Theodore E. Schall and Jacob D. Moses
Hastings Center Report 53, no. 3 (2023): 15-24.
DOI: 10.1002/hast.1486
Abstract
Gender-affirming care is almost exclusively discussed in connection with transgender medicine. However, this article argues that such care predominates among cisgender patients, people whose gender identity matches their sex assigned at birth. To advance this argument, we trace historical shifts in transgender medicine since the 1950s to identify central components of "gender-affirming care" that distinguish it from previous therapeutic models, such as "sex reassignment." Next, we sketch two historical cases-reconstructive mammoplasty and testicular implants-to show how cisgender patients offered justifications grounded in authenticity and gender affirmation that closely mirror rationales supporting gender-affirming care for transgender people. The comparison exposes significant disparities in contemporary health policy regarding care for cis and trans patients. We consider two possible objections to the analogy we draw, but ultimately argue that these disparities are rooted in "trans exceptionalism" that produces demonstrable harm.
Here is my summary:
The authors cite several examples of gender-affirming care for cisgender people, such as breast reconstruction following mastectomy, penile implants following testicular cancer, hormone replacement therapy, and hair removal. They argue that these interventions can be just as important for cisgender people's mental and physical health as they are for transgender people.
The authors also note that gender-affirming care for cisgender people is often less scrutinized and less stigmatized than such care for transgender people. Cisgender people do not need special letters of permission from mental health providers to access care whose primary purpose is to affirm their gender identity. And insurance companies are less likely to exclude gender-affirming care for cisgender people from their coverage.
The authors argue that the differences in the conceptualization and treatment of gender-affirming care for cisgender and transgender people reflect broad anti-trans bias in society and health care. They call for a more inclusive view of gender-affirming care that recognizes the needs of all people, regardless of their gender identity.
Final thoughts:
- Gender-affirming care can be lifesaving. It can help reduce anxiety, depression, and suicidal thoughts. Gender-affirming care can be framed as suicide prevention.
- Gender-affirming care is not experimental. It has been studied extensively and is safe and effective. See other posts on this site for more comprehensive examples.
- All people deserve access to gender-affirming care, regardless of their gender identity. This is basic equality and fairness in terms of access to medical care.
