My Body Requires No Explanation: Transmedicalism, Extinction Phobia, and Bodily Autonomy

If you are trans, you are afraid. It’s entirely uncontroversial to state this. The transphobic right wing is rising in power, most noticeably in the US and UK, threatening every aspect of trans life from the ability for trans children to use their preferred names and pronouns at school, to the ability to update legal gender markers. In June, when the Supreme Court ruled in United States v. Skrmetti that gender affirming care (GAC) bans do not violate the Equal Protection Clause of the Constitution, I felt it in my body as if I’d been physically attacked. After all, it was an attack on something as essential to my survival as food or water.

With the existential threat of transphobia surrounding us each day, I’ve been thinking a lot about the term “extinction phobia”. Originally coined by Lynne Stahl, I first encountered the term in C. Heike Schotten’s Trans Studies Quarterly article “TERFism, Zionism, and Right-Wing Annihilationism: Toward an Internationalist Genealogy of Extinction Phobia.” Extinction phobias, to quote Schotten, “are existential beleaguerment narratives that cast political opponents as threats to survival…” In the article, Schotten identifies both TERFism and Zionism as beliefs based in extinction phobia, and locates the origins of the former ideology within the latter, as expressed by Zionist lesbian feminists. Schotten looks at figures like Andrea Dworkin, who called for an establishment of a separatist (cis) women’s homeland in parallel to the Zionist separatist homeland, to demonstrate this lineage.

While I disagree with many of the conclusions Schotten comes to, I’ve been lingering on extinction phobia as the origin of most, if not all, extremist positions– that is, ideologies which rely on binarism, that reject nuance, that split the world into Us and Them. The fear of death is what propels the most basic and intense psychological and physiological responses in the human body, and so it’s no surprise that it fuels some of the most meteorically powerful and destructive ideologies in the world.

Extinction phobias are often but not always founded in traumatic experiences, which is why the ideologies Schotten focuses on originate within historically marginalized communities– women/lesbians in the former case and Jews in the latter. I’ll be setting aside discussion of Judaism for the remainder of this essay, as I want to focus on trans issues, but it’s sufficient to say that we Jews certainly have both lived and ancestral experience on which to base a fear of extinction.

The TERF has a well-founded fear of men (which she generalizes to mean all people with penises) as annihilators of women– physically, psychologically, spiritually, and politically– due to centuries of misogynistic violence and abuse, and patriarchal religious and political suppression. Having been traumatized by patriarchy and misogynistic violence, she believes that she must destroy or be destroyed. Trans women, in her view, are simply another group of men attempting to brutalize her (as well as appropriate and thus eliminate the concept of womanhood), while trans men are traitorous women who have allied themselves with patriarchy and surgically destroy their own womanhood. Ultimately, of course, in her manic quest to eliminate everyone and everything that could pose a threat to women, the TERF’s definition of “non-threat” becomes narrower and narrower. We’ve seen this clearly in the evolution of everyone’s favorite disgraced children’s author. As she has spiraled into mold-induced paranoia, the subjects of her wrath have shifted from trans women to all trans people to cis women of color to cis LGBQIA people, her world becoming smaller and smaller until everybody but her fellow TERFs is an enemy— and maybe not even them.

It’s been noted both by Schotten and others that TERFism, even as demonstrated by otherwise left-leaning figures like Dworkin, ultimately reinforces narrow sexist and gender essentialist narratives about gender. As I face down the well-founded fear of extinction every day, I’m prompted to wonder if extinction phobia is having the same corrosive effect on trans people. In the midst of political opponents who do concretely pose a threat to our survival, it stands to reason to me that if patriarchal trauma can give birth to the ultimately reactionary ideology of TERFism, then the same thing can happen to us.

I want to note before continuing that there is a practical difference between the power wielded by TERFs, and the power wielded by trans people I believe to be proffering extinction phobia-based beliefs. In the UK especially, TERF political organizations like For Women Scotland and A Woman’s Place UK have been major players in the stripping away of legislative rights for trans people. The strains of thought within the trans community that I’ve identified as harmful, while they do negatively impact people’s lives, do not have the same concrete influence and I am not attempting to conflate them. Rather, I write this as a call for self-examination on how we replicate the forces that oppress us, and course-correct away from those tendencies. I write this as an opportunity for us to re-focus on the things that will make our movement successful and help us all, collectively, to survive.

