Intimate standards: Medical knowledge and self-making in digital transgender groups

Abstract

Although recent scholarship focuses on the increasing significance of processes of standardization in contemporary social life, much less attention has been given to how standardization impacts intimate life, and how intimate standards are made meaningful in interaction. This article draws from participant observation in online transgender groups to examine how the medical standardization of transsexuality, known as the ‘wrong-body’ model, impacts the way users understand and communicate their gendered self. I show how rather than simply adopting the wrong-body model, participants use its language and logic in ironic and playful ways that carve out spaces for ways of knowing the self that feel authentically their own. This case shows how intimate standards become part of the language of the self in ways that may be unexpected.

Keywords

Authenticity intimacy medical knowledge standardization transgender

On 19 April 2012, Pheenx,¹ a popular trans² user on YouTube, published a video to announce that after much deliberation he had decided to seek testosterone replacement therapy, or “T” as he and most other users referred to it. “My biggest fear,” he shared, “is [the doctor] is going to say ‘no, sorry, you don’t qualify, you’re not trans enough…’ She will be like [switches to a sophisticated sounding, vaguely British accent] ‘oh, sorry, you’re actually not trans, you’re just a crossdresser!’” Through a series of video logs (or vlogs), Pheenx had documented an exciting and sometimes tumultuous process of self-discovery, in which he wrestled over his gender embodiment and gender identity. In the 19 April vlog, he declared that he was finally confident that the right way forward was to affirm a male gender identity publicly and begin taking T. Yet at this very moment of clarity, Pheenx’s hard-won self-knowledge ran up against the medical authority that could deny him this path. Fortunately for Pheenx, we learn in a later post, he ended up having a positive clinical experience, and after a few blood tests, he began his journey on T.

Thousands³ of trans persons, like Pheenx, log in daily to groups on Facebook, reddit, Tumblr, Yahoo, YouTube, and other sites. A dizzying array of topics emerge within these digital groups, yet a major theme uniting them involves sharing affective and embodied experiences of the gendered self. Most users express that at least some degree of medical gender transition (such as hormone replacement therapy) is necessary to achieve a reasonable level of comfort with their gender embodiment. Legal access to transition-related care has historically hinged on whether medical professionals identify one as “truly” trans according to a standardized model of the transsexual subject.⁴ This standard, developed largely by sexologists and psychiatrists, draws from a long tradition in western thought by conceiving of transsexualism in an inner (mind) versus outer (body) frame that Bettcher (2014) calls the “wrong-body” model. In this frame, one either becomes a man or a woman through the medical realignment of their mind and body, or simply is a man or a woman based on their inner gender, regardless of their outer body (Bettcher, 2014: 383; see also Meyerowitz, 2002; Rubin, 2003: 150). In both versions, the body is the site of error/conflict, while the mind is the site of deep, abiding truth; patients are expected to convincingly demonstrate to clinicians that they are, and have always been, the gender they claim to be (inside). Although procedures set by the Diagnostic and Statistical Manual (DSM) and the Standards of Care⁵ to evaluate the “authenticity” of trans patients have become less stringent over time, the wrong-body model’s legacy is such that it remains the dominant reference point for understanding and communicating trans experience, both inside and outside of the clinic (Bettcher, 2014).

In this article I use the medical standardization of transsexuality as a case for understanding how processes of standardization impact intimate life, and how intimate standards are made meaningful through everyday interaction. Specifically, I examine how this intimate standard impacts processes of self-making in digital groups. I use the term intimacy, following Wilson (2004), in order to point to the deeply felt orientations and entrenched practices that make up what we imagine to be our most personal or private lives, even our very sense of self (2004: 11). Self-making in this article refers to the intimate labor that goes into producing and maintaining our sense of self (Boris and Parreñas, 2010). Drawing from participant observation, interviews, and survey data involving group participants, I show how users regularly invoke the wrong-body model to understand and communicate their gendered self. Yet the presence of this standard – that is, its language and logic emerging in everyday interaction – does not alone predict how users make it useful or meaningful. In what follows, I show how rather than simply adopting the wrong-body model, users draw from it in ironic and playful ways that actually carve out space for ways of knowing the self that feel authentically their own. I argue that in these interactions, the wrong-body model becomes both useful as an explanatory frame and simultaneously the basis for disrupting its privileged status and the logic of justification that scaffolds it. These findings show that it is through the standard, as opposed to in spite of it, that users encourage alternative conceptions of trans selfhood that are less bound to the standard. Through this, we begin to see how standards and processes of standardization can impact the intimate labor of self-making in ways that may be unexpected. I conclude with brief suggestions for future research on trans self-making and further integration of the literatures on intimate life and standardization.

