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|Spectra and binaries|
“”Why does tragedy exist? Because you are full of rage. Why are you full of rage? Because you are full of grief.
Transmedicalism is a term used for a wide range of beliefs, although the core belief is that it is impossible to truly be transgender without having gender dysphoria. Many transmedicalists (or "transmeds" for short, or also "truscum") focus on gatekeeping.
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. Transmedicalists may be called "transmeds" or "truscum", whereas anti-transmedicalists may be called "tucutes" or pejoratively as "transtrenders".
Perhaps the reason truscum exist is that their transgender experience is so wrapped around gender dysphoria they cannot comprehend the notion of a transgender person without it. Immersed in their own pain, they attack people who appear not to be suffering.
Transmeds believe, fundamentally, that there is nothing positive about being transgender. According to a transmedicalist viewpoint, being transgender is a medical condition that causes great suffering. Transmedicalists may see gender transition as a necessary evil and the only way out of an already-cruel existence, other than suicide.
So transmeds feel contemptuous of people who identify as trans but don't seem to lead horrible lives. They see transtrenders as relatively privileged cis people who are appropriating the trans identity. "I feel sort of petty and awful but I wonder if I am sort of jealous of some transtrenders. They always seem to have super accepting families and get started on horomones/therapy right away," confessed one transmedicalist.
Gender dysphoria and trans identity
Many transmeds believe that gender dysphoria is necessary in order to be transgender. Some say that mild discomfort counts as dysphoria, whereas others have stricter criteria.
Experts have disagreed for over a decade. As early as the year 2000, researchers have noted that distress is associated with being transgender, but the evidence doesn't show that trans people always experience distress. The American Psychiatric Association, American Academy of Pediatrics, Canadian Paedeatric Society, World Medical Association, World Professional Association for Transgender Health, and other groups and experts explicitly state that not all transgender people experience dysphoria. The World Health Organization also notes that distress is common but not necessary. "Social factors are often key in the experience of gender dysphoria," notes the Gender Identity Clinic.
Transgender identity as a medical condition
Transmedicalists believe that trans identity is a biological condition that falls under the banner of intersex. Trans people, 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, trans people are pushed into the wrong gender roles and stigmatized, making life harder. Transmeds 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. Transmedicalists will often use studies about the average differences in brain structure between binary trans people and cis people to support their argument, although the brains of pre-transition trans people are often in between male and female brains rather than being at one end or the other. Additionally, the vast majority of the trans people who say that the only valid trans people are the ones who have brains of the opposite gender that they were assigned at birth have never had their brains scanned themselves pre-transition.[citation NOT needed][note 1]
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, TERFs, 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.
Targeting of "transtrenders"
“”It's as if we’re already past the whole thing about transness literally getting you murdered and we've made it to "trendy social standing" and I didn't even get the memo.
Transmeds carefully police the trans community for any sign of someone being a "transtrender" (i.e., faker). The "signs" of being a faker according to transmeds are basically, not being able (or at least in their eyes, not trying) to "pass" as cisgender, not wanting to medically transition without a "valid reason", or refusing to fully conform to the stereotypes of the gender binary.  
Transmeds will say they do this typically for one of two reasons (or both): because they think that "fakers" are taking away medical and other resources from "real" transgender people, or are making trans people look bad and thus hurting their progress.  
This however, does not truly get into the root of the problems. The vast majority of transphobes, including both the conservative and TERF breed, hate transgender people because a major part of their worldview revolves around some form of biological determinism which is challenged by the existence of transgender people. In addition, gatekeeping is far more of a problem than "fakers" taking away resources.
Bullying and harassment
“”Truscum know these fears [about being a faker]. They know them better than any other person could. And rather than step in to help other kids through that no man's land of terror, they weaponize that idea of fake, they turn it into a nuke.
- Interrogation about their genitals
- Intentional misgendering
- Name-calling, such as "faggot"
- Attacks on their reputation
- Suicide baiting
This is done in order to get them to stop identifying as trans. Vicious attacks by truscum can be devastating, especially to young or mentally ill trans people who already have enough problems in their lives.
Arbitrarily, transmeds have shown this pattern of behavior with non-binary people whom they think are pretending to be transgender without going through the hassle of transitioning.
Blaire White is a prominent Youtuber who, despite being a trans woman, frequently parrots alt-right views and talking points, and also promotes transmedicalism.
“”Isn't Elon Musk such a non-problematic guy? He's just trying to build tunnels.
Kalvin Garrah (born July 6, 2000) is a trans man and a truscum YouTuber. Although he is no longer very active, he is very notorious and is deeply hated among trans circles. He was so awful that even many truscum hated him. Not helping is that he consistently defended and associated himself with Blaire White, despite being far more left-leaning than her politically. ContraPoints's video "Transtrenders" was interpreted by many, and understandably so, to be a rebuke of the rhetoric espoused by Garrah and other transmedicalists.
From the content of his videos, it would be reasonable to presume that he was just another conservative, white cis dude, if he didn't bring up being trans constantly to justify himself. Like many other truscum, Kalvin believes that the reason why transphobia exists is largely due to "transtrenders", which to him, basically means trans people who experience dysphoria different from his expectations, or people he perceives to be "cringe". He would target supposed "transtrenders" (who typically had significantly smaller followings) by creating long videos in which he would personally attack them, lie about them, misgender and make fun of them, etc. Kalvin first became prominent after uploading a video titled "Trans Guy Reacts to CRAZY Transtrender", in which he spent about half an hour making fun of and misgendering a much smaller YouTuber named Brennen Beckwith, and gained nearly 2 million views, however, the video has since been deleted. But in case you forgot, Kalvin is trans.
