What do you think?
Rate this book
Trans Medicine: The Emergence and Practice of Treating Gender
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.
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.
224 pages, Hardcover
First published June 15, 2021
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 15 of 15 reviews
April 28, 2021
A well-researched look at gender-affirming medical care, including therapy, in the United States. The author, who is themself a non-binary trans person, puts a focus on the lived experiences of current medical providers of gender affirming care. To illuminate present day practices, Shuster traces the history of medical care in this area starting in the mid-20th century. While I was familiar with the broad outlines of the care (and barriers to care) to my generational trans pioneers, the detailed research of medical and psychiatric notes, particularly the correspondence between the few medical professionals at that time who worked with trans patients, was illuminating in ways both good and sad.
This book does not discuss specific treatments or procedures or make any recommendations of that nature, nor does it look at the evolution of medical interventions, except as such related to the decision-making process. The purpose of this book was to look at the professional lives of the medical practitioners and how they understand their trans patients, their role in providing care, their obligations to their professional standards, oaths, and statutory laws, and how they coalesce all this into arriving at a specific decision or a road map for care of a trans patient/client.
Shuster is an academic but the writing was very accessible for a layperson such as myself, infused with just enough academic-style to make me feel smart. I first accessed gender-related medical care in the late 1990s. Being in an urban area, I was able to find a general practitioner who, while she was not terribly experienced with trans patients (who was?), she was willing to learn. She taught me the value of engaging in frank conversations with one’s doctor and I was lucky that she initiated the approach that we were learning on this journey together, sharing knowledge and resources. This was an excellent life skill to have developed and I have used it in the 20+ years since when accessing medical care for any reason, not just gender-related care. Articulating questions, engaging with your doctor on your own healthcare plan, drawing on their knowledge for your own good, is excellent self-care. Most doctors have been receptive, some taken aback, but I happily have not had an outright negative experience.
Reading this book gave me a larger appreciation of the professional position and the professional world of medical care providers. I truly had not given active consideration to their obligations beyond the care plan that is devised for me; in addition to my care, they need to think about their medical license, FDA recommended vs. off-label use of drugs, how comfortable they are working outside their expertise, especially when gold-level studies and research are few to none. All this is in their minds as they consider me and my needs as a patient.
This book also crystallized for me something I already somewhat grasped. My lack of an “outright negative experience” has a lot to do with my race and class and my clear understanding of my gender and ability to communicate it in a way that a doctor in the U.S. can get comfortable with. My gender identity (and frankly my desired lifestyle) falls into society’s normative experience of a (gay) male. I’m lucky that my desired life and self-expression met “acceptable” expectations as the barriers to care for those outside the “acceptable” continue, often for the same reasons barriers to care existed some 50-60 years ago.
Recommended reading for medical professionals and for trans patients seeking care, most especially for trans persons (including non-binary persons), as it can help in our self-advocacy to appreciate and understand decision-making the medical field. It was particularly interesting to see how in some ways the changes in approach to trans medical care, and the role of doctors, is a microcosm of changes in the medical profession altogether. Also interesting was learning of the uneasy relationship between medical doctors and psychiatrists and between psychiatrists and therapists. I have to say that reading the excerpts and quotes of some of the correspondence, particularly in the earlier years, is disconcerting. I have such a clear and untroubled sense of myself and identity and even now, after so many years, it’s disheartening to read how murky and troubling I am, my being-ness is, to others. Well-done with kudos to Stef Shuster and a thank you to #netgalley and New York University Press for the advance reader copy.
This book does not discuss specific treatments or procedures or make any recommendations of that nature, nor does it look at the evolution of medical interventions, except as such related to the decision-making process. The purpose of this book was to look at the professional lives of the medical practitioners and how they understand their trans patients, their role in providing care, their obligations to their professional standards, oaths, and statutory laws, and how they coalesce all this into arriving at a specific decision or a road map for care of a trans patient/client.
Shuster is an academic but the writing was very accessible for a layperson such as myself, infused with just enough academic-style to make me feel smart. I first accessed gender-related medical care in the late 1990s. Being in an urban area, I was able to find a general practitioner who, while she was not terribly experienced with trans patients (who was?), she was willing to learn. She taught me the value of engaging in frank conversations with one’s doctor and I was lucky that she initiated the approach that we were learning on this journey together, sharing knowledge and resources. This was an excellent life skill to have developed and I have used it in the 20+ years since when accessing medical care for any reason, not just gender-related care. Articulating questions, engaging with your doctor on your own healthcare plan, drawing on their knowledge for your own good, is excellent self-care. Most doctors have been receptive, some taken aback, but I happily have not had an outright negative experience.
Reading this book gave me a larger appreciation of the professional position and the professional world of medical care providers. I truly had not given active consideration to their obligations beyond the care plan that is devised for me; in addition to my care, they need to think about their medical license, FDA recommended vs. off-label use of drugs, how comfortable they are working outside their expertise, especially when gold-level studies and research are few to none. All this is in their minds as they consider me and my needs as a patient.
This book also crystallized for me something I already somewhat grasped. My lack of an “outright negative experience” has a lot to do with my race and class and my clear understanding of my gender and ability to communicate it in a way that a doctor in the U.S. can get comfortable with. My gender identity (and frankly my desired lifestyle) falls into society’s normative experience of a (gay) male. I’m lucky that my desired life and self-expression met “acceptable” expectations as the barriers to care for those outside the “acceptable” continue, often for the same reasons barriers to care existed some 50-60 years ago.
