Like clockwork, my least favorite type of rhetoric is back. That hateful bigot we all love to jeer has augmented their appearance — Elon’s hair plugs, DeSantis’ lifts, Laura Loomer’s whole face — and now, so artfully, a well-meaning liberal or left-leaning news editorial has happened upon the perfect gotcha: calling it gender affirming care.
Recently, this type of framing targeted Karoline Leavitt. The publication’s public Instagram post about the Press Secretary’s lip filler described her choice explicitly as gender affirming care. Except, it’s not. Gender affirming care actually means something, and telling me the procedures I fought for in my transition are the same as a cis woman getting lip filler, is frankly, insulting.
Gender affirming care is defined by the World Health Organization as “any single or combination of a number of social, psychological, behavioural or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.” It is a category of treatment specifically attributed to the care of transgender individuals for whom the incongruity between their assigned sex and gender identity creates gender dysphoria. I am personally not one to insist upon the medical pathologization of transness. In fact, I think relying on definitions created by institutional medicine does us no favors and flattens the vastness of transness within ourselves and throughout history. But when it comes to receiving the interventions we need to lead fulfilling lives, we cannot afford to mess around with what falls under the umbrella of “necessary” care.
This argument glaringly misses the point of gender affirming care by attributing the same motivations to hormones and top/bottom surgery (among others) that they do to things like lip filler, nose jobs, hair plugs, and BBLs. If you consider yourself an ally, or better yet an advocate for trans people, then you have to recognize that for those who wish to receive gender affirming care, it is a necessity, not a desire or an added seasoning on top of social transition. Gender dysphoria is a deeply psychologically damaging experience that affects how one is able to move through the world. It is a fragmentation of one’s sense of self. It is not wanting to be prettier. The industry that offers elective cosmetic procedures feeds off of harsh beauty standards. It invents a need to be more attractive, more desirable. It chases a perfect and impossible ideal. Asking people why they got gender affirming care produces pretty much the same answer across the board. We did it because we had to. I’d rather be an ugly man than any woman at all.
Cis people often fail to realize that the feeling of dysphoria around sex characteristics is not about “not liking the way you look” or about imagining an idealized version of oneself like those drawings where a man is looking in the mirror and seeing a curvy bombshell. God knows you don’t get to choose what hormones do to you; ask any trans man who has turned into his father. It’s about a visceral need to make changes to your body in a direction that doesn’t feel foreign. It is an alleviation of the feeling of wanting to rip your skin off, break your own bones, tear yourself away from any physical body at all.
Before I got top surgery I couldn’t go half an hour without thinking about my chest: if it was visible, the tightness of my binder, the weight of my own body. Right after surgery, I couldn’t stop thinking about how glad I was that I got it. And then, after a couple months, I completely stopped thinking about my chest altogether. That is the actual goal of gender affirming care. It’s a treatment we undergo so we can just stop thinking about it.
There’s also the matter of safety. Being able to pass publicly is a monumental factor in the necessity of gender affirming care. Being able to choose who gets to know that you are trans is a freedom that gender affirming care allows. Even the simple aspect of looking your age lifts an enormous psychological weight. Cis people are not targeted for physical violence because they don’t have hair plugs, and they are not denied jobs and kicked out of locker rooms because they don’t have breast implants or lip filler. Cis people without cosmetic procedures are still cis people at the end of the day. There isn’t really a world in which getting buccal fat removal makes it less likely for you to be addressed by the wrong name, to have your personhood denied entirely. The stakes of getting gender affirming care are simply higher than having a nose that you don’t really like.
This whole idea is not so subtly intended to scorn cosmetic procedures in general. It is clearly taking an unfavorable stance on lip filler by positioning it as something that conservatives, bigots, and transphobes get, even though we know the Juvederm reaches across the aisle. We are allowed to mock the physical appearances of the people we hate. Their beliefs are disgusting, and so are the choices they made for their bodies. I’m not gonna get on some faux high horse and say Leavitt’s lip filler looks good, but when one Instagram story tells me she looks a mess and the next tells me what she’s doing is just like what I do, it betrays an underlying message that trans people are grossly mutilating ourselves and that society finds us disgusting.
