[Last Name] 1

Gabriela Motta

Prof.: Geoffrey Gilbert

EN2020

April 2020

Transitioning, Detransitioning and hormonal therapy: a discussion around

trans bodies in the Pharmacopornographic Era

From sin, to felony, to selfhood and experience, LGBT identities have always

been prescribed their societal place and subjectivity throughout history. Social

marginalization was an inevitable reality for those who did not fulfil those

prescriptions. In the Middle Ages, the church enforced severe physical and

psychological punishments to a handful of what they called sinners. Among the

sinners were all those whose gender and sexuality (although then, these concepts

were not yet named as such) did not mirrored the norm. As a result of this

marginalization, LGBT people –among other political minorities— were, and still are,

at higher risk of suffering negative outcomes experienced at social, political, and

environmental levels. Those aftereffects are a result of a systematic social

hierarchization based on class, race, gender, sexual identity, illness and disability.

To control the deviant individuals, societal institutions came up with a series of

explanations for those living an out of the normative lifestyle. Different institutions

imposed social control through various mechanisms. With secularization and the

erasure of the power being held by religious institutions, control was under the law

and deviants were then classifieds as criminals. Soon after, with the rise of the

medical practice, a so-called legitimate scientific space, a new tool for social control
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was now in place, and then, deviance became a medical issue. At the same time,

with the WWII as background, the necropolitical techniques of the war progressively

became biopolitical industries for producing and controlling subjectivities. Among the

technologies produced is the pharmaceutical development of synthetic molecules for

commercial use such as the Pill and Viagra (Preciado 2008). With the arrival of new

medical theories, a general discontent with religion was stablished and a

healthicization process started. Medicine was providing evidence to support the

transition of several conditions that were thought to be related to God. Explanations

now came from a scientific background and the sin was turned into illness. Key to

the emergence of medicalization is the conceptualization of problems that were

previously non-medical. This process was constructed via the healthicization

process. A “new health morality” that dictated normalized behaviours. Medicalization

refers to the entering of “social problems” in the realm of medical emergencies. It Is

the “greatest social control power that comes from having authority to define

behaviours, persons and things” (Conrad 1992). In the 1970s, the emergence of

medicalization brought discussions around social control through medical practices.

One occurrent example, and one I will focus on in this paper, is the case of

transsexuality, or “gender dysphoria”, how they name the phenomena in the late

DSM-V. Although the medicalization of transgender peoples may have positive

impacts such as coping (and sometimes, hopefully, getting rid of) with the dysphoria

and help them blend into the normative sphere through medical devices, it also

implicates an intense relationship of dependence of the medical, pharmaceutical

industries and reinforcement of prescribed ideas of how male, female and queer

bodies are supposed to look like and behave. The 2002 planning and revision

process of the DSM-V “Research Agenda for DSM-V” has been an important
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research tool for understanding the impact of socio-cultural aspects of mental illness,

the expression of disorders, and in this case, gender identity and dysphoria. Several

topics were identified as important branches for further research and revision i.e.

how health issues are manifested in various ways in different social and age groups. 1

The Agenda concluded that cultural mechanisms delineate how illness, disorders

and in this case, gender dysphoria, are represented and manifested. While medical

devices were produced and largely consumed, other phenomenon was identified

worldwide, one that also reinforced violent ideas about female bodies, racialized

bodies and those extremely fetishized which is the case of transvestites and

transgender people, particularly the United States of America - the insurgence of the

pornographic industry. In 1953, Hugh Hafner founded Playboy, the first North

American “porn” magazine to be sold at newspaper stands. In 1972, Gerard

Damiano produced Deep Throat, which was widely commercialized in the US and

became one of the most watched movies of all times (Preciado, 2008). This industry

is also co-dependent with pharmaceutics as the former serves as a lever, for

example, to impulse the production of technologies to keep the penis forever erect,

literally and/or metaphorically. Along with the turn to a medical morality, the rise of

the pharmaceutical industries and its products, the world experienced a shift towards

a globalized reality, industrial mass production and consumption, insurgence of the

