Earlier this year, Dr. Keith Ablow — a member of Fox News’ “Medical A-Team,” whatever that is — argued that, in his estimation, there is no scientific evidence supporting the existence of gender dysphoria. “I don’t believe,” he wrote, “we have definitive data… that any male or female soul has ever in the history of the world been born into the wrong anatomic gender.” Days later, writer and activist Brynn Tannehill took to The Huffington Post to refute Dr. Abbow’s claims, pointing to more than a dozen studies that suggest there may, in fact, be a biological basis for feelings of discomfort with one’s anatomical or assigned sex. As Tannehill argues, “the body of evidence showing biological origins of gender dysphoria, of having a mis-matched brain and body, is overwhelming.”
Indeed, the proliferation of research confirming a biological foundation for gender dysphoria (the diagnosis of which is often a necessary prerequisite for hormone therapy and other supervised medical interventions for trans folks) has become a staple of trans advocacy, both formally and informally. Agreement in the scientific community on a biological foundation for gender dysphoria stands to give trans folks its own “born this way” argument; it offers, at least superficially, vindication of the familiar trope of trans folks feeling “trapped in the wrong body.” The science is on our side, I’ve been told. The growing “body of evidence” emerging from biological and medical research, according to some commentators, speaks loudly and clearly: transgender people exist, science says.
Of course, we already knew that. On a deeply personal level, I’ve never needed a “body of evidence” to confirm the existence of my own transgender body.
In saying this, I do not mean to seem anti-science — I’m actually a big science fangirl! I marvel at my friends who are neuroscientists, awed by their ability to navigate the complexities of the human brain. I devoured recent stories covering the successful implantation of lab-grown vaginas, fascinated by regenerative medicine and its benefits. With regard to my trans sisters and brothers, I certainly do not deny the value of a robust scientific understanding of our particular medical needs. Research that points towards more effective interventions (hormonal or otherwise) is vital to improving the trajectory and quality of our lives. Moreover, I actively welcome any defensible “body of evidence” that can help persuade gatekeepers of all sorts that access to appropriate mental and physical care is necessary to alleviate the pain and anguish that marks many of our lives, as was the case with the recent overturning of Medicare’s ban on transition-related healthcare.
But, like any good fangirl, I am also critical of the enterprise. I’m especially critical of any overreliance on scientific evidence to validate the existence of trans identities — not because science is bogus, but because science (like any professionalized endeavor) is defined, in part, by what it excludes. It relies on certain practices, discourses, and “ways of knowing” in order to distinguish itself from, say, religion or the humanities. Or, you know, alchemy. But these “ways of knowing” do not appear out of nowhere — they are the result of centuries of social, political, and historical development. Simply declaring “science is on our side” flattens an otherwise diverse terrain of politics and history that inform different branches of science and its sub-fields. Any responsible approach to folding science into advocacy efforts should not only understand what scientific research says, but how and why it came to say what it does. For those interested in trumpeting a biological basis for gender dysphoria, this means understanding the history and limits of medical research in particular.
“Ontological” Limits of Medical Research
One of the limits of medical research for understanding trans people is ontological. If you went to college, you might remember being terrified by the term “ontology” and its metaphysical connotations (The Study of The Nature of Being and All Existence or Whatever). In less intimidating terms, an ontology is a particular way of identifying things and describing how those things relate to one another. Different domains employ different ontologies to make sense of the world — they name and arrange things in different ways, they allow for certain relationships and not others, and they render invisible those concepts or objects that do not fit into its scheme. In short, ontologies represent conditions of possibility: they set rules for what can and cannot possibly be within a given domain.
But ontologies are not born out of nothing. Instead, they emerge from (and are shaped by!) the active, open-ended, and everyday practices of the world they purport to describe. Annemarie Mol has referred to this process as one of “ontological politics” that influence how “problems are framed, bodies are shaped, and lives are pushed and pulled into one shape or another.” In the context of medical research, trans bodies are shaped by a variety of practices and tools — they are enacted through data gathered by researchers, as well as the instruments, languages, paperwork, statistical methods, and work structures that allow medical researchers to make sense of their data. In the clinic, trans people are shaped through a different set of practices and tools. In this setting, my transgender body is still shaped by instruments and paperwork, but they’re different instruments and paperwork. Rather than dealing in more or less comprehensive datasets, there’s just the one data point (me, waving “hello!”).
