Transgender Liberalism & Defending Medical Transition / Anthophorism

Transgender Liberalism & Defending Medical Transition

by Vim Lena
August 4th, 2025

Context

On July 21, 2025, the fairly well-regarded trans historian and author Jules Gill-Peterson published an essay called “Reject Transgender Liberalism” via The Baffler, an online magazine that bills itself as “America’s leading voice of incisive and unconventional left-wing political criticism, cultural analysis, short stories, poems, and art.” Gill-Peterson has previously published two other essays in The Baffler which you can read on her author page. Before moving ahead, I would encourage you to at least read her “Reject Transgender Liberalism” for the full context of this essay, which is in part a criticism and commentary on it.

In my understanding, Gill-Peterson’s goal in publishing this essay was to make the case for revising the political and legal strategy utilized by trans people in advocating for their rights. She explores the historical context for the recent United States v. Skrmetti supreme court case, discusses the origins and character of the term transgender and how it frames trans identity, and criticizes what she sees as an ineffective strategy for change. Towards these ends, she has a few key points in her essay:

She argues that the recent supreme court case, United States v. Skrmetti, ignored the historical precedent of Frances Thompson, a black trans woman and former slave, in the formation of the Fourteenth Amendment. For those who are unaware or are not well-versed in American politics, the Fourteenth Amendment to the US Constitution concerns who is considered an American citizen following the emancipation of slaves and their rights to a fair trial under the courts as well as their rights to be treated equally under the law (please bear in mind that I am not a lawyer). The outcome of United States v. Skrmetti was the affirmation that a Tennessee ban on trans minors accessing puberty blockers or hormone replacement therapy (HRT) did not violate the Amendment. Gill-Peterson co-authored an amicus brief which was not mentioned by any of the judges in the case although she is unsure it would have effectively persuaded the conservative majority even if it was considered. Her argument is essentially this: a reactionary anti-black series of riots in Memphis, Tennessee was instigated by white southerners intent on asserting that even though slavery was over, black people would not achieve equality. Throughout the course of these riots, Frances Thompson (a black trans woman and former slave) was horrifically violated by white men, some of them police officers. At the time of these riots, the Fourteenth Amendment was still moving through the legal system. The subsequent report on the riots, which featured Thompson’s experience being violently and unjustly targetted, was responsible for swaying Congress towards Reconstruction as well as the adoption of the Fourteenth Amendment. Therefore, trans people were part of the creation of the Fourteenth Amendment and banning trans minor’s access to healthcare is discriminatory as well as historically unfounded.
The trans community is divided into antagonistic groups with different class character. Gill-Peterson argues that there is a group which she identifies with what she calls transgender liberalism who do not medically transition are primarily concerned with the ideological: “self-actualization, cosmopolitanism in style and language, and personal declarations of being above or beyond the gender binary.” She argues that this group was formed in the 90s during the coining and widespread popularization of the term “transgender” and were upwardly mobile academics who “deliberately declined to transition so that they could conserve their jobs, marriages, private wealth, and social status” as they were “tilted against transitioning sex” and were responsible for “vainly championing the ostensible superiority of androgyny.” In contemporary times, this same strain of thought persists and is characterized by “a kind of immaterial, nonbinary idealism.” This is in contrast to transsexuals who have a working class, non-academic class character and are more concerned with attaining medical care and surviving. Transsexuals struggle to navigate downward mobility due to widespread discrimination in the gendered labor market, the cost of transitioning, and the frequent loss of family support. She argues that transsexuals denounced the transgender “flight into the elitist idealism of college-educated radicalism” as it became primarily focused upon the nature of “endless and shifting personal identification” rather than any material concerns.
Gill-Peterson argues that embracing transgender liberalism has not proven to be a viable method for systematic political change due to it’s belief in the primacy of “personality expression, therapeutic culture, and the private individual as a sacred refuge from a crumbling public.” The right-wing MAGA politics of current are anti-neoliberal, seeking to “dismantle the political-economic order of the past fifty years and replace it with permanent minority rule by corporate interests, Christian nationalists, and party loyalists,” and are not swayed by arguments based in liberalism. In fact, these broad and inclusive ideas present in transgender liberalism can actually be used against transsexuals seeking medical transition as they do not stress the importance of it’s access or the material struggles present in pursuing it. In light of this failure of transgender liberalism, we learn from our mistakes and re-orient ourselves towards advocating for and defending what Andrea Long Chu calls “the right to change sex.”