Standardization, medicalization and intimate life

I begin with an overview of recent advances in the literature on standardization, drawing attention to the promising, yet underdeveloped insights this literature has for studying intimate life. This growing body of work has demonstrated that standards are often the crucial links (or barriers) to making possible many of the political and economic processes scholars attribute to contemporary social life, such as commodification and globalization. Standards emerge from processes of standardization, or the “process of constructing uniformities across time and space, through the generation of agreed-upon rules” (Timmermans and Epstein, 2010: 71; see also Bowker and Star, 1999). Governments, courts, national and international NGOs, activist groups, and charismatic leaders all drive the production and implementation of standards (Epstein, 2009; Olshan, 1993; Shenhav, 1999), and while processes of standardization are ubiquitous in human societies, they occur at varying rates across fields (Noble, 1984), and have become particularly significant engines of globalization (Lakoff, 2005). Once in place, standards often become taken for granted, naturalized, or seemingly inevitable despite their fundamentally social origins, making them very difficult to change (Bowker and Star, 1999: 14; Thevenot, 2009).

While more often this literature focuses on structural and institutional levels of analysis, standards have also been shown to heavily inform intimate labors, including self-making. These intimate standards of the self tell us who and what we are, will be, and have been. Igo (2007), for example, shows how modern surveys in the USA, developed as a tool of population administration, underwrote the emergence of widely held and intimate categories of common-sense knowledge, from “the average American” to the sexual self. Czerniawski (2007) shows how height and weight tables, originally designed to standardize selection processes for life insurance companies trying to assess risk, facilitated the notion of “ideal” body weight in the USA. As these studies show, qualities that we understand as inherent aspects of human life in the contemporary world were once simply tools designed by standards regimes for industrial and government pursuits. While standards are often understood as politically neutral metrics for gauging existing realities, they are also productive of reality (Timmermans and Epstein, 2010). As a result, they are part of the moral economy of the modern world, having considerable impact on fundamental questions about who we should be and how we should live (Busch, 2000).

Medicalization, or the process by which a particular human experience comes to be defined, treated, and experienced as a medical condition (Conrad and Schneider, 1980), is a particularly influential concept for analyzing the productive power of standards of the self. Literature on medicalization has shown how standardizing a set of biophysiological phenomena under a specific medical diagnosis can have a profound impact on one’s sense of self (Rosich and Hankin, 2010). Recent research has pointed to the internet and social media as increasingly significant culprits in an ever-widening scope of medicalized ways of knowing the self. These studies have shown that digital groups are not merely places to reflect upon health and illness, but play a key productive role by turning lay persons into lay experts of their condition (Broom, 2005; Fox et al., 2005), facilitating patient-driven medicalization (Barker, 2008), resisting the normalization of treatment (Richardson and Cherry, 2011), and influencing identity-formation (Fox and Ward, 2008). These studies point to an ever-widening scope of medicalized ways of knowing the self, which, at least implicitly, suggests the foreclosure of other ontological and epistemological possibilities.

Medicalization and standardization, however, do not simply render the world standardized (Timmermans and Epstein, 2010). Modification and negotiation are central to making standards meaningful in the real world (Lampland and Star, 2009: 4), and sometimes those processes can have unexpected outcomes, potentially undermining the standard’s original purpose. Everyday interaction is a crucial site where this negotiation takes place. By looking carefully at the way standards percolate up into everyday interactions, we can build a better understanding of their relationship to intimate life.

(De)medicalizing transgender

Like all standards of the self, the medical standardization of transsexuality under the wrong-body model has profound implications for how gender-variant persons understand and communicate their gendered self. As a result, the model has long been a contentious issue for transgender politics. Feinberg (1993) and Bornstein (1994) identified this standard as the medical regulation of non-binary bodies aimed at the erasure of gender-variant persons. In order to liberate non-binary bodies, these foundational theorists advocated a new way of knowing and a consciously political identity under a new term “transgender.” This term was meant to loosely encompass a broad array of gender-variant persons under a new model of personhood that was distinctly “beyond-the-binary.” This new model called upon transgender persons to remain visibly outside of the categories of woman/man, rendering suspect attempts to medically transition the body from one binary position to another (Bettcher, 2014).

