Axiomatic: Constituting ‘transexuality’ and trans sexualities in medicine

This article argues that medicine misunderstands the necessarily complex ways trans people experience sexuality. Despite revisions to treatment guidelines and diagnostic descriptions, transgender medicine continues to be based on a paradigmatic narrative of ‘being born in the wrong body’. This narrative performatively reproduces sex, gender and ‘gender dysphoria’ as static, predetermined and independent of medical encounters. It also constructs trans sexualities as limited by and dependent on gender/genital ‘alignment’, which necessarily neglects many trans people’s sexual lives. By mobilising critiques of singularity from science and technology studies (STS), which emphasise how discourses and practices produce both what is knowable and materially possible, this article explores how medicine understands and constitutes ‘transexuality’ as a singular phenomenon that limits trans sexualities. By analysing contemporary medical guidebooks alongside the foundational text of trans medical treatment – Harry Benjamin’s (1999 [1966]) The Transsexual Phenomenon – I argue that medicine constitutes transexuality and understands trans sexualities via four axioms: 1) Transexuality is a disjuncture between mind and body; 2) Transexuality is hating having the wrong genitals; 3) Transexuality is painful and debilitating; and 4) Transexuality is resolvable with hormonal and surgical body modifications. In so doing, medicine flattens out the complexities of trans people’s experiences of gender and sexuality, and simultaneously disavows many trans people’s sexual lives.