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A rich examination of the history of trans medicine and current day practice Surfacing in the mid-twentieth century, yet shrouded in social stigma, transgender medicine is now a rapidly growing medical field. In Trans Medicine, stef shuster makes an important intervention in how we understand the development of this field and how it is being used to "treat" gender identity A rich examination of the history of trans medicine and current day practice Surfacing in the mid-twentieth century, yet shrouded in social stigma, transgender medicine is now a rapidly growing medical field. In Trans Medicine, stef shuster makes an important intervention in how we understand the development of this field and how it is being used to "treat" gender identity today. Drawing on interviews with medical providers as well as ethnographic and archival research, shuster examines how health professionals approach patients who seek gender-affirming care. From genital reconstructions to hormone injections, the practice of trans medicine charts new medical ground, compelling medical professionals to plan treatments without widescale clinical trials to back them up. Relying on cultural norms and gut instincts to inform their treatment plans, shuster shows how medical providers' lack of clinical experience and scientific research undermines their ability to interact with patients, craft treatment plans, and make medical decisions. This situation defies how providers are trained to work with patients and creates uncertainty. As providers navigate the developing knowledge surrounding the medical care of trans folk, Trans Medicine offers a rare opportunity to understand how providers make decisions while facing challenges to their expertise and, in the process, have acquired authority not only over clinical outcomes, but over gender itself.


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A rich examination of the history of trans medicine and current day practice Surfacing in the mid-twentieth century, yet shrouded in social stigma, transgender medicine is now a rapidly growing medical field. In Trans Medicine, stef shuster makes an important intervention in how we understand the development of this field and how it is being used to "treat" gender identity A rich examination of the history of trans medicine and current day practice Surfacing in the mid-twentieth century, yet shrouded in social stigma, transgender medicine is now a rapidly growing medical field. In Trans Medicine, stef shuster makes an important intervention in how we understand the development of this field and how it is being used to "treat" gender identity today. Drawing on interviews with medical providers as well as ethnographic and archival research, shuster examines how health professionals approach patients who seek gender-affirming care. From genital reconstructions to hormone injections, the practice of trans medicine charts new medical ground, compelling medical professionals to plan treatments without widescale clinical trials to back them up. Relying on cultural norms and gut instincts to inform their treatment plans, shuster shows how medical providers' lack of clinical experience and scientific research undermines their ability to interact with patients, craft treatment plans, and make medical decisions. This situation defies how providers are trained to work with patients and creates uncertainty. As providers navigate the developing knowledge surrounding the medical care of trans folk, Trans Medicine offers a rare opportunity to understand how providers make decisions while facing challenges to their expertise and, in the process, have acquired authority not only over clinical outcomes, but over gender itself.

