Tag Archives: nonbinary gender

PCOS, Gender Identity, and Medical Oppression

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Debbie says:

Ariana Smit’s terrific article at Women’s Media Center, “Healing my PCOS does not mean confirming to your ideal feminine body” is decorated with the author’s own artwork (example above). WMC doesn’t provide a bio, so I don’t know what pronouns Smit uses; since they are completely clear about being gender non-binary, I’m going to go with “they.”

Here’s their quandary:

Five to 10 percent of women have PCOS — a statistic that doesn’t include me and my queer, nonbinary body. Beyond not feeling represented or seen by my doctors, the persistence of a binary understanding of sex and gender in the medical field has failed to account for the way I, and patients like me, deserve and need to be treated.

For those who don’t know about PCOS (polycystic ovarian syndrome), Smit gives us a little background, describing it as:

a condition caused by a reproductive hormonal imbalance. The condition can manifest in different ways from person to person, but my symptoms include weight gain, acne, facial hair, and hyperpigmentation.

They also experience intense pain, which they describe in the opening of the article, but  don’t mention in the symptom list, perhaps because the pain is the symptom the medical profession seems to be least concerned with:

Gynecologists and general practitioners have told me time and time again that my hirsutism (a subjective diagnosis of “excess” hair growth), weight gain, hair loss, acne, and hyperpigmentation are all “issues” that need to be “dealt with” in order to make me “normal” again. In other words, the only way for my body to be acceptable to society is for it to conform to society’s idea of the perfect woman: hairless, thin, and with clear skin. While it is true that these symptoms are important indicators of a hormonal imbalance in my body that have had a debilitating effect on my mental health, the symptoms these doctors focus on treating do not actually threaten my physical health — treating them is cosmetic, not medically necessary. The number of stubborn hairs on my chin in and of themselves affect neither my health nor my identity.

In other words, the issues of how Smit looks take precedence over how they feel. Waking up every morning in an almost unbearable amount of pain — well, that’s just part of having PCOS. But “excess hair” (a phrase rather like “overweight”), now that’s an issue worth reckoning with. After all, “she” might not get married and have children, if “she” has “excess hair.”

As one of the best-known symptoms of PCOS is infertility, Smit takes on that concern of the medical profession:

For example, gynecologists constantly identify the only definitive reason to heal my PCOS as enabling me to have children with my husband one day. I have not corrected doctors who make this false assumption, but rather have hidden my identity because I do not want to have to teach them about how they should treat me. I do not want to have to explain that I do not identify as cisgender and that my partner does not either. I am also afraid that telling my doctors would lead to enduring erasure of the very identity I would explain to them — that they might not believe me or take my identity seriously because I am still (mostly) female-presenting.

Again, buried in the “only definitive reason” language is an assumption that everyday pain is not a definitive reason to treat Smit.

The medical profession both reflects and transmits simple binary gender thinking, getting this oversimplification from the larger community and sending it back.

PCOS Diva, one of the most popular PCOS dedicated websites, states on their homepage that they “[offer] women the tools they need to gain control of their PCOS so that they can regain their fertility, femininity, health, and happiness.” This focus on femininity is alienating for queer people with PCOS, as their goals are not based on restoring some kind of essentialized femininity based on fertility, hairlessness, and thinness. Although I am confident in my identity as a queer, nonbinary person with little intention of having children, this kind of rhetoric is still isolating, and I sometimes feel trapped into having to prescribe to these ideas in order to feel like I am taking adequate care of myself.

And that’s the core of the problem. Confidence and sureness of our own self-worth is almost always somewhat vulnerable to the assumptions of people in power, and perhaps even more so to the assumptions of our peers. Smit sounds like they have good support in their nonbinary identity, and good tools to defend themselves; still, the essay screams with not only the physical pain of PCOS but the emotional pain of not being seen for who they are, not being able to walk into a doctor’s office or open a website and see acknowledgment of people like themselves. In this context, I especially appreciated their mention of a related but different group, mentioning “cisgender women who do not conform to stereotypical notions of femininity” — another cohort that might not want a doctor to focus on hair or weight gain when treating PCOS.

What does Smit want? What we all want!

Ultimately, I want to love myself while looking after myself. I don’t want trips to the gym to be shrouded in the idea that in order to feel “normal” again I need to mold my body into the perfect image of femininity. I want to go to the gym acknowledging that yes, I have issues that require me to maintain a healthy, balanced lifestyle, and regular exercise forms an important part of fulfilling that need. I do not believe that framing this within femininity is productive for anyone looking to heal themselves.