Response & Criticism

Transsexual Vs Transgender

First, I want to address Gill-Peterson’s assertion that there is a historically coherent class division between transgender and transsexual politics. My sources for this section are primarily going to be “Trans America: A Counter-History” by Barry Reay (2020) and “In The Life Episode 602 ‘Interview with Kate Bornstein, Leslie Feinberg’” (1996).

The term transgender was used before the early-mid 1990s but that decade did see it’s widespread popularization. Chapter 5 of Reay’s Trans America entitled “The Transgender Turn” discusses the development of this term and it’s history in-depth. In the 2008 book “Trans People In Love,” Susan Stryker notes that she first heard the term transgender in 1990 San Francisco, California, writing “I felt it fit me, and created a bit of distance between the old medical mindset associated with ‘transsexual’ and the bohemian life I was living.” Summarizing Joanne Meyerowitz’s “How Sex Changed: A History of Transsexuality in the United States” (2002) and Dallas Denny’s “Changing Models of Transsexualism” (2004) from the Journal of Gay & Lesbian Psychotherapy, Reay says the following:

[The transgender turn] arose out of a combination of dissatisfaction with what was perceived to be the inflexibility of the university gender clinics (the medical model of transsexuality with its “heterosexual graduates”), and the growth of private practices catering for a perceived market… But the turn was also a result of increasing transgender community organization. The strands are hard to separate. Trans accounts stress community agency.

Reay also quotes the introduction to the first issue of Transgender Studies Quarterly written by Susan Stryker and Paisley Currah:

…from the beginning, the category “transgender” represented a resistance to medicalization, to pathologization, and to the many mechanisms whereby the administrative state and its associated medico-legal-psychiatric institutions sought to contain and delimit the socially disruptive potentials of sex/gender atypicality, incongruence, and nonnormativity.

In the 1996 interview with Kate Bornstein and Leslie Feinberg, Bornstein defines transgender as “transgressively gendered,” meaning that it includes anybody who “[transgresses] against the mores and codes that would make up gender in the culture.” Bornstein notes that this is an intentionally broad term for a large movement. Feinberg adds that, at the time of the interview, there is an effort to “forge the largest movement possible of people who have crossed the boundaries of sex or gender assumptions that you’re assigned at birth.” Feinberg notes that this label includes “transsexual women and men, or masculine women and feminine men, or bearded women who allow their beards to grow, or women weightlifters who can’t use the women’s bathroom because they’ve been pumping iron.” Bornstein says later in the interview that they see the transgender movement as an extension of feminism and that the popular feminist ideas “biology is not destiny” and “keep your laws off my body” resonate with it’s goals.

With all of this in mind, we can see that the strong dichotomy proposed by Gill-Peterson between working class non-academic transsexuals and upwardly mobile transgender academics is not as clean cut as she states in her essay. The popularization of the term transgender in the 90s of a was an attempt by transsexuals as well as non-transsexuals to move beyond a pathologized, medicalized, and rigid model of gender as historically outlined by the psychologists, psychiatrists, sexologists, and the state. These are the same institutions responsible for gatekeeping healthcare as well as defining, interpreting, and enforcing other systematic and material aspects of gendered life. It’s also worth noting that even if a transgender person does not take HRT or pursue surgery (for any number of reasons), they are still subject to patriarchal systematic oppression and are not simply understood and accepted by society because of this. Gill-Peterson’s assertion that non-transsexual transgender people “deliberately declined to transition so that they could conserve their jobs, marriages, private wealth, and social status” is suspect at best and she does not cite any source for this supposedly historical statement.

None of this is to say that upwardly mobile transgender academia is necessarily concerned with the extreme difficulty of being a working class transsexual. There is a sort of detached academic theorization of gender that is not particularly concerned with liberation due to the blunted effect of being wrung through the academy as an institution as well as the way in which liberal individualist politics relate to how we think of gender and sexuality more broadly. An example of this is the way that transgender academia as well as liberal transgender activists seem to be fixated on nebulous and immaterial concepts such as “visibility” or “validity” at the cost of understanding and advocating for more material demands like access to housing, getting healthcare, or countering workplace discrimination. What good does the affirmation that a transsexual person is valid serve if they can hardly pay their rent after struggling to keep their transphobic job? What does media visibility do to make a poor transsexual less suicidally dysphoric when they have to reschedule life-saving surgery due to unexpected financial strain? Asserting that gender isn’t logical or that we should abolish gender hardly softens such a blow.