However, some scholars have argued that this beyond-the-binary model is not an adequate alternative to the wrong-body model. Namaste (2005) argues that taken to its logical extreme, this beyond-the-binary model suggests that any gender-variant person who does not identify outside of the categories of man or woman is the victim of a sort of false consciousness and represents a threat to a formidable transgender rights movement. Prosser (1998) argues that this model reduces gender to nothing more than an oppressive cultural construct, while most transgender persons identify as transgender precisely because their gender identity seems so visceral, so resistant to being (re)shaped by cultural expectations.

Finally, the beyond-the-binary model has also proven problematic in recent years as transgender health advocates have found great success in leveraging the legitimating authority of the wrong-body model to demand competent, legal, and respectfully provided medical services, as well as rights and protections against discrimination more broadly (Meyerowitz, 2002; Stryker, 2008; Wilchins, 2004). Bettcher (2014) and Connell (2012) argue that in order to move beyond the limitations of both of these dominant paradigms for understanding trans personhood and trans politics, we need more research that actually accounts for the lived realities of trans populations. By examining how trans persons actually make use of the language and logic of the wrong-body in everyday interactions, this study works toward filling that gap.

Methods

I first discovered these groups years ago through my own desire to connect with and learn from the experiences of other cross-gender identified and gender non-conforming persons.⁶ Between March 2013 and March 2014, I engaged in intensive participant observation within trans groups and among trans users on Facebook, YouTube, and web forums. Throughout this time, I participated in forum discussions like any other user – reading recent posts, engaging in commentary, and occasionally continuing the conversation in private, one-on-one messages with group users and administrators. On YouTube I followed the vlog entries of several active users, many getting tens of thousands of views per video upload. At least once per week I spent several hours watching videos and response videos, reading and participating in the comments section discussions that emerged from the videos, and through Facebook following the posts and comment streams in several trans groups. All of these groups influenced my analysis, but the examples shown here come almost entirely from YouTube and two web forum groups where I was able to participate most thoroughly.

I treat these groups as “digital field sites” where I can observe everyday interactions. Digital field sites offer unique opportunities and challenges for social science research (Lazer et al., 2009). Digital ethnography, in particular, has very rich, undervalued potential; however, it also presents challenges, particularly through the lack of temporal and spatial boundaries that characterize typical field sites (Constable, 2003). Indeed, the immense wealth of information available through the internet and new media forced me to make decisions about how to limit and direct my ethnographic gaze. For example, I decided that I needed to pay close attention to the conversations that emerged from original posts in comments or reply sections. These sections carved out a form of “digital backstage”⁷ where meanings of original posts were interactively constructed, contested, affirmed, and contradicted, providing invaluable clues for my analysis. Despite the unique challenges and considerations one must make in conducting digital ethnography, in conducting this research I have treated digital groups as merely particular, if somewhat strange, settings for everyday life interactions. Zhou (2005) argues that it is important not to imagine the internet as somehow an independent entity from the “real world.” Both the “real” and “virtual” worlds are always composed of interactions.

Another challenge for online research is the lack of context and demographic data often used by social scientists to identify their sample and population composition (Golder and Macy, 2014: 141). Other important distinctions that are meaningful for the setting may also be masked to the researcher (Lewis, 2014). To address these challenges, I also collected questionnaire and interview data that serve as a check on ethnographic findings and as a means to maximize interpretive validity. I conducted a total of 10 semi-structured interviews with users, medical providers working with trans populations, and trans health activists. Interview questions focused loosely on the significance of digital groups for trans patients and lasted for approximately one hour each. Interviews were transcribed and coded in conjunction with the coding of field notes in order to compare emergent themes. Additionally, I distributed an open-ended questionnaire to users in the groups in which I participated, and the questionnaire was also distributed by users to other digital trans groups. The questionnaire consisted of 25 questions and responses continued to be collected through October 2014, reaching a total of 138 respondents.

