Is Dysphoria Necessary for Being Trans? The “Truscum” Debate

There’s a debate raging in the trans world that has been on going for awhile. The debate is between self-described “truscum” (also called trans medicalists) vs what I will call “maximals”. Truscum believe that gender dysphoria is necessary for being trans and that being trans is essentially a medical condition defined by dysphoria and the desire for “opposite” sexed bodily characteristics. The name comes from the idea of “true trans” – the idea that we can develop a way of determining who is “truly trans” vs those who are merely “trans trenders” i.e. cis people confused into thinking they are trans for whatever sociological/personal reason, perhaps because they want to fit into niche internet communities or what truscum would call the “special snowflake” phenomenon.

Before I go on further, I need to point out that trans medicalists have self-consciously reappropriated the term “truscum” to describe their position. A more traditional way of talking about this debate is in terms of separating “true transsexuals” from “transgender” people where “transgender” means those trans people who don’t want to medically transition and “transsexual” means those that have dysphoria and want to medically transition. But “transsexual” is a very outdated term that comes from the old-school psychiatric community. Try to read this post without thinking the term “truscum” is pejorative. As you will see, I believe there is a huge amount of truth in the truscum concept so I’m not bashing the belief system, merely using the term I see most often used by self-described trans medicalists.

In contrast, “maximals” believe that dysphoria is not necessary for being trans and generally want to expand the trans umbrella to be maximally inclusive. Maximals often lump crossdressers and gender nonconforming people into the “trans” category (though this is an oversimplication I will discuss below). Maximals don’t believe being trans is necessarily a medical condition or believe that if you’re trans there’s something necessarily “wrong” with you. Instead of defining trans people as those people with gender dysphoria, maximals often define being trans as the state of having a gender that is different from the gender/sex you were assigned at birth. This definition is maximally inclusive because it doesn’t require dysphoria in the definition. For example, if you are non-binary, perhaps agender, you might not have dysphoria about your body but your gender is different from the gender you were assigned at birth.

Let’s get some other definitions out of the way. “Gender dysphoria” is generally defined as a disconnect between the sexed body and your self-model of how you want your body to be. If you were assigned male at birth but feel your body should be female instead then you have gender dysphoria and vice versa for trans males.

So what’s the beef between these two viewpoints? Truscum often argue they are trying to help “real” trans people get better access to medical care for transition. They also argue they are trying to break down gender stereotypes insofar as they argue that if you’re a guy who enjoys femme clothing and makeup that doesn’t necessarily make you trans and vice versa for butch women. The idea is that crossdressing and gender nonconformity is not enough to be trans – one must be deeply dissatisfied with your sexed body and desire the “opposite” sexed body, otherwise we lose the very distinction between gender nonconforming cis people and trans people.

In contrast, maximals generally argue that the line between gender nonconformity and being trans is fuzzy and hard to pin down precisely. They deny that dysphoria is necessary because they want to deny that gender can be reduced to any physical characteristics such that if you have an assigned-male body you don’t necessarily need to medically transition in order to feel comfortable in a female gender identity or live your life socially as a female – and they would go further and argue society should accept these people as “real” women just as real as any other woman, cis or trans. Furthermore, maximals often emphasize that sometimes trans people transition not because they experience gender dysphoria but rather they experience gender euphoria. Gender euphoria is the joy one experiences in taking on a new gender identity, expression, pronouns, social existence, etc. Euphoria can also be achieved through medical transition. One might not necessarily hate one’s body but nevertheless desire to medically transition because one believes that would bring greater satisfaction into one’s life.

Another argument available to maximals depends on transgenderism in non-Western societies. Take native “Two Spirit” people, which is generally the term for trans/gender expansive people in Native American society. The argument goes that being Two Spirit cannot be so easily mapped onto Western ideas of transgenderism which typically revolve around gender dysphoria and medical transition. Instead, transgenderism in non-Western societies or historical contexts generally depends on a more complicated gender role system that is outside the Western male-female binary. But we must be careful because historical trans people sometimes did take steps to alter their bodies e.g. eunuchs in the Bible would sometimes self-castrate. So we can’t necessarily say that non-Western transgenderism is entirely divorced from gender dysphoria. And I will admit frankly I don’t know enough about these other cultures to definitely state anything about whether trans people in these societies felt what is now called gender dysphoria. But the general point maximals make is that transgenderism has been around a long time before it was “medicalized” by the West into a pathological condition that needs to be corrected with HRT and surgery. For example, Two Spirit people would not necessarily believe there is anything wrong with being Two Spirit in the sense of it being a medical pathology.

But we need to be careful – I know a Two Spirit trans woman who does have dysphoria and has been on HRT to correct it – so Two Spiritism and modern medical transition are not at odds necessarily. But the general point maximals make is that transgenderism in non-Western societies cannot just be reduced to Western conceptions of what it means to be trans because that would be trying to force a complex system of beliefs and social roles into something they’re not.

Another argument the maximals can make is refer to the complexities of how the drag world relates to the world of trans people. Most drag queens are just cis males who enjoy expressing a feminine self from time to time but ultimately don’t desire female bodily characteristics and like being able to come home and take off the drag and get back into guy mode. But if you know anything about drag you know that some drag queens eventually do go on to identify as trans and medically transition. But these drag queens often continue to perform as drag queens during their transition. Is that fair? Allowing trans women to compete in what is traditionally a male activity? The issue is complicated because gender is complicated and messy, with boundaries between different identities being fuzzy. This is what fuels maximalist arguments: gender noncomformity is an expansive phenomenon that reflects many complex facets of identity and social roles.

But clearly truscum are right that gender noncomformity in and of itself is not sufficient for being trans. A man who wears makeup is not necessarily trans just because it’s noncomformist for men/boys to wear makeup. Similarly, a woman with short hair who shops in the men’s section is not automatically trans otherwise we wouldn’t have a distinction between butch women and real trans guys. To think otherwise is to buy into sexist stereotypes that men must act/behave in a certain way in order to be “real men” and vice versa for women. Interests in cars or barbies does not define gender. Whether you are assigned male or female at birth cannot predict the range of interests and activities that someone is going to take up in their lifetime. Some men are femme and some women are masc and some people are very fluid in their gender expression.

So who’s “right”? Truscum or maximals? In my view that debate boils down to a false dichotomy and over simplification. I take a non-reductionist view of transgenderism. It cannot be defined in terms of necessary and sufficient conditions universal to all trans people nor can it be reduced to any one physical condition or medical pathology. Where maximals go wrong is in saying that gender dysphoria has nothing to do with being trans. Gender dysphoria is experienced by almost all trans people in some fashion or another, but truscum go wrong in assuming this dysphoria can be defined neatly in terms of desires for the “opposite” sexed body. First of all, this relies on what Julia Serano calls “oppositional sexism” – the idea that men and women are total “opposites”. Instead, Serano argues that people overlook the massive similarity and overlap between the two sexes and further argues that the very idea there are only two sexes/genders is overly simplistic when we consider intersex phenomena and complex multi-gender systems in non-Western cultures where there are sometimes upwards of 5 different genders.

One thing philosophers learn is that there is often a grain of truth to all theories that have been developed by smart people. There are smart, informed people on both sides of the truscum debate. Both sides think they are doing something to help trans people achieve greater acceptance in society. But the problem with the “debate” is that it tries to reduce the phenomena of transgenderism into a narrow box. Both truscum and maximality are narrow-minded insofar as they try to reduce the complexity of gender and sex to a single ideological system.