Chapter 5: But What Does The Research Say

Over the past few years, four researchers working independently across different disciplines and institutions have arrived at strikingly similar conclusions about transmedicalism, and none of them are kind about it. What makes their convergence significant is not that they agree, but how they agree: each uses entirely different methodologies, theoretical frameworks, and entry points to reach the same foundational claim. When scholars working in different languages, affect theory, discourse analysis, scientific critique, and intracommunity ethnography, all point toward the same structure, you are likely looking at something genuinely systemic rather than incidental.

S.J. Dillon, an anthropologist at Emory University, published “Transmedicalism's Seduction: Normative Gender, Affectual Productions, and White Trans Legitimacy” in Feminist Anthropology in 2025. [1] Dillon uses feminist autoethnographic techniques to analyze interactions with a white trans woman she calls Beth, exploring how gender dysphoria functions as an “affectual currency” that circulates between white bodies to produce legitimacy through anti-Blackness rather than through challenging cisnormativity. Her work is theoretically dense and explicitly grounded in Black trans scholarship, Black feminist theory, and critical race analysis. It is not an easy read, but it is a rigorous one.

Kiah Hendrie, writing their honors thesis in 2022, produced “The Trap of Transmedicalization”, a more accessible but no less rigorous intervention into transmedicalist logic. [2] Hendrie grounds transmedicalism historically in medical racism, explicitly documents how intracommunity conflict operates as respectability politics, and argues that transmedicalism offers a seductive but false path to liberation. Hendrie's strength is clarity and historical specificity: they can show you exactly where medical gatekeeping came from and what it has done.

Norfleet, in their 2023 honors thesis “The Effects of Medicalizing Gender,” takes on the scientific claims of transmedicalism directly. [4] Norfleet debunks Rapid-Onset Gender Dysphoria (ROGD), autogynephilia, and brain-body incongruence frameworks by showing exactly where the science is being misused and why that misuse persists. Beyond scientific critique, Norfleet documents the erasure of Indigenous gender systems and names transmedicalism as colonial violence. Their work is polemical in the best sense, it is clearly argued, well-evidenced, and unafraid to call things what they are.

Lex Konnelly, a linguist whose work “Transmedicalism and 'Trans Enough': Linguistic Strategies in Talk About Gender Dysphoria” appeared in Gender and Language in 2022, brings discourse analysis to bear on the problem. [3] Konnelly shows how institutions claim “semantic authority” over what dysphoria is, and how trans people strategically deploy dysphoria language within constrained institutional contexts. Konnelly's crucial contribution is recognizing trans people as linguistic agents rather than victims, strategically navigating systems while simultaneously constrained by them.

What you will find in what follows is the intersection of these four bodies of work. Each validates and reinforces the others. Each fills in gaps the others leave. Together, they comprise a comprehensive debunking of transmedicalism that moves from the theoretical (Dillon), to the historical (Hendrie), to the scientific (Norfleet), to the linguistic (Konnelly). Together, they justify not merely critiquing transmedicalism but shunning it, understanding it not as a flawed framework that can be reformed but as a system fundamentally committed to pathologizing gender itself and dividing trans communities.

What follows is what happens when you put these four voices together and let them speak to each other.

Across Dillon, Hendrie, Norfleet, and Konnelly, a unified framework emerges, one that moves from individual critique to systemic analysis, from institutional to interpersonal, from theoretical to linguistic. These four bodies of research validate and build upon each other to create a coherent understanding of transmedicalism that is simultaneously a racial ideology, a medical apparatus, a linguistic regime, and an intracommunity trap.

Transmedicalism is not a neutral medical framework; it is ideology serving white supremacy and colonialism. [1][2]

This claim appears in different registers across the papers:

- Dillon argues it through affective analysis and anti-Blackness [1] - Hendrie demonstrates it through historical medical racism and respectability politics [2] - Norfleet documents it through scientific debunking and colonial erasure [4] - Konnelly shows it through institutional language and semantic authority [3]

What validates this across papers is that each uses different methodologies, autoethnography, historical analysis, scientific critique, discourse analysis, yet arrives at the same foundational observation: transmedicalism is a system serving specific political purposes, not a discovered truth about gender.