And allow me to address the inevitable response: “They are saying this to make conservatives mad! To point out that they are benefitting from the very thing they are trying to ban!” and let me stop you right there. They don’t care. If pointing out conservative hypocrisy worked, it would have worked, and it never has. Doing so has been the primary strategy of the Democratic Party for the last decade, and the opposition barely tries to justify it anymore. Conservatives flex their political dominance by legally enshrining a care-for-me-and-not-for-thee policy. They are not deterred when their hypocrisy is brought to light; they get off on it. You do not have a moral high ground for “admitting” your cosmetic procedure is gender affirming care. All it does for trans people is single us out and create new ways to put us in the middle of a debate we have no desire to be in.
When you say trans healthcare serves the same purpose as lip filler and cosmetic surgery and that they should be treated the same, I know you are saying they should be destigmatized in the same way. That’s lovely, but changing public attitudes over issues is nearly impossible without structural changes to the ways we interact with these things in real life. The logical progression of the idea that gender affirming care should be treated the same as any other cosmetic procedure is that we should remove gender affirming care from insurance plans and relegate trans healthcare to private practice clinics run for profit. And people do say that. While the far right wants to eradicate trans care and trans people altogether, that argument is coming out of the moderate left. Liberals are allowing themselves to fall for the propaganda and become scared of trans people because we are unwillingly at the center of the culture war. Democrats abandoned trans people in the last election cycle, distancing themselves from the community, keeping our issues out of their platforms, and going on podcasts and talk shows saying that, while they supported trans people, they were wary of giving us any of the things that we are asking for.
I’m young, but I’m old enough to remember “I support gay people but I just don’t know about letting them get married.” I support trans people but I don’t know about them playing sports. Or going to the bathroom. Or being in schools. Or our tax dollars funding transitions. It’s the falsely “moderate” position that this argument is silently suggesting. Imagine a world where you can’t transition with health insurance at your doctor’s office. Just kidding! You don’t have to imagine it. That’s how it used to be. Before trans healthcare became accepted medical practice, trans people had to seek “gender affirming care” through underground clinics and tragically short lists of practitioners who were willing to work with trans people. Many of whom took advantage of their patients, knowing they had nowhere else to go. People got botched, took unsafe chemicals, and had unsafe procedures performed on them. Oh, and they died. People died.
Not everything trans people do to transition is gender affirming care. It’s not like we are trying to gatekeep these things for ourselves either. Transition is self-actualization in ways that often overlap with the self-actualization cis people pursue. There’s lots of reasons for new wardrobes, haircuts, even name changes. Making the definition of gender affirming care so expansive as to include anything that deals with traits that are traditionally associated with masculinity or femininity (every trait!) ends up pushing out the needs of trans people. If lip filler is gender affirming care, then so is a haircut. If everything is gender affirming care, then nothing is.
Even in the murky areas where cis and trans people are receiving the “same” treatments — for example, menopausal cis women who take estrogen, cis men who get gynecomastica surgery, or transmasculine people who get hysterectomies — the dosages, considerations, motivations, and perhaps paramount to all of this, insurance coverages, are different. Because they are treating different needs. Trans care is a unique type of care that doesn’t need to be assimilated to the treatments that cis people get. And that is fine, actually! Transness does not need to be compared to cis experiences and perspectives to be valued, protected, and legitimized. The procedures cis people undergo to make their bodies more appealing are not under the same scrutiny that gender affirming care is, and they are not addressing the same need. Pretending they are is cruel to the people who do receive gender affirming care. We can’t protect ourselves if we are folded in with a category of care that is not threatened. Regardless of what the fearmongering wants you to believe, trans people are a very small minority, and diluting our essential treatment with a shapeless mass of elective nonessential care means we are going to get lost in the shuffle.
