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"Crips and Trannies Need to Pee Too!": The Intersectionality of Trans* and Disabled Identities

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"Crips and Trannies Need to Pee Too!"

The Intersectionality of Trans* and Disabled Identities

Sula Malina


I. Are Trans Bodies Necessarily Disabled? 

Before beginning this piece, I engaged in an email discourse with the mother of a close friend. Here I will call her Mrs. Shepherd. Mrs. Shepherd has raised a mentally and physically disabled son (whom I will call Jackson) from birth. She has watched him grow and learn in a world that is not built to be accessible for those with any level of disability. While possible surgeries and treatments have come along that could help her son move closer to conforming to the expectations of his community, she and her husband have chosen, each time, not to “subject” Jackson to these procedures. For Jackson, disability is part of his identity, and (as with many individuals in the disabled community), surgery rejects this identity, assuming that disability is in some way “wrong” because it can sometimes be cured. Mrs. Shepherd does not believe in gender-related surgeries. When asked whether she considered there to be a difference between implant procedures (such as breast implants) and reductive procedures (such as chest masculinization), she did not feel there was much of a moral or ethical difference, though she did express not understanding the need to “cut off a part of yourself.”

Though many people in the trans community do not believe in the necessity of surgery, it is still far less stigmatized within the community as a treatment option than it is in the disabled community. This creates an interesting tension between identity and medical intervention. What makes a disabled body? How do identity and medicine work together to come to conclusions on disability?


II. Mastectomy


For many trans men, a double mastectomy is the first, and sometimes only step toward a more masculine presentation. Mastectomies do not require a daily testosterone intake, and are a generally simple procedure—and far less expensive than genital surgeries, which can run at over $15,000. Furthermore, the mastectomy procedure is one that has existed for many years, as it continues to be used on male-assigned patients, and female-assigned patients with cancerous tumors or pendulous breasts that can lead to back pain or injury. Henry Rubin, author of Self-Made Man: Identity and Embodiment among Transsexual Men, writes: “These female bodies commanded surgical attention because they were ill bodies [. . .] Since standards of beauty are considered conventional, rather than immutable, the choice to pursue cosmetic surgery has been considered suspect” (Rubin 58-59). Rubin goes on to explain that patients with identifiably and visibly ill bodies were considered “morally innocent” due to the nature of their procedures—while the wider population could visually recognize the necessity of their surgeries, it has been historically more difficult for this same population to recognize a necessity that is only internally evident and very personal—especially when transgenderism as an identity is only beginning to become recognized as legitimate at all.

Additionally, Rubin points out, cosmetic surgery has historically been performed primarily on female bodies, and thus has an element of assumed vanity on the part of the subject. In this way, it appears that neither trans men nor trans women can escape this stigma; either female-assigned individuals are vain for wanting to manipulate their body parts, or male-assigned individuals take on this vanity by attempting to achieve the form of a woman.

Chest Masculinization

Double mastectomies in the trans masculine community (colloquially known as “top surgery”) toe a fine line between cosmetic and non-elective procedures. Even within the trans community, many individuals strongly oppose physical surgeries, insisting that physical alterations to ones body in order to conform to a societal standard of “what a body should look like” only serve to reduce gender to physical body parts. However, for many people, the dysphoria caused by having the “wrong” sex organs can be so great that it is life threatening.

Gender-related double mastectomies are cosmetic, but require a letter from a psychiatrist, primary care doctor, or other official caregiver, explaining that surgery is the next necessary step in the individual’s transition. This is problematic for multiple reasons—first, because it is counter to the labeling of the surgery as cosmetic (though it still must hold this official title, linking it to vanity and choice), and secondly because it makes the procedure inaccessible to those who either do not have access to psychiatric help, or to those who cannot “prove” the need for surgery to the “support person” they do have. At times, this means that the desperate patient is pressured to lie or bend the truth in order to receive the surgical treatment he/they need. Dean Spade, a transgender activist and writer, quotes a fellow trans activist experiencing the struggle to get clearance for chest surgery.

Someone suggests that since I won’t be on hormones, I can go in and pretend I’m a woman with a history of breast cancer in my family and that I want a double mastectomy to prevent it.  I have these great, sad, conversations with these people who know all about what it means to lie and cheat their way through the medical roadblocks to get the opportunity to occupy their bodies in the way they want.  