The emphasis on validity also raises the question of who exactly is defining what is and is not valid and what the stakes are for such a status. Is a transsexual man not valid until he gets a M on his driver’s license? Is he valid only when he is accepted by his peers? Is there some sort of poll on the internet to determine this? If it is not a formal process, how is this informally defined and decided? If everybody is valid then the term seems to not be rhetorically or theoretically useful; if this is not the case, the criteria for validity seems unclear.

Non-Binary Idealism & MOGAI

Second, while some may take issue with Gill-Peterson’s invocation of upwardly mobile transgender academics focused in “a kind of immaterial, nonbinary idealism” as incorrect or being dismissive of non-binary people, that has been a feature of academic circles and the broader transgender community for quite a while now and it’s not an indictment of being non-binary. There’s this sort of underlying assumption in the way many talk about gender online and in academia: if we intellectualize and perfectly articulate gender, we can understand and move beyond it. Specific individuals are not at fault in discussing gender as a phenomenon, it’s something that is very confusing and complicated which characterizes many aspects of our lives, but at a certain point discourse or language can only go so far. Thinking about a world where, say, gender is abolished or serves as a social/cultural symbol without being tied to oppression is an interesting exercise and maybe something worth hoping for one day but we are a very long way off from such a system. There are real world things that demand our attention now and gender is not something we can opt out of.

As somebody who was active on Tumblr during the early to late 2010s, I’m drawing from my own experience to say that this non-binary idealism Gill-Peterson spoke of is exemplified in a contemporary context by the phenomenon of MOGAI (Marginalized Orientations, Gender Alignments, and Intersex). “Millions of Dead Genders: A MOGAI Retrospective” by Lily Alexandre (YouTube) and “That Time Tumblr Invented Its Own Genders” by Strange Æons (YouTube) are explorations of this topic if you aren’t familiar (although I do have criticisms of these videos but that isn’t really the point here).

While many of the people active in MOGAI internet spaces didn’t necessarily engage much or at all with academic transgender theory, they arguably derive the foundation of their worldview from points made in transgender academia that seeped out into the broader culture, namely: the decoupling of sex and gender, framing gender as something primarily socially constructed and performed, a focus on culture and media as to the origins and enforcement of gender, and an embrace of liberal individualism. The main differences between transgender academia and the MOGAI community is that the former generally focused on a descriptive analysis of gender and were adults with a more formed sense of self whereas the latter was generally prescriptive and speculative and were largely young people sorting out who they are. That being said, they share a compatible underlying theoretical framework and ultimately have the same pitfalls in their shared goal of articulating transgender theory and ways of being.

The acronym MOGAI was proposed as a more inclusive alternative to the typical LGBTQ initialism around 2014/2015. Tumblr users that argued the LGBTQ initialism is exclusionary in that there is a limited number of letters you can add before it becomes impractical and that a new term should be adopted to avoid this issue. During this period, Tumblr users began to coin new identities in an attempt to articulate the bredth of human gender and sexuality and to affirm that this new way of thinking would follow through on it’s inclusive goals. Explaining the nature of this community, Lily Alexandre said that MOGAI “…casts a very wide net, without centering any one group” and that “right from the start, the movement was heavily focused on language.” Comparing the difference between the goals of early LGBTQ activists and the MOGAI community, Alexandre says the following:

…where labels like “bisexual,” “lesbian,” or “non-binary” describe the way a group of people already relates to the world, MOGAI seemed to take it in the opposite direction, instead describing ways one could theoretically relate to the world, whether or not anyone did. Where for the bisexual community, language was the first step to achieving their goals, it seems that in the MOGAI community language was their goal. A vocabulary for every possible experience of the self or the world. Real or not, marginalized or not.

