gender dysphoria is a distinction, its honestly not enough of one imo.
Furthermore, I worry because there are definitely people who use a medicalized model of transness to attack nonbinary people or to attempt to push a one size fits all transition on people. A nonbinary person may or may not use HRT or various gender affirming surgeries. Similarly even a binary trans person may choose to not undergo HRT or take certain surgeries for many many reasons (and sometimes this is not out of choice but necessity).
First: congrats on starting T! I’m glad to hear you were able to navigate the hellish maze that is US healthcare to get what you needed.
Now for my main comment: I think a flaw in the medical system’s view of transness is the same as in how it views pregnancy care—the practice of medicine is to solve a medical problem. By that logic, transness has been equated to a problem, and not a fact of life. Never mind that trans people have existed and led happy lives throughout all of history!! I feel like modern medicine thinks that history started in England in 1780 or something because there is so much the field needs to catch up with.