March 31, 2022 | 11 minutes read | Tags: Oppression and Liberation

Let A Hundred Sexes Bloom, or: Transcending Paternalism

Comrade AE offers an understanding of the necessary relationship between trans liberation and socialist revolution whilst criticising strains of reactionary thought.

A Critical Response to Cosmonaut’s “Trans-cending the Market”

In September 2019, Cosmonaut published an article titled “Trans-cending the Market: How Socialist Planning Can Meet the Needs of Transgender People”, authored by Stani Bjegunac. This article was more recently brought forward by Red Fightback’s Economics Circle, a weekly cross-party group for studying economics, as a basis for a joint educational session with the party’s Anti-Patriarchy Caucus. What follows is a critical response that emerged from the caucus reading and discussion of Bjegunac’s article, originally written as a preface to the dialogue between APC and EconCircle. We publish it now to advance an understanding of the necessary relationship between trans liberation and socialist revolution, and to critique the strains of reactionary thought in the article which pose obstacles to both these goals alike.

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In our current political hellscape — in which many on the so-called “radical left” uphold the same lines about gender/sex/sexuality as the most brazen reactionaries and fascists — the premise of “Trans-cending the Market” is a welcome one. Bjegunac sets out to refute the idea that socialist policy can only account for the needs of a homogeneous gender-conforming population, and proposes that central planning can advance trans liberation by efficiently providing two key things for trans communities: gender-neutral bathrooms, and “uniquely transgender needs like Hormone Replacement Therapy (HRT) and sex-reassignment surgeries.” This framing, while benevolent, reveals veins of paternalism and basic ignorance that run deeply throughout the article. Rather than addressing issues line-by-line, this response will take the form of a general argument that walks us through Bjegunac’s broader analytical failings.

At the outset, the article’s conception of “transgender needs” is couched in a fetishistic understanding of transness/transition as primarily defined by Hormones And Surgery™. Some of the less fixated-upon services that transition might involve, like hair removal or voice training, or other surgeries like facial feminisation surgery, are not even mentioned; yet these services would surely need to be brought into the realm of healthcare in any system taking a holistic approach to trans health. Nor is there any awareness shown of the costs (in money, time, and energy) of navigating bureaucracy, updating identification, generally organising one’s own transition in whatever that entails — or of other possible expenses like new clothes or assistive items such as binders, gaffs, packers, wigs, etc. The overall understanding of transition displayed here is disappointingly shallow, but since the terrain of the article is ultimately limited to hormones and “sex reassignment” surgery, let’s start there.

While access to hormones and surgery is arguably more relevant to trans people than the rest of the population, it’s completely erroneous to say that they are “uniquely transgender needs.” Bjegunac does go on to acknowledge this, somewhat contradicting the article’s opening pitch, but their acknowledgement is devoid of political analysis. In reality, various forms of hormone treatment are also used to treat non-transgender people: e.g. cis women going through menopause, cis men diagnosed with “low testosterone” or with prostate cancer, and some intersex people with specific medical needs — which, it should be made clear, are more often than not the result of complications from nonconsensual “corrective” interventions in their infancies and childhoods, rather than an inherent nonviability of intersex bodies. It’s also extraordinarily easy for cis people to access these hormones, compared to the intensive programmes of gatekeeping that mediate trans people’s access, because that is who they are actually produced for. In other words, most hormones (and blockers, etc.) are manufactured with the assumption that they are to be used for stabilising cis-normative gender/sex embodiment rather than facilitating gender/sex transition. Injectable testosterone comes with leaflets warning women to stop taking the medication if they notice their voice deepening, androgen blockers come with instructions for men to be wary of reduced libido — and so forth. Likewise, even genital reconstruction is hardly a uniquely trans phenomenon. There are procedures to give cis men bigger, shapelier penises and cis women smaller, neater labia: can these honestly be described as anything but gender-affirming surgeries — genuine “sex reassignment surgeries”, even, in the sense of a reiterative assignment of the original assigned sex?

The point here is that, essentially, gender-related medical practices for cis and trans people are more different in their political applications than in their material functions. For example, the double mastectomy (surgical removal of both breasts) is often categorised in trans health discourse as a transmasculine procedure (“top surgery”), but other than typical aesthetic differences in the final stage of reconstruction, it’s functionally the same surgery that is performed on cis women with breast cancer (or those at severe risk of such). It’s also the same surgery that is performed on cis men with “gynecomastia”, a totally benign “condition” in which a cis man has prominent breasts (fun fact: because the only harmful side effect of gynecomastia is gender dysphoria, gynecomastia is one of the clinical diagnoses that can be officially used for billing trans mastectomies to health insurance in countries like the US). It’s not the surgical method or the biological condition that differs between each of these cases, all of which simply amount to the removal of breast tissue: it is the gendered positionality of the patients.