Spade begins his piece by comparing the “cosmetic” surgery of double mastectomies to the cosmetic surgery of rhinoplasty, or a nose job. Writing as the doctor who has been asked to do the procedure, he satirically explains: “Then you have rhino-identity disorder [. . .] But first [. . .] we want you to get letters from two psychiatrists and live as a small-nosed woman for three years…just to be sure” (Spade 2000). Here, Dean Spade points out the insufficiencies of the term “cosmetic” to label a surgery that for many people is a matter of life or death. To label mastectomies as cosmetic is to severely overlook the power the surgeon has to determine whether or not the patient is “prepared” to live with the surgical changes they are about to endure.

So we are led to an essential question: If the term “cosmetic” is clearly insufficient to describe the necessity of surgery and gravity of many trans people’s situations, and if we are led to assert that gender-related surgeries are, in fact, non-elective, then mustn’t we define trans bodies as disabled and in need of some level of attention? Is it not safe to say that, though not all disabled bodies are in need of surgical attention, all bodies in need of surgical attention are, at least in some way, experiencing disability?


III. Doctor-Assisted Mutilation?

Transgender Children

For many people (and medical ethicists in particular), qualms with gender-related surgical removal or adjustment of apparently “healthy” body parts are summarized in one, assumptive word: “mutilation.” The term mutilation implies power over one’s body that has become corrupt—and this seems particularly significant in the case of transgender children and teenagers. For those trans individuals who are under 18 and are not legally allowed to make decisions around surgery and treatment on their own, their bodies are essentially at the command of their parents, who make final decisions around whether to adjust their children’s bodies. This raises several ethical questions around the concept of “mutilation,” as not only are the surgeries performed by an outside professional, but the final decision itself is decided by someone other than the child in question.

In a WBUR Common Health story from January of this year, the story of a transgender teenager in search of treatment is weighed in on by not just medical ethicists, but also the Catholic Church:

 The Catholic Church comes down on the side of mutilation. John Haas, president of the National Catholic Bioethics Center, says the church hopes that all children will flourish in the image of God as created at birth.

“If they are surgically mutilated,” Haas says, “that clearly would violate their best interests and it probably would not be in the best emotional health to be dressing up as the opposite gender and acting out in that way.”

 Other medical ethicists, like Nick Tonti-Filippini, themselves believe that “sex-change operations are just a form of mutilation” (Kelleher 2009), and this opinion is more often found in cases of children who are undergoing an operation. Because society as a whole is so focused on The Child as the ultimate symbol of our goodness and innocence, it is easy to twist any “unnecessary” surgical intervention with children into an evil, ungodly act.

Cancer-Related Mastectomies

It is impossible to examine the ethics of gender-related double mastectomies without looking as well at the example of elective breast cancer-related mastectomies. For many who see this operation as an unfortunate one that takes an essential womanly part away due to illness, it is easy to see a purely elective gender-related surgery of the same strain as excessively unnecessary. However, this view is put into question when we evaluate the personal views of women who have experienced cancer-related mastectomies.

Surveys conducted in both 1999 and 2014 concluded that the majority of women who undergo elective mastectomies for cancerous reasons (both at the suggestion of their physicians and their own suggestion) were ultimately happy with the decision, and would make it again. However, it is important to consider the fact that these preventative surgeries do not actually seem to have any affect on survival rates—women who do not remove their breasts have a 10-year 83.2 percent survival rate, while women who do undergo the procedure have a lower 10-year survival rate, at 81.2 percent.

 If the argument against gender-related surgeries is that it is not a life or death decision, and therefore that it is morally questionable in comparison to cancer-related mastectomies, the argument is statistically invalid; it seems impossible to argue that cancer-related mastectomies truly save lives any more than non-surgical treatments do. Thus, we can only conclude that cancer-related surgeries are no more medically necessary than gender-related surgeries, implying again that trans mastectomy patients fit just as accurately into the umbrella of disability as cancer patients do.

