All genders have been impacted by the medicalization of gender. As with many social institutions, gender is influenced and interacts in many different ways with the medical field. Medicalization is a process where a condition or set of conditions becomes medically and systematically studied, diagnosed, and treated. For example, intersex individuals (those with ambiguous sexual organs or sex organs/traits from both male and female sexes) have been hidden, treated, and dismissed by the medical community as a problem that needs an intervention and label.

The medicalization of transgender individuals is apparent in the lack of insurance coverage for their care, laws that make it illegal to seek treatment, and the rejection they face in many school communities. Men also deal with medicalization issues, such as being unable to admit they need help due to societal norms of masculinity where they would be perceived as weak for asking for help or admitting pain (Novak, 2019).

2.3.1 Intersex Individuals

The existence of sex variations challenges the notion of biological sex as a binary category. Intersex describes variation in sex characteristics, such as chromosomes, gonads, sex hormones, or genitals. The bodies of intersex individuals do not fit typical definitions of what is culturally considered male or female. Intersex, like female and male, is a socially constructed category that humans created to label bodies. The term marks biological variation among bodies. There are a number of specific biological sex variations. For example, possessing one Y and more than one X chromosome is called Klinefelter Syndrome.

Does the presence of more than one X mean that the XXY person is female? Does the presence of a Y mean that the XXY person is male? These individuals are neither chromosomally male nor female; they are chromosomally intersex. Some people have genitalia that others consider ambiguous. The Intersex Society of North America estimates that 1.5% of people have sex variations—that is 2,000 births a year. So, why is this knowledge not commonly known? Many individuals born with genitalia not easily classified as “male” or “female” are subject to genital surgeries during infancy, childhood, or adulthood. Surgeons reduce the size of the genitals of female-assigned infants they want to look more typically “female” and less “masculine”; in infants with genital appendages smaller than 2.5 centimeters, they reduce the size and assign them female (Dreger 1998). In each instance, surgeons literally construct and reconstruct individuals’ bodies to fit into the dominant, binary sex/gender system.

While parents and doctors justify this practice as “in the best interest of the child,” many people experience these surgeries and their social treatment as traumatic since they are often performed without patients’ consent. Some parents may not have all of the information or time to intervene in an infant surgery. Individuals often discover their chromosomal makeup, surgical records, or intersex status in their medical records as adults, after years of physicians hiding this information from them. The surgeries do not necessarily make bodies appear “natural” due to scar tissue, disfigurement, or chronic infection. The surgeries can also result in psychological distress. In addition, many of these surgeries involve sterilization, potentially part of a historical eugenics projects which aim to eliminate intersex people (Sparrow, 2013). Therefore, a great deal of shame, secrecy, and betrayal surround these surgeries.

Figure 2.7. Statue of Hermaphoditus a Greek god who was depicted to have both male and female sex characteristics.

Historically intersex individuals were seen as special and celebrated in some cultures. The ancient Greek Hermaphroditus (Figure 2.7) was merged with a nymph so they could be together forever, shown in depictions as having both male and female attributes and mixed-sex characteristics (Greekmythology.com). We have also seen this in Asia where special communities existed for intersex individuals.

2.3.2 Gender Inequalities in Medical Institutions

Medical institutions perpetuate gender inequality, and this inequality becomes even more pronounced within already marginalized groups. For example, women struggle with gender bias and the assumption on the part of medical professionals that they are not as smart as men and cannot make rational decisions. Researchers have shown that medical professionals listen to women less than men (Dusenbery 2019). In 1993 a Federal law was enacted that stated that the National Institute of Health must use inclusive recruitment of women and minorities in clinical research, partly based on studies that showed diagnoses and treatment of women’s illnesses were slower and fewer than that of men’s which continues to this day (Levy, 2018).

One example of gender bias in medical institutions is the differences in treatments for chronic pain. According to data such as the National Health Interview Survey (NCHS, 2019), women experience chronic pain more than men but are more likely to be diagnosed with a psychological reason for the pain. Doctors are less likely to believe that women are in as much pain as they describe, so they receive less pain medication and less effective pain medication. They are treated for mental health instead of physical health (Kiesel, 2017).

Figure 2.9 Shows a group of people with disabilities, the color of their skin and/or gender identity can significantly impact their healthcare quality and experiences.

This trend is more extreme concerning women of color (Figure 2.9), as discussed in good detail in this article about race and healthcare quality: Why the Color of Your Skin Can Affect the Quality of Your Diagnoses. Women in the BIPOC community struggle with bias, unreliable diagnoses, access to pain management, and poor pregnancy care within all medical institutions (Chinn, Martin, & Redmond, 2021; van Daalen, Kaiser, & Kebede, 2022). Research shows that women with autoimmune diseases, such as lupus, are often labeled as complainers and have their efforts at diagnoses dismissed. Studies reveal the same trends with blood disorders, heart disease, mental health, and other conditions.

Men are affected by these same ideals and biases. Men who report chronic pain tend to receive stronger pain management medicines than women. However, men tend to be affected by the labels of “strong,” “brave,” and “resilient” and may take longer to request care or admit that they are in pain. Men also experience a disparity in mental health care . Social pressure on men to be tough and mask emotions makes it difficult for them to receive help and support (Novak, 2019). This might be one reason the suicide rate is higher for men than women.

According to the American Foundation for Suicide Prevention, the rate of suicide is highest in middle-aged white men and men died by suicide 3.88x more than women in 2020. A recent Mayo Clinic Network article states that White men account for nearly 70% of suicide deaths and attributes this high rate to research that shows men ignore health symptoms, delay medical intervention, and may withhold information during any medical visits. Many of these relate especially to mental health, which is significantly undiagnosed in men (Watkins, 2021). Even though systemic sexism and the gender binary favor male-ness over female-ness, men are not excluded from these negative effects.

Trans people also experience marginalization in the medical system. The 2021 Alabama ban on gender-affirming health care for transgender minors has occurred in more states, with many more on the dockets around the country (see this Bill Tracker for a complete list). Not only are there bans and bills blocking trans healthcare for youth, but trans adults also face barriers to healthcare. These obstacles include bias, economic barriers, insurance refusals, untrained medical staff, and fear of being honest about their trans status due to discrimination and hate crimes. The U.S. Trans Survey discusses these barriers in its 2015 reports, but other researchers have found similar barriers (Cicero, 2019; Kachen, 2020). All of this feeds into the marginalization and treatment in healthcare and medical institutions and practices.

Trans and nonbinary individuals face frequent rejection of their identities by the medical establishment. On many medical and institutional forms, male and female are the only options under gender and sex identity. Those seeking gender-affirming care, medical treatment through hormone replacement or surgery, are currently diagnosed with gender dysphoria. Gender dysphoria means psychological distress about one’s biological sex and gender identity. While diagnoses help to justify care, they also categorize trans people as having a mental disorder instead of simply being trans.

Gatekeeping, controlling access to or information about their healthcare, disproportionally affects trans people (de Vries, 2020; Garcia, 2022; Hostetter, 2022). As a result, trans people do not seek care as quickly and cannot access the care they need. Access to gender-affirming care is difficult due to these barriers and inaccessible due to the expense and recovery time required for these procedures. Many insurance companies do not cover gender-affirming care or make it difficult to obtain.

Watch this video on the 2022 trans healthcare ban in Florida (figure 2.10)

Figure 2.10. Video about the trans healthcare ban in Florida from 2022.