Transnormativity

Conceptual Overview

A noteworthy body of academic literature has called attention to how normative understandings of sex and gender, characterized by binary essentialism, have permeated medical, academic, and legal discourse and are enacted through institutional and interpersonal accountability or gatekeeping practices. For instance, early trans care clinics in the mid-20th century often required trans women (trans men were infrequently considered at this time) to perform stereotypical European femininity, profess a heterosexual sexual orientation, and narrate their identities as some variant of being “born in the wrong body” in order to access gender-affirmative medical care of any kind. Today, many governments still require proof of complete and irreversible surgical medical intervention that medically changes a person’s sexed body before they will grant court orders for legal gender marker changes. In reality, trans people report a wide range of gender identities, sexual orientations, and transition trajectories. However, these normative standards (e.g., traditional gender expression, binary gender identity of male or female, and “complete” linear medical transition involving hormones and surgeries) have remained a metric by which the legitimacy of trans identities are measured across social contexts and institutions, from health care and the criminal justice system to education and the family.

In an attempt to synthesize these normative standards into an overarching conceptual framework, scholars have invoked the construct of transnormativity, defined as a regulatory, normative ideology that holds trans people’s identities accountable to a medicalized, binary framework. In a 2019 paper titled “Transnormativity in the Psy Disciplines: Constructing Pathology in the Diagnostic and Statistical Manual of Mental Disorders and Standards of Care,” Damien Riggs and colleagues identified the history of how transnormativity has been codified and institutionalized within such documents as the fifth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the World Professional Association for Transgender Health’s (WPATH) Standards of Care (SOC) for the Health of Transsexual, Trans, and Gender-Nonconforming People, Version 7 (SOC-7). In 1980, “Gender Identity Disorder” was listed in the DSM-III as a psychological disorder with defined diagnostic criteria. Even with the 2013 change in DSM-5 to “Gender Dysphoria,” little has changed in the way psychiatric taxonomies have regarded trans experiences, and these guidelines still arbitrate what constitutes legitimate trans experiences. For example, a psychiatric diagnosis of gender dysphoria is often still required for individuals to pursue gender-affirmative medical interventions, meaning that individuals must narrate their trans identities in a way that sufficiently conforms to the DSM criteria in order to access gender-affirmative health care. Likewise, WPATH’s SOC is used by most gender-affirmative surgeons to determine eligibility for genital surgery, such as metoidioplasty, phalloplasty, and vaginoplasty. In SOC-7, access to these genital surgeries includes the requirement that patients undergo 12 continuous months of hormone therapy and 12 continuous months of “living in a gender role congruent with their gender identity.” Although perhaps well meaning, such standards impose a normative transition trajectory that assumes all trans people seeking genital surgeries must also desire hormone therapy. This narrow medical model of trans identity transcends health care and operates as a normative accountability structure for trans people across social contexts and institutions, including the state and national vital records, the criminal justice system, and trans community groups.

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