The Biopolitics of Youth Transition

Transgender rights are once again in the national spotlight. Marjorie Taylor Greene threatens to assault Sarah McBride, the first trans member of Congress. Chase Strangio, a trans attorney, argues before a hostile Supreme Court on a Tennessee law banning youth gender transition. Donald Trump advertises "Kamala is for they/them. I am for you." Congressman Seth Moulton—and a raft of reactionary centrist pundits along with him—argue that Democrats need to back off on trans rights and other cultural issues. 

At the same time, there is not yet anyone advocating for direct, explicit discrimination against trans adults in key areas such as employment and housing. Rather, the current policy debate has centered itself on trans youth, which is to say on youth transition, including medical transition such as puberty blockers and hormone replacement therapy.

This is not an essay about what is politically savvy. This is an essay about youth transition: what it is and why it matters. In particular, it is about why youth transition is such a lightning rod, and why it is not some "culture war" nothing but rather a central pillar of trans rights. To understand this we need to talk in an honest way about medical transition and what it means.

What hormones do

What do hormones do? Some act as if testosterone is a one-off stat boost that makes you into a supersoldier. This is why random couch potatoes think they could take Serena Williams in tennis. This is why some think that women are inherently incapable of bench pressing their own body weight, winning a race against men, or serving in front-line combat. This is not so much a scientific conclusion as it is the fantasy of patriarchy wearing a scientifical mask.

And yet. Hormones certainly do something, especially during puberty. And it is impossible to have an honest conversation about youth transition without beginning from a place of medical reality. So: what do hormones do?

Some of what hormones do is affect the body in an ongoing way. Our muscles and bones are being constantly rebuilt; this is how we gain and lose muscle and bone strength over the years. This is why going on anabolic steroids makes you huge and going off them makes you shrink. This is why postmenopausal women are prone to osteoporosis. This is also why studies consistently show that two years of hormone replacement therapy leave trans women without any discernible athletic advantage.

On the other hand, hormones do have powerful, permanent effects on the shape of us: height, voice, hair, face, hips, to take just a few notable ones. Some of these changes can be brought on at any time (testosterone will make a trans guy's voice drop even well after puberty), while others are specific to the pubertal period (bone and skeletal structure most prominently). These changes are relatively irrevocable, not in any metaphysical sense, but merely in that our medical science is middling at dealing with them. Our methods for post facto altering the bones that underlie the shape of the face, height, hip—these are primitive at best. These facts about medical transition represent contingent features of the progress of our medical science. 

So what of youth transition? Many of the most visible aspects of sex in humans are produced by sex hormones during puberty. Not all of them—whether you have testes or ovaries does not much depend on your hormone mix—but a great many of the most obvious ones are, whether that's height, the mass of your muscles, the shape of your face, the pitch of your voice, or the width of your hips and shoulders. In other words, hormone therapy during puberty mostly produces trans adults who are indistinguishable in most ways from cis adults.

Amazing—or unnerving, depending on your perspective.

The weight of the body

Appearance matters. We'd like it to be otherwise, or at least we say we do, but the reality is: in our world how you look matters. There's a reason people pay to have their teeth straightened and whitened, their hair done and their acne cleared, why skincare products are a $24 billion industry. How we look matters to how we are treated.

This goes well beyond whether or not you are pretty or handsome. As (cis) author Nora Vincent discovered by living as a man for a year, when the world saw her as a man, it treated her in pretty fundamentally different ways than it did when she was perceived as a woman. As Alice Evans documents, (in some places at least) a woman alone on the street feels a weight on her: the weight of the eyes of men, and the violent possibilities those eyes suggest, whether or not they are actualized.

But it's more than that. The weight of others' regard presses on us in deeper ways. As Rousseau argued, we human beings are social animals, which means we live to some degree in the eyes of others. How others perceive us affects how we perceive ourselves; how we perceive ourselves affects how we feel and how we act. Vincent is relevant here as well, in that by living as a man for a year she appears to have unwittingly induced severe gender dysphoria in herself, leading to suicidal distress and a mental breakdown.

There's always some voice arguing that we shouldn't "medicalize" our appearance, because that just feeds the idea that appearance matters, when actually we should be abolishing appearance (the people saying this always seem to already look pretty normal, for some strange reason). I remember growing up with ads from skincare companies advising their viewers to "love themselves just the way they are." As an egg suffering from severe dysphoria I could neither name nor understand, this message was profoundly alienating. I tried to make it work anyway. I spent the better part of my young life trying to think my way out of the problem, trying to figure out the right combination of thoughts so that I could stop wanting to set myself on fire every time I caught sight of my reflection. But of course none of it worked—nor, for that matter, did any level of love and acceptance from others, in whatever flavor. I did not love myself the way I was. Do you know what did make a difference? Those little blue pills that read b/887-2 on them. Estradiol. Hormone therapy.