Recommended reading for medical professionals and for trans patients seeking care, most especially for trans persons (including non-binary persons), as it can help in our self-advocacy to appreciate and understand decision-making the medical field. It was particularly interesting to see how in some ways the changes in approach to trans medical care, and the role of doctors, is a microcosm of changes in the medical profession altogether. Also interesting was learning of the uneasy relationship between medical doctors and psychiatrists and between psychiatrists and therapists. I have to say that reading the excerpts and quotes of some of the correspondence, particularly in the earlier years, is disconcerting. I have such a clear and untroubled sense of myself and identity and even now, after so many years, it’s disheartening to read how murky and troubling I am, my being-ness is, to others. Well-done with kudos to Stef Shuster and a thank you to #netgalley and New York University Press for the advance reader copy.
Read
June 9, 2021shuster's exploration of the ways in which health practitioners -- both mental health workers and physicians -- manage their anxieties around providing care to trans people, and in particular providing medical interventions related to gender, is a fascinating blend of history and sociology. The author draws upon archival resources from the Kinsey Institute, interviews with present-day practitioners, professional documents that outline best practices, and observational notes from trans health conferences to consider what has and has not changed since the 1950s when it comes to treating gender in the heathcare community. This focus on practitioners (all of those discussed in the book seem to be cis) rather than trans people offers a unique window into the challenges that the medicalization of transness during the twentieth century have created for both care providers and the trans patients seeking medical interventions to shape their experience of embodied gender. Both mental health practitioners and medical doctors historically expressed, and continue to express, a high degree of anxiety regarding how to diagnose and treat transness as a health problem. shuster describes how medical and mental health professionals struggled to determine whether transness was best treated as a condition of the mind, or the body, or both (they don't seem to have considered the possibility it is neither). Sometimes at odds, sometimes in collaboration, health practitioners in both areas have historically acted, and continue to act, as gatekeepers to care for trans patients -- with the authority for that gatekeeping role grounded in very little medical/scientific evidence. Rather, health practitioners continue to draw on understandings of transness developed in the mid 20th century that depend heavily on a binary and fixed understanding of gender -- one that does not fit particularly well with most trans peoples' lived experience or needs. I highly recommend this book to anyone interested in the history or present-day practice of treating gender.
I was provided a copy of this book by the publisher via NetGalley in exchange for an honest review.
I was provided a copy of this book by the publisher via NetGalley in exchange for an honest review.
April 12, 2021
Wonderful book covering the evolution of trans medicine and the current practice. Very well structured and nicely documented. I was expecting a much more academical read, but I am positively surprised about how accessible is.
Very often we take science and the medical discourse as unquestionable. But science is indeed about questioning, and that is exactly what this book does: opening up the debate on how the pathologization of trans identities was built through the 20th century to our days.
Some of the most interesting points that I recall are:
• The chronological analysis, showing the construction of a narrative not only to control trans bodies and lives through medicine, but also building some of the prejudices trans people face still nowadays, at least in Spain.
• The ‘legitimacy wars’ between physicians and therapists, as well as the clashes they had on the definitions and treatment for trans people at the time.
• The random construction of protocols based on providers’ personal criteria that have survived over time, impacting in trans lives today. An example of this is providers’ expectation for trans people to align with their gender roles and gender norms’ ideas, which still happens currently – despite the lack of science backing these prejudices.
• The “real life test” (asking trans patients to live their life as if they had already physically transition, but without the aid of hormones or surgery) is another unscientific approach taken by providers that we can still see nowadays in many countries, where trans people are expected to wait for a given amount of time before they are provided with hormones or access to surgical interventions.
• How regret is weaponized by “pro-life” activists against abortion, using potential regret of the person who has an abortion to fight against abortion itself. It seems providers are also concerned by trans people regretting their transitions, which is also weaponized by transphobes very often to fight against trans access to hormones or surgery.
The only aspect I missed a little bit the book to cover were interviews with trans people. What are their views on the current way medicine treats them? How the different approaches taken by providers (flexible interpreters and close followers, as the author names them) impacts on them? I would have loved having their voices included here.
In short, could we move the spotlight to the way that medicine is pathologizing trans identities (without scientific evidence) and finally move forward towards trans liberation?
Very often we take science and the medical discourse as unquestionable. But science is indeed about questioning, and that is exactly what this book does: opening up the debate on how the pathologization of trans identities was built through the 20th century to our days.
Some of the most interesting points that I recall are:
• The chronological analysis, showing the construction of a narrative not only to control trans bodies and lives through medicine, but also building some of the prejudices trans people face still nowadays, at least in Spain.
• The ‘legitimacy wars’ between physicians and therapists, as well as the clashes they had on the definitions and treatment for trans people at the time.
• The random construction of protocols based on providers’ personal criteria that have survived over time, impacting in trans lives today. An example of this is providers’ expectation for trans people to align with their gender roles and gender norms’ ideas, which still happens currently – despite the lack of science backing these prejudices.
• The “real life test” (asking trans patients to live their life as if they had already physically transition, but without the aid of hormones or surgery) is another unscientific approach taken by providers that we can still see nowadays in many countries, where trans people are expected to wait for a given amount of time before they are provided with hormones or access to surgical interventions.
• How regret is weaponized by “pro-life” activists against abortion, using potential regret of the person who has an abortion to fight against abortion itself. It seems providers are also concerned by trans people regretting their transitions, which is also weaponized by transphobes very often to fight against trans access to hormones or surgery.