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I see the roots of extinction phobia extremism playing out most clearly in transmedicalist ideology. Transmedicalists hold that transness is a medical issue with a biological origin, defined by body dysphoria and “solveable” through GAC– and, more importantly, that any deviation from this definition makes one not genuinely transgender. Militant transmedicalism has waxed and waned throughout the history of the trans movement, and is currently undergoing a resurgence. It’s no coincidence, and perhaps no surprise, that this resurgence is occurring at a time of unprecedented attacks on GAC.

Those of us who need GAC to survive are scared for our lives, and to many, it may seem that those who reject the medical model, or who emphasize gender euphoria over gender dysphoria, aren’t taking that threat seriously enough. While I reject the transmedicalist movement’s conclusions, I understand and sympathize with their concern; I sometimes find myself wondering, if the cis find out that you don’t need to medically transition to be trans, will they simply hijack that slogan to justify GAC bans? In the recent Baffler article “Reject Transgender Liberalism”, historian Jules Gill-Peterson argues that exactly this led to the downfall United States v Skrmetti:

Justice Roberts cleverly adopts the liberal definition of “transgender” as describing people for whom “their gender identity does not align with their sex,” and relies on the liberal truism that only “some transgender individuals suffer from gender dysphoria” to uphold Tennessee’s right to restrict medical care without it technically discriminating against all transgender people. Justice Barrett’s concurrence goes even further, citing the extremely broad “umbrella” definitions of being transgender used by the World Professional Association for Transgender Health and the American Psychological Association as evidence that transgender people are not discrete enough to be a suspect class that has faced discrimination. These adoptions of liberal definitions, which stress the sovereignty of personal identity over social reality, and which the court pins on expert organizations, made the plaintiffs’ case vulnerable.

According to Gill-Peterson, it was the ideas of the non-medicalist wings of the trans community themselves which led to such a massive blow to trans rights. Jules Gill-Peterson’s perspective on transness, as expressed elsewhere in her writing, can broadly be understood as transmedicalist. Throughout her work, she bemoans the shift in trans politics and identity from centering around medical procedures to expansive, non-bioessentialist expressions of gender identity. In “The Un-importance of Wearing Clothes,” Gill-Peterson goes as far as to rewrite trans history in order to further this point:

Indeed, “transgender” was a term invented by crossdressers to conserve their wealth and legal rights by shrinking transition down to the scale of the private individual’s “lifestyle.”...Over time, the crossdresser’s middle-class philosophy has become the dominant current of US queer and transgender culture, which strategically draped itself in the language of 1970s radicalism to certify its good political taste.

While I’m not a historian, I am very much a student of queer history, and am particularly well-read on the era Gill-Peterson is discussing in which the term “transgender” became common queer parlance. It is well-documented that one of the fiercest proponents of this terminology, who is largely responsible for its broad usage today, was activist Leslie Feinberg.

Feinberg, a devoted Communist who spent much of hir life in blue-collar factory labor, struggling to access healthcare, is about as far as one can get from the middle-class liberals Gill-Peterson credits with coining the term. Zie, as well as frequent collaborators like Kate Bornstein, promoted “transgender” as an alternative to the then-popular dichotomy between "transsexuals" and “transvestites”. While “TS/TV” created divisions and hierarchies within the community based on who desired and had access to medical procedures, “transgender” was intended as a broader identity encompassing the vast range of transgressive gender expressions. In Transgender Warriors: Making History from Joan of Arc to Dennis Rodman, and Trans Liberation: Beyond Pink or Blue, as well as Bornstein’s Gender Outlaw: On Men, Women, and the Rest of Us, the expansiveness of “transgender” is highlighted as a tool with which to build broad coalitions.

For Gill-Peterson to so boldly defy documented trans history without any citation gives me considerable pause. While I want to trust her expertise as an academic, I can’t help but suspect that she is purposefully misrepresenting activists like Feinberg in order to discredit them and present her own position as the more radical and “correct” one. Transmedicalists like Gill-Peterson feel the threat of annihilation emanating not just from the cis establishment, but from their own community, who they feel are minimizing the necessity of what is, for them, a life-saving resource.