Aesthetics matter more than just personally and interpersonally: they matter politically. It is not an accident that the anti-trans movement invariably tries to find the ugliest, clockiest trans woman they can to be the target of their wrath; it is not an accident that Sarah McBride, the first trans congresswoman, looks quite normal. (For those less familiar with my subculture's dialect: "clocky," from "clocked," as in "recognized as trans.") It is not an accident that the immense success of the gay marriage movement came from emphasizing that gays like me are just normal people who want normal things.

Their truth, our flesh

Not far from where I live there is a homeless encampment underneath a bridge; I pass it on my bike occasionally. In the summer it smells like raw sewage. The people who live there are dirty, their clothes are dirty, their teeth are dirty. Of course, this is not some intrinsic feature of the people, but rather the inevitable result for anyone who spends a few months living under a bridge without flush toilets or running water. But to many, it is precisely these superficial features of the homeless that justify their homeless status: "Just look at those people, they stink, they're filthy, they must deserve whatever's happened to them."

In other words, there is a feedback loop. The conditions of their existence produce certain visible physical traits; these visible physical traits are in turn taken to justify the conditions of their existence.

I have argued in a previous essay that a similar model applies to sports, and how the hidden rules of sports encourage different kinds of performance from men and women, which performance is in turn taken to justify those rules—for instance, the different kinds of floor routines performed by male and female gymnasts. Women get points for dancing, so women dance; men get points for flaring, so men flare; audiences go home thinking women are naturally better dancers but incapable of flaring—so we might as well write that into the rules.

The same principle applies to youth transition, and the denial of it. As argued above, the aesthetic changes made by sex hormones during puberty are not readily reversible. To put it quite bluntly, the earlier you start transition, the more easily you pass as normal. Forcing trans people to wait until they are eighteen to begin medical transition functions to mark us out as different not just symbolically but physically. And of course these physical results are constantly used to justify precisely this treatment—as noted above, conservative media is forever seeking out pictures of the clockiest trans women they can find to symbolize trans people in general.

They are trying to write their truth onto our flesh.

Changing the body

Imagine you are a cis girl, maybe nine or ten, and one day the men from the government come to your parents' house and explain that from now on you'll be receiving weekly testosterone shots. Over the next several years, your voice will drop, you will grow a beard, develop a thicker brow and jaw, and in these and so many other ways experience a typical male puberty. All the while the men from the government will be there, watching you, and explaining that this is for your own good, and you'll soon grow out of the childish delusion that you ever were a girl. Afterwards, they'll cite your severe mental distress as evidence that you were never competent to make such decisions in the first place. If you still claim you really are a woman, they'll cite your male features as proof that you aren't—male features you can never completely mitigate, given the state of our science. This is the biopolitical feedback loop in action.

We rightly recognize this as a program of torture and mutilation practiced on a child. This is what conservatives want for trans girls: this same program of torture and mutilation. And all the while they will be insisting "this is just natural." But eyeglasses are not natural. Vaccines are not natural. Hormonal birth control is not natural. Electric lights in the darkness, jet aircraft dancing between continents, glass bricks with all the libraries of the world inside: none of these are natural. The natural is no good guide to what is good for a free and equal citizen, the bleating of reactionaries be damned. We human beings have escaped our natural environment, and that is our self-liberation from the prison biology built for us.

But if the "natural" does not exist, it must be created, by violence if necessary. It is not an accident that these anti-transition laws always include special carveouts for "gender conformity" surgeries on intersex infants and gender-affirming care for cis children (such as breast reduction for boys with gynecomastia). The point is not to prevent anyone from doing anything related to gender to children; the point is to enforce a particular vision of gender on children—and on their bodies. You might call this an artificial telos: the man-made "natural" that both explains and justifies itself. The unruly flesh of humanity hacked at until it fits their obsessions, and that mutilated body held up as the reason such mutilation is necessary, natural, and normal.

Second-wave feminism was right to recognize that hormonal birth control was a seismic social possibility. It was easier to change the body than it was to win the culture war—or rather, by changing the body, they made progress on the culture war. We must recognize both that the body matters and that the body is mutable, and this mutability is relative to both technology and regulation. This is liberation in progress.

Featured image is The Anatomy Lesson of Dr. Nicolaes Tulp, by Rembrandt