All four papers identify how transmedicalism works as a system that requires dysphoria as proof of legitimacy, creating a self-fulfilling cycle that pathologizes gender itself. [1]

The mechanism works like this (validated across all):

1. Dysphoria becomes currency: Dillon theorizes dysphoria as “the normative affectual currency of gender and engendering”, a form of proof that circulates between bodies and institutions. [1] For dysphoria to function as proof, it must be performed, recognized, and validated in specific ways. 2. The performance requirement: Konnelly shows how this creates linguistic burden, trans people must deploy dysphoria language strategically to access care, even when their actual experience is more complex. [3] They perform dysphoria because institutions claim “semantic authority” to define it. 3. Self-fulfilling dysphoria: Hendrie identifies that if legitimacy requires dysphoria, people learn dysphoria. [2] The system produces what it claims to discover. This is validated by Norfleet's observation that the “wrong body” narrative is actually taught, it does not preexist institutional pressure. [4] 4. The cost: Konnelly names the exhaustion of strategic performance: “We do what we need to do to keep going.” [3] Hendrie makes this intracommunity: trans people learn to hate their bodies because that is what proves they are “really trans.” [2]

The reinforcement across papers: Dillon provides the theoretical depth (affect as material force), Hendrie names the intracommunity consequence (dysphoria cycles), Norfleet identifies the logical contradiction (if nonbinary people exist, why do binary people need dysphoria?), and Konnelly shows the linguistic reality (what gets said in medical rooms).

All four papers, though with different emphasis, identify that transmedicalism achieves legitimacy specifically for white trans people through anti-Blackness and colonialism. [1]

The mechanism:

1. Colonial foundations: Norfleet and Hendrie document that the gender binary itself was imposed through colonialism and slavery. [4][2] This is not background context; it is structural. The system transmedicalism defends is literally built on the erasure of Indigenous gender systems and the ungendering of Black people. 2. Anti-Blackness as the operating system: Dillon theorizes that white trans legitimacy requires Black gender nonnormativity as its referent. [1] White bodies can achieve “invisibilization into proper gender” because Black bodies are constructed as permanently nonnormative. She calls this fungibility. 3. Institutional amplification: Hendrie documents that medical institutions literally designed gender categories to exclude non-white bodies. [2] Cauldwell and early sexologists denied care to non-white, non-heterosexual, disabled bodies, constructing which trans subjects would be “visible and viable.” 4. Linguistic enforcement: Konnelly shows how institutions maintain semantic authority, the power to define what dysphoria is, who counts as trans, what language is legible. [3] This authority is not neutral; it is wielded through frameworks built on white supremacy.

The reinforcement: Dillon provides the theoretical architecture (how anti-Blackness functions), Hendrie provides historical specificity (who did this and when), Norfleet names colonial erasure (what was destroyed), and Konnelly shows how it is maintained linguistically in real time.

All four papers identify that transmedicalism functions as gatekeeping that divides trans communities through respectability politics. [2][3]

The mechanism:

1. Respectability as survival strategy: Hendrie explicitly names that transmedicalism sells respectability, the promise that if you conform (dysphoria narrative, medical transition, binary presentation), you can achieve acceptance. [2] But this acceptance is conditional and only available to some. 2. Intracommunity weaponization: All four papers note that trans people police each other through transmedicalist frameworks. Hendrie documents the truscum/tucute divide as manufactured through respectability politics. [2] Dillon shows how this policing circulates through affect, dysphoria talk becomes a way of distinguishing “real” from “fake” trans people. [1] 3. The divide serves the oppressor: Norfleet is explicit: “trans liberation as a whole challenges many constructs that make up the fabric of Western culture…by dividing trans people, transmedicalists become tools that can be used by the oppressive system to divide the collective persuasive power of the trans community.” [4] This is not coincidental; division is the function. 4. Strategic linguistic enactment: Konnelly shows how this plays out in language, institutions reward dysphoria narratives, and trans people circulate those as proof of legitimacy, creating feedback loops that police others. [3]

The reinforcement: Hendrie provides accessibility and intracommunity focus, Norfleet names the political strategy, Dillon shows how it circulates affectively, and Konnelly demonstrates the linguistic enforcement.