For many of these cancer patients, as with trans patients, these surgical changes become a part of their identity—as demonstrated by the recent trend of post-operative chest tattoos meant to highlight and assert ownership over a post-operative chest (Kiernan 2014). An example is pictured below:




For most people who contest the validity of gender-related chest surgery, the argument is reduced to the idea that it is wrong to “cut off a healthy part of yourself.” Yet, if this “part” is so healthy, why do gender-related surgeries so often lead to immense relief on the part of the patient? This relief and ultimate happiness can be compared to that of amputees, for whom “cutting off a part of oneself” is not limited to sex organs.

A 2006 survey conducted by the Amputee Coalition revealed that, “when asked to rate their quality of life from 1 to 10, with 1 being the lowest and 10 being the highest, the majority of amputees responded that their quality of life was good to excellent (5 and above on the scale” (“How Are You Feeling?” 2006). Other medical sources contribute this seemingly positive attitude to the fact that “some people report feelings of relief as their amputation was expected and resulted in freedom from pain with improved function” (“Coping With Your Amputation”).

Those in obvious, visible need of amputation due to pain or necrotic tissue are seen as morally innocent just as cancer-related mastectomy patients are. However, the relief and high quality of life they experience post amputation are similar to those experienced by many post-operative trans patients, who are less often seen as morally innocent. This brings us to question our culture’s focus on visible (versus invisible) disability; perhaps trans patients are seen as more morally culpable because the pain and struggle they face pre-operation is psychological, and therefore does not seem as legitimate as visibly necrotic tissue. 


IV. Clinical Understandings of Transgender Bodies 

Transgender identities have had an official place in medicine for now several editions of the DSM (Diagnostic and Statistical Manual of Mental Disorders). However, their inclusion has not been without issue, and it has changed dramatically over time. The DSM-IV includes GID, Gender Identity Disorder—a disorder that essentially labels transgender identities themselves as the problem. While surgery is a suggested method of treatment, granting the identity some level of legitimacy, this representation essentially reduces the transgender identity to the way lesbian, gay, and bisexual sexualities have historically been seen as “curable.” 

The DSM-V was a dramatic and positive change to the official representation of transgender individuals, as it marked a shift from GID to Gender Dysphoria—essentially, the anguish produced by the mismatch of gender and physical body. Gender Dysphoria is much like a trans-identity-specific form of anxiety, and it does not negate the trans identity, but rather, takes seriously the issues raised when trans individuals are not allowed to live in the body they identify with.

Within the trans community, there continues to be a great deal of backlash against any sort of transgender inclusion in a book that lists disorders and their cures. However, Eli Clare, an activist in the transgender and disabled communities has a different opinion. Clare contests the idea that trans people should see themselves as “normal” and nondisabled pre or post transition, because it directly works against the efforts of disabled individuals, who have struggled for years to have their physical “abnormalities” seen as acceptable and sources of pride. Clare argues that an attempt to eliminate Gender Dysphoria from the DSM is an attempt to avoid owning psychological trauma that mentally disabled individuals have fought for years to reclaim.

However, at the same time he expresses that “there’s another important strand of naming at work in our communities—a strand that declares transness not a disease, gender non-conformity not a pathology, and bodily uniqueness not an illness—a strand that turns the word dysphoria inside out, claiming that we are not the ones dysphoric about our genders, but rather dysphoria lives in the world’s response to us” (Clare 263). Here, Clare argues that by trans people accepting their place in the DSM, there is an opportunity to reclaim the wording, and to turn it around to reflect on society’s reaction to “abnormal” bodies, rather than an internalized discontent on the part of trans people.


V. Trans Privilege? Disabled Privilege?

All too often, sources meant to express the intersectionality between two identities put a focus on the ways in which one identity has privilege that the other does not. In fact, this seemed to be the case in almost all available sources around the intersection of transgenderism and disability. Trans privilege, in this intersection, is considered to be the ability to “potentially rehabilitate itself” while only the “exceptional disabled body can overcome its limits” (Puar 2014). In other words, the trans body, to some extent, has the capacity to transition and pass as a seemingly perfectly normative member of society. While disabled bodies can oftentimes do the same things that nondisabled bodies can, this is seen as “overcoming” obstacles, and the disabled individual is reduced to the character of the “supercrip.”