porn industry and a boom of the World Wide Web regime; which, combined, make

the snapshot of what Preciado calls a pharmacopornographic regime. Although my

focus here will be around trans identities and bodies, parts of my research is a

critical analysis of Preciado’s work Testo Junkie, where he will narrate his

experience taking testosterone (a cross-sex hormone therapy, as he was born a

1
According to a document released by the UCLA school of law, there is an incidence

of trans identification and gender dysphoria among a younger population

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female). His motive, however, does not come from experiencing gender dysphoria,

or, at least not initially, identifying as a trans man. He does it, he says, to avenge

death, the death of a friend. But also, as an anarchical protest, a socio-political

experiment to challenge and disrupt the system. Nonetheless, I will argue there is no

possible way to challenge the heteronormative patriarchal system when you are, in

fact, using of the same elements, or molecules, in this case, that are part of the

social construction created by this very system. Furthermore, I will touch on the

phenomenon of detransition, a process some people (who did and/or still do) identify

as transgender go through to undo the steps taken previously. 2 Both these

processes, transition and detransition might have different reasons I will later

discuss.

Medicalization, Healthcare and the Multiplicity of Trans Identities

The discussion around transgender identities is rather new (if not non-

existent) to the larger portion of society and it is still not well understood, accepted

and respected. The identity has only been present in the medical discourse since the

1930s and It was only first recognised in official documents in the 1960s and later

gained its first international organization for trans health care (named after Dr. Henry

Benjamin who performed the first few gender-reaffirming medical procedures) which

published a document setting the Standards of Care for the health of this community

in 1979, long after the first gender-confirming surgeries attempted around the world.

Originally, this “acceptance” within the medical community came from a demand of

trans peoples who wished to transform and adequate themselves according to the
2
The transition process might be only one or a combined version of social transition

and medical transitions.

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ideas of what being men and women meant. Today, the demand also comes from a

population who claim a non-binary identity 3, that is, either a combination or a

rejection of both genders and/or something beyond those two entirely. Gender non-

conformity launched its first appearance in the DSM-III in the 1980s as

“transsexualism” and “gender identity disorder” which hold a strong connotation for

illness or disease, finally, in the DSM V, released in 2013, the term was replaced by

gender dysphoria which takes the attention/problem away from person’s identity and

places it into the discomfort experienced by some trans people in relation to their

body. Because of all the tardiness in accepting this identity (just like we have seen

with all other non-normative sexual and gender identities) there was no accord in

how to care for these individuals neither psychologically nor physically. But since the

existence of this community is not assigned and defined by normative institutions,

the community have always found ways to fulfil their identity, through various legal

and illegal channels. Then, since the appearance of a globalizing and revolutionary

tool, the internet, the synthetic molecules that supposedly create the bodily gender

experience became more and more accessible to people, there has been an

incidence (empirically observed in research) of people identifying with trans

identities; one or more of the 70+ options of trans identifications. Through the

widespread experiences of this community, this context not only facilitated the

access to transition practices (social and medical) but eased the process and put

pressure in the formal entities of health to officially address this healthcare issue. As

we might expect, though, there is very little data on the healthcare of transgender

individuals, especially on the administration of gender-confirming therapies

(hormonal and surgical). And it is known in the community, because of the scarcity of

resources both from state-nations, institutions and the patients themselves and the
3
The semi-structured guiding questions will be attached in the end
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lack of awareness throughout society and sometimes in the medical sphere, the

community often turns to self-administration of the hormones that can potentially

have irreversible changes in someone’s body if, but not only if, not properly

monitored and cared for. So, amid this urge towards a healthcare for the trans

community and to make treatment to the ‘patients’ even easier and more accessible

for providers everywhere, in 2009, the Endocrine Society put together brief clinical

practice guideline. Around this time, the media was already being consumed with

transgender content, both positively and negatively.

