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lattelibrarian's review
2.0
I definitely want to start out by saying that shuster and I do operate under different viewpoints, so my review and rating is largely based on my thoughts while reading this book. I think it's important to read things that make us uncomfortable, and in doing so it expands our worldview and how we navigate the various communities in which we exist. I also want to start out by saying that I admired the research and structure of this book as well. For a first book of its kind--especially one that is accessible to those not in the medical field--I think it accomplished what it set out to do, especially for its main audience (of which I am not a part).
However, as a reader, I was not convinced.
For me, the most interesting part was regarding the ever-changing and quickly evolving stance doctors and therapists took when treating trans patients. How they worked historically hand in hand to confirm that someone is "really" trans prior to going on hormones or receiving surgery was intriguing, and I can't deny that I found some of the steps to be unfair as well. shuster is clearly a huge fan of bodily autonomy (ie, it's my body so I can do what I want with it!), but I find that shuster's attitudes regarding doctors and therapists--even the ones who try very hard to do right by their patients--is that they are not doing enough, even when they go out of their way to learn what medical school has not taught them, they are not doing enough, even when they try to take into account the ways in which medicine affects various bodies, they are not doing enough. The goal post continues to shift.
"Into the 1960s," shuster states in relation to research, "more providers began to mandate that their patients live for a year in their target gender. Referred to as the 'real life test'--where a trans person was expected to live their life as if they had already physically transitioned but without the aid of hormones or surgeries--the milestone of one year in one's target gender was used by providers to determine if trans people were committed to 'going all the way' in accessing surgical interventions.[55] Yet contained within the naming of this test is the tacit idea that trans people's lives, up until the moment that they sought medical care, were not real." While I can sympathize the notion that anything prior to seeing a doctor didn't actually happen is unfortunately used across all aspects of medicine, I can also understand the doctors' point of view: prove to me that you can successfully live as your target gender, and I will know that the pros of you living your fullest life offset the cons of not knowing how gender affirming surgery affects not only one's livelihood but physical self nor not knowing how hormones more typically present in the opposite sex will affect someone down the line.
shuster also discusses the Bathroom Scare, in which women view trans women entering their bathrooms not as an act of safety on trans women's parts, but as an act of violation against women's parts. This violation invokes decreased senses of safety due to sharing a space in which women must reveal themselves--albeit behind closed doors--to relieve themselves. If trans women are allowed to enter their sex-segregated space as male-bodied and male-socialized people, then what is to stop men from entering their space under the guise of trans womanhood as well?
Yet shuster's affirmation that trans women only want to use the bathroom to relieve themselves is effectively shut down with this example: "My [faithful] patient stated that the patient arrested had recognized someone clear across the room and called out, 'Yoo hoo! I'm a woman now; I have been operated on by a surgeon. Yoo hoo!' Then she used the toilet and got arrested." Is this example supposed to make women feel better? This example does not correspond with the idea that trans women just want to use the bathroom--it corresponds with the idea that they want to use the bathroom and purposefully make others uncomfortable. Of course, not all trans women, but of course, not all men, too.
One thing I do appreciate this book is the discussion of lack of financial accessibility surrounding the medical field. Especially when it comes to specialists where one may have to travel to in order to receive care of any kind. Yet in highlighting this disparity, shuster uses the following example in which a trans person writes directly to a doctor for some assistance:
"Dear Dr. [Name],
I want to have the sex change operation from male to female. I want to know how much this will cost and how long. I have very little money and I want this done free, and if you know of a doctor who will do this free, let me know. I want to meet you, let me know when you are coming to L.A. I would like to have this done here or in your office. Also, I need a home and money and employment. Do you know of anyone I can stay with?"
I was baffled that this example was used. Yes, it highlights the disparities that trans people face--lack of housing, employment, finances. But the fact that this patient first and foremost desires the sex change operation/gender affirming surgery before working to amend any of their other problems was absolutely shocking. Not receiving a gender affirming surgery will not kill you in the way a double mastectomy for breast cancer will kill you. Not receiving a feminizing facial surgery will not harm you in the way a rhinoplasty for a deviated septum will harm you. Then again, it is important to recognize that we're operating on two different definitions of life-threatening. My definition in these situations lends its hand more to what our bodies do to us rather than shuster's definition, which lends its hand more to what we will do to our lives. (Internal forces rather than external/personal in these cases).