The only aspect I missed a little bit the book to cover were interviews with trans people. What are their views on the current way medicine treats them? How the different approaches taken by providers (flexible interpreters and close followers, as the author names them) impacts on them? I would have loved having their voices included here.
In short, could we move the spotlight to the way that medicine is pathologizing trans identities (without scientific evidence) and finally move forward towards trans liberation?
March 11, 2021
I loved learning so much about trans medicine in this book! I expected it to be dense throughout, but it felt accessible to non-academics seeking to learn more. A must-read for anyone who knows and loves someone trans.
June 15, 2021
Book Review
Title: Trans Medicine: The Emergence and Practice of Treating Gender by Stef M. Shuster
Genre: Non-Fiction, Gender and Sexuality, Social Issues, Health
Rating: 4 Stars
As this is non-fiction around the history and progression of trans medicine I am going to be giving a lot of my personal thoughts on the information contained in this book. The introduction to the book introduces us to the author who is trans and how they learnt about both the social and medical sides of being transgender and who is in charge of making medical decisions regarding trans people and this is going to be explored in further depth as we progress through the book.
From the outset Shuster provides a thoroughly researched look into not only gender-affirming medical care and therapy but into the social role of physicians for trans people. While this is specific to the United States which meant I couldn’t personally identify with the struggles of paying for healthcare I did sympathise with those that do. As Shuster is a non-binary trans person it really put a lot of focus on the experiences of medical providers of gender affirming care rather than the medical guidelines which often exclude trans people as they are seen as so unique and different from cis people that made healthcare providers won’t treat them. I really like how Shuster put the spotlight on present day practices as they trace through the history of medical care for trans people.
I was a little disappointed that this book didn’t discuss specific treatments or procedures as this would be helpful to trans and non-binary people and I felt that Shuster having lived through some of these experiences could have given some recommendation on the process of medical interventions but that seems to have been overlooked. The purpose of this book was to look at the professional lives of the medical practitioners and how they understand their trans patients, their role in providing care, their obligations to their professional standards, oaths, and statutory laws, and how they coalesce all this into arriving at a specific decision or a road map for care of a trans patient/client. That being said it did feel like at times you were reading a dissertation which isn’t a bad thing considering that Shuster is an academic and the writing was very accessible even to people that know little about the topic but it was difficult in places to get through and I did find myself a little bored at time which was upsetting been as I identify so much with the author.
One thing I really liked about this book was how it gave me a larger appreciation of the position of medical professional who often have to juggle recommended guidelines with individualistic treatment style as there isn’t a one size fit all treatment for trans and non-binary people. This book also highlights the fact that trans and non-binary people who haven’t had any negative experiences with medical professional might have some sort of privilege to do with race or class which is something I never considered but it made absolute sense given the fact we see these kinds of privileges in other areas all the time. Overall, I would say that this book should be recommended to medical professionals and trans patients seeking care especially those going down the self-advocacy route. I have to say that reading the excerpts and quotes of some of the correspondence, particularly in the earlier years, is disconcerting and I would definitely recommend that people be aware of this before reading as it can be quite upsetting in places for those that aren’t secure in their gender identity.
Title: Trans Medicine: The Emergence and Practice of Treating Gender by Stef M. Shuster
Genre: Non-Fiction, Gender and Sexuality, Social Issues, Health
Rating: 4 Stars
As this is non-fiction around the history and progression of trans medicine I am going to be giving a lot of my personal thoughts on the information contained in this book. The introduction to the book introduces us to the author who is trans and how they learnt about both the social and medical sides of being transgender and who is in charge of making medical decisions regarding trans people and this is going to be explored in further depth as we progress through the book.
From the outset Shuster provides a thoroughly researched look into not only gender-affirming medical care and therapy but into the social role of physicians for trans people. While this is specific to the United States which meant I couldn’t personally identify with the struggles of paying for healthcare I did sympathise with those that do. As Shuster is a non-binary trans person it really put a lot of focus on the experiences of medical providers of gender affirming care rather than the medical guidelines which often exclude trans people as they are seen as so unique and different from cis people that made healthcare providers won’t treat them. I really like how Shuster put the spotlight on present day practices as they trace through the history of medical care for trans people.
I was a little disappointed that this book didn’t discuss specific treatments or procedures as this would be helpful to trans and non-binary people and I felt that Shuster having lived through some of these experiences could have given some recommendation on the process of medical interventions but that seems to have been overlooked. The purpose of this book was to look at the professional lives of the medical practitioners and how they understand their trans patients, their role in providing care, their obligations to their professional standards, oaths, and statutory laws, and how they coalesce all this into arriving at a specific decision or a road map for care of a trans patient/client. That being said it did feel like at times you were reading a dissertation which isn’t a bad thing considering that Shuster is an academic and the writing was very accessible even to people that know little about the topic but it was difficult in places to get through and I did find myself a little bored at time which was upsetting been as I identify so much with the author.
One thing I really liked about this book was how it gave me a larger appreciation of the position of medical professional who often have to juggle recommended guidelines with individualistic treatment style as there isn’t a one size fit all treatment for trans and non-binary people. This book also highlights the fact that trans and non-binary people who haven’t had any negative experiences with medical professional might have some sort of privilege to do with race or class which is something I never considered but it made absolute sense given the fact we see these kinds of privileges in other areas all the time. Overall, I would say that this book should be recommended to medical professionals and trans patients seeking care especially those going down the self-advocacy route. I have to say that reading the excerpts and quotes of some of the correspondence, particularly in the earlier years, is disconcerting and I would definitely recommend that people be aware of this before reading as it can be quite upsetting in places for those that aren’t secure in their gender identity.