I understand the impulse to make these comparisons, and I know the people making them are trying to help. It feels “important” to tell the world that trans people are just like cis people. If that were entirely true, though, we wouldn’t be in the situation we are in. We have our own things, and gender affirming care is one of them. When you want to talk about the appearance of a politician you hate, it would be nice if you could just keep us out of it. There are conversations worth having, like fighting to keep gender affirming care accessible to all, including children. Allowing us to change our legal gender markers and keep our passports accurate when we have to renew them. The disproportionate rates at which trans people, especially trans women of color, experience physical and sexual violence, homelessness, and poverty. For now though, I’d just rather not continually be compared to the people you despise.
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I also refer to these types of procedures, as well as the hormone replacement therapy given to many cis people, as gender affirming care, and I’m trans. Don’t get me wrong, I absolutely understand and comiserate with you. But, whether the person is a piece of garbage like the aforementioned or not, the basic idea of affirming ones gender identity remains the same. And when it comes to the bills targeting trans people and the medical care we may or may not need, pointing out that cis people also benefit from gender affirming care is super important. No, the current administration doesn’t give a damn, but it could help so many others finally understand what we’ve been screaming for so long.
My preferred analogy to bring up to cis internets randos are surgeries that are technically elective (well any non-emergent ones are elective, but the most elective I suppose), but no one actually thinks of them that way, ex. knee surgery, cataract removal, breast reconstruction after cancer. No one’s gonna physically die without them so it’s a quality of life issue, rather than strictly a “medical necessity” one. And if they can get behind those quality of life procedures, maybe they can think differently about the ones for trans people.
I always think of these procedures for cis people as “gender-enforcing” care tbh. When trans people have them, they’re to alleviate dysphoria, but also for safety in a world that punishes gender nonconformity. The industry as aimed at cis people seems to reinforce racist, patriarchal, ableist, transphobic beauty standards in a way that I don’t think can be compared to gender-affirming care. In many ways the elective plastic surgery industry actively makes trans people’s lives harder by profiting off a narrow view of what it means to be seen as a specific gender. I am a big believer in people doing whatever they want with their bodies but I spend a lot of time thinking about how much the elective cosmetic plastic surgery industry really narrows our idea of “masculine” or “feminine” features in a way that makes everyone’s lives harder. I want more trans people who are unable to access surgeries for whatever reason to feel happy and safe, and I want trans and cis people who are happy with having atypical features for their gender to continue to feel that way without the pressures of an industry treating this as needing “correction”.
I think you are brushing off the medical needs of cis intersex people when talking about “murky areas where cis and trans people are receiving the ‘same’ treatments”. When my friend with PCOS (arguably an intersex conditions) is recommending a hair removal clinic to her transfem friend for electrolysis, they are, in my opinion, both seeking gender affirming treatment, regardless of insurance billing practices.
And yes, both are getting it to 1. affirm their gender identity and 2. not get harassed or sexually assaulted in women’s bathrooms.
Trans and intersex people need to rally together to affirm their bodily autonomy, especially when it comes to medical interventions and being properly insured for their care. Restricting gender affirming care to solely trans people will leave a lot of people behind when it comes to medical options and coverage, including intersex people but also nonbinary people that the medical system doesn’t deem trans enough.
Thank you for saying this and for articulating it so well. In its righteous fury this article completely overlooks intersex people (which is not surprising but is disappointing). I think I understand the point the author’s making but I have very complicated feelings about it. Ultimately, I don’t want to be considered somehow fundamentally different from a cis person getting the same damn procedures done as me. Sometimes people have them done for frivolous reasons, sometimes for very serious quality-of-life reasons. Who are we to decide which case is which?
Every time someone tries to argue that “words have definitions” with regard to the lgbtqia community, somebody (including people from within the same community) will always counter with “definitions change” and “you’re gatekeeping” if you try to argue against people using their own definitions.
I’ve seen it numerous times with numerous terms. Like when someone says ‘gay’ means a person who’s only attracted to their own sex, and people counter that it’s actually an umbrella term and you can also call yourself gay if you’re bi….Or people arguing about what the correct definition of ‘lesbian’ is, or people arguing about the definition of bi (attracted to both sexes, or attached to your own and one other gender?)…etc.
A person can either stay upset about it, or learn to accept the fact that not everybody is using the same definition of a word as you are.