TRANS MEDICINE: The Emergence and Practice of Treating Gender, urgently needed explication of a subject most people do not "get"

TRANS MEDICINE: The Emergence and Practice of Treating Gender
stef m. shuster
NYU Press
$28.00 trade paper, available now

Rating: 4.5* of five

The Publisher Says: A rich examination of the history of trans medicine and current day practice

Surfacing in the mid-twentieth century, yet shrouded in social stigma, transgender medicine is now a rapidly growing medical field. In Trans Medicine, stef shuster makes an important intervention in how we understand the development of this field and how it is being used to "treat" gender identity today.

Drawing on interviews with medical providers as well as ethnographic and archival research, shuster examines how health professionals approach patients who seek gender-affirming care. From genital reconstructions to hormone injections, the practice of trans medicine charts new medical ground, compelling medical professionals to plan treatments without widescale clinical trials to back them up. Relying on cultural norms and gut instincts to inform their treatment plans, shuster shows how medical providers' lack of clinical experience and scientific research undermines their ability to interact with patients, craft treatment plans, and make medical decisions. This situation defies how providers are trained to work with patients and creates uncertainty. As providers navigate the developing knowledge surrounding the medical care of trans folk, Trans Medicine offers a rare opportunity to understand how providers make decisions while facing challenges to their expertise and, in the process, have acquired authority not only over clinical outcomes, but over gender itself.

I RECEIVED A DRC FROM THE PUBLISHER VIA EDELWEISS+. THANK YOU.

My Review: "Gender-affirming care" is a phrase that, to me, ought to be unexceptionable, even anodyne. Instead it causes fury and terror among people who subscribe to high-control religious and social systems.

I've never understood why.

I'm an old, cisqueer, white guy. I participate in several streams of privilege. I have no tiniest sense that my privilege is in any way threatened by the existence and/or acceptance and/or celebration of people not like me. The threats to my privilege come from those who want to deny the legitimacy of any of the founts of the privileges I enjoy. Trans folk aren't among those people as far as I can tell.

And this is despite the long, tragic history of gender-affirming care's resisters. That same kind of control is what we all agree is terrible about anti-Semitism. But it's okay when directed against those transgender...? Why? Because you, o great-hater, aren't yourself trans? Are you Jewish? Does that make hating Jews okay? Difference is not evidence of turpitude, or some kind of curse; spectra are the norm in all systems of what we call (without knowing what it means) the real world. We've barely begun to understand the world as it is. Part of that learning is, of necessity, not knowing, having certainty taken from us.

Somehow this kind of person doesn't ever answer these kinds of questions or address these realities. Their old certainties feel too comfy to give them up.

Most of us who aren't trans have no concept of what it takes to get access to gender-affirming care. I had only an inkling before I read this book. My inkling is still more than most have, and I'm now au fait with a much greater swath of how the concept of affirming the gender of a trans person came about. How it's been debated and designed to exclude, how it's been denied...a human-rights violation if there ever was one...how it's been weaponized and reshaped by the great-haters.

I have never met a trans person who is anything but kind, caring, and decent. Not one trans person I know, or know of, has ever advocated for anything remotely like enforcing their identity on anyone. The canard that education about trans people makes more trans people is a (deliberate, says my inner cynic) misframing of the truth: Education gives trans people access to an identity. to a word, an idea, that they know from the inside describes and delineates them. Had I grown up twenty years before I did, I would never have been aware or brave enough to invent gayness for myself. Education doesn't create difference, it enables the different to define themselves, to discover they are not the first, the only, the freak.

Gender affirmation will never be easy for some, there are trans people who struggle with it, too. This is a huge reason it needs affirming care from trained professionals. "It costs too much" is an absurd sentence coming from anyone in the richest country...the richest culture...there has ever been on the planet. No one should go without in a world of obscene abundance. That most definitely includes rtrans folk.

This book's essay-and-excerpt fabric will keep some readers from fully investing in the concepts. I found the sheer breadth of identities all speaking in support of trans-affirming care to be one of the greatest strengths of the read. I encourage other allies, and those who simply do not understand the idea of transness, to pick the book up. It can, if you decide to allow it to, help you find your empathy for these, our sibling humans.