I had the chance to talk in detail with 2 trans persons for the purposes of this

paper.4 Although it would be impossible to entirely refer to the interviews, I will try

and bring, according to my judgement, important points and passages from the

conversations. They could, otherwise, be transformed entirely to a whole 20-page-

paper each. The first person I talked to, who I will call Ariel 5, commences the timeline

of their gender questioning with: “Am I gonna succeed in being a woman? I can’t be

desirable like a woman... then I started fitting in and people started to look at me that

way, and I didn’t want it, I didn’t want to make the rest of the effort. I didn’t want to

shave my legs.” Then they question and criticize the constructions around

womanhood: “Why do you want to be this pretty, clean, not very active person? I’ve

found my own gender that nobody gets to have.” When I asked about this long-time

feeling regarding their trans identity they told me about, they responded: “It was

definitely a political feeling. I didn’t like the femininity exposed in magazines like

Cover Girl, but I didn’t want to change the system entirely. It sounded like a lot of
4
This person identifies as non-binary, so I’ll be using they/them pronouns
5
Ariel explained to me gender euphoria is a concept they use to facilitate talking

about their body as gender dysphoria does not necessarily apply to them, at least not in the

ways the medical community expects it to.

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work... I didn’t do the work and drifted towards masculinity and claimed that. It felt

like I could play more with that than femininity... What got me into this process of

accepting I’m trans is definitely “gender euphoria” 6, not dysphoria. I don’t want that

gender in general, I want more of that.” Ariel, who identifies as non-binary, places

themselves outside of the binary, symbolically speaking, but drifts towards and

choses to appropriate masculinity; they do, however, differentiate their type of

masculinity with embodied masculinities in male born. According to them, the former

is used as an asset to maintain the degrading gender structures in place, which

scares them, whereas the latter, their type of masculinity, would be a tool to enlarge

their possibilities to navigate gender. When asked to clarify their ideas around

masculinity and femininity, if they place femininity into womanhood and masculinity

into manhood, they bluntly answered: Yes. They told they didn’t know “[one] could

feel very strongly and happy with [their] identity” until they saw the positives of

gender in queer communities they came to know. When I questioned what they

make of the butch lesbians they knew when younger, they said: “I never thought it

could be for me, I think because I was so put in that insecurity as a teen”. What is

striking to me is the disconnected bodily feeling they experienced throughout their

teen years and how this might have turned out if taken to another direction rather

than the choice of hormonization. The uncanny feeling towards their own body was

built up during years of a confusing gender experience, as it is relational; and they

strongly suggested a disconnection with womanhood, at least the womanhood

socially constructed to appeal the structural controlling patriarchal gender system.

One that dictates how women and men are supposed to look like and present

themselves as, as well as how the translation of femininity and masculinity should

take place when embodied by the sexes, respectively. Ariel particularly expressed a
6
The usual nomenclature for double mastectomy in the trans community
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discontent with the need to be assertive and more aggressive in order to get their

thoughts across, especially when they were still presenting in a more feminine way,

when they were “read” as female. In the chapter “Becoming T”, Preciado explores

his pathway to identifying as a trans man, or else, his path challenging the

boundaries of imposed womanhood. He explains he tries every day to cut one of the

wires attaching him to the cultural program of feminization but as Faith Wilding in her

performance in the Womanhouse project:

“I keep waiting to be taken into someone’s arms, waiting for

life to begin, waiting to be loved, for pleasure to arrive,

waiting... But I’m also a trans man. With or without T. To the

list of feminine waiting, I must add the endless list of ways of

hoping, for the advent of masculinity: waiting for my beard to

grow... waiting for power, waiting for recognition, waiting for

pleasure, waiting...” (Preciado, 137)

Furthermore, Ariel explains they understand, and they have accepted the fact

that they care a lot about gender, as most of us do, and that gender is a really

important way in which they read their identity and presentation in a nonconformative

way. They further tell me: “gender is one of the ways [they] can tackle the body

image problem... The ways in which [they] feel good about [their] body can be solved

through the masculinity angle, but it’s a trial and error or trial and success but leading

to a next.” They also explain to me they think testosterone is right for them because

of the euphoria they get thinking of how they could look; the plan is to go on low

dose testosterone and going to the doctor will possibly validate their experience and

allow family and colleagues to support them in a better way. The wider society says

they are not how they expect them to be, but they have doctors’ respect and trust,
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which is used as a strategy. Lastly, they explained they want to live in constant

gender euphoria. (…)

