6mg micronized estradiol 17, sublingual
50mg cyproterone acetate
75mg methadone (in tang solution)
two inhalations salbutemol, every four hours as needed
I depend on these medications. In literal senses as well as existential ones, I need them in order to survive. Who and what I am, as well as my continued existence, hinges on modern medicine. Had I been born a century or so earlier, I wouldn’t have even survived past infancy in order to experience the nightmares of gender dysphoria and opiate dependence. And in the event of a zombie apocalypse, I’m totally fucked. Unless I were to take to hunting female zombies and harvesting their ovaries.
Needless to say, the Naturalistic Fallacy ends up feeling a tad personal for me. I’m a naturally unnatural Natalie.
Yesterday on twitter I came across a woman calling herself Yeats Infection who decided to chastise the “decision” trans people make to become dependent on the “capitalist pharmaceutical industry” for the rest of our lives, framing us as having somehow been duped by the evil conspiracy of Big Pharma.
What an insulting, condescending, privileged, uncomprehending, self-righteous, patronizing infuriating, ignorant thing to say. Ugh. Just ugh. Well, no, not just ugh. Ugh and a heartfelt “fuck you” as well.
What it brought to mind for me, and made explicit, was the incredible degree of privilege and entitlement that often underlies the “natural medicine”, “alternative medicine”, “non-allopathic”, anti-“Big Pharma” attitude. That beneath the preference for these “natural” alternatives was the luxury of a normative physiology, and that to extrapolate from that luxury a prescriptive, paternalistic attitude towards the not-so-inconsequential choices others make about their health and bodies belies considerable classism, ableism and, yes, cissexism.
It’s really easy to talk about “natural medicine” and criticize pharmaceuticals when your life and identity aren’t dependent on your medicine actually working.
But not all of us have those same luxuries. Some of us don’t have normative bodies, don’t have perfectly “natural” physiologies, and need to rely on the tools of science rather than the empty comforts of placebos and “traditional”, “non-allopathic” care. Some of us need the disease to be treated, not “the person”. Some of us aren’t at liberty to treat our medications as a mere lifestyle choice, something you pick off a shelf because it presents the right cultural image and makes you feel cozy and enlightened. Some of us have more at stake than a vague sense of middle-class ennui or a case of the sniffles that will go away on its own regardless. Some of us need to survive.
It’s interesting in how she framed this in terms of us trans people having been deceived. It’s staggering the degree to which cis people simply refuse to accept the possibility that trans people are actually rational, capable, intelligent people who’ve thought things through and come to a decision about what we need to do (not unlike the republican idea that every woman who ever chose to terminate a pregnancy just didn’t think it through properly, and there should be laws forcing her to). Staggering how much they just don’t bother to consider the fact that maybe we’ve put a little thought into the question, and maybe did our homework, and maybe the five minutes they spent considering the question of gender variance might not be providing some unique, devastating, heretofore unconsidered truthbomb that none of us ever possibly could have considered before and that will totally blow apart the myths us poor deluded trans people have blindly stumbled into uncritically accepting.
I understand that this whole reluctance to consider us having real, genuine agency and education thing is mostly about the fact that accepting us as fully informed, aware, rational agents poses a giant threat to a whole lot of foundational cultural assumptions about gender and sex (“how could anyone in their right mind choose to be a woman?!”), and so there’s an enormous amount of cultural tug in the direction of dismissing, ridiculing and pathologizing us, as well as coming up with various reasons to believe we’re delusional or deceived (by the patriarchy, by the gender binary, by homophobia, by the gay agenda, by our own [insert unrelated co-morbid psychological condition here], by Satan, by the pharmaceutical companies, whatever), but still… the arrogance required to presume that a cursory examination of our existence by your mighty, unclouded cis minds will reveal these amazing facts we just plain don’t understand about “biological realities” or “only cosmetic” or “why not just be a butch lesbian?” or “unnatural” or “capitalism” is still something I can’t quite understand.
But it’s certainly largely about privilege. Privilege and entitlement. No cis person has ever been forced to consider gender in its multifaceted complications, or reconcile its contradictions and paradoxes, or weigh the relationship between sex and gender identity and gender expression and assignment and socially prescribed role and sexuality and everything, or have to hold on to that sense of selfhood against an immense cultural force baring down at all times from all sides, or “prove” the legitimacy of their gender against an endless procession of family, friends, teachers, therapists, doctors, bureaucrats, clerks, customs agents, security guards, human resources personnel, police officers, nurses, hiring managers, landlords, property managers, neighbours, roommates, whosoever happens to cross their path and is afforded at least some tiny scrap of power or authority. Cis people are not forced into the position of understanding how deep the ocean of gender’s complexities goes, and are therefore able to believe (though yes, Pending Whiny Angry Commenter, being able doesn’t mean all do) it’s as shallow a pool as their own shallow understanding. A five minute dip in to the bottom step of the kiddie pool (“Oh… but that means they have to take pills for their WHOLE LIVES? That’s kuh-razy!!!”) and they come back out thinking they’re the very first to discover the ocean floor.
