Transitioning as Body Modification: An Argument Against Medical Gatekeeping

Medical gatekeeping – the practice of denying medical treatment to individuals based on a set of criteria that differs based on their ascribed identities – is a practice that physically transitioning transgender individuals are far too familiar with. Although the practice of informed consent regarding surgery and hormone treatment is growing in popularity, many individuals are forced to go through a vetting process involving psychotherapy and counseling – including, currently, myself.

However, medical gatekeeping doesn’t make much sense from a psychological perspective. If I so chose to do so, I could easily permanently modify my body in irreversible or not easily reversible ways – which I already have, through piercings, stretchings, and tattoos – with a much less stringent vetting process. All I needed to present was proof that I was the age of majority, and pay for the procedure. I did not need to justify to a third party why I wanted to get the procedure.

Some might argue that this is a different issue entirely from masculinzing or feminizing hormone treatment, but when permanent radical body modification procedures – such as extreme stretching of cartilage, full-body tattooing, tongue splitting, and scarification, to name a few – are publicly and freely available, and most side effects of hormone treatment therapy are often almost entirely reversible, it is hard to justify the difference in requirements other than innate transphobia. It is not the procedure itself that presents a problem for medical gatekeepers, but the rationale behind the procedure. Closer examination of the philosophy of medical gatekeepers often reveal underlying transphobic beliefs.

However, the arguments presented by medical gatekeepers are often meant to redirect from their other beliefs and present their argument in a way that is logically convincing. Medical gatekeepers often bring up the permanence of the procedure, or the chance that the individual may change their mind and regret their decision. They bring up the side effects of the procedure or the social burden on the individual as possible reasons why that individual would regret undergoing these procedures. All of these are legitimate factors for the individual receiving treatment to consider, and the individual alone. These gatekeepers do not have to live with the consequences of the action of the transitioning individual, but the transitioning individual is forced to deal with the consequences of having the autonomy over their own body stripped from them.

Medical gatekeeping is no more than a very specific set of sumptuary laws. These laws tell transitioning individuals that they are not to be trusted in making informed decisions about their own bodies in the same way a cisgender person could be trusted to make an informed decision. These laws pathologize the transgender experience in a way that defies cultural history and puts the misplaced concern of the gatekeeper over that of the individual who has to live in their own body. In order to address transphobia and inequality, we must cast aside medical gatekeeping and embrace informed consent.



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