41 review for Trans Medicine: The Emergence and Practice of Treating Gender

  1. 5 out of 5

    TimInCalifornia

    A well-researched look at gender-affirming medical care, including therapy, in the United States. The author, who is themself a non-binary trans person, puts a focus on the lived experiences of current medical providers of gender affirming care. To illuminate present day practices, Shuster traces the history of medical care in this area starting in the mid-20th century. While I was familiar with the broad outlines of the care (and barriers to care) to my generational trans pioneers, the detailed A well-researched look at gender-affirming medical care, including therapy, in the United States. The author, who is themself a non-binary trans person, puts a focus on the lived experiences of current medical providers of gender affirming care. To illuminate present day practices, Shuster traces the history of medical care in this area starting in the mid-20th century. While I was familiar with the broad outlines of the care (and barriers to care) to my generational trans pioneers, the detailed research of medical and psychiatric notes, particularly the correspondence between the few medical professionals at that time who worked with trans patients, was illuminating in ways both good and sad. This book does not discuss specific treatments or procedures or make any recommendations of that nature, nor does it look at the evolution of medical interventions, except as such related to the decision-making process. The purpose of this book was to look at the professional lives of the medical practitioners and how they understand their trans patients, their role in providing care, their obligations to their professional standards, oaths, and statutory laws, and how they coalesce all this into arriving at a specific decision or a road map for care of a trans patient/client. Shuster is an academic but the writing was very accessible for a layperson such as myself, infused with just enough academic-style to make me feel smart. I first accessed gender-related medical care in the late 1990s. Being in an urban area, I was able to find a general practitioner who, while she was not terribly experienced with trans patients (who was?), she was willing to learn. She taught me the value of engaging in frank conversations with one’s doctor and I was lucky that she initiated the approach that we were learning on this journey together, sharing knowledge and resources. This was an excellent life skill to have developed and I have used it in the 20+ years since when accessing medical care for any reason, not just gender-related care. Articulating questions, engaging with your doctor on your own healthcare plan, drawing on their knowledge for your own good, is excellent self-care. Most doctors have been receptive, some taken aback, but I happily have not had an outright negative experience. Reading this book gave me a larger appreciation of the professional position and the professional world of medical care providers. I truly had not given active consideration to their obligations beyond the care plan that is devised for me; in addition to my care, they need to think about their medical license, FDA recommended vs. off-label use of drugs, how comfortable they are working outside their expertise, especially when gold-level studies and research are few to none. All this is in their minds as they consider me and my needs as a patient. This book also crystallized for me something I already somewhat grasped. My lack of an “outright negative experience” has a lot to do with my race and class and my clear understanding of my gender and ability to communicate it in a way that a doctor in the U.S. can get comfortable with. My gender identity (and frankly my desired lifestyle) falls into society’s normative experience of a (gay) male. I’m lucky that my desired life and self-expression met “acceptable” expectations as the barriers to care for those outside the “acceptable” continue, often for the same reasons barriers to care existed some 50-60 years ago. Recommended reading for medical professionals and for trans patients seeking care, most especially for trans persons (including non-binary persons), as it can help in our self-advocacy to appreciate and understand decision-making the medical field. It was particularly interesting to see how in some ways the changes in approach to trans medical care, and the role of doctors, is a microcosm of changes in the medical profession altogether. Also interesting was learning of the uneasy relationship between medical doctors and psychiatrists and between psychiatrists and therapists. I have to say that reading the excerpts and quotes of some of the correspondence, particularly in the earlier years, is disconcerting. I have such a clear and untroubled sense of myself and identity and even now, after so many years, it’s disheartening to read how murky and troubling I am, my being-ness is, to others. Well-done with kudos to Stef Shuster and a thank you to #netgalley and New York University Press for the advance reader copy.

  2. 5 out of 5

    Anna

    shuster's exploration of the ways in which health practitioners -- both mental health workers and physicians -- manage their anxieties around providing care to trans people, and in particular providing medical interventions related to gender, is a fascinating blend of history and sociology. The author draws upon archival resources from the Kinsey Institute, interviews with present-day practitioners, professional documents that outline best practices, and observational notes from trans health con shuster's exploration of the ways in which health practitioners -- both mental health workers and physicians -- manage their anxieties around providing care to trans people, and in particular providing medical interventions related to gender, is a fascinating blend of history and sociology. The author draws upon archival resources from the Kinsey Institute, interviews with present-day practitioners, professional documents that outline best practices, and observational notes from trans health conferences to consider what has and has not changed since the 1950s when it comes to treating gender in the heathcare community. This focus on practitioners (all of those discussed in the book seem to be cis) rather than trans people offers a unique window into the challenges that the medicalization of transness during the twentieth century have created for both care providers and the trans patients seeking medical interventions to shape their experience of embodied gender. Both mental health practitioners and medical doctors historically expressed, and continue to express, a high degree of anxiety regarding how to diagnose and treat transness as a health problem. shuster describes how medical and mental health professionals struggled to determine whether transness was best treated as a condition of the mind, or the body, or both (they don't seem to have considered the possibility it is neither). Sometimes at odds, sometimes in collaboration, health practitioners in both areas have historically acted, and continue to act, as gatekeepers to care for trans patients -- with the authority for that gatekeeping role grounded in very little medical/scientific evidence. Rather, health practitioners continue to draw on understandings of transness developed in the mid 20th century that depend heavily on a binary and fixed understanding of gender -- one that does not fit particularly well with most trans peoples' lived experience or needs. I highly recommend this book to anyone interested in the history or present-day practice of treating gender. I was provided a copy of this book by the publisher via NetGalley in exchange for an honest review.

