Testosterone’s Absence: Transgender Medicine and the ‘Evidence of Treatment’

• In Event: Producing Transformations: Drugs, Bodies, and Experimentation 2

Abstract

In this paper, I explore how practices of transgender medicine compel those people who seek female-to-male transgender surgeries to commit to using testosterone as a condition of treatment. While there are always ways people resist and exceed these controls, overwhelmingly, treatment guidelines and their application demand that trans patients adhere to stereotypical understandings of sex-gender through rigorous psychiatric scrutiny and medical surveillance. For trans men, this means narrating their life experiences and expectations in line with dominant understandings of maleness and masculinity, and aesthetically, by using testosterone to sufficiently appear to be nontransgendered. By drawing on notions of performative realities and ontological politics from science and technology studies (STS), I argue that these practices act in constituting sex, gender and ‘gender dysphoria’ as static, predetermined and independent of medical encounters. This paradigm also relies on and reproduces dubious forms of ‘evidence’ that gender dysphoria is a psychiatric disorder, erasing the necessarily complex ways trans people experience gender. Through research on mastectomies (surgical breast removal), I examine how access to treatment differs between nontrans men, trans men taking testosterone and those people designated female at birth who do not identify as men and/or do not take testosterone. By mobilizing philosophical insights from STS, I show how care for trans people could be improved by active engagement with individual interventions and patients, rather than as a package of pursuits that form a very narrow bridge of ‘changing sex’ from one stable sex category to the other.

Author

• J.R. Latham, The University of Melbourne