Anatomical Authorities: On the Epistemological Exclusion of Trans- Surgical Patients

Abstract

American feminist health activists in the 1970s created representations of genital anatomy intended to replace the abstracted images of biomedicine’s ‘modest witness,’ with what Michelle Murphy has called the ‘immodest witness,’ authority explicitly derived from personal and embodied experience. Decades later, a feminist publication in the tradition of the immodest witness called Femalia was adopted into the practice of an American surgeon specializing in trans- genital sex reassignment surgery (GSRS). Based on ethnographic and textual research, I show how oppositional claims to represent the ‘natural’ female body—one valued for its medical objectivity and the other for its feminist subjectivity—effectively foreclosed these as modes of authority through which the trans- patient might contribute to her surgical care. I argue that trans- patients’ double epistemological exclusion contributes to a broader asymmetry in the use of patients’ subjective reports in the everyday practice of GSRS and the clinical research by which it is evaluated.

• feminist epistemology
• sex reassignment surgery
• surgical practice
• trans- medicine

Notes

1. Wilson was quite adamant that I use his real name. Like many of the surgeons I interviewed, he was proud of his work and welcomed the opportunity to have it recorded, even in light of my explanation that my treatment would be analytical rather than hagiographic. For my part, I value the opportunity to include specific and accurate information because this type of historical record is sorely lacking in the study of trans- surgery. I am happy to enrich that record here.

2. These surgeries are known by a variety of names, each of which reflects particular political and moral understanding of the effect the procedure is intended to produce. Changes in the nomenclature—first ‘sex conversion operation,’ later ‘sex reassignment surgery,’ and more recently ‘gender confirmation surgery’ or ‘gender affirmation surgery’—correspond not to changes in surgical technique so much as changing understandings of the nature of the problem surgery is meant to address, as well as a democratization of who—experts or otherwise—have been allowed to speak authoritatively on the topic. I use “sex reassignment surgery” here because that framing most closely matches Wilson’s approach to his patients. It also matches the orientation of surgeons trained in the United States in the 1960s, 1970s, and 1980s. I use the term “genital sex reassignment surgery” to call attention to the genital nature of these procedures, as opposed to chest, facial, or vocal surgeries that are also employed in the name of surgical sex reassignment.

3. A note on the use of trans- : Whereas Stryker, Currah, and Moore (2008) used the term trans- in order to leave open the possibility of kinds of crossing that are not limited to gender, here I use it in order to draw attention to the multiple gendered endings to the word trans that have come to hold important personal and political stakes for those who use this word to identify themselves. Because this article foregrounds surgeons’ practice rather than patients’ narratives, it is important to use this open-ended descriptor rather than assign people into categories that they did not self-designate. Trans- leaves this space open.

4. “Sex Change Facility Is Closing.” The Argus-Press. March 5, 1981, p. 5.

5. Wilson estimated that he has performed between five and eight phalloplasties each year since that initial procedure in the late 1970s.

6. I have conducted a year of fieldwork in the offices and operating rooms of two American surgeons who specialize in Facial Feminization Surgery, a month with a European plastic surgery team focusing on trans- surgeries, and conducted in-depth interviews with other surgical specialists in North and South America.

7. The first American gender clinic was founded at the University of California at Los Angeles in 1962. Focusing on psychological research, it did not offer surgical services.

8. For an explanation of the factors that lead to the rapid closure of the clinics see Stryker 1999, Irvine 1990, and Rudacille 2005.

9. WPATH recommendations are widely followed in North America and Europe, although less strictly followed elsewhere in the world.

10. The Standards of Care are a set of professional recommendations that guide the hormonal and surgical treatment of people variously classified as transsexual, transgender, and gender dysphoric. Adhering to the guidelines set forth in the Standards of Care helps to safeguard clinicians from claims of professional misconduct.

Additional information

Notes on contributors

Eric Plemons

Eric Plemons is a member of the School of Anthropology, University of Arizona, Tucson, Arizona, USA. He has studied sex reassignment surgical practice in North America, South America and Europe. His book on facial feminization surgery is forthcoming from Duke University Press.