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To Challenge Trans Injustices, We Must First Understand Why They Exist

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I live in New York State. In 2003, when I changed the sex marker on my driver’s license, the state required applicants to “submit evidence of medical, psychological, or psychiatric evaluations, with a medical determination that one gender predominates over the other.” The only evidence the DMV would accept was a letter signed by a “physician” on official letterhead. I went in person to get the sex marker on my NY driver’s license changed from F to M, and I came prepared with a letter from a surgeon attesting to my gender. But the whole thing almost fell apart when the DMV agent at the window disputed the validity of the letter. “The policy says this letter needs to be from a physician,” the agent told me, “but this person says he’s a surgeon.” It took consults with two levels of supervisors and one phone call before the DMV workers could agree that a surgeon’s letter would suffice. Once that had been settled, the sex marker attached to my record and on my license was changed.

What happened to me at the DMV could be described as a mundane instance of what T. Benjamin Singer called the “transgender sublime.” During this transaction, the gender disorientation my application created was transposed onto confusion about medical credentials. Years ago, the presentation of a transgender figure—in a text, in person—would often induce a certain vertigo. In these moments, people unexpectedly confronted with a gendered figure who confounded everything they thought they knew about sex would find themselves at the edge of a precipice beyond which cognition fails: “The sheer variety of trans bodies and genders exceeds providers’ cognitive capacity to comprehend them.”

To illustrate this point, Singer—who spent years studying the provision of health care to transgender people, as well as training health care professionals about trans issues in the 1990s—recounted an incident involving a medical resident working in the emergency room of a large urban hospital. When a transgender woman with a broken arm came into the hospital’s emergency room, the resident took one look at her and announced that he could not set her arm because he hadn’t received any medical training on transsexuality.

For this resident, who undoubtedly had set and put casts on many broken limbs during his tenure in the ER, the gendered category crisis the patient triggered was so unsettling that it threw all that he knew into confusion, including the most routine of treatments. A broken arm is a broken arm regardless of a patient’s gender presentation or genitalia or secondary sex characteristics, but the perplexed MD had lost—one hopes only momentarily—his ability to see that.

Readers habituated to assuming that gender depends on genitals at birth can also have a hard time making sense of accounts of people who move away from their assigned sex. At the very least, keeping track of who is a man and who is a woman can use up a lot of the brain’s processing power, power that might be needed to engage with the argument itself.

To illustrate: over a decade ago, a colleague in political science told me, over dinner, about an article he had recently reviewed for a journal and had recommended rejecting. He thought I would be interested in the topic since the article was about efforts to reform New York City’s policy of issuing amended birth certificates with no sex markers at all to people who had transitioned. “It was impossible to follow,” he told me. “From the very beginning, I couldn’t keep track of who was a man, who was a woman, if a........

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