All four papers acknowledge that medical transition genuinely provides access, agency, and relief for many trans people, while simultaneously critiquing the system that requires medicalization. [2][3]

This is crucial and often misunderstood. These papers are not saying “medical transition is bad.” They are saying:

1. Medical access is real: Hendrie explicitly recognizes that medical transition genuinely matters, opening legal pathways and providing embodied relief. [2] Konnelly shows trans people strategically accessing care despite constrained language. [3] 2. But medicalization is the trap: The problem is not medical transition; it is the system that says it is the only legitimate way to have a valid trans identity. [2] As Norfleet argues, the trap is that transmedicalism says “acceptance is paved by conforming to a system that has done everything in its power to dispose of gender-nonconforming identities.” [4] 3. The class and race dimension: Norfleet emphasizes that in a country where medical interventions are class-restricted, medicalism creates a double bind: trans people of color are required to suffer from dysphoria while being denied access to the cure. [4] This is not accidental. 4. Strategic navigation is not complicity: Konnelly's contribution is crucial here, showing that trans people using dysphoria language are not duped; they are strategically deploying it while often simultaneously critiquing it. [3] This is “critical thirding”, neither pure resistance nor pure compliance.

Norfleet's scientific debunking is validated by structural observations across all papers. [4]

Norfleet documents:

- ROGD as methodologically compromised: Abigail Shrier only interviewed parents who opposed their children's transitions, confirmation bias parading as science. [4] - Autogynephilia as pseudoscience with authority: Ray Blanchard's “two-type model” circulates because Blanchard has institutional credibility, not because the science is sound. [4] - Brain-body incongruence as misinterpretation: No clear male or female brain differences exist; claims that they do misrepresent neuroscience. [4]

These are not isolated scientific errors. They are validated by Dillon's observation that transmedicalism creates “gender not as an identity or even social phenomenon, but rather as a kind of successful or unsuccessful discursive and visual claim-making”, the science serves the ideology, not the reverse. [1]

Norfleet also identifies a fundamental logical contradiction: if nonbinary people can be trans without a “right body” to transition toward, why do binary people need dysphoria and transition to be valid? [4] This contradiction is acknowledged across all papers but never adequately answered by transmedicalists because it exposes that the framework is ideological, not logical.

Konnelly's linguistic analysis validates what the others theorize from different angles: institutional frameworks determine what can be said, known, and legitimized about gender. [3]

This appears across all papers:

- Dillon's “visual claim-making” requires an audience with authority to validate [1] - Hendrie's respectability politics require learning a specific language of conformity [2] - Norfleet's scientific claims are validated through institutional credibility [4] - Konnelly shows that institutions claim “semantic authority” to define dysphoria, and trans people must work within that authority to be heard [3]

The deeper point: all four papers suggest that what counts as “real” trans experience is linguistically and institutionally constructed, not discovered. Different language, different institutions, different times would produce different “realities.”

Dillon's central contribution, explaining why transmedicalism persists despite its harms, is reinforced by all other papers.

Dillon names transmedicalism as “seductive” because it promises escape from gender violence through legibility and passing. [1] But Hendrie, Norfleet, and Konnelly show why it persists:

- It actually works for some people: Medical transition genuinely provides relief and legal recognition. [2][3] Transmedicalism does not persist because it is false; it persists because it delivers something real for those it serves. - It appears logical: Norfleet notes it “promises that one's gender presentation can be exchanged for a specific embodied legibility”, it is intuitive within a system that requires visual proof. [4] - It offers safety within oppression: Hendrie argues that for trans people experiencing real violence, medicalism offers a concrete path to conditional safety. [2] Even recognizing that path is limited and conditional does not erase that it feels safer than alternatives. - It circulates affectively: Dillon shows that dysphoria talk moves between bodies, creating belief through emotional transmission, not just argument. [1] You feel dysphoria because someone else's dysphoria talk resonated with you; you then validate theirs because you have experienced yours.