The other person I had the chance to talk to about this project is a long-time

friend, Alex7, whom I had previously talked to in the beginning of his transition, back

in 2013. Unfortunately, I could not recover the recording, but he gladly went through

the whole process again with me. He tells me throughout his childhood he happily

played with all toys, there was no such thing as differentiating boy toys or girl toys,

except with the adults, who did make this differentiation. His first contact with

transsexuality, apart from a sensationalist block on Brazilian TV show, he saw cases

of the first few trans man that were broadly spoken about and televised. At the time,

he had relationships with both men and women, but because of social pressure from

the LGBT community he ended up identifying for a long time as a lesbian. He

explains after getting properly in touch with transsexuality, its nomenclatures and

explanations, he said he identified himself with that narrative after realizing that what

people said was uncomfortable to them, was also to him, both bodily discomforts and

social ideas of womanhood. He further says in terms of “erogenous zones”, he

always felt pleasure, but when he looked at it, he did not like what he saw, it felt like

it did not match him. At the time of the beginning of his hormonization process, the

“Transsexualizing Project” at the local hospital was momentarily inactive so he then

had to turn to unsupervised under the table means. He told me that through an

online trans community he discovered the usual testosterone doses and guidelines.

He also mentions when he was only having access to low quality testosterone, he

felt like they were doped with something else. As well as being restrictive in terms of

access, they were also an important monthly expense. In 2015, Alex was able to get

7
Alex identifies as a trans man, so I will be using he/him pronouns
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access to the “Transsexualizing Project”. Before his top surgery 8, though, he

voluntarily underwent psychological therapy, as well as attend various psychiatrists

who at the time, barely knew what transsexuality was. He explained a medical report

was needed to perform any medical transitions through the public health system,

while if you were to do it in a private facility, you would “depend on the doctor’s good

will”. Sometime after starting hormonal therapy he was going through a period of frail

immune system, getting sick a lot, he then decided to stop the hormonal therapy,

which was also advisable to do before top surgery. After the surgery he ended up

discontinuing the treatment since without the breasts his dysphoria diminished and

the other effects of stopping cross-sex hormones did not necessarily upset him.

Although when he stopped testosterone it was not exactly thought through, now it is

a conscious political decision. But it was not necessarily easy, though, as his body

was already used to the new hormone and now, he would be going back to other

hormonal levels, that would result in what he calls a “mind bug”. Now, 2 years after

stopping the cross-sex hormone therapy, he tells me his voice has mostly not

changed back, but he lost some of the body mass he gained before and has also

restarted the menstrual cycle back to what it was before treatment. He then, went

back to uninterrupted contraceptive use to stop the period, which made the “mind

bug” worse, so he decided to stop that too and be hormone free. Now, he tells me,

although he likes hormonization because he feels stronger and mentally more stable

(because of the lack of female hormones) he chose to stop testosterone as he does

not feel it is necessary to him, especially now that his body has already changed. He

stressed although this is his case, he still fights for trans hormonization and thinks

this is an important step for trans people to have their body matched to their gender

identity. A trans identity that, for him, does not necessarily mean identifying with the
8
See Lois McNay 2000 Gender and Agency: Gender, Subjectification and Agency
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“other gender” but not identifying as the one you were “born with”. He continues

saying this is important not only for trans people but for society, for them to

understand who/what you identify as and for yourself to feel validated, given gender

is a mostly relational production.

Intersectionality, Queer Theory and the social minefield

The overlap between the structural patriarchal society and other social

inequalities experienced in the Global North is the subject of a critical feminist

analysis. These structural conditions allow precarious living situation for women,

