Recently there’s been a fair bit of discussion about the changes being made to Gender Identity Disorder (now, as it it seems it will become, Gender Dysphoria) in the DSM-V, the Diagnostic and Statistical Manual used by American psychologists (as well as some from other countries). This renewed discussion has brought up an issue that has come up many times over the years, that of removing diagnoses related to transsexualism from the DSM. I’m going to address one of these arguments, and why I don’t think it really holds up.

Essentially, this argument can be summed up as that transsexualism is a physical disorder rather than a mental one, and should be removed from the DSM on that basis. This statement is generally backed up by one of a couple reasons. The first of these reasons is that studies (most commonly Zhou et al., a study that looked post-mortem at transsexual and cissexual brains) show that transsexualism has a physical cause, and thus it is a physical disorder. The second is that the brain is the arbiter of gender, and so a body that differs from it is disordered, meaning the problem with transsexualism lies with the body rather than the brain.

Though these are both important points, they fail to hold up in this case. First of all, though there are many issues with Zhou et al., which I will address at a later date, let us assume that it shows that there is a usually a clear physical correlate for transsexualism, and further let us make the logical leap that this physical correlate is in fact some sort of cause for transsexualism. Even assuming this, it’s still unreasonable to conclude that transsexualism is therefore a “physical disorder”. Every disorder in the DSM has a physical correlate in the brain, and we can assume this even if we haven’t actually found it since everything that has any mental consequences whatsoever (from schizophrenia to deciding to eat ice cream one day) has a physical correlate in the brain. In many cases, such as depression or ADHD, the specific neurobiological correlates are better characterized than in transsexualism, with larger sample sizes and effects that can be measured adequately in the living. So, a neurobiological correlate isn’t sufficient to consider something to not be “mental”.

Second, there is the argument, which I believe to be more compelling, that the body is disordered rather than the brain, and so therefore the disorder is physical. This is sometimes phrased as saying that since the treatment is physical, transsexualism is a physical disorder. This still fails to hold up for me as a reason for removal from the DSM, because even if it is the body that is disordered, the only way that this could actually be discovered is through communicating with the patient – that is, through a mental diagnostic process. Now, at this point, you might be objecting – “but if there’s a physical cause to transsexualism, can’t that be measured instead?” The issue with this is that even though there might be a physical cause in nearly all the cases, wherever they do disagree, it would be cruel or unusual to deny or administer the person treatment based merely on a brain scan. Therefore, the person’s self identification, and therefore, ultimately, their mental state, has to always be the gold standard for diagnosis. Since the DSM is a diagnostic manual (rather than a treatment guide), the -diagnostic- character of the condition has to take precedence, and since transsexualism can only ever be diagnosed mentally, it will remain a mental disorder for the purposes of the DSM (even if it retains a physical treatment, along with depression, schizophrenia, and other established mental disorders).

Finally, some people argue that transsexualism should not be considered a mental disorder because that might stigmatize trans people by lumping them in with other people who have mental illness. This is an excellent argument for having a blank DSM, since -everything- in the DSM could potentially be stigmatized for being in a book of mental illnesses. In logical terms, this is the fallacy of special pleading. The proper response to this is to fight the stigma surrounding mental illness, not to argue on completely arbitrary terms that specific disorders should be deleted from the book by virtue of the fact that being in the book causes stigma. This, I think, is both the weakest argument and the true motivation of many people who want transsexualism out of the DSM.

I just thought I’d share my thoughts on this, and I know I’ve left a lot of things untouched, but I’d be eager to hear thoughts on this and address the remaining issues in another post. In particular, I haven’t addressed why I think transsexualism is a “disorder”, but that topic is big enough to justify its own post.


I’ve stayed abreast of various developments with regards to trans rights, and in Ontario, where I’m from, a recent lawsuit caused a section of the Vital Statistics Act to be declared a violation of the Human Rights Code, resulting in the Registrar General allowing trans people to change their gender markers on their birth certificates without surgery. After a delay, the Registrar General finally released their revised rules in October.

As can probably be anticipated, this was fairly big news within the Ontario trans community, and most people took the news with optimism, perhaps tinged with an undertone of “it’s about time”. However, in the immediate aftermath of the change, I saw an article by Christin Milloy, an Ontario trans activist, expressing frustration with various aspects of the change. Milloy identified four main issues that she saw as problematic under the new rules – the $97 fee, the requirement for access to a doctor to sign off on the form, a statutory declaration that Milloy claims excludes nonbinary people, and the fact that the changes only address people born in Ontario. I’ll address each of these concerns in turn, and then highlight what I think was a glaring omission in Milloy’s critique.