Virtual intimacies

In the following sections, I outline the key findings. I begin by situating the virtual spaces these digital groups occupy in the lives of the users. The internet and social media, collapsed here as digital groups, are particularly important for trans communities. Trans persons (as we would call them today) were “early and enthusiastic adopters” of the internet as an infrastructure for building communities of support (Wilchins, 2004; Rosser et al., 2007). Digital groups provide crucial linkages between trans persons and trans communities often separated by social and geographic divides. As a result, these groups provide a unique opportunity to witness the intersection of self-making and standardization in action.

Dallas Denny, a prolific writer, speaker, and activist in the trans community, started the first transgender newsfeed in 1995 through the website Yahoo.com. In an interview, Dallas shared that she sort of “ended up” an activist in her efforts to find cheap and convenient ways to acquire and disseminate information about trans identities and transitioning. “I realized that to survive we were going to have to accept that the whole service delivery system of sending [paper pamphlets] was too costly and slow; through the Internet you could provide unlimited information to potentially unlimited numbers of people and they would get it instantly.” Nearly two decades later, the internet is as important as ever for trans populations. Based on questionnaire responses (see Table 1), the internet and social media are users’ most significant sources of medical information about gender transition, followed closely by peer networks. While 50% of respondents indicated that the internet was a primary or secondary source of information about transition-related care, less than 15% indicated that medical professionals were primary or secondary sources. These findings are not meant to be generalizable, but they are well supported by a recent national survey that found fully 50% of transgender patients have to teach their medical providers about transgender care (Grant et al., 2011).

Table 1.

Significant sources for transition-related information (n = 138).

Source	Primary	Secondary	Total
Internet/social media	98	22	120
Peer networks	31	14	45
Medical professionals	16	6	22
Medical literature	2	7	9
Trans-authored literature	4	7	11
Other (e.g. conferences, nonprofits)	5	7	12
Unspecified literature	4	5	9

Note: This table represents the frequencies with which particular sources were identified as primary or secondary sources. Several users listed more than one source in each category. Finally, the list of sources was populated retroactively through analysis of the data; in the original questionnaire it was an open question.

Far more than simply downloading information, users actively generate much of the information they seek. The knowledge users generate is simultaneously local/affective and scientific/objective, covering everything from types of hormone-replacement therapies, methods of administration, drug regimens, and side effects, to neurological and psychological changes, and impacts on libido. Tipper writes, “it wasn’t until I joined a number of online groups that I knew a surgery option that was suitable for me was actually possible… I’ve also heard a lot about anecdotal experiences and side effects of taking T, a lot of which is barely documented anywhere else.”

Yet users are not only supportive and affirming as they were for Tipper, they also censor and police each other. Some users express that extensive transition seems expected, and that users should desire to, and seek whatever means available to them, to “pass,” or appear cisgender.⁸ In a YouTube video where a popular trans user posted a vlog about her recent breast augmentation, a user commented, “being transgender doesn’t mean you have to get 3423 surgeries, starting to look ridiculous.” In response, Jaynee replied: “actually it does mean that. Especially trans women who had very masculine looking faces. They need multiple surgeries to get their face as feminine as possible.” While the first user criticizes what they see as excessive measures to pass, for Jaynee, transition is understood as a corrective measure whose efficacy is demonstrated when one is able to pass. Some users supported Jaynee’s comment, noting that being able to pass in public is important to reduce the risk of violence.

These debates about passing highlight that transition is more than a desire to be pretty in a conventional sense, or an internalization of the wrong-body model’s expected trajectory that the body should be “corrected.” Rather, it is also a practical consideration in ensuring one’s health and well-being and reducing potential exposure to transphobic violence. Despite the complex circumstances surrounding transition, one might conclude that these interactions are nonetheless promoting a medicalized way of knowing the trans self. However, in the next section, I will show that when users explicitly discuss their gendered self and their reasons for transitioning, they actually carve out space for ways of knowing the self that feel authentically their own, using the language and logic of the wrong-body model.

A self authentically their own

In contrast to other spaces – medical, occupational, educational, and legal spaces – where users are expected to affirm a deep and abiding sense of a binary gendered self, in these digital groups users were able to explore their gendered self and embodiment. Users excitedly and curiously discuss physical, sexual, and affective changes that transition technologies are bringing to them and what these changes mean for the self they are becoming. These discussions repeatedly invoke the language and logic of the wrong-body model; however, through ironic and playful uses of the standard, I argue that users actually disrupt the standard’s privileged status and the logic of justification that scaffolds it. In so doing, they carve out space for alternative ways of knowing the self that feel authentically their own.

