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Finding natural variation: assembling underdetermined evidence of gender dysphoria, doing trans therapeutics

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Abstract

Trans medicine has historically naturalized a heterosexual binary model of gender by treating variation as aberrant. Gender dysphoria, the current psychiatric diagnosis that often facilitates trans medicine, is represented by mental health experts and LGBTQ groups as a superficial semantic shift in this tradition. Based on in-depth interviews with experts who crafted gender dysphoria for the fifth edition of the Diagnostic and Statistical Manual (DSM-5) in 2013 and archival study of the experts’ research process, I find far more than semantics at stake. Because experts had an imperative for evidence-based revisions to the DSM-5 and an underdetermined research based on gender identity development, their revision affirms gender variation as natural and non-pathological. Gender dysphoria is maintained as a mental disorder because experts insist on its importance for the institutional legitimation of trans people, not because gender variation is understood to be pathological. This move toward treating gender variation as a flexible spectrum of illness and wellness required a new scientific interpretation of evidence. This interpretation (1) finds underdetermined research to be credible evidence of natural variation and (2) applies this variation simultaneously to traits (like gender) and also to health status. Consequently, natural variation becomes a scientific finding.

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Notes

  1. “Trans” is how I refer to a broad group or community of people with non-normative gender identities and experiences. I use the term “gender-variant” to more accurately reflect the clinical language of experts when discussing the subjects of their work.

  2. “Gender dysphoria” is introduced here in quotes to indicate that I am referring to the psychiatric diagnosis which may or may not be the actual experience of dysphoria that many trans people have. In this article, gender dysphoria will refer to the diagnosis rather than the experience unless specified otherwise and will not appear in quotes.

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Correspondence to Cal Lee Garrett.

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Garrett, C.L. Finding natural variation: assembling underdetermined evidence of gender dysphoria, doing trans therapeutics. BioSocieties 17, 28–52 (2022). https://doi.org/10.1057/s41292-020-00201-9

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