A trend I noticed in this book is that shuster seems to demonize doctors who are reticent in prescribing hormones or signing off on gender affirming surgeries in patients who otherwise have other present health problems. We do not know what these do to an otherwise healthy person in the long-term, much less when there is a chronically ill person or someone who requires other medical assistance through medication. shuster assumes a stance of "let trans people do whatever they want to their bodies, no questions asked" when that is just...not the reality. I mean, clearly, that's why shuster is arguing in favor of this stance. But shuster largely fails to realize that it isn't just that trans person a surgeon would be affecting. A double mastectomy for someone's mental health is not as life saving as it is for someone with stage 3 breast cancer. There, I said it. You can't therapy or cope your way into not having cancer. I'm not saying that therapy or coping methods can cure dysphoria either, but there is a very real and deadly disease inside some people and if a surgeon's time is being taken up with someone who would otherwise be alive..? It just shows me that trans folks, at least in these examples shuster provides, are selfish. Instead of arguing for a radical rearrangement of the health care system, shuster places trans people's needs on a pedestal and is willing to let others suffer in ways that can only be cured through medical intervention. This is of course, not to mention that this requires doctors to act in ways that they may not find ethical in regards to patient care.
shuster cites an example from his research and his response to this example seems to only clarify my point: "We had a patient who had an A1C (a blood test for glucose levels) of 13 percent and was pretty hypertensive when she presented at our office. We were not her primary care provider. Her gender identity seemed to be intact, but the answer was no. There's a lot of comorbidities that are unmanaged and unaddressed that make me think she didn't understand the relationship between all of these things and taking estrogen." shuster then goes on to address this citation: "In addressing the concerns with other medical professionals at a healthcare conference, the nurse suggested that while the patient's gender identity wasn't being called into question, the existence of high blood glucose was enough evidence to halt hormone therapy." Honestly? How could you not agree with the doctor in this situation? At the time of this doctor's interaction with this patient, how much had been written or researched regarding glucose levels and hormones? Of glucose levels and trends in the male body? How hormones interact with insulin, diabetes, pre-diabetes, retinopathy, blood circulation--literally anything that high blood glucose could possibly affect? Is getting estrogen more important than your baseline health?
Not to mention, of course, the times when shuster wants to break down the barriers between female and male, which begs the question of how do we know which hormones are prevalent in which people? How do trans women know they want estrogen and how do trans men know they want testosterone, if these are not present in their desired sex? The blurring of not just gender but sex offers a very scary reality in which women are already not present in medical research. It would be great if navigating the world of gender and medicine could be easier in terms of changing one's body. But it's not, because that's just...not how reality works?
According to shuster, it is. Also according to shuster, evidenced subtextually in these various examples, trans folks should be able to get whatever whenever. Do we know the effects of hormones or surgeries beyond 5-10 years? Are we taking into account anecdotal or resesarched evidence from detransitioners who now suffer from bone density problems, chronic pain, organ failure, and more?
Perhaps part of my problem is that I want shuster to do more. I understand the problem he wants to fix, but he does not seem to understand how to actually go about fixing them. The problem is that trans people are not being given these life-saving therapies (by therapists who don't care about them, apparently), hormones (by doctors who don't care about them, apparently), or surgeries (by surgeons who don't care about them, apparently). The problem is that trans people do not have access to inclusive doctors, or money to pay for these treatments, or a job to save money, or a home.
To shuster, the solution seems to be that we give trans people what they want because they think it is a need. But these things--though they may be distressing to not receive and therefore warrant accessible support groups, therapies, and communities to find solidarity--are not necessary. What is, is non-discrimination laws regarding housing and employment. What is, is access to information that ensures that trans folks know exactly what the side effects are for their surgeries and hormones and treatment rather than an all-affirming "empowering" idea of bodily autonomy. What is, is access to therapists and counselors who are sympathetic/empathetic and can offer coping strategies, a safe ear, and a means to reduce their emotional turmoil.
I suppose I'll wrap it up here, as I could go on. Ultimately, shuster and I hold similar but extremely different ideologies. The easing of trans pain and suffering is a must, but how we go about it is entirely different for vastly differing reasons. However, it was well-cited, and I again enjoyed learning about the history of the medical field regarding the trans community. It was an informative but largely exasperating read.