This entire review has been hidden because of spoilers.
June 27, 2021
Thank you to NetGalley and NYUPress for an e-ARC of this book in exchange for an honest review!
I had the pleasure of hearing stef present some of this work a few years back, and I jumped at the chance to get my hands on this book, even though I tend to struggle with non-fiction reads. I was pleasantly surprised at how easy it felt to read this book!
As a grad student, I'm used to slogging through academic texts and cross-referencing dictionaries, google, and other books to figure out what an academic is actually talking about. It was such a relief to NOT have to do this for TRANS MEDICINE. shuster does an excellent job of breaking down complicated ideas around the production of knowledge and expertise to contextualize the history and present of trans medicine– their use of jargon is intentional and explained in a way that I think non-sociologists and non-academics would find more approachable than they'd expect.
Although I was expecting something more in depth chronologically, one of the biggest strengths of this book for me was how it is positioned in the context of wider medical and sociological practices. shuster has a keen eye for the ways in which evidence based medicine impacts the experience of people of color and disabled people negotiating their way through the medical field.
I was a little disappointed not to have read conversations or interviews with trans and nonbinary medical/therapy providers, but I think shuster does a good job explaining why they interviewed who they did, and the lack of such perspectives is likely more reflective of the current state of trans medicine and how the medical field understands expertise.
Honestly, I would recommend this book widely beyond the medical field! I think this is an excellent example of an strong citational practice, and offers a plethora of delight for readers who think about evidence and how we understand the experiences of gender and sexual minorities within normative systems. For data nerds like me, I would also strongly recommend giving the appendices a thorough read to think about how researchers position themselves within social and institutional groups.
I had the pleasure of hearing stef present some of this work a few years back, and I jumped at the chance to get my hands on this book, even though I tend to struggle with non-fiction reads. I was pleasantly surprised at how easy it felt to read this book!
As a grad student, I'm used to slogging through academic texts and cross-referencing dictionaries, google, and other books to figure out what an academic is actually talking about. It was such a relief to NOT have to do this for TRANS MEDICINE. shuster does an excellent job of breaking down complicated ideas around the production of knowledge and expertise to contextualize the history and present of trans medicine– their use of jargon is intentional and explained in a way that I think non-sociologists and non-academics would find more approachable than they'd expect.
Although I was expecting something more in depth chronologically, one of the biggest strengths of this book for me was how it is positioned in the context of wider medical and sociological practices. shuster has a keen eye for the ways in which evidence based medicine impacts the experience of people of color and disabled people negotiating their way through the medical field.
I was a little disappointed not to have read conversations or interviews with trans and nonbinary medical/therapy providers, but I think shuster does a good job explaining why they interviewed who they did, and the lack of such perspectives is likely more reflective of the current state of trans medicine and how the medical field understands expertise.
Honestly, I would recommend this book widely beyond the medical field! I think this is an excellent example of an strong citational practice, and offers a plethora of delight for readers who think about evidence and how we understand the experiences of gender and sexual minorities within normative systems. For data nerds like me, I would also strongly recommend giving the appendices a thorough read to think about how researchers position themselves within social and institutional groups.
June 26, 2021
Trans Medicine is a sociological book analysing the medical field(s) that work with trans people, namely the professionals involved - following trans medicine since it's conception in the 1950s up until contemporary times.
As a sociological work, this feels academic, but the writing is very accessible to non-academics; however, this book is not a "one-sitting" type of book, nor do I think it should be.
Throughout, shuster (non-binary trans person) lays out the assumptions and bias of medical professionals in the 1950s, contextualizing them in post-WWII medicine, and shows how that starting point is still affecting trans medicine today. For this, I think this book is an invaluable resource to any health professionals (or training to be), both physicians and in mental health. I also think it is appropriate for a non-medical audience, as it will clarify the way medicine operates, not only regarding trans patients but other demographics.
There are some things described in this book that can be very disconcerting, mostly the older records, but also some of the discourse of newer physicians (especially because you're given the historical context beforehand and you can see the root of it) regarding who should have access to trans medical care, and how - gatekeeping for "non-worthy patients" in the 50s and, currently, for some outside of the binary. So I advise care for anyone not in a good place with their gender identity, if they suspect they won't be able to digest some of the content.
I voluntarily read and reviewed an advanced copy of this book. All thoughts and opinions are my own
As a sociological work, this feels academic, but the writing is very accessible to non-academics; however, this book is not a "one-sitting" type of book, nor do I think it should be.
Throughout, shuster (non-binary trans person) lays out the assumptions and bias of medical professionals in the 1950s, contextualizing them in post-WWII medicine, and shows how that starting point is still affecting trans medicine today. For this, I think this book is an invaluable resource to any health professionals (or training to be), both physicians and in mental health. I also think it is appropriate for a non-medical audience, as it will clarify the way medicine operates, not only regarding trans patients but other demographics.
There are some things described in this book that can be very disconcerting, mostly the older records, but also some of the discourse of newer physicians (especially because you're given the historical context beforehand and you can see the root of it) regarding who should have access to trans medical care, and how - gatekeeping for "non-worthy patients" in the 50s and, currently, for some outside of the binary. So I advise care for anyone not in a good place with their gender identity, if they suspect they won't be able to digest some of the content.