With these examples we can begin to understand how, under patriarchal social and economic systems, normative gender is foundational in constructing norms of health and wellness, illness and pathology. Intersex people — and to a lesser degree, cis people who may or may not be intersex but in any case possess “incongruent” secondary sexual characteristics (e.g. cis men with breasts) — may not suffer medically from their physical differences, but nevertheless are deemed to have diagnosable “conditions” because of them. Trans and gender-nonconforming people (who may also be intersex) are deemed psychologically unwell because we consciously pursue this hated gender-sex incongruence in order to overcome it, or to embody it intentionally and defiantly. Cis people, though, with their baseline conformity to patriarchal capitalist gender structures, may seek hormones and surgery to artificially maintain or increase their “natural” sexual dimorphism, and not only will they still be considered perfectly normal and healthy, they will be upheld as the models of normalcy that we pitiable inter/transsexuals should aspire to.

Regardless of who gets them and why, all medical interventions into the gendered appearance of human bodies are fundamentally interrelated. To problematise one is to problematise them all. And, while we can articulate the possibility that many if not all of the social/cultural pressures which produce gender dysphoria in trans and cis people alike may eventually wither away along with various other vestiges of capitalism and colonialism, we can also uphold the principle that bodily sovereignty must be the cornerstone of a post-revolutionary society. If full communism is achieved, patriarchy is totally abolished, and it turns out that some people still desire physical transition, can there be any non-reactionary case for stopping them? Bjegunac makes a deeply awkward attempt at representing both sides of this argument: one that hopes transness will disappear, and one that envisions its fantastical proliferation. “Let a hundred sexes bloom,” indeed; the thing is, a hundred sexes are already blooming — no need to wait for a sci-fi-esque xenofeminist future to make this possible — but too many of them are being cut and discarded as soon as they begin to grow, pressed into the cold pages of newspaper obituaries or academic journals, and uprooted from social/cultural/political existence altogether.

It is not possible to speak seriously about central planning for gender liberation without proposing, first and foremost, a centralised dismantling of the existing tyranny of legal sex categorisation, which is used in myriad ways to ensure the coerced assimilation and violent confinement and destruction of countless trans, intersex, gender-nonconforming people’s lives. Bjegunac writes of liberating trans people by demolishing gender-segregated bathrooms and rebuilding sexy new gender-neutral ones. While there is merit to addressing the organisational problems embedded in capitalist architecture, it would do more good for trans liberation to simply remove gendered signage from existing toilets, and instead prioritise demolishing the institutional precedents for our entire lives to be forcibly structured around a designation of “M” or “F” (or even “X”). Where is the proposal to abolish sex as a legal category, to forever ban conversion therapy and nonconsensual ‘corrective’ surgeries? Why should we direct “phone-gazing unemployed youth” to spend their days calculating the quantities of brick and timber it will take to build new bathrooms, when the source of trans people’s oppression is not the bathrooms themselves, but the gendered and racialised systems of policing, surveillance, and criminalisation that threaten us for using them?

The limits of the article’s understanding of “trans needs” are also revealed in its discussion of gatekeeping. The assumption seems to be that if the gates are flung open, the same meagre proportion of the population will keep trickling through them. But in our present context, the gatekeeping of physical transition also functions as the gatekeeping of transness itself. As Bjegunac does rightly articulate, not everyone who wants to medically transition is necessarily able to. Social pressures aside, the economic barrier to hormones and surgery (as well as the various other possible needs discussed earlier) is a high one. But gender nonconformity also exists beyond the boundaries of conventionally medically-defined transsexualism; we know from our own communities’ histories that the lines between L, G, B, and T have never been anything but blurred, try as clinicians might to draw them in black and white. While “true transsexuality” has been wielded by institutions as the prerequisite for medical transition for decades, the desire to access what is now called “trans healthcare” is a desire that is present, often latently, throughout the nebulously defined queer population. Just as there are trans people who don’t necessarily want medical interventions, yet still live openly in their gender, there are also people who do want these things without necessarily Identifying As Trans™. Under a healthcare framework free from gatekeeping, based on principles of bodily autonomy and true informed consent, more people than ever before will want to “transition” in some sense. This is what socialist central planning will actually need to account for. The end of gatekeeping means the opening of the floodgates: a deluge of a hundred or maybe a thousand more sexes, eager to bloom on their own terms.