First of all, it’s important to note that with the possible exception of the specific wording of the statutory declaration, all of these restrictions existed before this change. The $97 fee is unfortunate but not completely exorbitant for a one-time expense, and is consistent with the user fees charged for other Ontario government services (in fact, Milloy acknowledges a name change is even more expensive, at $137). Furthermore, as Callie has pointed out in the comments of Milloy’s article, in the vast majority of cases a “long form” birth certificate is not used in Ontario and many cis people don’t routinely have copies of it, so the true cost of bringing one’s birth certificate information up to date with what a cis person would routinely have is probably actually $63 rather than $97. Furthermore, Ontario has universal health care, which strongly mitigates the difficulty inherent in having a doctor sign off on the change (and of course this is a huge improvement over the previous requirement of having both a surgeon who performed “transsexual surgery” on the applicant and an additional Canadian doctor fill out separate forms for the change of sex designation). Though again not necessarily the most progressive solution, this is still ahead of most of the rest of the world on this issue.

As for the statutory declaration, the wording is as follows: “I am living full-time in the gender identity that accords with the requested change in sex designation and intend to maintain that gender identity.” Milloy brings up the specter of a perjury suit based on a hypothetical individual changing their sex designation to male but wearing female clothing on the weekends. Given current jurisprudence in Ontario, it is highly unlikely that a suit could proceed. Especially with the prior passage of Toby’s Act, which protects Ontarians in the provision of services based on gender expression, judges would be loath to make a restrictive determination of what constitutes “living full-time” in the “gender identity” that “accords” with the requested change in sex designation. As Milloy herself states, her hypothetical trans individual wishes to have a male ID because that suits his life circumstances best. This would be more than sufficient to fulfill the requirements for the statutory declaration – the full-time gender identity that he lives in (the one where he would desire male ID for most tasks that require it) accords with the requested change in sex designation (to male). Though many trans people have a narrow interpretation of what living “full time” means, largely informed by aging, outdated medical terminology, the Ontario court system would be loathe in the current legislative landscape to rule narrowly on what constitutes “full time”, as to do so would be to adjudicate on what “gender expression” accords with which “sex”, a declaration that would fall afoul of section 1 of the Human Rights Code as amended under Toby’s Act. So I don’t think that the statutory declaration constitutes a serious concern under Ontario law as it currently exists.

Next, Milloy points out that the change of sex designation only serves to cause a new birth certificate to be issued and doesn’t create a “Change of Sex Designation” certificate analogous to the current Change of Name certificate issued by the Ontario government for statutory name changes (that is, not linked with a life event like a marriage). The major issue I see with this is that it would be borderline if not explicitly fraudulent for the Government of Ontario to do so. A Change of Sex Designation certificate would have no legal recognition at the federal level (relevant to documents like the passport), and the Ministry of Government and Consumer Services, named in the suit, does not have jurisdiction over other Ontario ministries like the Ministry of Health and Long-Term Care (which administers OHIP, the universal health care plan of Ontario) or the Ministry of Transportation (which administers driver’s licenses). The Change of Name certificate that is currently issued is different, as it is generally recognized by governmental and non-governmental entities as valid. Without prior consultation and recognition from the federal government and other branches of government that the Change of Sex Designation certificate would be seen as valid, the Ontario government would be exposing trans people to significant hardship by charging for and issuing a document that may have no validity whatever. Therefore, it is important that we see such change at the federal level and in the other provincial departments before provinces begin issuing such documents. It may be a good idea for such documents to exist if the proper regulatory and policy frameworks are in place to issue them, but that sort of change goes well beyond a single government department or even a single province. When gender recognition certificates have been implemented in the past (most notably in the UK) they’ve been accompanied by wide-ranging national legislation, not introduced in response to litigation.

I’d finally like to address a significant oversight that I believe Milloy made. One of the revisions to the standards introduces a new restriction that in fact is not present anywhere in the current legislative framework. This restriction is the gratuitous and unnecessary exclusion of those under 18 from being able to have their gender markers changed under any circumstance. Milloy doesn’t mention this anywhere, even though this requirement is completely impossible to overcome for those who fall afoul of it, unlike the $69 or doctor access barriers. Furthermore, this restriction actually represents a significant scaling back of rights that not only existed before these changes, but were actually exercised (although vaginoplasty for trans women has been historically restricted in most, but not all, of the world, to individuals 18 and over, trans men who were 16 and 17 have obtained top surgery and used it to apply for legal changes of sex in Ontario). I’m not sure why Milloy completely left this new restriction out, as there is a class of specific people (those under 18 who have had some sort of surgery) who were before able to get their birth certificates changed and now cannot. Furthermore, those under 18 are often in greater need of updated birth certificates than adults are, as driver’s licenses, which are the most commonly used ID card for adults and could already be changed without surgery, are not available to anyone in Ontario under 16, and an updated birth certificate is required to update the Ontario Student Record (at least, last time I tried), the Canadian passport, and the OHIP card. Barring trans youth capriciously and arbitrarily from access to accurate ID is fundamentally unjust and exposes them to danger and discrimination, and I hope this blemish on what would otherwise be a clear step forward will soon be excised.