I voluntarily read and reviewed an advanced copy of this book. All thoughts and opinions are my own
June 25, 2021
pride month isn't just for fun queer romances it's also about learning!!!
this was a super informative read for me on an area that I knew almost nothing about but I think it's a great starting point for people wanting to learn more about the transgender community and become better, more informed allies! It is a super easy and accessible read even if you have no medical or scientific background and really shocks you with how so much and so little progress has been made in regards to trans medicine. My only critiques of this book are that the author tends to repeat the point of each section over and over again every time a new point is brought up which can give you a little bit of fatigue when reading it. As well, when introducing a new quote the author spells out what is meant instead of leaving room for any interpretation (I can see why this was done but after a few chapters it felt a little draining). Overall, this is a great, informative read that I would def recommend for anyone that is trying to educate themselves a little more!
Thank you NetGalley for the review copy!!
this was a super informative read for me on an area that I knew almost nothing about but I think it's a great starting point for people wanting to learn more about the transgender community and become better, more informed allies! It is a super easy and accessible read even if you have no medical or scientific background and really shocks you with how so much and so little progress has been made in regards to trans medicine. My only critiques of this book are that the author tends to repeat the point of each section over and over again every time a new point is brought up which can give you a little bit of fatigue when reading it. As well, when introducing a new quote the author spells out what is meant instead of leaving room for any interpretation (I can see why this was done but after a few chapters it felt a little draining). Overall, this is a great, informative read that I would def recommend for anyone that is trying to educate themselves a little more!
Thank you NetGalley for the review copy!!
April 25, 2022
I definitely want to start out by saying that shuster and I do operate under different viewpoints, so my review and rating is largely based on my thoughts while reading this book. I think it's important to read things that make us uncomfortable, and in doing so it expands our worldview and how we navigate the various communities in which we exist. I also want to start out by saying that I admired the research and structure of this book as well. For a first book of its kind--especially one that is accessible to those not in the medical field--I think it accomplished what it set out to do, especially for its main audience (of which I am not a part).
However, as a reader, I was not convinced.
For me, the most interesting part was regarding the ever-changing and quickly evolving stance doctors and therapists took when treating trans patients. How they worked historically hand in hand to confirm that someone is "really" trans prior to going on hormones or receiving surgery was intriguing, and I can't deny that I found some of the steps to be unfair as well. shuster is clearly a huge fan of bodily autonomy (ie, it's my body so I can do what I want with it!), but I find that shuster's attitudes regarding doctors and therapists--even the ones who try very hard to do right by their patients--is that they are not doing enough, even when they go out of their way to learn what medical school has not taught them, they are not doing enough, even when they try to take into account the ways in which medicine affects various bodies, they are not doing enough. The goal post continues to shift.
"Into the 1960s," shuster states in relation to research, "more providers began to mandate that their patients live for a year in their target gender. Referred to as the 'real life test'--where a trans person was expected to live their life as if they had already physically transitioned but without the aid of hormones or surgeries--the milestone of one year in one's target gender was used by providers to determine if trans people were committed to 'going all the way' in accessing surgical interventions.[55] Yet contained within the naming of this test is the tacit idea that trans people's lives, up until the moment that they sought medical care, were not real." While I can sympathize the notion that anything prior to seeing a doctor didn't actually happen is unfortunately used across all aspects of medicine, I can also understand the doctors' point of view: prove to me that you can successfully live as your target gender, and I will know that the pros of you living your fullest life offset the cons of not knowing how gender affirming surgery affects not only one's livelihood but physical self nor not knowing how hormones more typically present in the opposite sex will affect someone down the line.
shuster also discusses the Bathroom Scare, in which women view trans women entering their bathrooms not as an act of safety on trans women's parts, but as an act of violation against women's parts. This violation invokes decreased senses of safety due to sharing a space in which women must reveal themselves--albeit behind closed doors--to relieve themselves. If trans women are allowed to enter their sex-segregated space as male-bodied and male-socialized people, then what is to stop men from entering their space under the guise of trans womanhood as well?
Yet shuster's affirmation that trans women only want to use the bathroom to relieve themselves is effectively shut down with this example: "My [faithful] patient stated that the patient arrested had recognized someone clear across the room and called out, 'Yoo hoo! I'm a woman now; I have been operated on by a surgeon. Yoo hoo!' Then she used the toilet and got arrested." Is this example supposed to make women feel better? This example does not correspond with the idea that trans women just want to use the bathroom--it corresponds with the idea that they want to use the bathroom and purposefully make others uncomfortable. Of course, not all trans women, but of course, not all men, too.
One thing I do appreciate this book is the discussion of lack of financial accessibility surrounding the medical field. Especially when it comes to specialists where one may have to travel to in order to receive care of any kind. Yet in highlighting this disparity, shuster uses the following example in which a trans person writes directly to a doctor for some assistance:
"Dear Dr. [Name],
I want to have the sex change operation from male to female. I want to know how much this will cost and how long. I have very little money and I want this done free, and if you know of a doctor who will do this free, let me know. I want to meet you, let me know when you are coming to L.A. I would like to have this done here or in your office. Also, I need a home and money and employment. Do you know of anyone I can stay with?"
I was baffled that this example was used. Yes, it highlights the disparities that trans people face--lack of housing, employment, finances. But the fact that this patient first and foremost desires the sex change operation/gender affirming surgery before working to amend any of their other problems was absolutely shocking. Not receiving a gender affirming surgery will not kill you in the way a double mastectomy for breast cancer will kill you. Not receiving a feminizing facial surgery will not harm you in the way a rhinoplasty for a deviated septum will harm you. Then again, it is important to recognize that we're operating on two different definitions of life-threatening. My definition in these situations lends its hand more to what our bodies do to us rather than shuster's definition, which lends its hand more to what we will do to our lives. (Internal forces rather than external/personal in these cases).
