In this chapter I highlight a formidable barrier to trans health: the medicalization of transness under healthcare systems, including the NHS, as ‘gender identity disorder’. The problem with medicalization is two- fold. Firstly, it stigmatizes transness which is a barrier to good mental health and, secondly, it creates medical gatekeepers and bureaucratic barriers that delay or prevent trans people from accessing quality healthcare. To fully understand this problem I map transness using medical sociologist Peter Conrad's framework of medicalization, expanding upon it throughout in order to unpack the ways medical social control is enacted on trans people. I conclude with an argument for demedicalization, looking at how trans services would manifest if they were not treating a medical condition but rather were providing access to necessary medical technologies.

What is medicalization?

To understand medicalization I am focusing on two works by Peter Conrad. Firstly, I will be using ‘Medicalization and Social Control’ (1992), because it contains a thorough analysis of the relevant (particularly post- 1980) literature on medicalization. Secondly, I will be pulling from ‘The Shifting Engines of Medicalization’ (2005) which provides a more contemporary update to that previous work. While Conrad only mentions transness briefly, I am using these theories to understand on a micro level the way that transness specifically is medicalized. In ‘Medicalization and Social Control’, Conrad explains that ‘ “medicalization” describes a process by which non- medical problems become defined and treated as medical problems, usually in terms of illness and disorders’ (1992: 209). Conditions can be medicalized to a greater or lesser degree and it is a complex process with care providers, researchers, government bodies, patients, and other agents all playing a part. It is a broader social pattern that can be deliberate or unintentional on the part of the medical profession. It is also often a gendered phenomenon, as ‘gender segmentation is a propitious strategy for defining problems and promoting medical solutions, both exploiting and reinforcing gender boundaries’, something that becomes especially relevant for trans people (Conrad, 2005: 11).