Of course, misdirected trauma is not the only element at play in the rise of transmedicalism. It is also a movement borne of respectability politics, the reflex within the oppressed to seek approval from the dominant group by proving themselves as “one of the good ones”, worthy of protection, while “those people” are not. While we most often associate respectability politics with minority Republicans like Candace Owens or establishment Democrats like Pete Buttigieg, its influence can still crop up in otherwise-leftist individuals, whenever they give into the instinct to validate their identities by delegitimizing the identities of others. Transmedicalists attempt to police other trans people into being the “right kind” of woman or man: namely, a woman or man indistinguishable from a cishet person (nonbinary identities are verboten in these circles.)

Throughout the 2010s, YouTuber Kalvin Garrah made a career out of publicly shaming other transmasculine people for not looking, dressing, or behaving masculinely enough, and for not demonstrating “enough” dysphoria. In 2018, Garrah made a video attacking fellow YouTuber Brennan Beckwith for all of these supposed crimes. Garrah picked apart not only Beckwith’s testimonials of his own experience as a trans person, but his personal character, fashion sense, and weight. Like Gill-Peterson blames trans people for the downfall of Skrmetti, Garrah claimed that “trans trenders” like Beckwith were “the reason Republicans fucking hate us.” Galvanized by this, Garrah’s fanbase flocked to Beckwith’s social media profiles with death threats and suggestions that Beckwith starve and kill himself. Beckwith is only one of many trans men to whom Garrah and his fans caused immense psychological harm.

While lacking a recognizable figurehead like Garrah, over in the transfeminine corners of the internet, many heterosexual, passing, traditionally-feminine trans women still use the language of Ray Blanchard’s discredited typology of transsexualism to distinguish themselves from “autogynephiles”, “transvestites”, and “crossies”— that is, trans women who have medically transitioned, do not pass, and/or are attracted to other women. For the purpose of transparency, and since I criticized Gill-Peterson for not citing sources, I want to note that when I encounter people expressing these views, I block them, and I’m not interested in poisoning my social media algorithm by hunting down examples at this time.

From Garrah’s insistence that “real” men reject all femininity, to Blanchard’s implication that attraction to men is an essential part of “legitimate” female identity, it’s clear that transmedicalist spaces routinely rely on heteropatriarchal definitions of what makes someone a man or woman. Thus, however radical a transmedicalist’s views on economics or foreign affairs may be, they reinforce a conservative worldview regarding gender. And, because gender-affirming care is expensive and Western gender norms are constructed within the confines of racist and fatphobic notions of the “ideal” white body, these spaces are rife not only with misogyny and homophobia, but with classism, white supremacy, and fatphobia. To the transmedicalist, the problem is not that society controls people’s bodies and lives through assigning and reinforcing the gender/sex binary; it’s simply that they had the wrong side forced onto them.

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With all this discussion of how transmedicalism reinforces heteropatriarchy, I think it’s important to acknowledge the ways in which medical transition, and transness in general, is demonized within certain progressive circles– and how these circles fall into the same ideological pitfalls as transmedicalism. All of these ideologies traffic in extinction phobia to one degree or another.

For what Schotten identifies as the “Marxist- or socialist-minded TERF”, the idea of gender identity simply reinforces gender roles, by assuming that anyone who deviates from the norms assigned to their sex must not “really” belong to it; they believe that “trans ideology” wants to force masculine women into becoming men and feminine men into becoming women rather than face the reality of gender-nonconformity.

This viewpoint is typified by leftist detransition influencer Bebe Montoya, who formerly identified as nonbinary and now views nonbinary identity as (to paraphrase, as again, I have blocked her) the creation of a third box to force people into if they cannot sufficiently perform one role or the other. Marxist TERFs like Montoya prop up sex-based (bioessentialist) definitions of “man” and “woman” as a more inclusive alternative to gender identity. Since no amount of gender labels will ever perfectly encapsulate the range of human existence, Montoya argues, we should define people by something concrete that impacts their daily lives: their genitals. If we could simply accept that there are many ways to be a woman/man, or if we rejected the construct of gender entirely, there would be no trans identity.