Unfortunately it would appear that Bjegunac, consciously or not, still bears some degree of allegiance to the gatekeepers. Their proposal for post-revolutionary hormone access is that “anyone who wants HRT can have it; all that is required is to ask for a prescription, then the necessary tests can be conducted.” Anyone who has been to an existing informed consent clinic is already familiar with how this scenario goes. You ask for a prescription, and are told by a kindly cis doctor that you’ll receive it, pending “the necessary tests”, the necessity of which will not be explained to you because it is a lie told to control you and scare you off “DIY” methods. Then, if for any reason the doctor feels that you might not be in the ideal place circumstantially to begin taking hormones — perhaps you’re about to move, or start a new job? it’s not as if transition is often accompanied by other major life changes, after all! — they can turn you away on the basis of their medical expertise. This proposed model does nothing to deconstruct the often abusive power dynamic that exists between trans people and our self-appointed “professionals”. On the contrary, it presumes, under socialism, an outright continuation of this oppressive dynamic and the institutional powers of medical professionals over trans health — it merely insists that we can trust them now because they are socialist medical professionals, and perhaps they’ll face repercussions (like being “blacklisted”) if they guard the gates too closely.

The point of revolutionary trans healthcare, though, is that we should hold complete power over our own transitions. A better proposal would be to make hormones available on pharmacy shelves, right alongside medications like paracetamol and aspirin — medications which are potentially dangerous if used irresponsibly, yet are used safely by millions of people every day without any need for institutional surveillance. Trans people deserve total control over our transitions because the material reality (a biological fact, if you will) is that there is no one more qualified to wield it. As a dysphoric intersex child, I grew up hearing cis women talk about how they experienced the shifts of their hormonal cycles, and had no idea what they meant; as a transsexual adult who’s tried nearly every hormone there is to try, I know now exactly what they were talking about. Hormones are highly individual, and the effects they can have on mood, energy levels, and general feeling of balance in one’s body can only be usefully assessed by the person taking them. With this in mind, concerns about the safety of HRT are wildly overblown; the claim that “an effective and safe HRT regime requires monitoring of blood samples for hormone levels and effects on the organs” is outright GIC propaganda. It’s a tautology often repeated by doctors anxious about self-medding (and sometimes by trans people anxious to stay in good repute with their doctors), but it is simply not universally true, any more than it is true that all cis people need to get regular blood tests lest their organs fail. Monitoring of hormone levels primarily serves to measure trans people’s biological functions against a target cis ideal. Unless an individual has particular serious risk factors (of the sort which would have already been identified by a competent health system), there is no need for ongoing monitoring as a general rule, and the insistence otherwise amounts to a pathological framing of transition as something inherently dangerous — one of the primary justifications for gatekeeping under the current system.

Of course, as the article correctly states, scientific research into transition is lacking by comparison to other medical issues. This doesn’t mean that medical knowledge about transition doesn’t exist, though; it just means that the sites of knowledge production lie outside of the medical establishment. Community knowledge has long subsumed and outstripped institutional knowledge, and under socialist healthcare, it should finally be given the respect and status it is due. Here, central planning could be used to implement a programme of collating and distributing community-sourced information about trans health: using our collective expertise as the basis for a revolutionary healthcare framework, forging pedagogical relationships between trans communities and new socialist institutions of health and medicine. In aspects of transition where the labour of trained experts is required — such as surgeries, voice coaching, operation of electrolysis/laser equipment, and indeed the pharmaceutical production of hormones and development of new medicines — the state should not only plan to train and employ such workers, but should also provide resources and accessible pathways for trans people, ourselves, to become them. With socialist revolution, the future of trans healthcare, and indeed the future of all healthcare, will be a project of oppressed people collectively taking power over their lives and well-being into their own hands. An end to gatekeeping cannot be achieved by making policy changes within a structure that gives medical professionals the power to preside over transition; it requires a change to the system of relations in which they can act as gatekeepers at all. It doesn’t mean just handing everyone instructions to acquire a key to the gates — it means unequivocally smashing the gates.

Perhaps the greatest fallacy of Bjegunac’s article is the assumption that trans people actually have all that many “unique” needs that socialist central planning will need to solve. When all is accounted for, we don’t have distinct needs so much as we face distinct oppression in being refused basic needs, basic freedoms — social and economic punishment for breaking the “natural” laws of patriarchy. Trans oppression under capitalism is characterised by denial, rejection, suppression, marginalisation, and attempted eradication on the basis of our transness. Our gender nonconformity is used as the basis to exclude us from all arenas of social and public life. Perhaps we can’t get jobs because employers won’t hire us, or we fall into poverty because our birth families cast us out in disgust. The list of examples could go on and on; institutional enforcements of sex categories are designed to trip, humiliate and strangle us out of existence at every turn. Remove the boots of the state and the medical establishment from our necks, though, and we will be capable of managing ourselves. If a centrally planned socialist system can deliver on the promise of universal access to food, housing, and radical healthcare, no gendered bathroom will suffice to maintain patriarchy amidst the forward surge of trans liberation. The paternalistic notion that we need to be carefully tended to, rather than being left to bloom wild as our own natures intend, is just another facet of the current oppressive system that must — sooner rather than later — be transcended.