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Transmedicalism is a term for a wide range of beliefs in the transgender community that are critical of transgender people who are not, or do not desire to be, transitioned medically. According to a self-definition by the subreddit /r/transmedicalism, the term describes
- trans people and allies who believe that only those who experience gender dysphoria are transsexual / transgender, and that gender dysphoria (transsexualism) is a medical condition.
Although the debate has been going since the '60s, it has gained more notoriety in the Internet age, particularly on Tumblr. On Tumblr, anti-transmedicalists often refer to transmedicalists as truscum and to themselves as "tucutes", whereas transmedicalists often refer to "tucutes" as transtrenders.
The existence of a medical condition known variously as transsexualism, gender identity disorder or gender dysphoria is not medically or scientifically controversial, although it is widely opposed by various religious groups, trans-exclusionary radical feminists, and the anti-psychiatry movement. Rather, the controversy in this case is a social debate rooted in identity politics over the equivalence (or lack thereof) between people who have such a condition and people who have no such condition but still identify as transgender. Participants in this social controversy may run the gamut between extreme reactionaries who want to return to the medical definitions of last century (e.g. the infamous Benjamin scale) to weekend crossdressers who live and identify as their assigned sex but want to be recognized as transgender or even transsexual.
Perhaps the reason why truscum exist is because their transgender experience is so wrapped around gender dysphoria they cannot comprehend the notion of a transgender person without it. Thus the lack of understanding and transphobia from society both result in fear and distrust of these "alien" transgender people.
It is also possible that transmedicalists see nothing good or inherently valuable about the experience of gender transition, and even view it as something they would rather not ever have to go through, but see their dysphoria as a materially disadvantageous and mentally debilitating biochemical aberration. Because dysphoria is, by definition, an experience that is not even anywhere close to enjoyable, people who have it see gender transition as a necessary evil and the only way out of an already-cruel existence, other than suicide. So transmedicalists feel contemptuous of people who are going through transition when they do not apparently need to, much as a person who accidentally loses their legs might feel contemptuous of someone who appears to have chopped off their legs on purpose. They see transtrenders as relatively privileged cis people who are appropriating the trans identity while further stigmatizing "actual" trans people, who are already marginalized as it is and who are urgently in need of help and resources, as "scum" whenever they speak up about this appropriation.
Transmedicalists believe that transsexualism is a biological condition that falls under the banner of intersex. Transsexuals, they believe, are people born with the brains of one of the major sexes, but all (or most) of the external characteristics of the other major sex. This causes extreme gender dysphoria, a sense of disconnection and disgust towards the body. On top of this, transsexuals are raised by their unknowing parents to be the sex they look like, however this is not the sex that they are, and this makes the whole thing even worse, as does the lack of understanding and extreme stigma surrounding the condition. Doctors and transsexuals themselves believe the only way to cure this condition is through cosmetic surgery, reshaping the body to look like the individual's "true sex", and by rejecting much of the incorrect gender role that had been forced on them. This view of transsexualism is supported by empirical evidence.
The problem for transmedicalists is that not all transgender people fit this biological definition. Many transgender people identify as a gender other than the one they were assigned at birth, but do not feel the extreme body dysphoria of transsexual people and do not desire to transition. The most extreme transmedicalist argument is that these people are "transtrenders", essentially people who misunderstood what being trans means and see it as a way to defy gender roles and be special snowflakes. Much of the current argument rests on an increasing amount of these "non-dysphoric transpeople" on Tumblr who define themselves by new genders and pronouns that are based more around personality or personal aesthetic. Despite this, in the post-ironic internet world, it is impossible to determine who is taking the piss and who isn't.