Trans anti-medicalists, on the other hand, oppose bioessentialism and conceive trans people who medically transition as complicit in perpetuating it. By seeking to surgically change our bodies, they argue, we are reinforcing the idea that gender is reducible to a body type: a trans man seeks out a penis because he believes that a penis is what makes somebody a man, and vice versa for trans women. We contort our bodies to conform them to regressive notions of what a “male” or “female” body is. To the anti-medicalist, we are tools of the state’s and medical-industrial complex’s hunger to control gender. If we could simply transcend the idea that biology has any relationship to gender or identity, there would be no need for gender-affirming care.

Both of these viewpoints position trans people, or at the very least those who transition medically, as regressive. They paint us as instruments of our own, and everyone else’s, oppression. They ignore the lived experience of those of us with body dysphoria, and don’t account for our ideological complexities.

Here is my lived experience: I know very well that there are butch women in this world, and that they deserve to be recognized and respected as women. I’m just not one of them. My existence does nothing to infringe on theirs, because I am not interested in replicating coercive systems. On the other hand, I want to someday get a hysterectomy, but my desire has nothing to do with any belief that a uterus equals womanhood. Many trans men keep their uteruses, and many even carry children, and I can respect their choices without taking them as a prescription for my own relationship with my body.

I have modified my body in the ways I have, because I personally needed to. I can’t logically explain why having breasts felt like a foreign object growing on my body, or why, after removing them, a debilitating buzz in my mind was finally silenced. I have no theoretical basis for why my brain operates optimally and my body feels like mine at a higher level of testosterone. These biological needs of mine simply exist. They cannot be reasoned or theorized away, and I know that because I’ve tried. My trans body simply exists, and I no longer feel a need to confine my gender or its vessel with a definition.

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The trans anti-medicalists, the Marxist TERFS, and the transmedicalists all demonstrate some degree of extinction phobia, because all of them position themselves as the “radical” antidote to systems of oppression bent on annihilating us. The implication of each is that if trans and gender-nonconforming people could simply get with the program and choose the “correct” identity in the “correct” body, we could free ourselves from the forces plotting our destruction. And, if we’re not able to alter our identities to suit this “better, more radical” alternative, then we are complicit in the extinction awaiting our communities.

But why should “correctness” be the goal? I, for one, do not identify as nonbinary in some attempt to one-up people with binary identities; I simply am nonbinary, and I embraced this identity because I needed to in order to survive. Even if my identity were somehow regressive, declaring it regressive would not change my internal sense of self, and I hardly see how forcing myself into a role that isn’t authentic could possibly be liberatory. I am not interested in winning some hypothetical competition for the most radical, most queer form of existence. I simply want to be my authentic self and build a liveable life for that person. 

The point of activism is supposed to be to make life more enjoyable, not to create an endless gauntlet of rules in which nobody is ever good enough. We as queer people, and leftists in general, would save a lot of valuable time and energy if the people constantly starting discourses about who is “most radical” were honest about the real purpose of those discourses: to quiet their own fears that who they are is not enough, and that they are responsible for and deserving of their suffering.

If only it were that simple! If ending oppression were a matter of picking out the “bad eggs” of our communities and reforming or excising them, we probably would have accomplished it by now. But not only is this an impossible task due to the flawed nature of every human being, it’s ultimately a pointless one that ignores the real roots of our problem. The antidote to threats of extinction is not the elimination of anyone and anything we perceive as part of that threat. Rather, it is the expansive recognition of everyone and everything that could potentially play a role in our freedom.

Which brings me back to a point from earlier in this essay: the dissonance between us members of the trans community who need gender affirming care, and those who don’t. I’ll be honest, I can’t imagine being trans without body dysphoria. I don’t even know how I would have discovered my transness without it. But just as my body requires no explanation, neither does yours. If you are reading this and have no desire to medically transition, have no gender dysphoria, but know that you are trans, you are part of my community. Not only will I respect and affirm your identity, but I will fight for it. Both of us are comrades in the same fight: the battle for bodily autonomy. And every body gets freed together.