LGBT people and non-white populations in societies that wish to conform to a

Eurocentric heteronormative ideal. This framework demands social change and

challenges in the status quo. One concept essential to the understanding of these

structural processes consists of framing the intersection of different layers of

oppression. Social categories such as gender, race, sexual orientation and origin

work as different parts of an interlocking system of oppression that together work as

a cage for individuals who pertain one, two or more of these categories combined in

different ways and layers. This concept, intersectionality, was coined in 1989 by

professor Kimberlé Crenshaw to describe how race, class, gender, and other

individual characteristics “intersect” with one another and overlap. Comprehending

the global layers that make an individual and how this might affect their treatment in

society is the most effective way to reach a thorough and complete analysis of

individuals, groups and communities, but I also believe that in a postmodern reality in

which we see a steep shift to an individualized identity that remains largely within the

symbolic, or more narrowly a linguistic conception of the construction of corporeal

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identity should be more carefully analysed. Following the linguistic turn initiated by

the poststructural thought, and further explored by Queer Theorists, difference is

understood principally as instability within meaning systems and not, in more

sociological terms, as the differentiated power relations constitutive of the social

realm.9 Queer theory is based on the premise that all bodies and gendered/sexual

identities are socially constructed. The theorists resist the notion that any identity

category can ever be fixed or static and find those bodies and identities which

challenge social norms to be the most radical and emancipating. Furthermore, Queer

Theory holds limited space for an incorporation of the transgender body, because

many transgender identities are marked by identity categories that must remain fixed

to make sense. Hence, there is no non-binary without the binary, and no trans

without the cis. An individual that has undergone sex-reassignment surgery relies, in

part, on the conflation between sex and gender to maintain an identity that is easily

recognizable. Without the social equation of female = woman, a transsexual woman

would have a much more difficult time negotiating the cultural spaces they/she

sought to outline for themselves/herself. For this reason, queer theorists have had

the same types of conflicts with transgender (particularly transsexual) theorists as

they have with some feminist theorists, such as radical feminism. Queer theory’s

notions of fluidity restrict the right of transgender individuals to define themselves in

opposition to socially constructed norms, a restriction that often means the erasure

of transgender subjectivity. The spaces that transgender bodies must negotiate often

fall outside the parameters of feminist politics, particularly those feminist politics that

rely on identity to define both their movement and their membership; nonetheless,
9
I.e. Kai, a trans kid who started hormone blockers at age 10, started cross-sex

hormone therapy a couple of years after that and had the whole process filmed.

https://www.youtube.com/watch?v=DM-91n_qRhE
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this remains an extremely tricky crisscross considering even in an intersectional

framework, a certain level of material dimension of identification is needed to start

assessing the layers of oppression. Among all these different framings gender could

be taken to, some conservative thinkers draw on the divided political minority

momentum to also invade theoretical understandings of Trans bodies. Some firmly

believe in the essentialism of gender, that one is born and destined to perform

moralized ideas of womanhood and manhood according to their sex, in that way, sex

and gender would be one in the same thing. Thus, gender would be a biological

tendency aligned with the sexes. But added to the bellicose rhetoric often used, they

fail to recognize at least two things: one, that gender is a socially constructed social

category that prescribes how female and male born people are supposed to look and

behave (of course, sexual and gender minorities are mostly not even included in this

mindset), and two: even biologically, for decades we know at least one more

possibility exists, intersex people, which has also been debunked as being a single

third option, and in fact, there at least five other arrangements of sex (intertwined

phenotypically and/or genotypically).10 Amid the rise of general visibility of trans

identities, a prejudiced and mediatic sensationalization of the latter, dissemination of

misinformation, and the polarization of discourses, most often than not, in the

Internet on sites that massively narrate trans discourses, critical theories and

10
There is at least a couple of hundred hours of self-documented (and otherwise) and

uploaded quotidian of trans kids and their parents online who often equate their kids’

supposed transsexuality with performances of social constructions of womanhood and

manhood (I.e. femininity and masculinity, respectively) as well as an enormous amount of

cases where the kid would only “come out” after having a peer doing so.
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theorists were caught up in the crossfire which slow down the progress --or even

obstruct completely-- for sexual and gender minorities.

