Transmedicalist symbol

The transmedicalist flag/symbol

Transmedicalism is the belief that all transgender people 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] That distress may range from mild discomfort to extreme self-hatred regarding how their body does not match their gender identity; therefore, transmedicalists feel that anyone who does not experience any gender dysphoria is cisgender, not transgender. People with a strong belief in this position are generally called transmedicalists, shortened to "transmeds", or derogatorily referred to as "truscum". Some transmedicalists also 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 with a strong belief that the only requirement for being transgender is self-identification, thus the medical condition of gender dysphoria is not necessary to be transgender, are called "anti-transmeds" or "tucutes". Some describe transgender people as experiencing gender incongruence, a "disconnect between a person's gender identity and their body, which may or may not result in dysphoria". Many anti-transmeds also embrace new identity terms that are not widely accepted among transmeds, including microlabels, xenogenders, neopronouns, and other recently coined terms.[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 non-binary or genderfluid and only accept the man/woman gender binary.[1]

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

  • Gender dysphoria is not necessary to be transgender.[3]
  • Gender is not a binary.[1]
  • 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. These barriers include waitlists, lack of insurance coverage, high out-of-pocket costs, and required referrals.[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 medical interventions such as HRT. For people without access to a diagnosis, this presents a barrier to receiving gender-affirming care. Many transmedicalists believe that the diagnosis is justified based on regarding gender dysphoria as a defining aspect of being transgender. Anti-transmedicalists may believe that simply trusting in transgender individuals to know what is best for their own health could be beneficial, particularly for those who are unable to access a gender dysphoria diagnosis.[4]

Radical forms of transmedicalism affirm the gender binary and invalidate non-binary identities despite widespread evidence to the contrary.[6] A significant percentage of LGBTQIA+ populations are non-binary; for instance, a survey of 34,700 LGBTQIA+ youth by The Trevor Project found that over 26% of the respondents were non-binary.[7]


  • American Psychiatric Association:
  • "Both, and: Transmedicalism and resistance in non-binary narratives of gender-affirming care" by Konnelly, Lex in Toronto Working Papers in Linguistics, vol. 43. Published June 2021. (web archive)
  • Gender incongruence and gender dysphoria in childhood and adolescence-current insights in diagnostics, management, and follow-up(web archive)
  • Gender dysphoria - NHS(web archive)


  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 1.8 Who Counts as Trans? A Critical Discourse Analysis of Trans Tumblr Posts [vol. 46, no. 1] by Jacobsen, Kai; Devor, Aaron; & Hodge, Edwin. (web archive)
  2. "What Is Gender Dysphoria?" by on <>(no backup information provided)
  3. 3.0 3.1 "What Does the ContraPoints Controversy Say About the Way We Criticize?" by Earl, Jessie on [Pride]. Published 2019-10-21. (no backup information provided)
  4. 4.0 4.1 "Transmedicalist barriers in healthcare" by Ellis, Kate on <>. Published 2020-11-16. (no backup information provided)
  5. "The New Frontier: Trans Rights In Iceland" by Fontaine, Andie on Reykjavik Grapevine. Published 2019-08-02. (no backup information provided)
  6. Non-Binary Genders: Navigating Communities, Identities, and Healthcare by Vincent, Ben. Published 2020-07-02 by Policy Press. ISBN 978-1-4473-5193-1.
  7. "'Young People Are Taking Control Over Their Gender Identity.' New Research Examines Diversity of Nonbinary Youth" by Carlisle, Madeleine on <>. Published 2021-07-21 by Time. (no backup information provided)