  3. 5 out of 5

    David

    Wonderful book covering the evolution of trans medicine and the current practice. Very well structured and nicely documented. I was expecting a much more academical read, but I am positively surprised about how accessible is. Very often we take science and the medical discourse as unquestionable. But science is indeed about questioning, and that is exactly what this book does: opening up the debate on how the pathologization of trans identities was built through the 20th century to our days. Some Wonderful book covering the evolution of trans medicine and the current practice. Very well structured and nicely documented. I was expecting a much more academical read, but I am positively surprised about how accessible is. Very often we take science and the medical discourse as unquestionable. But science is indeed about questioning, and that is exactly what this book does: opening up the debate on how the pathologization of trans identities was built through the 20th century to our days. Some of the most interesting points that I recall are: • The chronological analysis, showing the construction of a narrative not only to control trans bodies and lives through medicine, but also building some of the prejudices trans people face still nowadays, at least in Spain. • The ‘legitimacy wars’ between physicians and therapists, as well as the clashes they had on the definitions and treatment for trans people at the time. • The random construction of protocols based on providers’ personal criteria that have survived over time, impacting in trans lives today. An example of this is providers’ expectation for trans people to align with their gender roles and gender norms’ ideas, which still happens currently – despite the lack of science backing these prejudices. • The “real life test” (asking trans patients to live their life as if they had already physically transition, but without the aid of hormones or surgery) is another unscientific approach taken by providers that we can still see nowadays in many countries, where trans people are expected to wait for a given amount of time before they are provided with hormones or access to surgical interventions. • How regret is weaponized by “pro-life” activists against abortion, using potential regret of the person who has an abortion to fight against abortion itself. It seems providers are also concerned by trans people regretting their transitions, which is also weaponized by transphobes very often to fight against trans access to hormones or surgery. The only aspect I missed a little bit the book to cover were interviews with trans people. What are their views on the current way medicine treats them? How the different approaches taken by providers (flexible interpreters and close followers, as the author names them) impacts on them? I would have loved having their voices included here. In short, could we move the spotlight to the way that medicine is pathologizing trans identities (without scientific evidence) and finally move forward towards trans liberation?

  4. 4 out of 5

    Robyn

    I loved learning so much about trans medicine in this book! I expected it to be dense throughout, but it felt accessible to non-academics seeking to learn more. A must-read for anyone who knows and loves someone trans.

  5. 5 out of 5

    Jodie "Bookish" Cook

    This review has been hidden because it contains spoilers. To view it, click here. Book Review Title: Trans Medicine: The Emergence and Practice of Treating Gender by Stef M. Shuster Genre: Non-Fiction, Gender and Sexuality, Social Issues, Health Rating: 4 Stars As this is non-fiction around the history and progression of trans medicine I am going to be giving a lot of my personal thoughts on the information contained in this book. The introduction to the book introduces us to the author who is trans and how they learnt about both the social and medical sides of being transgender Book Review Title: Trans Medicine: The Emergence and Practice of Treating Gender by Stef M. Shuster Genre: Non-Fiction, Gender and Sexuality, Social Issues, Health Rating: 4 Stars As this is non-fiction around the history and progression of trans medicine I am going to be giving a lot of my personal thoughts on the information contained in this book. The introduction to the book introduces us to the author who is trans and how they learnt about both the social and medical sides of being transgender and who is in charge of making medical decisions regarding trans people and this is going to be explored in further depth as we progress through the book. From the outset Shuster provides a thoroughly researched look into not only gender-affirming medical care and therapy but into the social role of physicians for trans people. While this is specific to the United States which meant I couldn’t personally identify with the struggles of paying for healthcare I did sympathise with those that do. As Shuster is a non-binary trans person it really put a lot of focus on the experiences of medical providers of gender affirming care rather than the medical guidelines which often exclude trans people as they are seen as so unique and different from cis people that made healthcare providers won’t treat them. I really like how Shuster put the spotlight on present day practices as they trace through the history of medical care for trans people. I was a little disappointed that this book didn’t discuss specific treatments or procedures as this would be helpful to trans and non-binary people and I felt that Shuster having lived through some of these experiences could have given some recommendation on the process of medical interventions but that seems to have been overlooked. The purpose of this book was to look at the professional lives of the medical practitioners and how they understand their trans patients, their role in providing care, their obligations to their professional standards, oaths, and statutory laws, and how they coalesce all this into arriving at a specific decision or a road map for care of a trans patient/client. That being said it did feel like at times you were reading a dissertation which isn’t a bad thing considering that Shuster is an academic and the writing was very accessible even to people that know little about the topic but it was difficult in places to get through and I did find myself a little bored at time which was upsetting been as I identify so much with the author. One thing I really liked about this book was how it gave me a larger appreciation of the position of medical professional who often have to juggle recommended guidelines with individualistic treatment style as there isn’t a one size fit all treatment for trans and non-binary people. This book also highlights the fact that trans and non-binary people who haven’t had any negative experiences with medical professional might have some sort of privilege to do with race or class which is something I never considered but it made absolute sense given the fact we see these kinds of privileges in other areas all the time. Overall, I would say that this book should be recommended to medical professionals and trans patients seeking care especially those going down the self-advocacy route. I have to say that reading the excerpts and quotes of some of the correspondence, particularly in the earlier years, is disconcerting and I would definitely recommend that people be aware of this before reading as it can be quite upsetting in places for those that aren’t secure in their gender identity.