De-privileging the wrong-body

Users regularly draw upon the notion of an inner/outer self that is central to the wrong-body model. For many users, these groups are the first places where they express to another person that they might “actually” be a woman/man “inside” despite having been assigned a different gender at birth and having presented a gendered self that matched that assignment. The wrong-body model carries an air of legitimacy having been developed by medical professionals, and users often expressed comfort in its authoritative language. However, while users did not reject the model outright, they regularly disrupted its privileged status as the only legitimate route to self-making, creating room for alternative ways of knowing. Take for example Leona, a new user who made the “mistake” of assuming that users would apply some explicit criteria to determine what their experience of their gender and sexuality meant. Leona posts the following thread:

I am confused. All I know for sure is that I don’t want to take the clothes off, and I don’t want my chest hair to grow back. I am tired of shaving my face. I am tired of pretending to be tough. I feel like putting down my weights and picking up some nail polish. I think I would make a pretty, smart, fun woman. But am I a woman on the inside, or just a giant pervert? Or both? I don’t know.

In this post, Leona expresses affinity for a few female gender markers – nail polish, lack of facial and body hair, being pretty – and contrasts those to opposing male gender markers – chest and face hair, lifting weights, and toughness. Unsure if this is confirmation of an inner/outer gender misalignment or simply the mark of a “pervert,” Leona longed for some concrete way to separate the two, a longing that might be easily satisfied by the wrong-body model.

However, the following examples from TransBoards⁹ demonstrate how, in response to posts like Leona’s, users actually used the language of the wrong-body model to complicate and expand rather than standardize or medicalize Leona’s self-making:

Mallie: Here’s the way I see myself. I am female, the inner me is. I don’t think that I’m trapped in a male body although I don’t particularly care for the construct of my body as it was given to me. I feel more compelled to step out of my physical body and extend my feminine spirit wherever and whenever I can. I know that I cannot change the inner me nor do I want to. I’m very happy as a woman. I can change the outer shell that carries this woman about her daily life and I am doing so now. Occasionally I feel frustrated that my transition cannot happen faster yet I do take time to enjoy every minute of progress and celebrate each new step toward a unified body and mind. Just writing this response has made me feel better about myself.

Miraj: Trapped in the wrong body? I dunno. When I first started transition, I did relate to that thought … but … I simply felt wrong. Now, 2.5 years later on hormones and now fulltime … I look in the mirror and see a pretty girl (when I have makeup on). The problem is … when I see the reflection, it’s almost as if I’m looking through the eyes of a stranger. So explain THAT one?!

These responses provide affective and embodied accounts of users’ own sense of what it means to be trans. Although they use the language of the wrong-body model, they complicate the explanatory power of its inner/outer dichotomy. As Bettcher helpfully points out, in the wrong-body model “gender presentation (attire in particular) constitutes a gendered appearance, whereas the sexed body constitutes the hidden, sexual reality” (2007: 48). But here, Mallie indicates that although she is certainly on a path toward a “unified body and mind,” she does not necessarily see her body as male and her mind as female, she simply “doesn’t care for the construct” of her body. Similarly, Miraj claims that although the idea of being “trapped in the wrong body” resonated with her early on in her transition, now that her body is allegedly much closer to her “inner self,” when she looks in the mirror she feels she is looking through “the eyes of a stranger.” By gliding back and forth between the inner and outer as sites of dysphoria, deception, and truth, users disrupt the privileged status of the wrong-body standard. In this way, they actually complicate the notion of medically aligning inner/outer selves even while they are medically transitioning. This self might seem less satisfying than a neat, standard case of a wrong-body “corrected” by medical technology, but for these users, it is authentically their own.

Of course some users regularly indicate that the best course of action is to seek “professional [medical] help,” where a diagnosis can provide scientific legitimacy and clarity for users who are unsure what they are experiencing. However, these responses are notably in the minority. More often users emphasize the importance of trusting and valuing self-knowledge over medical diagnostic criteria, even when self-knowledge is complicated and confusing. At the same time, many of these users indicate that for trans persons, seeking medical technologies to feel more comfortable in their own body is often a necessary, perhaps life-saving, course of action. As Nelly put it: “Surgery is only necessary if you think it is. The only wrong way to do transition is to not do what is right for you.” In this way, users navigate an understanding of trans selves that draws from both beyond-the-binary and wrong-body models, asserting the epistemological supremacy of embodied and affective self-knowledge.