A trend I noticed in this book is that shuster seems to demonize doctors who are reticent in prescribing hormones or signing off on gender affirming surgeries in patients who otherwise have other present health problems. We do not know what these do to an otherwise healthy person in the long-term, much less when there is a chronically ill person or someone who requires other medical assistance through medication. shuster assumes a stance of "let trans people do whatever they want to their bodies, no questions asked" when that is just...not the reality. I mean, clearly, that's why shuster is arguing in favor of this stance. But shuster largely fails to realize that it isn't just that trans person a surgeon would be affecting. A double mastectomy for someone's mental health is not as life saving as it is for someone with stage 3 breast cancer. There, I said it. You can't therapy or cope your way into not having cancer. I'm not saying that therapy or coping methods can cure dysphoria either, but there is a very real and deadly disease inside some people and if a surgeon's time is being taken up with someone who would otherwise be alive..? It just shows me that trans folks, at least in these examples shuster provides, are selfish. Instead of arguing for a radical rearrangement of the health care system, shuster places trans people's needs on a pedestal and is willing to let others suffer in ways that can only be cured through medical intervention. This is of course, not to mention that this requires doctors to act in ways that they may not find ethical in regards to patient care.
shuster cites an example from his research and his response to this example seems to only clarify my point: "We had a patient who had an A1C (a blood test for glucose levels) of 13 percent and was pretty hypertensive when she presented at our office. We were not her primary care provider. Her gender identity seemed to be intact, but the answer was no. There's a lot of comorbidities that are unmanaged and unaddressed that make me think she didn't understand the relationship between all of these things and taking estrogen." shuster then goes on to address this citation: "In addressing the concerns with other medical professionals at a healthcare conference, the nurse suggested that while the patient's gender identity wasn't being called into question, the existence of high blood glucose was enough evidence to halt hormone therapy." Honestly? How could you not agree with the doctor in this situation? At the time of this doctor's interaction with this patient, how much had been written or researched regarding glucose levels and hormones? Of glucose levels and trends in the male body? How hormones interact with insulin, diabetes, pre-diabetes, retinopathy, blood circulation--literally anything that high blood glucose could possibly affect? Is getting estrogen more important than your baseline health?
Not to mention, of course, the times when shuster wants to break down the barriers between female and male, which begs the question of how do we know which hormones are prevalent in which people? How do trans women know they want estrogen and how do trans men know they want testosterone, if these are not present in their desired sex? The blurring of not just gender but sex offers a very scary reality in which women are already not present in medical research. It would be great if navigating the world of gender and medicine could be easier in terms of changing one's body. But it's not, because that's just...not how reality works?
According to shuster, it is. Also according to shuster, evidenced subtextually in these various examples, trans folks should be able to get whatever whenever. Do we know the effects of hormones or surgeries beyond 5-10 years? Are we taking into account anecdotal or resesarched evidence from detransitioners who now suffer from bone density problems, chronic pain, organ failure, and more?
Perhaps part of my problem is that I want shuster to do more. I understand the problem he wants to fix, but he does not seem to understand how to actually go about fixing them. The problem is that trans people are not being given these life-saving therapies (by therapists who don't care about them, apparently), hormones (by doctors who don't care about them, apparently), or surgeries (by surgeons who don't care about them, apparently). The problem is that trans people do not have access to inclusive doctors, or money to pay for these treatments, or a job to save money, or a home.
To shuster, the solution seems to be that we give trans people what they want because they think it is a need. But these things--though they may be distressing to not receive and therefore warrant accessible support groups, therapies, and communities to find solidarity--are not necessary. What is, is non-discrimination laws regarding housing and employment. What is, is access to information that ensures that trans folks know exactly what the side effects are for their surgeries and hormones and treatment rather than an all-affirming "empowering" idea of bodily autonomy. What is, is access to therapists and counselors who are sympathetic/empathetic and can offer coping strategies, a safe ear, and a means to reduce their emotional turmoil.
I suppose I'll wrap it up here, as I could go on. Ultimately, shuster and I hold similar but extremely different ideologies. The easing of trans pain and suffering is a must, but how we go about it is entirely different for vastly differing reasons. However, it was well-cited, and I again enjoyed learning about the history of the medical field regarding the trans community. It was an informative but largely exasperating read.
However, as a reader, I was not convinced.
For me, the most interesting part was regarding the ever-changing and quickly evolving stance doctors and therapists took when treating trans patients. How they worked historically hand in hand to confirm that someone is "really" trans prior to going on hormones or receiving surgery was intriguing, and I can't deny that I found some of the steps to be unfair as well. shuster is clearly a huge fan of bodily autonomy (ie, it's my body so I can do what I want with it!), but I find that shuster's attitudes regarding doctors and therapists--even the ones who try very hard to do right by their patients--is that they are not doing enough, even when they go out of their way to learn what medical school has not taught them, they are not doing enough, even when they try to take into account the ways in which medicine affects various bodies, they are not doing enough. The goal post continues to shift.
