Hierarchies of ‘Treatment’: The Influences of Comorbid Psychiatric Diagnoses on Individuals with Gender Dysphoria

Since the introduction of the gender dysphoria (GD) diagnosis, previously marginalized trans individuals, such as emancipated minors, incarcerated individuals, and individuals with cognitive disabilities that are deemed able to participate in their various medical treatments, have been invited to have an autonomous role in their decisions to access medical methods of gender affirmation. It is important to note that trans individuals with psychiatric diagnosis/es in addition to GD are prohibited to this sense of autonomy since they are deemed to be incompetent due to these comorbid ‘psychiatric’ diagnoses. I investigate the creation and consequences of a hierarchy of treatment that is created by conceiving of the trans phenomenon as a psychiatric disorder which prioritizes effective management of the non-GD diagnosis/es before validating the gender identity through both social and medical methods. This hierarchical creation invariably leads to a pathologization of the trans phenomenon as medical professionals attempt to prove through causation the actual ‘true’ diagnosis embedded within the comorbidity. The consequences of this hierarchy of treatment denies a trans person with a multiplicity of psychiatric diagnoses access to gender affirming medical methods in favor of uncovering the truth of their pathology, which can exacerbate emotional distress, distress that can potentially have lethal physical manifestations, that an individual is already experiencing. The medical institution needs to reevaluate the principle “first, do no harm,” to understand how their resistance to grant autonomy to trans individuals with comorbid diagnoses can, in actuality, create the most harm. In order avoid further marginalization of this sub-population within the trans community, I propose an eradication of any diagnosis that attempts to depict the trans phenomenon in favor of a new reimagining of reimbursable medical methods of gender affirmation that privileges the autonomy of trans individuals.