These examples emerged during particularly existential moments when users discussed questions of who they are. But as I will show in the next section, users also complicated the wrong-body model when discussing more practical questions, such as what am I using this transition technology for, and what is it accomplishing?

Avoiding the logic of justification

The language of the wrong-body model describes transition technologies as corrective measures – bringing the sexed body in line with the “inner truth” of the gendered self. However, through ironic and playful uses of the standard, users avoided the logic of justification that scaffolds it when describing what these technologies are accomplishing and why they are using them.

For example, on YouTube there is a deluge of vlog posts where users document yearly, monthly, weekly, and even daily changes that they experience after beginning hormone replacement. Among these posts, a particular playfulness emerges. Users openly mock their own interest in documenting the changes that hormone replacement therapy is bringing to their bodies:

Beekmng: [in a highly exaggerated low, monotonous voice] This is my voice two

hours into T …

Made&Born: [having developed a significant increase in muscularity after a little

over two years on testosterone] With the camera resting on the ground, a shirtless Made&Born appears horizontally in the frame. One, he forces out as he struggles to press himself back up from the floor. Two. Thr-e-e, he barely manages to verbalize. I can do three pushups …

Beekmg mocks his own interest in lowering the tone of his voice and the power of testosterone therapy by pretending that within two hours of his first injection, he has achieved a hypermasculine, deep tone. Similarly, Made&Born’s vlog history indicates that he quite enjoys the increased muscle-building capacity of his body thanks to testosterone, but in this video he responds to other users’ request for a post-T pushup video by pretending that it is very difficult for him to do even three pushups after two years on T. For these users, medical transition is clearly very important for achieving a reasonable level of comfort with their gender embodiment. But by being playful with or mocking the effects of the transition, users avoid reproducing the binary and essentialist expectations that are associated with the wrong-body model, where “properly aligning” the body can often be reduced to very superficial and stereotypical gender markers such as muscularity and deep vocal tone for men, as well as delicate beauty and exaggerated femininity for women.

Many users emphasized that despite transitioning they would “always be trans” as opposed to erasing their trans identity post-transition by finally “becoming” a man or a woman as the logic of the wrong-body standard goes. Some users made a point to make sure others knew that they were trans, even if it felt good to “pass” as cisgender. Leanne states:

In the beginning I felt kinda weird going in public and stuff … but now that I have been full time for six months and I have been on hormones for a year … I’m definitely not ashamed of it. I’m proud of it. I wear it on my sleeve. I talk about it when I meet people. I’m not afraid to say ‘yep, I’m trans!’

Leanne’s affirmation that she is not ashamed of being trans and proudly shares that with people she meets fits well with the logic of the beyond-the-binary model. However, Leanne has also taken significant steps to socially and medically transition. In this way Leanne constructs a self that feels authentically her own, one in which she embraces her trans identification, and makes a point to publicly identify as trans, but also follows the logic of the wrong-body model by medically correcting her gender embodiment to better match her sense of her gendered self.

In the logical trajectory of the wrong-body model, through medical gender transition the body is understood as having been healed or corrected, where that healing is experienced through the normalized desires of the “healthy,” gendered body (Heyes, 2007). For example, when a transman appears rough, rugged, and muscular, or the “opposite” of feminine, their body has been healed. But even while Made&Born clearly gained muscularity and Beekmng’s voice did lower as a result of getting on T, in these digital groups, users create space to display those changes while rejecting that they reflect a corrected body. For these users, they reflect a changed body. A changed body did not necessarily have a normalized trajectory, but was ambiguous, or was open to new possibilities. Matilda makes this point explicit:

People … have often claimed that our bodies are normal and healthy, so being trans isn’t something that should be treated, physically. But what if we could be more than just normal? Why should we settle for what is supposed to be good enough when we have the option to become something even better? Others may see this as choosing to reject what’s normal, and in doing so relegating ourselves to being abnormal. But I don’t see this as a choice between normal and abnormal. I see this as a choice between average and awesome! Over the past two months, HRT has improved me in ways that I didn’t even know needed improvement!