Today I thought I’d speak to the personal experience of myself and of just about everyone I’ve spoken to who has transitioned at a similar age to when I did. Trans children and teenagers often find themselves at odds with the adult trans community (also known as “the trans community”), in part due to having different issues (which I’ll address in a later post) but also due to a rather insidious form of erasure that is ever-present, if not always explicit.

The erasure of which I speak usually is expressed like this: “Oh, you transitioned at 13 – you’re so lucky, I wish I could have done that.” Though this statement may seem innocuous, there are really several alienating messages contained within it.

First of all, the notion of “luck” is devoid of agency. When someone is called lucky for doing something, this assessment robs them of the responsibility for having made that thing happen. For a trans person who is or has deliberately and pointedly overcome at a very minimum the standard obstacles associating with initially coming out and seeking the resources necessary to transition, having it be implied that they bore no role in the significant accomplishment of starting transition is an act of erasure of their very real struggle. Yet this is what the “luck” insinuation does – it tells the trans person that they didn’t actually have to do anything to make their transition happen, that they merely sat around and won some cosmic lottery without raising a finger. The will and perseverance required to make a transition work is significant at any age, and the notion of agency is often of even more importance to a young person. Consider the environment that youth find themselves in. They are told that they lack the maturity to make their own decisions, that they are not permitted by the rules of the society to own and be responsible for their own property, that they only may live as the dependents of people who are probably not particularly qualified to be in such a role. These messages are amplified when a young individual seeks transition – they are faced at every turn with capricious and arbitrary restrictions on their ability to improve their lives predicated entirely on their age and blind to whatever personal qualities may distinguish them. Often in a situation like this, their agency is the only tool they have left. To then have their agency denied by having it dismissed as “luck” can feel like a betrayal.

Second, calling a young trans person “lucky” minimizes the struggles they have, in fact, faced. Trans youth face significant barriers, including most of the same transition barriers that trans adults face. They also face a wide variety of obstacles unique to being young and being legally considered minors. Though they may (eventually, if they’re able to acquire hormone blockers in sufficient doses early enough, and aren’t too affected by gonadotrophin deficiencies or other areas in which trans HRT, especially the conservative version of such most often used with children, fails to replicate the biological processes of cis puberty) have physical bodies closer to the statistical distributions of their genders than adult transitioners, this is relatively small comfort to someone at the outset of transition faced not only with what seems an wall of forces arrayed against them, but also an unsympathetic and alien adult trans community.

Finally, “luck” as a concept is something that is always experienced as a relative thing. Many adult trans people feel somewhat alienated from cis culture and throw themselves into trans communities with abandon, often feeling like they are home for the first time in their life among people who are able to understand and accept them for them. Though adult trans people may have jobs in which they must interact with cisgender people, the work day is usually encapsulated cleanly and doesn’t bleed into the rest of the person’s life – they are free to choose whatever social circles they desire and have freedom of movement outside of work to seek them out. This is not the case for a trans youth. The school environment is all-pervasive for them – it is mandatory, inflexible, and almost always constitutes the main social circle for a young person. The result of this is a failure in communication – the trans adult calls the trans child “lucky”, compared against the other trans people who make up the trans adult’s major social circle. The trans child must compare their circumstances against their own peers, who in this case are children and teens getting their gender identities (and often their puberties) “for free”, who are strongly integrating their gender identities into their lives without the challenges that face the trans child, and who are laying down the foundations for a lifetime of gendered intimacy and gendered relationships in front of the trans child’s very eyes. It is sometimes said jokingly by adult transpeople in transition that transpeople are like hormonal teenagers when they start transition. Well, trans youth beginning transition are also surrounded by hormonal teenagers, and hormonal teenagers at that which are supported by everything from their biology to the whole of cis society and culture. To call a trans youth in this environment “lucky” can feel dissonant at best and a cruel joke at worst.