In the subsequent years, those active in the MOGAI community began to coin a large number of varied terms, categories, pronouns, and axes along which people may hypothetically identify, some of which caught on but many of which are forgotten or left in obscurity. There’s an online wiki where you can browse the terms or concepts the community coined that were deemed worth documenting, many with their own distinctive pride flags. As of currently writing, the wiki has 9,325 pages, with many of them describing hyper-specific micro-labels adapted to articulate any nuance of sexuality you can reasonably conceive of. There is a lot of context required to understand the environment that fostered the unprecedented expansive language of this community and it received a lot of reactionary backlash at the time among those more interested in assimilating into broader mainstream culture which was largely undeserved because many of those active in it were largely young and trying to figure themselves out (for further discussion about this, please refer to the videos linked earlier as it’s out of the scope of this essay).

Developing new language or theory about gender, while individually useful, does not dismantle the institutions that uphold systematic oppression in and of itself. Action to fight against systematic oppression is required for actual large-scale change. Articulating a more expansive, understanding, and inclusive model of gender is not an end. Gill-Peterson absolutely is correct in assessing this approach as a failure and something we should learn from moving forward.

Defending Medical Transition

There have been a record level of anti-trans bills passed in 2025. You can view this sharp incline on the Trans Legislation Tracker website which also features an interactive map if you’re curious about what’s happening in your state. In 2021, the website documents 143 proposed and 18 passed anti-trans bills compared to 2025 where 953 bills have been proposed and 120 have been passed. The Williams Institute reports that in 2024, more than 90% of transgender youth live in states that have proposed or passed laws restricting their rights and that 39.4% (113,900) live in states that passed bans on trans healthcare. This legislation’s widespread effects are being felt in navigating healthcare, education, and public life in general as it’s number exponentially grows.

Andrea Long Chu, in her invaluable essay “Why Trans Kids Have the Right to Change Their Sex”, comments on Judith Butler’s analysis of who makes up the anti-trans bloc today in their 2024 book “Who’s Afraid of Gender?”:

Three main tendencies compose the anti-trans bloc in America today. The first, and most obvious, is the religious right, a principally Christian movement that holds that trans people are an abomination and that “gender ideology” is part of a broader leftist conspiracy to corrupt the youth. The second tendency is also obvious, if smaller: gender-critical feminists, better known as TERFs. This group has its roots in the lesbian feminism of the ’70s; today, the polemical acronym, which originally stood for “trans-exclusionary radical feminist,” is used to describe any feminist who justifies her anti-trans views by citing women’s rights. These views include the idea that gender must be smashed rather than affirmed; that women constitute a “sex class” on the basis of their shared biology; and that the trans-rights framework exposes natal women to sexual violence at the hands of trans women, who are imagined as predatory males. (Most TERFism in the U.S. is imported: TERFs have their strongest foothold in the U.K.)

But the most insidious source of the anti-trans movement in this country is, quite simply, liberals. Butler, in their survey of the political landscape, misses the liberal faction altogether. I suspect this is because the anti-trans liberal sees himself as a concerned citizen, not an ideologue. He is neither radical nor a feminist; he is not so much trans-exclusionary as he is broadly skeptical of all social-justice movements. He is a trans-agnostic reactionary liberal — a TARL. The TARL’s primary concern, to hear him tell it, lies in protecting free speech and civil society from the illiberal forces of the woke left, which, by forcing the orthodoxy of gender down the public’s throat and viciously attacking anyone who dares to ask questions, is trafficking in censorship, intimidation, and quasi-religious fanaticism. On trans people themselves, the TARL claims to take no position other than to voice his general empathy for anyone suffering from psychological distress or civil-rights violations.

With increasing levels of anti-trans legislation affecting almost all of the trans youth in America and a widespread lack of support in trans minors pursuing medical transition, it isn’t much of a surprise that sooner or later this would be weighed in on by the highest court in the country—the Supreme Court. It also, unfortunately, isn’t a surprise that the outcome of this case’s resolution allowed for this discriminatory healthcare practice to continue unabated considering the the fact that there’s a 6–3 conservative majority (3 of the justices were picked by Trump over his two terms) and that in 2022 the same court struck down Roe v. Wade’s federal protection around seeking abortions. The writing has arguably been on the wall towards a more conservative shift since the 2018 passage of FOSTA-SESTA which, despite ostensibly being about sex trafficking, largely served to censor online speech more generally but especially speech about sex education and LGBTQ issues while making sex work more dangerous (it also isn’t actually effective at preventing sex trafficking).