Here Matilda carefully filters both the wrong-body model as well as the beyond-the-binary model. For Matilda, both models seem to hinge on a sense of what is “normal.” In the wrong-body model, normal is a congruence between inner gender identity and outer sexed body, compelling trans bodies to seek medical intervention. In the beyond-the-binary model, normal is accepting the body you have, or seeing it as having no bearing on the self you can present to the world. But for Matilda, this model also invalidates those who seek transition technologies. To preserve space for a self that feels authentically her own, Matilda draws from the language of consumption, where users have the right as consumers to access the services they desire, and on their terms. This construction of transition technologies as merely commodities allows Matilda to avoid the logics of justification that support the wrong-body and beyond-the-binary models.

Intimate standards

In this article, we can begin to see how standards can impact the intimate labor of self-making. As I’ve shown, in digital trans groups the wrong-body model, a standardized medical explanatory frame for understanding gender-variance, is repeatedly drawn upon to communicate and understand how users experience their gendered self. This might be interpreted as evidence that these groups drive medicalized ways of knowing the self, inculcating the adoption of the wrong-body model. But, by paying close attention to the way participants actually make use of the standard in everyday interactions, we can see that they use its language and logic in ways that actively carve out room for alternative ways of knowing, for becoming something authentically their own. That is, it is not in spite of but through the wrong-body model that users construct an authentic sense of self. The wrong-body model becomes both a shared framework for communicating and understanding one’s experience, and simultaneously the basis for its own critique. This finding suggests that standards of the self become part of, or a grammatical element within, a broader language of the self. Certainly, then, standards can profoundly impact one’s sense of self; but, importantly, this process can have unexpected or unintended outcomes. In this case, everyday use of the wrong-body model does not wholly displace or affirm it, but complicates and manipulates it in ways that create room for ways of knowing that exceed or even challenge it. Thus, this finding shows that standards and intimate life can intersect in unexpected ways, urging further research on intimate standards.

Scholars of intimate life would benefit from paying greater attention to the interrelationship between standards and intimacy, or what I call intimate standards. This emphasis on standards focuses our analytical lens more firmly on the everyday processes that make possible broader shifts in contemporary social life. For scholars of intimacy, an explicit focus on standards promises to advance studies of domestic, erotic, reproductive, and care work, as standards regimes increasingly come to define the limits and norms of these formerly private spheres. For scholars of standardization, greater research is needed that highlights the relationship between these processes and our most private or personal lives. I echo Timmermans and Epstein (2010) in urging scholars to pay close attention to the creative or unexpected outcomes of intimate standards. In particular, scholars should examine the ways in which standards are made meaningful for everyday life in interaction, as I have begun to do here.

This article contributes to the need for more research on the lived realities of trans lives. However, further research is needed that addresses how axes of difference – race, class, gender – might impact an individual’s ability to “opt in” or “opt out” of the wrong-body and beyond-the-binary models. While the users in these groups shared trans-identification, they varied widely in terms of other identity markers, including age, race, gender, time of transition, degree of transition, and many more. Future research should advance and complicate the findings of this article by bringing these differences to the center of the analysis.

Footnotes

Acknowledgements

First, I want to thank the global network of users who participated in these discussions, and responded to survey questions. Many were kind enough to help me think through these data and some even advocated on my behalf within their communities to drive greater input. Second, I am greatly indebted to Rhacel Parreñas for spearheading the feminist research seminar from which this article emerged. Finally, I humbly thank the following scholars for their thoughtful and thorough readings of earlier drafts of this article (in alphabetical order): Renee Almeling, Nathaniel Burke, Nina Eliasoph, Katie Hasson, Feng-Mei Heberer. Chaitanya Lakkimsetti, Rachel Silvey, Hung Cam Thai, and two anonymous reviewers.

Funding

This project would not have been possible without the intellectual and financial support of the Center for Law, History and Culture as well as the Center for Feminist Research, both at the University of Southern California.

Notes

Demetrios Psihopaidas is a PhD Candidate in Sociology at the University of Southern California and Research Fellow at the Agency for Healthcare Research and Quality. His research examines the social structures that shape health policy, clinical decision-making, and scientific knowledge. His contributions to these broad areas are primarily within health disparities, transgender health policy, HIV/AIDS, and global health policy. He is currently working on a book project titled Unsettled Lives: How Transgender Became a Global Health Policy Priority.

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