Of course, these different ways of shaping trans bodies are not mutually exclusive — they frequently come into contact with one another, like when my hormone levels are evaluated according to “standard” (or “desirable” or :: shudder :: “normal”) levels as determined by medical research. If my hormone levels fall into a desirable range, then the clinic and the research lab coincide. But if my hormone levels fall outside this desirable range, the two different contexts come into conflict — and it is in this conflict that different possibilities do or do not present themselves. If I don’t match some standard set by the research lab, I might want to make adjustments to my medication in order to move closer to a desired range. Or, if I report feeling great and being happy with my progress in spite of my hormone levels — and if my doctor confirms that there is no other immediate threat to my health — we might decide not to change anything, in which case I will continue on with my life despite falling — hormonally, at least — outside of a “standard” or “normal” range.
These same continuities and conflicts play out when it comes to research into the origins of gender dysphoria. If I were to report feeling like “I have a girl’s brain trapped in a boy’s body,” then my account is roughly continuous with medical research suggesting that, indeed, a brain can follow a developmental pattern similar to that of females while the rest of the body develops along a path typical of males. If, however, I were to reject that familiar trope and instead say that “I didn’t hate being a boy but I like being a girl better,” the connection between my own account of my identity and scientific descriptions becomes less clear — in fact, it might even be seen as conflicting with the understandings that emerge from medical research. Put another way, the former description is easily reconciled with the ontology of medical research while the latter comes into conflict. But a problem arises when we seek to reconcile this conflict: which account “counts?” Which account is considered valid? Which one is dismissed?
Dominance of Scientific Explanations
Most often, the account offered by medical research wins out. Science — of which medical research is only a part — carries a lot of currency in our post-Enlightenment world. It is built on proven methods, employs transparent procedures of evidence, and is confirmed through rigorous testing and peer-review (ideally, at least). And this certainly isn’t a bad thing! Our lives and understandings of the universe have been greatly improved in some ways (she says, estrogen pill dissolving under her tongue as she types on her laptop computer). Of course, “bad science” gets through, but we’ve got people looking out for that (as Julia Serano so excellently does). But, as feminist discussions of science, technology, and knowledge have long pointed out, being critical of science goes beyond simply challenging “bad science.” It also also means attending to the ways in which established methods, procedures, and peer-review structures might be otherwise biased. As Sandra Harding has put it, we need to pay close attention to “the problematics, agendas, ethics, consequences, and status” of science as it is commonly understood. As a student of both moral philosophy and science and technology studies, I’ve watched and cringed as scientific explanations for my transgender identity have been picked up and wielded without complication, without regard to consequences or ethics.
One consequence of adopting scientific explanations is that other, non-scientific accounts either need to be reconciled with science or they get pushed out entirely. Perhaps no recent example better illustrates this than when the otherwise awesome Neil deGrasse Tyson dismissed philosophical inquiry and “deep questions” as “distracting” for the contemporary scientist. If humanistic speculation or questions of ethics get in the way of scientific progress, Tyson seemed to be saying, they should be left behind.
But, while scientific discourse is often totalizing, its understandings of the world aren’t total. Nonetheless (and as evidenced by Tyson’s comments), science tends to obscure or reject those things or explanations that don’t fit its ontology. To demonstrate just how forceful scientific explanations can be — and what they are capable of obscuring — consider Greg Grandin’s recounting of the aftermath of the voyage of the Joaquín, a Portuguese slave ship that saw the death of 270 kidnapped East Africans while sailing between Mozambique and Uruguay in 1803:
“City officials convened a commission of inquiry to explain the deaths…, calling on the expertise of five surgeons — two British doctors, a Spaniard, a Swiss Italian, and one from the United States. The doctors testified that before boarding the Joaquín, the captives would have felt extreme anguish, having already been forced to survive on roots and bugs until arriving on the African coast emaciated and with their stomachs distended. Then, once on the ocean, crowded into a dark hold with no ventilation, they would have had nothing to do other than listen to the cries of their companions and the clanking of their chains. Many would have gone mad trying to make sense of their situation, trying to ponder ‘the imponderable.’ The surgeons decided that the East Africans had died from dehydration and chronic diarrhea, aggravated by the physical and psychological hardships of slavery — from, that is, what they called ‘nostalgia,’ ‘melancholia,’ and ‘cisma,’ a Spanish word that loosely means brooding or mourning.”