However, as a reader, I was not convinced.
For me, the most interesting part was regarding the ever-changing and quickly evolving stance doctors and therapists took when treating trans patients. How they worked historically hand in hand to confirm that someone is "really" trans prior to going on hormones or receiving surgery was intriguing, and I can't deny that I found some of the steps to be unfair as well. shuster is clearly a huge fan of bodily autonomy (ie, it's my body so I can do what I want with it!), but I find that shuster's attitudes regarding doctors and therapists--even the ones who try very hard to do right by their patients--is that they are not doing enough, even when they go out of their way to learn what medical school has not taught them, they are not doing enough, even when they try to take into account the ways in which medicine affects various bodies, they are not doing enough. The goal post continues to shift.
"Into the 1960s," shuster states in relation to research, "more providers began to mandate that their patients live for a year in their target gender. Referred to as the 'real life test'--where a trans person was expected to live their life as if they had already physically transitioned but without the aid of hormones or surgeries--the milestone of one year in one's target gender was used by providers to determine if trans people were committed to 'going all the way' in accessing surgical interventions.[55] Yet contained within the naming of this test is the tacit idea that trans people's lives, up until the moment that they sought medical care, were not real." While I can sympathize the notion that anything prior to seeing a doctor didn't actually happen is unfortunately used across all aspects of medicine, I can also understand the doctors' point of view: prove to me that you can successfully live as your target gender, and I will know that the pros of you living your fullest life offset the cons of not knowing how gender affirming surgery affects not only one's livelihood but physical self nor not knowing how hormones more typically present in the opposite sex will affect someone down the line.
shuster also discusses the Bathroom Scare, in which women view trans women entering their bathrooms not as an act of safety on trans women's parts, but as an act of violation against women's parts. This violation invokes decreased senses of safety due to sharing a space in which women must reveal themselves--albeit behind closed doors--to relieve themselves. If trans women are allowed to enter their sex-segregated space as male-bodied and male-socialized people, then what is to stop men from entering their space under the guise of trans womanhood as well?
Yet shuster's affirmation that trans women only want to use the bathroom to relieve themselves is effectively shut down with this example: "My [faithful] patient stated that the patient arrested had recognized someone clear across the room and called out, 'Yoo hoo! I'm a woman now; I have been operated on by a surgeon. Yoo hoo!' Then she used the toilet and got arrested." Is this example supposed to make women feel better? This example does not correspond with the idea that trans women just want to use the bathroom--it corresponds with the idea that they want to use the bathroom and purposefully make others uncomfortable. Of course, not all trans women, but of course, not all men, too.
One thing I do appreciate this book is the discussion of lack of financial accessibility surrounding the medical field. Especially when it comes to specialists where one may have to travel to in order to receive care of any kind. Yet in highlighting this disparity, shuster uses the following example in which a trans person writes directly to a doctor for some assistance:
"Dear Dr. [Name],
I want to have the sex change operation from male to female. I want to know how much this will cost and how long. I have very little money and I want this done free, and if you know of a doctor who will do this free, let me know. I want to meet you, let me know when you are coming to L.A. I would like to have this done here or in your office. Also, I need a home and money and employment. Do you know of anyone I can stay with?"
I was baffled that this example was used. Yes, it highlights the disparities that trans people face--lack of housing, employment, finances. But the fact that this patient first and foremost desires the sex change operation/gender affirming surgery before working to amend any of their other problems was absolutely shocking. Not receiving a gender affirming surgery will not kill you in the way a double mastectomy for breast cancer will kill you. Not receiving a feminizing facial surgery will not harm you in the way a rhinoplasty for a deviated septum will harm you. Then again, it is important to recognize that we're operating on two different definitions of life-threatening. My definition in these situations lends its hand more to what our bodies do to us rather than shuster's definition, which lends its hand more to what we will do to our lives. (Internal forces rather than external/personal in these cases).
