Diagnosis vs. that's just me: why is medicalization bad?

I am a trans person, but I am not a diagnosis

We take diagnoses so seriously, sometimes. What is a “gender dysphoria” diagnosis anyway?

When I worked in medical software, I learned that a diagnosis is just a selection from a list of standard values. The doctor or nurse practitioner selects the diagnosis for the patient from a searchable list. It shows up with a name and a code, numbers and letters.

This diagnosis code gets sent to the insurance company, if relevant. If it’s for a prescription, the diagnosis code gets sent to SureScripts, which processes nearly all electronic prescriptions in the US.

Photo by Denin Lawley on Unsplash

The computer systems that handle billing and e-prescribing are complex, but they follow a few simple rules when it comes to deciding if you are eligible for a medication.

First, for some medical care, the gender marker on your health insurance plan needs to be eligible. This gender marker may or may not match the gender on your legal ID or coordinate with the body parts you have.

Next, you need to have a particular diagnosis to receive some medications and treatments. This is not a paragraph from your doctor explaining your condition; this is merely the diagnosis code of letters and numbers that has been assigned to you.

I say all this to emphasize that diagnoses are primarily required for billing insurance.

Photo by National Cancer Institute on Unsplash

Being trans is not equivalent to having a mental illness. But gender dysphoria (or, previously, gender identity disorder) is in the DSM, you say. Yes, that diagnosis code is required for prescribing gender-affirming hormone therapy and other treatments.

Whether I have a diagnosis of gender dysphoria or not perhaps depends on whether I need to bill my insurance for gender-affirming medical care (for example, talk therapy or medication).

Some trans people benefit from medical treatments, but that’s not the same as saying we are a problem that needs to be fixed. We are not a problem. We are part of the wonderful diversity of humankind.

Our medical system has a violent history, continuing today, of discrimination and cruelty towards Black people and people of color. Medical treatment does not tend to be inclusive of marginalized identities. White trans people have privilege in medical environments.

Perhaps standardizing medical care with processes and diagnosis codes and procedures can help reduce opportunities for discrimination. Or perhaps, that is a dream not based in the reality of bias against patients due to their skin color and identity.

From Wikipedia: “Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment.”

Being trans, to me, is more of a human condition than a medical condition.

Photo by Delia Giandeini on Unsplash

Some people think I’m mentally ill because I talk about being trans. That opinion truly says more about them than it does about me. I’m happier, more confident, and understand myself much better since I came out. I absolutely do not want to go back to pretending I am a cis woman. That makes me unhappy and I’m bad at it.

Diagnoses can help some people understand what’s going on with them. Diagnoses can help you find your community, learn about coping methods, and access medications that will increase your quality of life. So they aren’t inherently bad.

It’s just when we start reading more into a diagnosis than merely a code allowing us access to medical care, we start to bring stigma, shame, broken-ness into the picture.

Everyone should have access to equitable medical care. We should try to look at diagnosis as a tool, not as something that defines us.

I’m happy being trans and accepting myself for who I am, most of the time. That insight has revolutionized my wellbeing and care more than anything the medical system has done for me.

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Take care,

Rey