I understand that deciding to transition at any age can often be tinged with regret, and that many trans people, all other things being equal, want the physical traits that often accompany early (hormonal) transition. However, internal fantasies often translate poorly when applied over the messy lives of real people. So it’s important when talking to people to use empathy and consider whether well-intentioned words will contribute positively or be part of the problem.

Transition is something that gets talked about a lot within trans communities. Sometimes, it’s seen as a defining experience of what it means to be trans, or at least for some word that is taken to be a subset of trans, like “transsexual”. However, I think it’s given a lot more tangibility than it deserves.

What I mean by that is that the word “transition” is a label that we use alternately to apply to a collection of loosely delineated activities, or to apply to a fuzzy period of time, or to apply to a self-identified intention in how we intend to be seen by the world. Ultimately, though, what transition is not is a single, clearly definable action that either is taking place or not. This may seem like a linguistic quibble, but bear with me here.

Often, a lot of trans discourse, especially among those early in transition, revolves around fear of regret. These fears are often used as a motivation to avoid moving forward with specific concrete actions, like starting to take hormones or telling family one is trans. Now, these specific actions do have consequences, often irreversible ones. However, no particular action carries the full weight of “transition” and people often talk as if the next concrete action they take is going to forever make or break their “transition” and thus end up taking no action at all (or end up delaying their first actions until they are “sure about transition”, or worse yet counsel others to do the same).

This is probably most clearly seen in the bogeyman that is the “detransitioner”. The perception of detransitioners is that they are tragic figures, tinged by regret, who start out as misguided cisgender men or women who by some inexplicable desire are driven to “transition” and mutilate their bodies, only to realize their mistake and slink back to their original natural cis state having lost some of their body integrity and often ruined their lives for the sake of the malformed “transition” wish. In reality, the picture is much more complex than this. People who make a decision to “detransition”, or more specifically to take actions that affirm an identity consistent with their assigned sex at birth after having first taken actions affirming an identity not consistent with their assigned sex at birth, do so for a number of reasons, the most common of which correspond with the most common reasons for “transition” – that is, a desire to feel more comfortable, in the present, in one’s living situation. One thing that is often missed by people in the trans community is that it is quite possible for it to be the best decision, at a particular time, to take actions classed under “transition” and then, at a later time, under different circumstances, for it to be the best decision to take actions classed under “detransition”. That is to say, detransition and transition can both be the right choices in a single person’s lifetime and need not be seen as tragedy. Indeed, those who “detransition” usually don’t simply replicate the choices they made in transition and even less often end up in a similar place to where they set off – almost invariably, they have been changed by the experience in profound ways.

Though this might seem of little relevance to those who only transition once, I believe there is less anxiety inherent in dealing with the trees rather than seeing a forest when there might not even be one. It can be healthy, when making a decision that would normally be seen as a part of “transition”, to consider it as an individual action, with only its direct consequences to plan for and consider, and not be weighed down with more responsibility than the action entails. Considering “transition” to be a monolith can often lead to confusion and fear, while taking individual steps as desired are far more likely to place a person exactly where they wish to be without feeling the weight of their whole life on their shoulders.

So if you feel that you need to do something to be a better person, to be more fulfilled, or to feel more at home in your body, consider that thing on its own merits. Life is lived a day at a time, and continual steady improvement leads to happiness.

Hi. My name is Catherine.

I’m also trans. Dealt with it a long time ago, currently living my not-so traditional (but still awesome, and fulfilled, and all that other stuff) life, spent a while treating it as if it didn’t exist, got my genitals fixed, and all that.

When I started the process that is often collectively referred to as “transition”, I was 13, which against the backdrop of others transitioning in 2003, often set me at odds with others in the trans communities that existed at the time. Probably as a result, I’ve always felt like somewhat of an outsider within trans circles. For some time, I mostly faded into living an existence experienced as cis, putting a fair amount of cognitive distance between myself and a trans community I had come to regard in my mind as toxic and out of touch with anything of relevance to my experience.

I’m now 23. As of late, I’ve seen a significant shift in the way the trans issue has come to be treated by society at large. Trans issues are widely discussed, and in ever greater numbers even youth, like I was at the time of my transition, are transitioning in significant numbers and dealing en masse with the sorts of issues I had to individually forge through (such as interactions with school boards, parents, medical and administrative bureaucracies, families, and society). I’ve often found myself having opinions on these matters, and even chanced my hand at sharing my views with those closest to me. I think the time is ripe for me to blog about what I’ve seen, and perhaps even get a conversation or two started.

Looking forward to it,