Nevermind the other positions in which people end up “duped” by their health conditions into being dependent on pharmaceuticals. Like, say, heart transplant recipients or diabetics or people with severe pain management issues. No need to bother with that comparison, right? …Right? Gender, it seems, is something uniquely positioned to be considered understood by the ignorant, and gender dysphoria uniquely well positioned to be “just in one’s head”, because one who’s never experienced it can’t possibly grasp just how intensely real it is.
Actually, the pain comparison might be worth exploring. Try telling someone with irreparable nerve damage that it’s just in their head, and they’d be better off accepting themselves and learning to live with it rather than being tricked into dependence on the pharmaceutical industry.
Amazingly, in all this arrogant entitlement, those with the luxury of natural medicine, the class, able-bodied, cisgender privilege to eschew proven medicine, the thought never occurs to them that they might be the ones who have been duped. They never seem to think through long enough to remember that the purveyors of natural and alternative medicine and treatments are businesses too, with the same capitalist instincts, motives and biases. But way less controls and regulation.
And no evidence.
There are a few things I’d really like to clear up about this whole thing, before we find ourselves with a brand new means by which our identities can be invalidated though misconceptions and ignorance.
First of all,
Gender variance predates modern medical interventions designed to accommodate it.
Trans people have always existed, and trans people always will exist. Just like chemotherapy didn’t create cancer, exogenous hormones and genital surgery didn’t create transgenderism. They simply present options for care, for adapting to the condition, for attaining greater quality of life, greater happiness. We are not a creation. We are not an experiment. We are not Frankenstein’s monster. We are a fact of human nature, and of human gender.
Estrogen and testosterone ARE “natural”.
Whether produced in a laboratory or produced in a testicle, testosterone is the exact same chemical. The hormones taken by trans people in the 21st century are the very same hormones that already occur in the human body. We simply adjust the levels, so as to produce physiological changes that are already encoded as potentials in our DNA.
Comparatively, phytoestrogens or premarin or whatever, despite not necessarily being produced in labs or factories, are substances that are alien to the human body.
These kinds of statements are not harmless.
Describing transition as “unnatural”, or framing it as being “tricked” into dependence on some kind of evil, hand-wringing, mustache-twirling, mwa-ha-ha-ing pharmaceutical cartel, is, as stupid as it may be, not quite so easily shrugged off by everyone. Trans people who are in early phases of questioning can easily be thrown off by this kind of thing.
When you factor in the tragedy of how often, how widely, and how consistently the medical establishment has failed to meet the needs of our community, how it talks down to us, asks us to jump through countless hoops, how it refuses (like everyone else) to accept the possibility of us being rational people in full possession of agency and the ability to make informed choices about our bodies and genders and health, how it often prioritizes the maintenance of archaic concepts of gender and sex over our well-being, how often its members are ignorant of us and our needs and our bodies and how to treat us, how often its members are ignorant of how to demonstrate basic respect and sensitivity, and how it treats us with as much paternalism and condescension as those who would “protect” us from them, and you have a situation where people are very, very, very vulnerable to the suggestion that their interests are best met outside the framework of established medicine.
But proper medical care is what we need. Improvement of that care is vitally necessary, but giving up on it, casting it aside as the “enemy”, is a recipe for disaster. The problem with medical care for trans people as it currently exists is not that this medical care is overly “scientific” or “western” or “capitalist” or whatever-the-fuck. The problem is that how doctors have researched, understood and treated trans people is damaged by decades of extremely poor science, a lack of empiricism.
And the last thing we need is yet another avenue through which we’re described as unnatural, wrong, deluded, shameful.
Lives can be lost to this kind of thing. And if it goes unchallenged, they will be.
“Natural” is often just a code word for “normative”.
When speaking of human beings, the word “natural” breaks down into incoherence and nonsense. “All-natural arsenic! No dangerous additives!”. There is no strict, concrete, tidy definition for “natural” vs. “unnatural”. What these words ultimately mean in the context of human beings, human traits, or human behaviours is simply a value judgment.
And this value judgment is based on what seems normal, comprehensible, recognizable, easily understood and embraced within the pre-existing scope an individual subject-position. “Natural” means “this seems like something normal and un-frightening that totally fits into what I understand about how the world works”. “Unnatural” means “Oh noes! I’m going to have to rethink and adjust my understanding, or frame of reference, or understanding of how things are, in order to reconcile this thing I’m being confronted with! And I’d really rather not!”. “Natural” fits into your (always limited) conception of the order of things. “Unnatural” does not.
More so, “unnatural” suggests an unwillingness to adapt one’s understanding. “Unnatural” suggests you don’t wish to reframe anything, or ask any new questions, or consider any new possibilities, by which this new thing could be understood to be a “natural” part of your world. To name it “unnatural” is to exclude it from the set of facts you’re willing to accept.
“Natural” poses a normativity, a set of things you already know how to handle and conceive, and necessarily constructs an “unnatural” Other of that you wish to banish from your understanding, that you refuse to allow to fit in to your world. “Natural” forgives your comprehension of how things are as the only way things ought ever be. “Natural” is all about limiting the range of what you’re willing to understand. “Natural” is a limited, threatened, frightened, closed-in little world. “Natural” is hiding in your shell with what you’re already comfortable dealing with, and pushing away everything else, everything new, everything different. “Natural” is a Dalek in his casing.
In that sense, I am proudly unnatural.