The Scientific Case for Trans Acceptance is Simple and Necessary

And it's time we fight to put it back on the table

One thing I have been concerned about for several years now is the de-emphasis of the medical scientific case for trans acceptance, and the damage this is doing. Certain activists have attempted to silence the case for trans acceptance based on the medical scientific understanding of gender dysphoria, doing everything from discouraging people from discussing this in the trans community, to de-platforming those suspected of being 'transmedicalist', whatever that is supposed to mean. This has led to the medical scientific case for trans acceptance not being heard much in the trans discourse. In contrast, anti-trans forces often use their limited understanding of science in their arguments. While their use of science is flawed, it often goes unchallenged because the other side is unwilling to talk in scientific terms at all. All this has ultimately led to the appearance that anti-trans ideology is scientific and objective, and that clinical treatment for gender dysphoria is no more than a lifestyle choice, which ultimately leads to policies like withdrawing Medicaid funding for such treatments. This is clearly a problem we need to address, if only for the sake of preserving access to medically necessary treatments for gender dysphoria.

The medical scientific case for trans acceptance is simple. In clinical medicine, conditions are often diagnosed based on repeated observation of the same pattern in different patients, at different times and in different places. The validity of gender dysphoria as a medical condition is thus established because of it being repeated observed in thousands and thousands (or perhaps millions) of patients, across at least the past 100 years, and all over the world. This is actually a reliable method of establishing the validity of a condition, because things don't present in the same way randomly.

Moreover, the establishment of gender dysphoria as a diagnosis means that doctors can attempt to treat it. The goal of treatment in medicine is to alleviate pain and improve the quality of life. Ideological considerations like whether a certain kind of treatment conforms to social expectations are not relevant here, because they would distract from putting the patient first, which is what a doctor should be doing. (It is this point that I'm worried people like Jordan Peterson might not fully understand.) Instead, a doctor simply practices medicine in an evidence-based way, and the evidence shows that medical transition is the only treatment that is effective for relieving gender dysphoria that meets the established diagnostic criteria. While there is indeed a minority of cases of transition regret, many more patients end up benefitting from the treatment, which is why it is medically justified. To withhold the treatment from the patients who would benefit from it would be unethical indeed.

Those arguing that we can't prove the validity of trans identity and gender dysphoria because we don't know enough about the biomolecular pathways (e.g. DNA, genes, proteins) that lead to gender dysphoria simply don't know how medicine works. Doctors never start out knowing the biomolecular basis of a condition, and they certainly can't wait until the biomolecular basis is known before they start treating patients. If medicine functioned in this way, then doctors would need to refuse to treat a large number of conditions, because we still don't fully understand their biomolecular basis even today. However, to do so would be unethical, because to withhold treatment from patients who would benefit from it, while the treatment is available and established to be effective, would be unethical. Furthermore, the fact that we (meaning humankind) don't know the biomolecular basis yet is the fault of our understanding of the science not being advanced enough, and not the fault of the patients needing treatment. Society certainly should not punish the patients for our own lack of knowledge! Gender dysphoria is no different from the other conditions that fall into this category here.

The activists calling for the 'de-medicalization' of trans identity aren't helping either. They have encouraged several common misconceptions, like how 'de-medicalization' is needed for the acceptance of non-binary identities, or how those opposed to 'de-medicalization' only accept trans people on the condition that they have certain surgeries. However, what these misconceptions share is the idea that it is the surgical treatment that makes trans identity 'medical'. This, in itself, is perhaps the biggest misconception. As previously discussed, the medical validity of gender dysphoria is based on repeated clinical observation and diagnosis. The establishment of gender dysphoria as a condition is established prior to any treatment, and it is not in the option to undergo treatment that medical validity is established. Therefore, we actually do not need 'de-medicalization' in order to accept non-binary people etc. Recent trans rights reform proposals that recognizes these identities are also not dependent on the idea of 'de-medicalization' at all.

I believe the calls for 'de-medicalization' actually have less to do with non-binary acceptance and more to do with postmodern philosophy, particularly Foucauldian philosophy, which forms the foundation for what is called Queer Theory. Foucault was anti-medicine and arguably anti-objectivity, and these attitudes have carried over to Queer Theory. However, this model is highly unsuitable for arguing trans acceptance and trans rights. A decent society would certainly do their best to accommodate people with special needs. The medically established validity of gender dysphoria means that trans people should qualify as having special needs needing accommodation. However, Foucauldian philosophy, Queer Theory and activism based on these ideas actively deny the medical scientific case for trans acceptance, and instead places trans rights within  a framework of critical anarchism, where it doesn't belong at all. This serves to confuse the whole argument for trans acceptance and accommodation, and gives room for reactionary right-wing culture warriors to cast doubt upon the validity of trans identity, and ultimately take away trans rights. Therefore, at least in the current moment, I believe that Foucauldian philosophy and Queer Theory are enemies of trans acceptance, and I will be fighting against these ideas very hard at least until the scientific case is heard loudly again.