The idiomatic canary in the coal mine sang it’s last notes long ago and rights seem to be rolled back more and more every day that passes. Gill-Peterson was not speaking in hyperbole when she said that the current government seeks to “dismantle the political-economic order of the past fifty years and replace it with permanent minority rule by corporate interests, Christian nationalists, and party loyalists.” A vocal minority of congressional candidates, some of which won their race for congress, even openly support or engage with the baseless and bombastic conspiracy theory QAnon indicating that they seem to disavow even basing their politics in reality or a pursuit of truth but instead relying on faith in what they personally believe. It isn’t difficult to see how, in such an environment, arguments for trans rights or healthcare are simply discarded as the government is not persuaded by appeals of tolerance. The Obama era liberal optimism of declaring 2014 to be “The Transgender Tipping Point” riding the wave of #LoveWins gay marriage advocacy feels darkly comical now.

With this context, it’s understandable why Gill-Peterson contributed to the amicus brief in the United States v. Skrmetti Supreme Court case with the originalist argument she made regarding Frances Thompson and the origin of the Fourteenth Amendment. There was a lot on the line with the ruling and it makes sense to at least try to make a case and nobody can be blamed for trying. That being said, the idea that the Supreme Court Justices operate on logical grounds and can be persuaded towards a cause they don’t politically align with is a idealistic at best. The Supreme Court is a branch of the American government and will to defend it’s own interests before all else. Those on the Supreme Court are selected by the standing President for furthering their political agenda are not beholden to pursuing any kind of lofty humanitarian or ethical standard. She seems to acknowledge this, saying that “[i]t’s commonplace to point out that the Supreme Court’s supermajority openly mixes law and politics to secure outcomes for their conservative interests” and that “[t]here is no way to know” if the plaintiffs in Skrmetti would have succeeded had they made originalist arguments.

One of the arguments made by Gill-Peterson is that the conservative majority of the Supreme Court actually used the expansive and non-dogmatic nature of the transgender label as a grounds for ruling that medical transition isn’t necessary, specifically:

…that one need not experience dysphoria or even try to change sex to be transgender; that transgender identity involves endless and shifting personal identification, making it impossible to define; or that everyone might be, in fact, a bit transgender because anyone can adopt an androgynous style or challenge stereotypes about women and men.

While it’s fair to be alarmed by such an argument, she is assuming that the Supreme Court conservatives were acting in good faith by invoking these ideas. What seems more realistic is that they were cynically utilizing this rhetoric to muddy the waters and build support for the conclusions they were already working towards: denying trans minors legal access to medical transition.

What is notably absent from the Skrmetti case is an understanding that medical transition is needed by some; that regardless of how varied the broader label of transgender is, transsexuals require medical transition in a way that is not simply optional or preferred but urgent and potentially life-threatening if not pursued. This urgency is arguably missing from basically all discussion around trans rights and identity outside of transsexual circles where it is understood as a fact.

When a transsexual pursues medical transition, it is not a frivolous request to be taken lightly but instead something that ought to be taken seriously and followed up with a sense of immediacy for the sake of their well-being. Yet, rather than being taken at their word, the conservative will say they are brainwashed or delusional, the TERF will say they are perverse and that biology is destiny, the cis liberal will hesitate and speak as if they know better, and the trans liberal will see this as an extreme measure and remind them that they don’t need HRT or to get surgery to be valid. None of these are adequate responses, especially to trans minors who are essentially seen as property of their parents without autonomy over their own medical care which is increasingly subject to targetted attacks by the state.

Conclusion

We need to organize around the idea Chu presented in the earlier article as “the freedom of sex,” which she defines as “the right to change one’s biological sex without appealing to gender and the right to assume a gender that is not determined by one’s sexual biology.” Instead of focusing primarily on gender as site of struggle, we must consider the reality of biological sex as both something that exists and also something that can be changed bcause it is not actually a simple binary, static phenomenon. We must learn to accept diversity in biological sex not as a threat but as a natural variation present in all human life. Furthermore, having developed a better theoretical model of gender and sex, we cannot rely on the US Government for meaningfully addressing systematic oppression, such as the transphobia fueling reactionary legislation, and must take material action and organize towards a better future. Without revolution or some sort of radical transformation of society which uproots the origins of oppression, transgender and/or transsexual people will not be truly free.