The left must reckon with its part in this. It has hung trans rights on the thin peg of gender identity, a concept clumsily adapted from psychiatry and strongly influenced by both gender studies and the born-this-way tactics of the campaign for marriage equality. This has won us modest gains at the level of social acceptance. But we have largely failed to form a coherent moral account of
why someone’s gender identity should justify the actual biological interventions that make up gender-affirming care. If gender really
is an all-encompassing structure of social norms that produces the illusion of sex, critics ask, why would the affirmation of someone’s gender identity entail a change to their biology? As a result, advocates have
fallen back on the clinical diagnosis of gender dysphoria, known until about a decade ago as gender identity disorder, defined as the distress felt at the incongruence of gender identity and biological sex. The idea that trans people fundamentally suffer from a mental illness has long been used by psychiatrists to decide who “qualifies” for transition-related care and who does not. By
insisting on the medical validity of the diagnosis, progressives have reduced the question of justice to a question of who has the appropriate disease. In so doing, they have given the anti-trans movement a powerful tool for systematically pathologizing trans kids.