Throughout the last century the treatment of trans individuals in modern society has evolved and become more publicizedWC. With this increasing exposure, the discourse surrounding the treatment of trans individuals and their rights also increases. One important area of discourse is trans medicine. In their monograph Trans Medicine: The Emergence and Practice of Treating Gender, stef shuster discusses the history of trans medicine from the mid-20th century to the early 21st century. Shuster utilizes a multi-sited research design to incorporate archival records of physicians interactions and perspectives with a combination of modern day interviews to demonstrate the gaps in trans medicine that have existed throughout time. As modern medicine develops and new technology is created, the opportunity and range of treatment for a trans individual increases. However, treatment of trans patients still needs to be altered. The monograph covers topics from physician gatekeeping, to the balance of treatment between psychologist and physicians, and uncertainty regarding treatment.
This monograph focuses on trans-medicine from the perspectiveWC of a physician. It examines the variety of medical practices used throughout the 20th and early 21st century and it demonstrates the thought process exhibited by many physicians when dealing with trans patients. In an interview with Indian Public Radio, shuster declared that his monograph attempts to answer the following questions regarding trans medicine: “How do healthcare providers manage their uncertainty? How does their vast uncertainty challenge their sense of themselves as experts? What does trans medicine teach us about medicine in general?” I argue shuster succeeds in providing answers to these questions and accurately provides insight into the mind of a variety of physicians and their relationships with trans medicine. The monograph highlights the unique power dynamic between a trans patient and their physicianSAY MORE. ADD TRANSITIONS AND SIGNPOSTS THROUGHOUT, The common gender conforming interventions such as hormone interventions or surgical interventions are highly regulated and require approval from a physician or psychiatrist. Physicians are often crucial in the transitioning process so the relationship they have with their trans patients is extremely important. Shuster additionally highlights gaps within trans medicine and the treatment of patients that must be addressed. Shuster argues that medicine has become so uniform in the attempt to improve the quality and prevent mistakes that it no longer teaches how to approach each situation from an individualistic perspective. A clear framework for trans medicine does not exist CLARIFY SEEMING CONTRADICTION so many physicians do not feel prepared or qualified to treat trans patients.
The author of Trans Medicine: The Emergence and Practice of Treating Gender is stef shuster. Stef is a professor of psychology at Michigan State University. They earned their bachelor’s degree in Sociology from Indiana University, Bloomington and their Ph.D in Sociology from University of Iowa. Their work at Michigan State University focuses on medical providers, social movement actors, and language used to regulate subjugated groups. Shuster discusses their personal history in an interview on Indiana Public Ration (Chambers). Stef states that they identify as a part of the queer communities. In the same interview stef states they began to identify as trans during college and discovered that as they began to consider gender conforming interventions for themselves there were gaps within the healthcare for trans individuals. As their experience in this community grew, they identified a clear lack of education for doctors and healthcare providers on how to treat trans people. They discovered that although many doctors were willing to have trans people as their patients, they felt ill equipped to properly treat them and did not want to be a disservice to them. These discussions inspired shuster to look further into the field of trans medicine. They ended up writing their dissertation on the perspective of healthcare providers in trans medicine, which eventually developed into the monograph discussed in this paper.
The monograph is split into two sections, part one details the history of trans medicine and part two explores the modern day healthcare provider’s perspective on trans medicine. Shuster used a multi-sited research design ALONGSIDE BOTH HISTORICAL? AND QUALITATIVE METHODOLOGIES (11). Part one utilized historical archives from the Kinsey Institute which is composed of artifacts from the biologist and sexologist Alfred C. Kinsey who worked in the mid 20th century. Within these archives were detailed records from Harry Benjamin, an endocrinologist who was known for treating trans patients. Benjamin corresponded with many health care providers and trans patients throughout the mid 20th century. These letters of correspondence reveal an extremely flawed system surrounding healthcare that places the power directly in the hands of the physicians. During this time period the physicians willing to treat trans patients were extremely limited and those who did had a narrow minded view of the perception of trans people. Trans patients were expected to “feel disgust with their bodies, particularly their genitals, and always to want to dress in the clothing and play with the toys of the ‘opposite’ gender”(Shuster, 32). Patients who did not fit this description or have the financial means or social status deemed sufficient by the doctor were denied. MORE DETAILS–HOW DOES SHUSTER DISCUSS THEIR METHOD, DIGITAL ARCHIVES, SECONDARY MATERIALS OR PRIMARY SOURCES?
In part two of this monograph, shuster jumps in time to the modern status of trans medicine. This part consists of a series of interviews with 23 physicians about their history and experiences working with trans patients. These interviews demonstrate a wide variety of perspectives. In addition to these interviews, shuster attended a variety of medical conferences and observed the discussion of trans medicine. Conferences are designed to discuss emerging and new healthcare ideas and strategies. Finally, shuster examined the diagnostics and clinical guidelines created for trans-medicine. Combined these sources provide perspective on the individual and systemic level.
Shuster provides an unbiasedWC review of the history of trans medicine. Although they discuss the flaws within many of the common practices by physicians, they do not place blame on the physicians instead accrediting misdeeds to the medical institution and training system as a whole. Additionally, the monograph provides a wide range of physicians perspectives, including those who have become somewhat experts in the field of trans medicine as well physicians who know very little. CLARIFY THIS SENTENCE WITH EXAMPLES–>Shuster also does a remarkable job of parsing out the individual components of trans medicine. They provide ample evidence and direct quotations that demonstrate each aspect that is discussed.
This monograph provides a comprehensive overview of the history of Trans Medicine from the perspective of a healthcare provider, however it distinctly lacks information regarding the patient’s perspective. Excluding a few letters from patient’s during the mid-20th century, there are no modern day perspectives. It could have been helpful to include information from the patient discussing their experience with healthcare and the treatment they have received. Patient perspective is a crucial component in improving the system and adjusting to treat their needs. Although each patient is different, it can be helpful to know general strategies that are successful. The two parts of the monograph focus on the mid-20th century and modern times, the early 21st century, how it does not discuss the status of trans medicine in the intervening years. Although many of the issues in part 1 of the monograph are still concerns in the second part, a large chunk of progress and history is absent in that could illustrate the specific event that caused any changes in the practice of trans medicine. Additionally the monograph provides no future directions towards the improvement of trans medicine.
This monograph could serve as a powerful tool for physicians. Although it focuses on trans medicine the monograph emphasizes larger themes surrounding health care and interactions with patients. It stresses the importance of the doctor patient relationship and the trust that should be formed within this bond to make the best possible decision for the patient. Ultimately, it teaches physicians how to be more mindful. Each student coming out of medical school should be required to read this monograph to improve their understanding of trans medicine and develop an understanding of the history of trans medicine as well as the progress that still needs to be made.
References:
Chambers, A. (2021, November 8). Sociologist stef shuster. other, Bloomington, Indiana; WFIU Public Radio.
Stef Shuster. Department of Sociology | Michigan State University. (n.d.). Retrieved November 18, 2022, from https://sociology.msu.edu/people/directory/shuster-stef.html
Shuster, S. M. (2021). Trans medicine: The emergence and practice of treating gender. New York University Press.