Less extreme transmedicalists recognize that gender roles, beyond causing problems for transsexuals, also causes problems for non-transsexuals who do not fit them. They believe that "tucutes" essentially fall into the latter category. They support the right for people to live their lives in opposition to gender roles if that's what they want to do, but disagree with the way in which these people claim solidarity with, and to an extent have taken over the trans community. They argue that non-transsexuals who do not fit their gender roles should identify as "feminine males", "masculine females", "androgynous males", "androgynous females", etc. rather than the current trend of identifying as "biologically male, psychologically female", etc. They see the adoption of trans language and integration of "tucutes" into the trans community as confusing and damaging, but do not completely dismiss them the way more extreme transmedicalists do.
In the use of the word "transsexual" or "transgender", it is a case of "damned if they do and damned if they don't": if they call themselves "transsexual", transmedicalists are accused of being separatists and of using allegedly archaic language, despite the fact that this is still standard medical terminology. If they call themselves "true transgender", they receive accusations that they seek to claim the word "transgender" as only their right to use; attempting to appropriate "transgender" to mean transsexual. In either case, the result is that people who suffer from gender dysphoria and have medically necessary reasons for being transgender are marginalized within the trans community by people who do not have gender dysphoria and have absolutely no medical need to transition.
Anti-transmedicalists reject elements of the transmedicalist argument in favor of a more inclusive view towards what are commonly dismissed as "transtrenders". The least extreme anti-transmedicalist view is simply that transsexuals and non-dysphoric transpeople are two different groups based around different phenomena, but should be united under the "trans umbrella" to fight for their ultimately similar causes. More common anti-transmedicalists argue that every transgender person experiences a disconnect between their gender assigned at birth and their self-identified gender, however that disconnect may manifest in different ways, including gender dysphoria, a discomfort or distress with one's gender assigned at birth, and gender euphoria, joy experienced when one identifies or is referred to as their preferred gender.
Anti-transmedicalists are often frustrated by transmedicalist claims that they are "backed up by science" and claims that "science is on our side". Modern analysis shows that 21st century anti-transmedicalists have the backing of the medical community. For example, the DSM-V itself, on its introduction page on "gender dysphoria", states that GD is not a universal experience in the transgender community. The American Psychiatric Association (APA) also states that "not all transgender people suffer from gender dysphoria and that distinction is important to keep in mind" in an Expert Q&A. Organizations such as the NHS and TransEquality.org are also in agreement that gender dysphoria is not a prerequisite to being transgender, and that being transgender is simply identifying as a gender different from your gender assigned at birth. In transmedicalism is rejected by nearly all medical/psychological bodies, trans activist organizations, and broader LGBTQ activist organizations, all of whom embrace the aforementioned “gender identity” definition of being transgender.
Another fear of anti-transmedicalists is the fact that defining trans identity in terms of dysphoria “pathologizes” trans identity and trans people; it makes being trans the problem, which can be insulting or derogatory towards trans people. The approach of viewing dysphoria as the “disorder” or medical problem that needs to be treated, is seen as more supportive and affirming of trans people. Being transgender has been demedicalized, as to say, it is no longer considered a mental illness, and advocating for a world under which the criteria for being transgender is having a mental illness undoes decades of positive transgender activism.
Additionally, many anti-transmedicalists believe that the vehemont criticism of the trans* experience by other trans* individuals gives cisgender transphobes license to approach transgender people as a collective with disbelief and similar skepticism. They believe that transmedicalists are ignorant to the true nature of transphobia and oppression towards trans* individuals, and that further dividing such a vulnerable demographic will weaken both the trans* communities political power and solidarity, and its credibility as an (accepting) movement.
Many transmedicalists are accused of invaliding non-binary identities. However a survey of 100 Internet users, carried out by an anti-transmedicalist activist, potentially shows this notion to be false as transmedicalists will accept a non-binary person's gender if they have gender dysphoria. However this still invalidates many non-binary identities as not all non-binary people have gender dysphoria.
According to the same survey of 100 people on SurveyMonkey, the majority of transmedicalists are female to male transsexuals, young adults, and white Americans.
- DSM-III, ICD-10