Detransition as collateral damage of the Trans-woke Era

With the rise of an individualized bodily (and psychological) experience, which

somewhat aligns with a liberal thinking that supports individual rights above others,

with biocapitalism’s pharmacopornographic techniques of gender production

(Preciado 101) and a demand for community's recognition, one who has long

suffered from a structural violent treatment, gender became a biotech industrial

artifact, malleable and easily changed with the help of synthetic molecules along with

a medical discourse that supports hormonal and surgical transitions in the name of

unquestionable affirmation of gender identities and artificially designed gender codes

of visual recognition without proper scrutiny, we see a phenomenon that in the past

three years has been on the rise. Apart from the sensationalized mediatic exposure

of detransition, the phenomenon still arises in the Trans Community. Although some

people have detransitioned after poor psychological “assessment” leading to

reversible and irreversible changes in their bodies, realizing then the bodily

discomfort felt before is now understood as something other than identifying as

Trans; others, who also detransitioned (at least hormonally) but still identify as

transgender are part of a group that experiences highly discouraging side effects

from the cross-sex hormone therapy (due to a lack of research), as well as the

realization of another underlying mental health issue such as PTSD that was

translated into an extremely uncomfortable bodily sensation. In these cases, the

transition is a shallow solution for symptoms, not “problems”. The sudden onset of
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gender dysphoria also seems to be correlated with a couple of factors. One is social

media use, where great part of the community search for validation and do get some

of it; the second correlative factor is having peers who also identify as trans,

especially in the case of transgender kids, we are seeing them coming out together

in peer groups (Marchiano 348)1112. While I see an immense problem with how the

”assessment” (that can very well be read as an intrusive body regulation and

invalidation of experiences) and prescription of physicality and performance and

particularly the medicalization of bodies (long explained by a moralized discourse

that intents to prescribe female, male and also queer bodies), especially of those

partaking in political minorities; I do see the importance of a critical and analytical

reckoning and psychological follow-up with the individual seeking bodily

transformations, an attentive listening that would be able to identify the sources of a

gender dysphoria that might as well be an identification with a Trans Identity, but

could also be a sign of other underlying issues that are frequent among gender

nonconforming people as a result of an extremely prejudiced, sexist and homophobic

society. I will end this discussion with a piece of art made by Cari Stella, a blogger

and detransitioned female to male to female who has informally conducted an online

survey with 200 detransitioned peoples, particularly women, 65% of which have said

they had received no therapy before starting hormones, and those who had, only

went to a handful of sessions, and the average age they began transitioning was as

young as 17 years old. This first wave of detransitioners, who are mostly in their mid-

twenties, barely make a significant percentage within the trans community but with
11
See Anne Fausto Sterling’s 2000 Sexing the Body: Gender Politics and the

Construction of Sexuality
12
This is a reference, or else, an effort to rupture with the dichotomous male-female

binary system
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the advance of laws that contribute to children transition in the last 5 years as young

as 10 years old, I am afraid I do not expect a fast revision of the medical process as

well as the symptoms of the postmodern Era. Cari Stella says: ”[she] [is] a real live

22-year old woman with a scarred chest, and a broken voice and a five o’clock

shadow because [she] couldn’t face the idea of growing up to be a woman. This is

[her] reality”. In her artwork, she questions other possibilities her psychotherapist

could have been considered before affirming her transgender identity. Furthermore, I

keep my fingers crossed to a future with more respectful environments and a more

cohesive LGBTQ+ community as well as a thorough socio-political, material and

psychological understanding of the subjectivities of nonconformative identities.

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Bibliography
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Basiliere, Jennifer L. Bypassing Binaries: Towards a Feminist Politics of

Transgression, State University of New York at Buffalo, Ann Arbor, 2008.

ProQuest, http://proxy.aup.fr/login?url=https://search-proquest-

com.proxy.aup.fr/docview/304372374?accountid=40507.

Conrad, Peter. “Medicalization and Social Control.” Annual Review of Sociology, vol.

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Apr. 2020.

Conrad, Peter, et al. Deviance and Medicalization: From Badness to Sickness.

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Marchiano, Lisa. “Outbreak: On Transgender Teens and Psychic Epidemics”,

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10.1080/00332925.2017.1350804

Preciado, B. Paul. Testo Junkie: Sex, Drugs, and Biopolitics in the

Pharmacopornographic Era. Publisher: New York: The Feminist Press at

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