Am I recalling incorrectly that the primary scientific basis of transgenderism being both not a choice and not a "mere" mental disorder was a study showing their neurology had key aspects closer to the opposite sex? Or that a major aspect of the transgender community is using surgery and hormone supplements to force their anatomy to more closely correspond to the opposite sex?
What the fuck do you even mean by intersex if it isn't applicable to transgenderism? Because I have heard absolutely nothing of "intersex rights" as a distinct thing. Also, genderfluidity "is a thing", that directly requires the "because I say so" standard to at all be something one can tie any kind of policy to. To say nothing of nonbinaries.
You are absolutely correct about the neurology,
but you are overlooking a key fact. Those are relatively recent scientific findings, whereas the history of medical treatments here goes back to mostly the 1950s and 60s. At the time that doctors and surgeons were setting out the treatment protocols for all of this,
no one knew about the neurology and medical practice set a hard defining line between patients who were intersex and patients who were transsexual/transgender.
Intersex patients were defined on the basis of anatomical abnormalities in the gonads and/or external genitals, which were later understood to be the result of quite a few entirely unrelated genetic and hormonal causes. These cases were considered to be medical in nature, and the established protocols focused on enabling the patient to live as normal a life as possible by early detection and aggressive surgical and hormonal treatment. As I've mentioned in previous posts, the Reimer case
essentially involved applying the standard treatment protocols for an intersex child -- immediate reconstructive surgical intervention followed by hormone treatments in puberty, combined with ongoing psychological care to enforce the assigned gender role.
Transgender patients were defined on the basis of
not having any discernible physical abnormality, but exhibiting gender dysphoria. These cases were considered to be psychological in nature, and were initially treated as delusions to be "corrected" in pretty much exactly the manner that modern conservative activists want to go back to. However, such treatment was highly unsuccessful and caused
incredibly high suicide rates, whereas even with the
extremely crude and limited methods available as far back as the 1940s, transitioning produced much better results for the patient.
However, treatment protocols still treated transitioning as an extremely serious intervention which could only be accessed under extremely limited conditions including a
hard minimum of two continuous years of regular psychotherapy, a confirming second opinion from a second psychotherapist,
and only then being able to get an appointment with one of a tiny handful of specialist surgeons
and paying for all of it out of pocket. Under the initial versions of these treatment protocols, it was standard practice for therapists to demand that patients demonstrate total compliance with mainstream gender roles, to the extreme of being required to quit "gender inappropriate" jobs and dress in an extremely stereotypical manner. Those measures have thankfully become a thing of the past, although the fundamental restrictions on transition therapy do in fact remain.
So the bottom line is -- and I agree this is both ironic and confusing -- that although both patient categories are in fact receiving largely the same actual surgical and hormonal treatment, the *protocols* are totally different. For an intersex patient, the protocols called for immediate, unrestricted surgical and hormonal treatment,
preferably without the patient ever knowing about it, and in many cases
without even the consent of the parents. For a transgender patient, the protocols called for the exact opposite: delayed, highly restricted treatment with multiple layers of gatekeeping even with patient consent.
Because I have heard absolutely nothing of "intersex rights" as a distinct thing.
It is a distinct thing, but it's an
extremely obscure thing because it generally focused on patient advocacy and lobbying
of healthcare providers rather than political action. Intersex rights advocacy focused on replacing the "immediate, forcible normalization" model of treatment with a patient consent and choice based model in which no medical intervention occurs until the patient is old enough to express a clear and unambiguous gender identity, after which medical treatment is provided to match that identity.
In 1997/1998, the double-barreled exposure of John Money's absolute dishonesty in falsifying the outcome of the Reimer case in the mainstream press by journalist John Colapinto and in academic journals by Dr. Milton Diamond was the critical landmark. It completely inverted the professional narrative from, "Patients are increasingly demanding X, but medical experts still recommend Y" to, "The Y treatment protocol was based on completely falsified evidence, we need to re-examine everything we thought we knew."
By 2006, two widely accepted medical journal articles laid out the so-called "Chicago Consensus" position, which pretty much is exactly what patient advocates had been pushing for: delayed treatment on a patient consent model. With the broad acceptance of the Chicago Consensus position as the treatment standard, intersex advocacy essentially declared mission accomplished and wrapped up.