All four papers recognize colonialism, but Norfleet documents specificity that validates Dillon's abstract argument. [4][1]

Norfleet details [4]:

- Two-Spirit identities, māhū identities, and others that existed where gender variation was not pathologized - How English-language terminology itself misnames these identities by translating them as “trans” or “queer” - How medicalism does not just pathologize, it erases entirely different frameworks for understanding gender

This validates Dillon's point that the gender system transmedicalism defends is not universal or natural; it is a specific colonial imposition built to manage bodies through the binary. [1]

What emerges when you connect these dots:

Transmedicalism is a system that:

1. Pathologizes gender itself through requiring dysphoria as proof of legitimacy, creating self-fulfilling cycles of suffering [1][2] 2. Operates as white supremacy by requiring anti-Blackness and colonialism as its structural foundation, allowing white trans people to achieve legitimacy through Black gender nonnormativity [1] 3. Divides trans communities through respectability politics and intracommunity policing, turning trans people into enforcers of the system that oppresses them [2][4] 4. Creates access paradoxes where medical transition is genuinely necessary and genuinely insufficient, where people need the system while needing to resist it [2][3] 5. Masks ideology as science through misinterpreted neuroscience, methodologically compromised studies, and logical contradictions that never get resolved [4] 6. Maintains control through language and institutions that claim semantic authority over what counts as legitimate gender experience [3] 7. Persists because it works for some people in specific ways, even as it harms others, making it seductive and difficult to refuse [1][2] 8. Erases entire frameworks of understanding gender that existed before colonialism and that exist outside Western medical systems [4]

What these four papers prove together is that transmedicalism cannot be reformed from within. [1][2][4] It is not a medical framework that needs to be more inclusive or less gatekeeping. It is an ideological system built on white supremacy, colonialism, and the pathologization of gender itself.

This means:

- Expanding medical criteria does not fix it; it legitimizes the pathology - Including nonbinary people does not fix it; the framework still requires suffering to be valid - Making it more accessible does not fix it; it just extends the trap more widely

The solution requires building entirely different frameworks, ones that center trans joy, interdependence, and collective liberation rather than individual medical legibility. [2][4]

All four papers, in different languages and through different methodologies, are pointing toward the same inconvenient truth: transmedicalism is not the friend of trans people. It is the mechanism through which trans communities are managed, divided, and controlled within systems of white supremacy. To build liberation, we must refuse it entirely.

- What's the philosophical foundation of transmedicalism? → Chapter 1: The Architecture of Oppression

- What's the medical and strategic evidence against these claims? → Chapter 2: Why These Claims Fail

- Why do people defend gatekeeping despite the evidence? → Chapter 3: How Gatekeeping Becomes Conflict

- How does this pattern show up in other oppressive systems? → Chapter 4: The Mechanism Exposed

- Quick responses to common arguments → Quick Reference: Refutation Table

[1] Dillon, S. J. (2025). Transmedicalism's seduction: Normative gender, affectual productions, and white trans legitimacy. Feminist Anthropology, 6, e12157. https://doi.org/10.1002/fea2.12157

[2] Hendrie, K. (2022). The trap of transmedicalization [Honors thesis, University of Colorado Boulder]. https://www.colorado.edu/honorsjournal/sites/default/files/attached-files/hj2022-genderethnicstudies.pdf

[3] Konnelly, L. (2022). Transmedicalism and “trans enough”: Linguistic strategies in talk about gender dysphoria. Gender and Language, 16(1), 1–25. https://www.researchgate.net/publication/360440813_Transmedicalism_and_'trans_enough'_linguistic_strategies_in_talk_about_gender_dysphoria

[4] Norfleet. (2023). The effects of medicalizing gender: How Western transmedicalist ideologies harm transgender communities [Honors thesis, University of Texas at Austin]. https://repositories.lib.utexas.edu/handle/2152/118369