In his book Exile & Pride: Disability, Queerness and Liberation, Eli Clare presents one significant way in which being disabled gave him the privilege to discover and experience his trans identity: it asexualized him. He writes, “The same lies that cast me as genderless, asexual, and undesirable also framed a space in which I was left alone to be my quiet, bookish, tomboy self, neither girl nor boy” (Clare 151). For Clare, his trans and disabled identities have always been inextricably tied, because they each inform and permit the other. Unfortunately, this is only the case because being disabled has allowed him to be ignored and asexualized by society for long enough to experiment; even if this allowed him to come to a better understanding of his trans identity, was this worth the objectification he experienced? It seems difficult to label this any sort of privilege, though it is presented as such.

Yet the theme that comes up again and again in scholarly writing on trans and disability communities is the shared experience of bodies that are not “beautiful,” that are “mistakes” meant to be fixed, that are bodies the world does not grant access to just yet. Both trans and disabled bodies are often reduced to the “mistakes” that may have caused such bodies to end up in such a “abnormal” state—this is apparent in the disability community each time a new study comes out linking a pregnant mother’s behavior to her child’s autism, or a birth defect. In Far From the Tree, author Andrew Solomon writes about the possibility that a pregnant mother coming into contact with certain chemicals might lead to gender nonconformity in her child, which may later manifest in a transgender identity. In both cases, the desire to scientifically “explain” an already marginalized identity seems nothing more than an unhelpful attempt to develop a “cure” for a widespread community of people.

In her article, “Threads of Commonality in Transgender and Disability Studies,” Ashley Mog responds to the activist button labeled “Crips & Trannies Need to Pee Too!” which was originally publicized in a zine on disability and sexuality. This tagline speaks to the inaccessibility of dichotomized bathrooms designed for able-bodied individuals who are expected to easily determine which room they should enter (and which will not lead to discomfort on the part of other bathroom-goers). The Bathroom is a perfect example of our culture’s assumptions in action; it is simply assumed that just anyone can use a typical bathroom with little issue, and it is here that both disabled and trans bodies struggle with accessibility, even if for slightly different reasons.


VI. Conclusions

When I first spoke with Mrs. Shepherd, she did not show any signs of connecting the trans identity or body with those of a disabled individual, either consciously or subconsciously. Though Mrs. Shepherd has raised a disabled son from birth, she does not have first-hand experience with trans individuals, and has not had the opportunity to speak directly with a trans person about his/her/their internal pain that may have led to a surgical decision. While Mrs. Shepherd has a son with both visible and invisible disabilities, she is still unable to connect the trans identity to an invisible, painful struggle that might lead someone to opt for surgical solutions. Though this is somewhat understandable, it is a problem that must be addressed culturally, on a larger level.

Once we begin to understand the many overlaps between trans and disabled bodies, it is impossible to ignore the truth that trans bodies may very possibly be necessarily disabled. Though the pain caused by a disconnect between gender and physical body may not be visible until surgery shows an obvious shift, and while many trans people may have the opportunity to transition, pass as their gender identity, and go through the rest of their lives without the same internal issues, it is impossible to ignore the lack of accessibility offered to either community. Before we jump to conclusions about the privilege of one identity over the other (as so many scholars seem to do), we must first truly come to terms with the privilege of the rest of society over both trans and disabled bodies.



Works Cited 

Bebinger, Martha. "Uncertainty Surrounds Medical Treatments For Transgender Youth." Common Health: Reform and Ready. NPR. Wbur, Boston, MA, 24 Jan. 2014. Radio.

Bornstein, Kate, and S. Bear Bergman, comps. Gender Outlaws: The Next Generation. Berkeley: Seal, 2010. Print.

Clare, Eli. "Body Shame, Body Pride: Lessons From the Disability Rights Movement." The Transgender Studies Reader 2. Ed. Susan Stryker and Aren Z. Aizura. New York and London: Routledge, 2013. 261-65. Print.

Clare, Eli. Exile & Pride: Disability, Queerness and Liberation. Vol. 10. Cambridge: South End, 2009. Print. South End Press Classics.

"Coping With Your Amputation." Capital Health. Nova Scotia Department of Health and Wellness. Web. 24 Sept. 2014.

Diagnostic and Statistical Manual of Mental Disorders. Fourth: Primary Care Version ed. Washington, DC: American Psychiatric Association, 1995. Print.

"Gender Dysphoria." Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association, 2013. Web. 25 Sept. 2014.