  6. 5 out of 5

    Celia

    Thank you to NetGalley and NYUPress for an e-ARC of this book in exchange for an honest review! I had the pleasure of hearing stef present some of this work a few years back, and I jumped at the chance to get my hands on this book, even though I tend to struggle with non-fiction reads. I was pleasantly surprised at how easy it felt to read this book! As a grad student, I'm used to slogging through academic texts and cross-referencing dictionaries, google, and other books to figure out what an aca Thank you to NetGalley and NYUPress for an e-ARC of this book in exchange for an honest review! I had the pleasure of hearing stef present some of this work a few years back, and I jumped at the chance to get my hands on this book, even though I tend to struggle with non-fiction reads. I was pleasantly surprised at how easy it felt to read this book! As a grad student, I'm used to slogging through academic texts and cross-referencing dictionaries, google, and other books to figure out what an academic is actually talking about. It was such a relief to NOT have to do this for TRANS MEDICINE. shuster does an excellent job of breaking down complicated ideas around the production of knowledge and expertise to contextualize the history and present of trans medicine– their use of jargon is intentional and explained in a way that I think non-sociologists and non-academics would find more approachable than they'd expect. Although I was expecting something more in depth chronologically, one of the biggest strengths of this book for me was how it is positioned in the context of wider medical and sociological practices. shuster has a keen eye for the ways in which evidence based medicine impacts the experience of people of color and disabled people negotiating their way through the medical field. I was a little disappointed not to have read conversations or interviews with trans and nonbinary medical/therapy providers, but I think shuster does a good job explaining why they interviewed who they did, and the lack of such perspectives is likely more reflective of the current state of trans medicine and how the medical field understands expertise. Honestly, I would recommend this book widely beyond the medical field! I think this is an excellent example of an strong citational practice, and offers a plethora of delight for readers who think about evidence and how we understand the experiences of gender and sexual minorities within normative systems. For data nerds like me, I would also strongly recommend giving the appendices a thorough read to think about how researchers position themselves within social and institutional groups.

  7. 4 out of 5

    Sara

    Trans Medicine is a sociological book analysing the medical field(s) that work with trans people, namely the professionals involved - following trans medicine since it's conception in the 1950s up until contemporary times. As a sociological work, this feels academic, but the writing is very accessible to non-academics; however, this book is not a "one-sitting" type of book, nor do I think it should be. Throughout, shuster (non-binary trans person) lays out the assumptions and bias of medical profe Trans Medicine is a sociological book analysing the medical field(s) that work with trans people, namely the professionals involved - following trans medicine since it's conception in the 1950s up until contemporary times. As a sociological work, this feels academic, but the writing is very accessible to non-academics; however, this book is not a "one-sitting" type of book, nor do I think it should be. Throughout, shuster (non-binary trans person) lays out the assumptions and bias of medical professionals in the 1950s, contextualizing them in post-WWII medicine, and shows how that starting point is still affecting trans medicine today. For this, I think this book is an invaluable resource to any health professionals (or training to be), both physicians and in mental health. I also think it is appropriate for a non-medical audience, as it will clarify the way medicine operates, not only regarding trans patients but other demographics. There are some things described in this book that can be very disconcerting, mostly the older records, but also some of the discourse of newer physicians (especially because you're given the historical context beforehand and you can see the root of it) regarding who should have access to trans medical care, and how - gatekeeping for "non-worthy patients" in the 50s and, currently, for some outside of the binary. So I advise care for anyone not in a good place with their gender identity, if they suspect they won't be able to digest some of the content. I voluntarily read and reviewed an advanced copy of this book. All thoughts and opinions are my own

  8. 5 out of 5

    izzy

    pride month isn't just for fun queer romances it's also about learning!!! this was a super informative read for me on an area that I knew almost nothing about but I think it's a great starting point for people wanting to learn more about the transgender community and become better, more informed allies! It is a super easy and accessible read even if you have no medical or scientific background and really shocks you with how so much and so little progress has been made in regards to trans medicin pride month isn't just for fun queer romances it's also about learning!!! this was a super informative read for me on an area that I knew almost nothing about but I think it's a great starting point for people wanting to learn more about the transgender community and become better, more informed allies! It is a super easy and accessible read even if you have no medical or scientific background and really shocks you with how so much and so little progress has been made in regards to trans medicine. My only critiques of this book are that the author tends to repeat the point of each section over and over again every time a new point is brought up which can give you a little bit of fatigue when reading it. As well, when introducing a new quote the author spells out what is meant instead of leaving room for any interpretation (I can see why this was done but after a few chapters it felt a little draining). Overall, this is a great, informative read that I would def recommend for anyone that is trying to educate themselves a little more! Thank you NetGalley for the review copy!!