"Into the 1960s," shuster states in relation to research, "more providers began to mandate that their patients live for a year in their target gender. Referred to as the 'real life test'--where a trans person was expected to live their life as if they had already physically transitioned but without the aid of hormones or surgeries--the milestone of one year in one's target gender was used by providers to determine if trans people were committed to 'going all the way' in accessing surgical interventions.[55] Yet contained within the naming of this test is the tacit idea that trans people's lives, up until the moment that they sought medical care, were not real." While I can sympathize the notion that anything prior to seeing a doctor didn't actually happen is unfortunately used across all aspects of medicine, I can also understand the doctors' point of view: prove to me that you can successfully live as your target gender, and I will know that the pros of you living your fullest life offset the cons of not knowing how gender affirming surgery affects not only one's livelihood but physical self nor not knowing how hormones more typically present in the opposite sex will affect someone down the line.
shuster also discusses the Bathroom Scare, in which women view trans women entering their bathrooms not as an act of safety on trans women's parts, but as an act of violation against women's parts. This violation invokes decreased senses of safety due to sharing a space in which women must reveal themselves--albeit behind closed doors--to relieve themselves. If trans women are allowed to enter their sex-segregated space as male-bodied and male-socialized people, then what is to stop men from entering their space under the guise of trans womanhood as well?
Yet shuster's affirmation that trans women only want to use the bathroom to relieve themselves is effectively shut down with this example: "My [faithful] patient stated that the patient arrested had recognized someone clear across the room and called out, 'Yoo hoo! I'm a woman now; I have been operated on by a surgeon. Yoo hoo!' Then she used the toilet and got arrested." Is this example supposed to make women feel better? This example does not correspond with the idea that trans women just want to use the bathroom--it corresponds with the idea that they want to use the bathroom and purposefully make others uncomfortable. Of course, not all trans women, but of course, not all men, too.
One thing I do appreciate this book is the discussion of lack of financial accessibility surrounding the medical field. Especially when it comes to specialists where one may have to travel to in order to receive care of any kind. Yet in highlighting this disparity, shuster uses the following example in which a trans person writes directly to a doctor for some assistance:
"Dear Dr. [Name],
I want to have the sex change operation from male to female. I want to know how much this will cost and how long. I have very little money and I want this done free, and if you know of a doctor who will do this free, let me know. I want to meet you, let me know when you are coming to L.A. I would like to have this done here or in your office. Also, I need a home and money and employment. Do you know of anyone I can stay with?"
I was baffled that this example was used. Yes, it highlights the disparities that trans people face--lack of housing, employment, finances. But the fact that this patient first and foremost desires the sex change operation/gender affirming surgery before working to amend any of their other problems was absolutely shocking. Not receiving a gender affirming surgery will not kill you in the way a double mastectomy for breast cancer will kill you. Not receiving a feminizing facial surgery will not harm you in the way a rhinoplasty for a deviated septum will harm you. Then again, it is important to recognize that we're operating on two different definitions of life-threatening. My definition in these situations lends its hand more to what our bodies do to us rather than shuster's definition, which lends its hand more to what we will do to our lives. (Internal forces rather than external/personal in these cases).
A trend I noticed in this book is that shuster seems to demonize doctors who are reticent in prescribing hormones or signing off on gender affirming surgeries in patients who otherwise have other present health problems. We do not know what these do to an otherwise healthy person in the long-term, much less when there is a chronically ill person or someone who requires other medical assistance through medication. shuster assumes a stance of "let trans people do whatever they want to their bodies, no questions asked" when that is just...not the reality. I mean, clearly, that's why shuster is arguing in favor of this stance. But shuster largely fails to realize that it isn't just that trans person a surgeon would be affecting. A double mastectomy for someone's mental health is not as life saving as it is for someone with stage 3 breast cancer. There, I said it. You can't therapy or cope your way into not having cancer. I'm not saying that therapy or coping methods can cure dysphoria either, but there is a very real and deadly disease inside some people and if a surgeon's time is being taken up with someone who would otherwise be alive..? It just shows me that trans folks, at least in these examples shuster provides, are selfish. Instead of arguing for a radical rearrangement of the health care system, shuster places trans people's needs on a pedestal and is willing to let others suffer in ways that can only be cured through medical intervention. This is of course, not to mention that this requires doctors to act in ways that they may not find ethical in regards to patient care.
shuster cites an example from his research and his response to this example seems to only clarify my point: "We had a patient who had an A1C (a blood test for glucose levels) of 13 percent and was pretty hypertensive when she presented at our office. We were not her primary care provider. Her gender identity seemed to be intact, but the answer was no. There's a lot of comorbidities that are unmanaged and unaddressed that make me think she didn't understand the relationship between all of these things and taking estrogen." shuster then goes on to address this citation: "In addressing the concerns with other medical professionals at a healthcare conference, the nurse suggested that while the patient's gender identity wasn't being called into question, the existence of high blood glucose was enough evidence to halt hormone therapy." Honestly? How could you not agree with the doctor in this situation? At the time of this doctor's interaction with this patient, how much had been written or researched regarding glucose levels and hormones? Of glucose levels and trends in the male body? How hormones interact with insulin, diabetes, pre-diabetes, retinopathy, blood circulation--literally anything that high blood glucose could possibly affect? Is getting estrogen more important than your baseline health?
Not to mention, of course, the times when shuster wants to break down the barriers between female and male, which begs the question of how do we know which hormones are prevalent in which people? How do trans women know they want estrogen and how do trans men know they want testosterone, if these are not present in their desired sex? The blurring of not just gender but sex offers a very scary reality in which women are already not present in medical research. It would be great if navigating the world of gender and medicine could be easier in terms of changing one's body. But it's not, because that's just...not how reality works?