"How Are You Feeling?" LimbLoss Research & Statistics Program. Amputee Coalition, 2006. Web. 24 Sept. 2014.

Kelleher, Katy. "17 Year-Old Granted Permission For Double Mastectomy." Jezebel. Kinja, 5 May 2009. Web. 24 Sept. 2014.

Kiernan, Caitlin. "A Tattoo That Completes a New Breast." The New York Times. The New York Times, 2 June 2014. Web. 24 Sept. 2014.

Mog, Ashley. "Threads of Commonality in Transgender and Disability Studies." Disability Studies Quarterly 28.4 (2008). DSQ. Disability Studies Quarterly, Fall 2008. Web. 25 Sept. 2014.

"Most Breast Cancer Patients Don’t Regret Preventative Mastectomies." FOX News. FOX News, 24 Sept. 2014. Web. 24 Sept. 2014.

Puar, Jasbir K. "Disability." Transgender Studies Quarterly 1.1-2 (2014): 77-81. Transgender Studies Quarterly. Duke University Press, 2014. Web. 24 Sept. 2014.

Rubin, Henry. Self-Made Men: Identity and Embodiment among Transsexual Men. Nashville: Vanderbilt UP, 2003. Print.

Solomon, Andrew. "XI: Transgender." Far From The Tree: Parents, Children, and the Search for Identity. Simon and Schuster, 2012. 599-676. Print.

"Some Women Have Regrets About Preventive Mastectomy." WebMD. WebMD, 4 Oct. 1999. Web. 24 Sept. 2014.

Spade, Dean. "Mutilating Gender." Make Zine. 2000. Web. 24 Sept. 2014.


Anne Dalke's picture

Wow. You have done a power of research here, carefully, carefully laying out and unpacking the intersections of trans* and disabled identities, seeking overlaps and making distinctions…before arriving eventually at the claim that “it is impossible to ignore the truth that trans bodies may very possibly be necessarily disabled.” That that’s a truth statement with @ least two qualifications (“may very possibly be necessarily”) suggests some of the complexity and instability not only in the path you have traced, but also of your final point of arrival.

I learned a great deal from this project (and I would venture to say that you did, too). For starters, I had somehow not been aware that breast-cancer-related surgeries are no more “medically necessary” than gender-related ones; nor caught Eli’s relocation of dysphoria from an internal to the social realm; nor conceptualized gender dysphoria as a trans-specific form of anxiety. Seeing how far you could push the analogy between trans* and disabled identities, and--even more--how far you could push the differences between cosmetic and non-elective surgeries, has taken you some distance, and sent me off in a few other directions as well.

One of these was etymological. Turns out that “cosmetic” comes—of course!—from the Greek “kosmos”—order; so its original meaning is not @ all about superficiality, but rather about the ultimate order of the universe. “Mutilate” comes from the Latin “mutilus,” to truncate—so not necessarily “damaging.” “Rehabilitate” originally meant, in Medieval Latin, to “restore to former privileges or reputation after a period of disfavor”—it was all (and only) about social status.

And—perhaps most helpful to you?--“cure” comes from the Latin curare, ‘take care of,’ from cura ‘care.’ The original noun senses were ‘care, concern, responsibility,’ in particular spiritual care; the sense we now assume, of successful medical treatment, or remedy, came much later. This small English-professor-y exercise prods me to ask whether the terms of the conundrum you set yourself—are trans* people necessarily (i.e. definitionally) disabled?—might be re-set, whether the notion of seeking a “cure” for a “disability” mightn’t be replaced with some of the older terminology, such as simply seeking out care.

I may have told you during our writing conference that the professional conference of the Society of Disability Studies,  which I attended this summer, was fraught with deep shared ambivalence about “cure.” Eli Clare gave preview there of the “Slippery Definitions, Slippery Terrain” of his current book project, in which he is re-thinking the “politics of cure” as a return to a single standard, a “restoration” of health, and in doing so is drawing on the work of ecologists engaged in the complex, responsive process of restoring prairie eco-systems. What it might mean to seek a “cure” for someone like himself, for whom an “original non-disabled bodymind doesn’t exist”?

Lots of interesting re-thinkings, here, of both what is “normal” and what “natural.”
Thank you for sharing in this work.