A trend I noticed in this book is that shuster seems to demonize doctors who are reticent in prescribing hormones or signing off on gender affirming surgeries in patients who otherwise have other present health problems. We do not know what these do to an otherwise healthy person in the long-term, much less when there is a chronically ill person or someone who requires other medical assistance through medication. shuster assumes a stance of "let trans people do whatever they want to their bodies, no questions asked" when that is just...not the reality. I mean, clearly, that's why shuster is arguing in favor of this stance. But shuster largely fails to realize that it isn't just that trans person a surgeon would be affecting. A double mastectomy for someone's mental health is not as life saving as it is for someone with stage 3 breast cancer. There, I said it. You can't therapy or cope your way into not having cancer. I'm not saying that therapy or coping methods can cure dysphoria either, but there is a very real and deadly disease inside some people and if a surgeon's time is being taken up with someone who would otherwise be alive..? It just shows me that trans folks, at least in these examples shuster provides, are selfish. Instead of arguing for a radical rearrangement of the health care system, shuster places trans people's needs on a pedestal and is willing to let others suffer in ways that can only be cured through medical intervention. This is of course, not to mention that this requires doctors to act in ways that they may not find ethical in regards to patient care.
shuster cites an example from his research and his response to this example seems to only clarify my point: "We had a patient who had an A1C (a blood test for glucose levels) of 13 percent and was pretty hypertensive when she presented at our office. We were not her primary care provider. Her gender identity seemed to be intact, but the answer was no. There's a lot of comorbidities that are unmanaged and unaddressed that make me think she didn't understand the relationship between all of these things and taking estrogen." shuster then goes on to address this citation: "In addressing the concerns with other medical professionals at a healthcare conference, the nurse suggested that while the patient's gender identity wasn't being called into question, the existence of high blood glucose was enough evidence to halt hormone therapy." Honestly? How could you not agree with the doctor in this situation? At the time of this doctor's interaction with this patient, how much had been written or researched regarding glucose levels and hormones? Of glucose levels and trends in the male body? How hormones interact with insulin, diabetes, pre-diabetes, retinopathy, blood circulation--literally anything that high blood glucose could possibly affect? Is getting estrogen more important than your baseline health?
Not to mention, of course, the times when shuster wants to break down the barriers between female and male, which begs the question of how do we know which hormones are prevalent in which people? How do trans women know they want estrogen and how do trans men know they want testosterone, if these are not present in their desired sex? The blurring of not just gender but sex offers a very scary reality in which women are already not present in medical research. It would be great if navigating the world of gender and medicine could be easier in terms of changing one's body. But it's not, because that's just...not how reality works?
According to shuster, it is. Also according to shuster, evidenced subtextually in these various examples, trans folks should be able to get whatever whenever. Do we know the effects of hormones or surgeries beyond 5-10 years? Are we taking into account anecdotal or resesarched evidence from detransitioners who now suffer from bone density problems, chronic pain, organ failure, and more?
Perhaps part of my problem is that I want shuster to do more. I understand the problem he wants to fix, but he does not seem to understand how to actually go about fixing them. The problem is that trans people are not being given these life-saving therapies (by therapists who don't care about them, apparently), hormones (by doctors who don't care about them, apparently), or surgeries (by surgeons who don't care about them, apparently). The problem is that trans people do not have access to inclusive doctors, or money to pay for these treatments, or a job to save money, or a home.
To shuster, the solution seems to be that we give trans people what they want because they think it is a need. But these things--though they may be distressing to not receive and therefore warrant accessible support groups, therapies, and communities to find solidarity--are not necessary. What is, is non-discrimination laws regarding housing and employment. What is, is access to information that ensures that trans folks know exactly what the side effects are for their surgeries and hormones and treatment rather than an all-affirming "empowering" idea of bodily autonomy. What is, is access to therapists and counselors who are sympathetic/empathetic and can offer coping strategies, a safe ear, and a means to reduce their emotional turmoil.
I suppose I'll wrap it up here, as I could go on. Ultimately, shuster and I hold similar but extremely different ideologies. The easing of trans pain and suffering is a must, but how we go about it is entirely different for vastly differing reasons. However, it was well-cited, and I again enjoyed learning about the history of the medical field regarding the trans community. It was an informative but largely exasperating read.
creativerunnings's review
dark
hopeful
informative
sad
fast-paced
4.0
Content Warnings
Graphic: Medical content, Outing, Homophobia, Medical trauma, and Mental illness
robynthereader's review
5.0
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.
legs_mcgee's review
4.0
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.
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.
sara_m_martins's review
informative
slow-paced
4.0
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.
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.
novelbloglover's review
emotional
informative
inspiring
reflective
slow-paced
4.0
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.
sebrittainclark's review
informative
slow-paced
3.0
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.
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