The transmedicalist flag/symbol

Transmedicalism is the belief that in order to be transgender, a person needs to experience some level of gender dysphoria,[1] a medical term for feeling psychological distress based on having an assigned sex at birth that does not match one's gender identity.[2] People with a strong belief in this position are generally called transmedicalists, shortened to "transmeds", or derogatorily referred to as "truscum". Some transmedicalists believe that transgender people must additionally want and choose to alleviate gender dysphoria by pursuing a medical transition using Hormone Replacement Therapy (HRT) and/or Gender Confirmation Surgery.[note 1][1]

Those who do not believe that the medical condition of gender dysphoria is necessary to be transgender are called "anti-transmeds", or "tucutes". Many anti-transmeds embrace new identity terms that are not widely accepted among transmeds, including neogenders, neopronouns, and other recently coined terms. Although there are extremists on both sides, many transmeds and anti-transmeds would agree that one only needs gender "incongruence"—that is, a "disconnect between a person's gender identity and their body, which may or may not result in dysphoria"—to be transgender.[1]


The term "truscum" is a derogatory term that may be a portmanteau of "true transsexual" and "scum"; "true transsexual" was coined by Harry Benjamin in reference to people who seek surgery. Some transmedicalists call themselves truscum.[1]

The term "tucute" stands for "too cute to be cisgender" and is sometimes used as an identity label by anti-transmedicalists. A derogatory term "transtrender" alleges that tucutes are cisgender people pretending to be transgender to get attention.[1]


Transmedicalist beliefs may include any or all of the following:

  • Gender dysphoria is necessary to be transgender.[1]
  • Transgender people pursue medical transition to alleviate their gender dysphoria; someone who does not wish to medically transition is not transgender.[1]
  • Radical transmedicalists may also reject the idea of being nonbinary or genderfluid.[1]

Anti-transmedicalist beliefs may include any or all of the following:

  • Gender dysphoria is not necessary to be transgender.[3]
  • Since a clinical diagnosis of gender dysphoria is usually required to access gender-affirming treatments, such as hormone replacement therapy (HRT) or gender-affirming surgeries, beliefs about gender dysphoria have created barriers to accessing care.[4]
  • Transmedicalism is a harmful viewpoint that erases non-binary people who do not experience gender dysphoria and binary transgender people who experience gender euphoria.[3]
  • Transmedicalism is outdated and possibly transphobic.[5]


In many jurisdictions, a diagnosis of gender dysphoria is typically needed in order to receive HRT or SRS. Many transmedicalists believe that this is justified, as they believe gender dysphoria is needed to be transgender. However, many people have no access to a diagnosis, and therefore could be prevented from getting the gender-affirming care they need. As a society, moving away from a gender dysphoria diagnosis and simply trusting that transgender individuals know what is best for their body could be beneficial for those who are unable to access a gender dysphoria diagnosis.[4]

Radical transmedicalism usually invalidates nonbinary individuals.[6] A survey of 34,700 LGBTQIA+ youth by The Trevor Project found that over 26% of the respondents were non-binary.[7]



  1. This article has used more affirming language rather than the language of the cited source, which uses the term "sex reassignment surgery" for what is now commonly known as gender confirmation surgery or gender affirmation surgery.


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Jacobsen, Kai; Devor, Aaron; & Hodge, Edwin. Who Counts as Trans? A Critical Discourse Analysis of Trans Tumblr Posts. vol. 46, no. 1. (web archive)
  2. "What Is Gender Dysphoria?".
  3. 3.0 3.1 Earl, Jessie: "What Does the ContraPoints Controversy Say About the Way We Critisize?" (2019-10-21). Pride.
  4. 4.0 4.1 "Transmedicalist barriers in healthcare".
  5. Fontaine, Andie: "The New Frontier: Trans Rights In Iceland" (2019-08-02). Reykjavik Grapevine.
  6. Vincent, Ben. Non-Binary Genders: Navigating Communities, Identities, and Healthcare. Policy Press, 2020-07-02. (web archive)
  7. Carlisle, Madeleine: "'Young People Are Taking Control Over Their Gender Identity.' New Research Examines Diversity of Nonbinary Youth" (2021-07-21). Time.