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In the chapter “Racism, Birth Control, and Reproductive Rights” from Women, Race, and Class, Angela Y. Davis discusses resistance to the pro-choice movement among Black women. Women of color, particularly Black and Indigenous women, have endured generations of forced sterilization, child-stealing by slavers and colonizers, and other genocidal acts designed to prevent the survival of families and kinship networks. Enslaved Black women induced abortions and even practiced infanticide to spare their children from the horror of slavery, and Black and Latina women continue to seek abortions at far higher rates than white women, to this day. Throughout the 1960s and 70s, the rise of birth control and abortion access as central feminist issues created a dissonance between Black and white feminists. White feminists touted these treatments as “stepping stone[s] toward freedom”, while many Black women, Davis writes, viewed theirs as acts of desperation forced upon them by the oppressive system.

As Davis says, “the campaign often failed to provide a voice for women who wanted the right to legal abortions while deploring the social conditions that prohibited them from bearing more children.” In many ways, Black women had been struggling for the right to bear and raise healthy, prospering children. They felt threatened and unheard by a “liberation” movement that seemed at best indifferent to that struggle. Moreover, the abortion rights movement carried its own white supremacist and eugenicist history, typified by figures like Planned Parenthood founder Margaret Sanger. All of this being the case, Black women had good reason to be suspicious of abortion rights activism.

Davis’ writing called for the abortion rights movement to honestly grapple with the concerns of women of color, as well as white supremacy within its own ranks. She emphasized that the strength of a diverse reproductive rights movement depended on recognizing forced sterilization as an injustice just as horrific as forced pregnancy, and advocating for broad bodily autonomy rather than a simple rejection of motherhood.

The idea that the reproductive rights movement is anti-child persists, and it’s one reason why the anti-choice movement has become such a powerful force. While the image of abortion activists as “baby killers” is frequently a straw man or a smokescreen for conservative politicians who don’t care about children once they’ve been born, I have first-hand experience with people who genuinely believe that this is what we promote. I spent the summer of 2022 canvassing for Planned Parenthood, encouraging constituents to vote for politicians who would support the Pro Act. When women opened the door, visibly pregnant or holding a small child, it was astounding how frequently and how quickly reading the logo on my shirt filled them with visible fear. They held their children tighter or tucked them away, or placed a protective hand on their stomachs, as if I had shown up to personally drag their baby away and bash its head against a rock. These women really believed that I hated infants on principle, and while it’s a myth without factual basis, it’s one that understandably holds great emotional power over people.

I explained, over and over again, that Planned Parenthood, and the movement in general, have no interest in forcing people who don’t want abortions into having them; we simply want the option available to those who want or need it. While I have no way of knowing how these women voted in the end, I watched many of them physically relax and reconsider over the course of our conversation, and these encounters often ended on positive notes.

In recent years, there has been a shift of rhetoric within the movement from “abortion rights” or even “pro-choice” to “reproductive rights” and “bodily autonomy”. More reproductive rights advocates have joined Davis’ condemnation of forced sterilization and family separation, and many of the same people who decried the fall of Roe V Wade have rallied around protecting IVF. While naming and therefore de-stigmatizing abortion as a right is important, I think widening the tent of bodily autonomy and demonstrating the interconnectedness of these issues is a crucial step in building this movement. We need people who would never have an abortion, who even believe abortion is morally wrong, to understand that their freedom to choose a pregnancy is contingent upon other people’s freedom to end one.

I think of Davis’ work to bring forced sterilization into the reproductive rights conversation as parallel to Feinberg’s work of uniting transitioning and non-transitioning trans people. Both built a wide tent of reproductive rights and bodily autonomy that encompasses people with vastly varying needs and concerns. Nobody should be coerced into changing their body, and nobody should be forced to live in a body that feels foreign or threatening. This seems so simple when put in writing, but the rigid binaries that we are conditioned to think within can make it difficult to truly believe. And in times of danger and oppression, we want to retreat to the safety of extremes. We want to protect ourselves with high walls and narrow gates. But if our movement is to survive, we need to practice mental flexibility and the holding of multiple truths. In the face of extinction, we must spread our tent of protection wide.

My comrades who have no need for gender affirming care: I need you to fight for it as if you did, and to honor the alchemy that those of us who transition perform on our bodies. My comrades who have transitioned: we need to honor the gift of those who do not, because their existence testifies that transness cannot be legislated away. We need to say these things out loud, in the same breath, and not let them be separated. Because they aren’t separate. As Leslie Feinberg, whose memory blesses me daily, wrote: my right to be me is tied to your right to be you by a thousand strings.