Due to his hateful rhetoric and relative popularity, the people he targeted in his videos would become the targets of vicious and extensive harassment by Kalvin's fans, and at least two different people attempted suicide after being targeted in his videos. But in case you forgot, Kalvin is trans. An individual from Australia named Lars was one of these two people. The video about them also received almost 2 million views, and they ended up in a psychiatric ward after their attempt. During Lars' stay, they were secretly recorded by another patient and then the footage was sent to Kalvin. They were bullied by other patients, and were forced to quit their treatment early because of it. The other case was a non-binary, child sexual abuse survivor named Noah. After Kalvin found out about Noah's attempt, Kalvin being Kalvin proceeded to mock Noah's attempt, then claimed Noah faked it, and said that if Noah hadn't faked it, it wasn't Kalvin's fault because he didn't specifically tell Noah to attempt suicide. Sheesh. But in case you forgot, Kalvin is trans.
However, Brennan (see above) would later on make a video after being silent for 3 years, and this caused many of Kalvin's fans to turn on him. He has since lost nearly 80,000 subscribers, and hardly posts to his channel, gaining very few views when he does.  
“”"Transgender" is not an exclusive club that we can bar people from because they refuse to conform to cisnormative ideas about bodies and gender.
|—Sam Dylan Finch, a trans man who was bullied by transmedicalists|
"Tucutes" (or anti-transmeds) believe in including everyone who identifies as transgender, regardless of dysphoria. They believe that gender euphoria (joy experienced when someone is referred to by their preferred gender) and/or a disconnect between one's assigned sex and gender are enough reason for someone to transition if they so choose. This position is also held by some transmeds (who call themselves "soft transmeds"). Most tucutes don't believe that "transtrenders" exist. Others believe that they do exist, but support them regardless; gatekeeping them would also harm lots of trans people, and make it harder for trans people to discover that they're trans.
Another fear of anti-transmeds is the fact that defining trans identity in terms of dysphoria pathologizes trans identity and trans people. Treating transgender identity as a problem can be insulting or derogatory towards trans people. Viewing dysphoria (not trans identity itself) as a disorder is seen as more supportive and affirming of trans people. Transgender identity is now recognized not to be 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. Transmeds usually respond to this by saying that the demedicalization of gender dysphoria can make it harder for a trans person to transition; gender dysphoria is a problem, and treating it as such will make it easier to fix. Additionally, treating transness as a lifestyle choice rather than a necessity, which they think will come about from demedicalization, makes transitioning easier to attack.
Tucutes also worry about the bullying and abuse of gender non-conforming transgender people. Transmedicalists have bullied people they see as "transtrenders". And if cisgender transphobes see transgender people mocking gender-nonconforming people, then they may feel emboldened to do it themselves.
Many transmeds 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 transmeds will accept a non-binary person's gender if they have gender dysphoria.
Note that transmedicalists obviously don't accept all non-binary identities - although, according to the survey, most believe that, as long as you have dysphoria, you can be non-binary, just like you can be transgender.
According to the same survey of 100 people on SurveyMonkey, the majority of transmedicalists are female to male transsexuals, young adults, and white Americans.
A note for trans kids
“”Self loathing isn't an innate part of us
Despite what you might hear, being trans isn't a sentence to lifelong suffering. Gender dysphoria can ease or even disappear in time, especially with a supportive community and/or a proper transition. If your gender dysphoria starts fading away, this doesn't mean you are or were "faking," it means you're learning how to live a happy and functional life. This is a good thing.
Don't let people fool you about suffering being an automatic part of being trans. It's not. If you're miserable, it's not because this is what life is always like for trans people, it's because something is wrong in your life and you need help. You don't have to face this alone. Talk to a therapist or trusted adult about what you're going through. It can get easier.
Stay away from bullies, even if they say they are your friends.
And please don't think that if you haven't transitioned that you are not valid in the trans community. You are visible; your struggle is heard. You are young. You are learning. If you are experiencing bullying or severe depression, please reach out to someone.
- A transgender person with gender dysphoria's response to a truscum.
- "Transtrenders" by Contrapoints: Goes over many of the flaws with transmedicalist arguments.
- As opposed to post-transition, as HRT does have an effect on the structure of your brain.
- "Truscum": Why Do They Hate The Way They Do? - Medium
- Checking Our Privilege, Working Together: Notes on Virtual Trans* Communities, Truscum Blogs, and the Politics of Transgender Health Care - The Feminist Wire
- Ex-truscum vs ex-tucutes - Feminism and Media on Tumblr
- Is Gender Identity Disorder in Children a Mental Disorder? (PDF)
- Expert Q & A: Gender Dysphoria - American Psychiatric Association
- What does transgender mean? - APA (See "Is being transgender a mental disorder?")
- Pediatricians are key in supporting transgender, gender-diverse youths - AAP (See paragraph 4)
- Gender identity - Canadian Paedeatric Society
- WMA Statement on Transgender People - World Medical Association (see recommendation #2)
- Position Statement on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A. - WPATH
- FAQ: Equal access to health care - Lambda Legal
- Gender Dysphoria - Health Link British Columbia
- Surgical Management of the Transgender Patient - via Science Direct
- ICD-10 Version: 2016 - World Health Organization
- Gender dysphoria - Gender Identity Clinic
- DSM-III, ICD-10
- Why aren't more trans people denouncing truscum? - Let's Queer Things Up!
- What's a transtrender? - VERED Counseling
- Truscum - The Rogue Feminist on Tumblr
- Comic by a gender-nonconforming trans boy who has been bullied by truscum