One very widespread perception about nonbinary people is that we don’t need to transition. Nothing could be further from the truth. While every nonbinary person is different and not all of us need or want to transition, some of us do, and we cannot access support for transitioning without lying and prevaricating; to transition, we need to lie about our gender, because transition for nonbinary people is not recognised. As a result, those of us who want access to medical transition, to hormones and surgery, must pretend that we are binary and must be able to do so effectively enough to be ‘approved’ by the gatekeepers.
The medical community doesn’t really recognise nonbinary gender in general, and there’s resistance to it in some sectors of the transgender community. Among people who aren’t binarist, there’s a lack of understanding about what it means to be nonbinary, and many people think ‘oh, they don’t need to transition.’ This isn’t the result of bigotry, simply ignorance, because the numbers of out nonbinary people are relatively low and we are so diverse; people interacting with me, for example, cannot and should not take me as representative of all nonbinary people. We ourselves, trapped in a highly binary culture, are not always sure about the need for transition. Some questions I get asked a lot by nonbinary people looking for help and support are ‘can I transition?’ ‘do I need to transition?’ ‘how do I transition?’
I know that my body is not in alignment with my gender. I want to transition. But I can’t. I cannot access hormones and surgery because nonbinary people are not recognised and there isn’t a standard when it comes to talking about transitioning for us. And I myself get tangled in binary ideas about gender performance, like feeling guilty about the fact that I usually wear women’s clothing because that’s what fits this body. Feeling bad when I femme up because obviously I’m not a girl so I shouldn’t do girly things like wearing skirts and dresses. Feeling like I have to perform my gender at all times or I’m a fake, even though there is no established and accepted way to perform nonbinary gender; in a world where gender performance is everything, I can’t find my lines, the set, or my costume. When I interact with my body, I know that it feels wrong to me but it’s hard to articulate how, and if I discussed the things about my body that I want to change with a doctor, I would probably be slapped with a psychiatric diagnosis, rather than being supported with transition.
I know a handful of nonbinary people who have transitioned. All of them did so by appearing to be binary trans people. They talked the talk and walked the walk. They got their hormones, and in some cases had top or bottom surgery, or both. Had any of them talked about being nonbinary, it’s likely treatment would have been withdrawn. For nonbinary, neutrois, agendered, nongendered people, medical transition is labeled as ‘unethical’ and doctors could actually lose their licenses for providing services to us, unless some sort of legitimate medical reason can be established; I, for example, could get a double mastectomy on the grounds that it would reduce my risks of developing breast cancer, as a person with high risk for breast cancer. I couldn’t access T, unless I was willing to say I was a trans man, which I’m not. As for bottom surgery…
Medical control of transition is not just a problem for nonbinary people. Transition is often held up as the holy grail for transgender people; it’s assumed that every binary trans person wants medical transition and that it’s the eventual direction everyone will move in, even though that’s not actually the case. For those who do want/need to transition, it’s not universally available. You have to go through a gamut of medical evaluations that some people may not pass. Some because they simply can’t afford to go through the medical establishment at all. Others because they don’t fit into neat diagnostic boxes. And as soon as you start wavering from the DSM, treatment will be halted or withdrawn. You will be questioned about whether you ‘really’ want to transition. You will be asked if you know your own gender; cis readers, have you ever been asked if you ‘know for sure’ that you’re a man or a woman?
For people who manage to access medical transition, there are barriers to staying on hormones including cost and pharmacy access. Surgery is expensive and often not covered by insurance, and also comes with a lengthy recovery time that can be difficult for some people to afford. You may be required to submit proof that you are sterile if you want to change the gender markers on government identification; people say forced sterilisation doesn’t exist anymore? Well, it does, and the transgender community can tell you all about it, as, of course, can the disability community, and it’s notable to look at who our society wants to deny reproductive rights to, isn’t it.
The medical approach to the transgender community seems to be primarily one interested in fixing/repairing/curing/hiding us; look at all the research done into what ’causes’ people to be transgender, often with the stated goal of preventing us from existing. It’s not surprising that the medical community makes binary trans people jump through hoops to access medical transition if they want it, and it’s not surprising that the approach to medical transition is highly binarist.
The only way to reform that is to fight. To fight the establishment. To be out and nonbinary, to lobby for medical transition for nonbinary people who want it, to create a framework for giving us access to the treatment that some of us need. Some of us are dying because we cannot transition or because our transition has been interrupted.