Note that the scientific explanation for the deaths was dehydration and chronic diarrhea — not, you know, being forced into slavery and made to cross the ocean under inhumane conditions. While the explanation given by the surgeons is clearly rooted in prevailing racist attitudes, it also demonstrates a consequence of adopting scientific explanations for things: medical descriptions move to the fore and social or political explanations are pushed out. Later, Grandin also shows how “slavery helped in what might be called the disenchanting of medicine, that is, how concepts like melancholia cited by the surgeons were taken “out of the hands of priests, poets, and philosophers” and given meaning in a medical context (Ann Cvetkovich has offered a similarly enlightening discussion of melancholy being medicalized as depression). And this is the risk of an overreliance on scientific explanations: in order to preserve its ontology, science forestalls, co-opts, or transforms understandings that do not square with the ways in which science makes sense of the world.
Uneven Distribution of Science’s Benefits and Burdens
It must be pointed out that my choice of illustration above is a challenging one. As a white transgender woman, it would be disingenuous of me to summon or co-opt an example of racialized violence in order to support an argument that isn’t specifically about communities of color. Recognizing this challenge, however, reveals a further problem posed by the appeal to scientific explanations for justifying trans identities: it is a bad foundation upon which to build solidarity within the trans community, which includes people of color and the history of violence enacted upon them in the name of scientific inquiry.
Trans folks exist at the intersections of many different identities — racial, ethnic, sexual, socioeconomic, and beyond. Further, our trans identities relate to these other identities in complicated ways that are overlooked by any blanket appeal to scientific explanations. Not only does science have a tendency to muscle out other ways of knowing, but the benefits and burdens of scientific research (and medical research, in particular) have not been fairly distributed. Most often, marginalized racial, ethnic, and socioeconomic groups have shouldered a larger share of its burdens and reaped fewer benefits. Simply claiming that science is on trans folks’ side sweeps aside the ways in which the pursuit of scientific knowledge has been harmful to marginalized communities.
As the voyage of the Joaquín starts to suggest, modern medicine was built, in part, on the exploitation of enslaved populations. But you don’t have to reach back as far as the 18th and 19th centuries to find other examples; medical research has a rich tradition of exploiting certain populations well into the 20th and 21st centuries. Released in 1978, The Belmont Report — which sets out some basic ethical principles for research involving human subjects — was issued, in part, as a response to the horrors of the 40-year Tuskegee syphilis experiment. In the experiment, which exploited vulnerable populations of African-American men from 1932 to 1972, researchers sought to better understand the natural progression of syphilis in the human body — and it continued even after penicillin had been identified as an effective cure for the disease. Afflicted participants were denied access to the drug and, instead, researchers watched and took notes as many men suffered and died. Perhaps even more egregiously, the study continued even after the Nuremberg Code (an international code protecting the rights of research subjects formulated in light of the horrors of Nazi medical experiments) had been articulated at the end of the 1940s. Many of those complicit in the study’s continuance participated, in the words of John Heller, Director of the Public Health Service’s Division of Venereal Diseases, for “the glory of science.”
Even more recently, researchers at Arizona State University were reprimanded and fined for exploiting genetic material obtained from blood samples of the Havasupai Indians in the early 1990s. The samples had originally been gathered in an effort to better understand the devastation diabetes was causing the tribe. Later, however, samples gathered for the original study were reused for various other purposes, including “theories of the tribe’s geographical origins that contradict their traditional stories.” Again, scientific explanations risk squeezing out other ways of knowing. For the Havasupai, unsanctioned research into their DNA threatened to override and supplant native understandings of the tribe’s origins and history.
In deferring to the work of science and medical researchers, trans people and advocates run the same risk: we make our own forms of evidence vulnerable to the totalizing effects of scientific discourse. Uncritical appeals to medical research ignore the relevance of trans folks’ diverse and complicated racial, ethnic, and socioeconomic identities. Turning to scientific explanations in a quick or thoughtless manner alienates us from our own stories. Most importantly, the claim that “science is on our side” fails to account for the uneven ways the benefits and burdens of medical research have historically been distributed. If you’re affluent and white, then, sure, science has (usually) been on your side — if you’re not (if you’re black or indigenous or poor, for example), not so much.
Preserving Diverse Understandings of Ourselves
As Laverne Cox has consistently and forcefully reminded us: “There’s not just one trans story. There’s not just one trans experience.” Practically speaking, however, when we defer to science to validate the identities of trans people, we bulldoze diverse understandings of our bodies and our experience in favor of medicalized explanations of our existence. We risk supplanting our community’s own explanations for scientific ones. Ultimately, while medical research holds out the promise of new understandings and new therapies to improve the quality and trajectory of our lives, too heavy or too dogmatic of an appeal to science to validate our existence runs the dual risk of pushing out alternative ways of explaining ourselves while simultaneously hindering the development of solidarity throughout the trans community.