  9. 4 out of 5

    Colin

    Focused on the historical and contemporary role of physicians, psychiatrists, and psychologists navigating the uncertainty around gender transition, I found this read to be intensely academic. I felt as though I were reading a dissertation, which is not neccesarily a bad thing, as it is clearly researched, informative, authoritative, and well-cited above all… though difficult to not go bleary-eyed at times. I felt the publisher summary was a bit misleading in this regard. This is a useful resour Focused on the historical and contemporary role of physicians, psychiatrists, and psychologists navigating the uncertainty around gender transition, I found this read to be intensely academic. I felt as though I were reading a dissertation, which is not neccesarily a bad thing, as it is clearly researched, informative, authoritative, and well-cited above all… though difficult to not go bleary-eyed at times. I felt the publisher summary was a bit misleading in this regard. This is a useful resource for a student or sociological or medical professional and would make for excellent industry conference material, but not as meaningfully accessible for the general public. While the research and argument were clearly presented, I wish this book had included greater reflections from the author or the trans community itself, which would have made it more approachable, and not just the perspective of the provider-side. I had trouble rating this book. If you’re researching for a paper or presentation, this is a great resource. If your goal (as mine was) is to better understand the trans experience, a summary of concepts from this book might suffice. ARC provided by NetGalley in exchange for an honest review.

  10. 4 out of 5

    Karen

    This is a sociological study of the ways medical providers (doctors and therapists) approach medical care for trans people. A lot of it is horrifying, such viewing non-binary people as not having a stable identity and therefore not good candidates for any physical changes. There is so much paternalism and judgment from the doctors, and these are the ones who want to help! I was unsure who the audience was for this book. I don't know that it would be useful for a trans person to read, any more th This is a sociological study of the ways medical providers (doctors and therapists) approach medical care for trans people. A lot of it is horrifying, such viewing non-binary people as not having a stable identity and therefore not good candidates for any physical changes. There is so much paternalism and judgment from the doctors, and these are the ones who want to help! I was unsure who the audience was for this book. I don't know that it would be useful for a trans person to read, any more than a black person would want to read a book of white people saying racist things. But I do think it's good that it exists, that it is making medical discourse and mindsets visible to people who aren't in that field. It was interesting reading the quotes from the supportive doctors who genuinely didn't know what to do, because prescribing hormones to help someone transition is considered "off-label" and is not well studied. I wish there had been more to this book, both more data and more theory. It felt like she was publishing a dissertation.

  11. 4 out of 5

    Sarah

    This is a really interesting, academic look at the history of trans medicine beginning in the 1950s. It continues to present day to show the ways in which a historical lack of information and data continues to affect the medical care of trans people today.

  12. 4 out of 5

    Stephanie Solomon

  13. 5 out of 5

    Grayson

  14. 4 out of 5

    J.E. Sumerau

  15. 5 out of 5

    Kit

  16. 4 out of 5

    Mx.

  17. 5 out of 5

    emmy

  18. 4 out of 5

    pplofgod

  19. 4 out of 5

    Rikki Tanner

  20. 4 out of 5

    Leo

  21. 4 out of 5

    Fabio Gaiato

  22. 5 out of 5

    Igor

  23. 4 out of 5

    Airmid

  24. 4 out of 5

    Reb

  25. 4 out of 5

    Nessa

  26. 5 out of 5

    Mika

  27. 5 out of 5

    James

  28. 5 out of 5

    Orion

  29. 4 out of 5

    Rían

  30. 5 out of 5

    Garth Reese

  31. 5 out of 5

    Atul

  32. 4 out of 5

    Aspen

  33. 5 out of 5

    Frances Love

  34. 4 out of 5

    Sara

  35. 5 out of 5

    xar

  36. 5 out of 5

    Nicole Donawho

  37. 4 out of 5

    Vee

  38. 5 out of 5

    Aaron

  39. 5 out of 5

    Madde Hoberg

  40. 4 out of 5

    Sam

  41. 5 out of 5

    Neva

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