According to shuster, it is. Also according to shuster, evidenced subtextually in these various examples, trans folks should be able to get whatever whenever. Do we know the effects of hormones or surgeries beyond 5-10 years? Are we taking into account anecdotal or resesarched evidence from detransitioners who now suffer from bone density problems, chronic pain, organ failure, and more?
Perhaps part of my problem is that I want shuster to do more. I understand the problem he wants to fix, but he does not seem to understand how to actually go about fixing them. The problem is that trans people are not being given these life-saving therapies (by therapists who don't care about them, apparently), hormones (by doctors who don't care about them, apparently), or surgeries (by surgeons who don't care about them, apparently). The problem is that trans people do not have access to inclusive doctors, or money to pay for these treatments, or a job to save money, or a home.
To shuster, the solution seems to be that we give trans people what they want because they think it is a need. But these things--though they may be distressing to not receive and therefore warrant accessible support groups, therapies, and communities to find solidarity--are not necessary. What is, is non-discrimination laws regarding housing and employment. What is, is access to information that ensures that trans folks know exactly what the side effects are for their surgeries and hormones and treatment rather than an all-affirming "empowering" idea of bodily autonomy. What is, is access to therapists and counselors who are sympathetic/empathetic and can offer coping strategies, a safe ear, and a means to reduce their emotional turmoil.
I suppose I'll wrap it up here, as I could go on. Ultimately, shuster and I hold similar but extremely different ideologies. The easing of trans pain and suffering is a must, but how we go about it is entirely different for vastly differing reasons. However, it was well-cited, and I again enjoyed learning about the history of the medical field regarding the trans community. It was an informative but largely exasperating read.
April 15, 2021
Focused on the historical and contemporary role of physicians, psychiatrists, and psychologists navigating the uncertainty around gender transition, I found this read to be intensely academic.
I felt as though I were reading a dissertation, which is not neccesarily a bad thing, as it is clearly researched, informative, authoritative, and well-cited above all… though difficult to not go bleary-eyed at times. I felt the publisher summary was a bit misleading in this regard. This is a useful resource for a student or sociological or medical professional and would make for excellent industry conference material, but not as meaningfully accessible for the general public.
While the research and argument were clearly presented, I wish this book had included greater reflections from the author or the trans community itself, which would have made it more approachable, and not just the perspective of the provider-side.
I had trouble rating this book. If you’re researching for a paper or presentation, this is a great resource. If your goal (as mine was) is to better understand the trans experience, a summary of concepts from this book might suffice.
ARC provided by NetGalley in exchange for an honest review.
I felt as though I were reading a dissertation, which is not neccesarily a bad thing, as it is clearly researched, informative, authoritative, and well-cited above all… though difficult to not go bleary-eyed at times. I felt the publisher summary was a bit misleading in this regard. This is a useful resource for a student or sociological or medical professional and would make for excellent industry conference material, but not as meaningfully accessible for the general public.
While the research and argument were clearly presented, I wish this book had included greater reflections from the author or the trans community itself, which would have made it more approachable, and not just the perspective of the provider-side.
I had trouble rating this book. If you’re researching for a paper or presentation, this is a great resource. If your goal (as mine was) is to better understand the trans experience, a summary of concepts from this book might suffice.
ARC provided by NetGalley in exchange for an honest review.
March 16, 2021
This is a sociological study of the ways medical providers (doctors and therapists) approach medical care for trans people. A lot of it is horrifying, such viewing non-binary people as not having a stable identity and therefore not good candidates for any physical changes. There is so much paternalism and judgment from the doctors, and these are the ones who want to help! I was unsure who the audience was for this book. I don't know that it would be useful for a trans person to read, any more than a black person would want to read a book of white people saying racist things. But I do think it's good that it exists, that it is making medical discourse and mindsets visible to people who aren't in that field. It was interesting reading the quotes from the supportive doctors who genuinely didn't know what to do, because prescribing hormones to help someone transition is considered "off-label" and is not well studied. I wish there had been more to this book, both more data and more theory. It felt like she was publishing a dissertation.
October 5, 2021
I am old enough to remember when Christine Jorgensen returned to the US from Europe to become the first known American to have a Male-to-Female "sex reassignment surgery." She and then later, Renee Richardson were the only recipients of a "sex change" that I knew of for the longest time. When I read Dr. Richardson's autobiography Second Serve, I learned more about how she felt than anything else. It was the first time I thought about gender identity, but of course, I did not have the language to fully articulate those thoughts. Trans Medicine helped give me the verbiage that I still lacked.
This book could be easily read by those who have a basic understanding of gender -- no need for a medical degree. It is informative and surprisingly entertaining. The interviewees were varied and each added their own stories to help understand the topics. I recommend reading this book to anyone who wants to learn more about this timely and important subject.
This book could be easily read by those who have a basic understanding of gender -- no need for a medical degree. It is informative and surprisingly entertaining. The interviewees were varied and each added their own stories to help understand the topics. I recommend reading this book to anyone who wants to learn more about this timely and important subject.
July 13, 2022
Interesting, relatively short read. Useful, I think, for getting the context to understand how the community has been burned by medical practitioners in the past, how that has influenced and shaped how the community grew, and some of the pitfalls and positive trends in contemporary medicine. Would be useful for providers now and people who want to understand how the trans community feels as they interact with them and consider options.
June 15, 2021
This is a really interesting, academic look at the history of trans medicine beginning in the 1950s. It continues to present day to show the ways in which a historical lack of information and data continues to affect the medical care of trans people today.
June 15, 2022
Great for understanding the context of medical standards and decision making regarding trans medical issues. Recommend!
Displaying 1 - 15 of 15 reviews