I also want to be able to acknowledge that yes, I do have acne and residual scarring, but that does not mean that I am “ugly” or in need of a quick fix so that people will be more accepting of me. Instead I want to enjoy looking after my skin by indulging in homemade bentonite clay face masks but still be happy going out without any makeup on, or with the fear that someone will judge me for it.

I came away from this essay with a very high regard for Smit, with an increased awareness of what gender nonbinary people face from the medical profession, especially when they have diseases associated with a given binary gender, and with a renewed determination to move my language away from the gender binary.

In the U.S., we’re so steeped in electoral and other national politics that I also appreciate the perspective  of someone half a world away (Smit lives in South Africa) and their commitment to linking their personal experiences to a political lived reality around the world.

Follow me on Twitter @spicejardebbie.

Gender News, Gender Views

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Debbie says:

I feel like I keep up pretty well with changes in the areas of California law that interest me, but the fact that my state seems about to make it legal to register as a person with a nonbinary third gender completely snuck up on me. And what a delightful surprise in the middle of the 2017 experience of keeping track of the news.

The law has passed the California Senate and is in committee hearings in the Assembly. A final yes vote is expected “by the end of summer,” and it seems likely that Governor Brown will sign.

Questioned on whether the legislation will cover such identities as bigender, cisgender, intersex, trans and two-spirit, [Jo Michael, Legislative Manager for Equality California] added that female, male and non-binary options will “cover pretty much everyone.”

Earlier this month, Oregon became the first state to allow a third gender option on government issued ID cards.

This is truly a huge sea change, and if it does pass in California, I predict that it’s likely to spread fairly quickly through the blue states. I also predict legal issues (and probably harassment) when someone with a third-gender California or Oregon drivers’ license goes to Mississippi, or Texas, or Arkansas. This is how change happens.

***

Before I saw that news, I had already bookmarked the amazing Julia Serano‘s piece “Debunking Trans Women Are Not Women Arguments,” posted on Medium. Serano is one of the clearest thinkers, and most organized writers who tackles gender, and this essay is no exception. Body Impolitic has blogged her writing a couple of times.

Like women more generally, many trans women are feminists. Feminism and transgender activism are not in any way incompatible or mutually exclusive. As feminists who acknowledge intersectionality, we believe that we should be fighting to end all forms of sexism and marginalization — this includes both traditional sexism and transphobia. Forcing trans women into a separate group that is distinct from cis women does not in any way help achieve feminism’s central goal of ending sexism.

After clarifying her terms and setting the stage, Serano systematically sets up and knocks down

  • the “biological woman” fallacy
  • the Caitlyn Jenner fallacy
  • the “male energy” and “male privilege” fallacies

Male privilege is a very real thing. In my book Whipping Girl, I talk at length about my own personal experiences of having it, and subsequently losing it post-transition. However, not every trans woman experiences male privilege (e.g., younger transitioners). Furthermore, the whole purpose of talking about privilege (whether it be male, white, middle/upper-class, able-bodied, or straight privilege, to name a few) is to raise awareness about the advantages that members of the dominant/majority group experience due to the fact that they do not face a particular type of sexism or marginalization. And the fact that the trans-women-aren’t-women crowd constantly harp about trans women’s real or imagined male privilege, yet refuse to acknowledge or examine their own cisgender privilege, demonstrates that their concerns about privilege are disingenuous, and that they are merely using the concept in order to delegitimize trans women’s identities and lived experiences as women.

  • the “trans women as caricatures of women” fallacy
  • the “brain differences” fallacy
  • the Rachel Dolezal fallacy
  • the “trans women refuse to acknowledge any distinction” fallacy

Here’s part of Serano’s conclusion:

There was a time in the 1960s and 1970s when many heterosexual feminists wanted to similarly exclude lesbians from women’s organizations and from feminism. The justifications that they forwarded were eerily similarly to trans-women-aren’t-women arguments: They accused lesbians of being “oppressively male” and of “reinforcing the sex class system” (see earlier Twitter thread). If you read the Wikipedia article I linked to earlier in this paragraph, you will find that lesbians fought back against such accusations. They didn’t do this because they believed that they were 100 percent identical to heterosexual feminists. They did it because some feminists were attempting to exclude them from feminism and the category of woman. Just like those who forward trans-women-aren’t-women arguments are attempting to do to us now.

Trans women are women. Trans men are men. And nonbinary people are neither. It isn’t complicated–and it’s only threatening if you are convinced that you are threatened when someone walks in the world differently than you do — and you don’t want to give them the respect of believing their truth.