By Mir Ijlal Shaani

There is a particular kind of violence that does not bruise the skin. It leaves no visible wound. It arrives softly, carrying the language of care. This is the violence of medicalisation.

It tells trans people that their bodies are questions waiting for answers. That their identities are problems waiting for solutions. That somewhere inside the clinic, beneath fluorescent lights and behind closed doors, lies the permission to be whole.

The modern medical story of transness is tidy. First discomfort, then diagnosis, then treatment, then relief. A clean arc that fits neatly into files and billing systems. It is comforting because it promises an endpoint. But lives do not move in straight lines, and neither does gender. What is presented as science is often ideology wearing a white coat.

Long before gender became a medical specialty, it was a social fact. Long before surgeons and psychiatrists claimed authority over identity, communities already knew how to hold difference.

Among many Native American nations, Two-Spirit people were not understood as bodies that had gone wrong. They were not seen as unfinished men or failed women. They were recognised as people who carried more than one way of being, often holding respected roles as healers, mediators, artists, and keepers of ceremony. Their identities were not conditional on altering flesh. No one asked them to prove themselves through pain. They belonged because they existed.

This matters because it reminds us that the idea of fixing gender is not universal. It is cultural. And in many cases, colonial.

In South Asia, too, gender variance lived long before it was diagnosed. Hijras, kinnars, jogappas existed as part of the social fabric, marginalised often, but not born out of a medical error. Colonial rule changed that. British law and Western psychiatry brought binaries, classifications, and the urge to discipline what could not be neatly sorted. Gender was turned into a condition. Identity… into a case file.

Today, that legacy survives in subtler forms. Wrapped in the language of choice and affirmation, medicine often positions itself as the final authority on who is real. Access to legal recognition, safety, and dignity is routed through diagnosis. Care becomes a gate. And gates always have guards.

This logic now reaches children, too. Puberty, once understood as an awkward, confusing, and formative passage, is increasingly treated as a medical emergency. Puberty blockers are described as neutral pauses, as harmless delays. Yet there is growing concern about what it means to interrupt a process that shapes not only the body, but the psyche, sexuality, and sense of self. A child navigating discomfort is quickly translated into a patient. Exploration becomes intervention. Time itself is medicalised. Childhood, with all its uncertainty, is shortened.

This is not about denying care or compassion. It is about asking whether a system that struggles to tolerate ambiguity should be making irreversible decisions in the name of certainty.

This is also not an argument against medical care. Many people choose hormones or surgery and find relief, stability, even joy. Their experiences are real and deserve respect. But choice does not exist in a vacuum. When a system repeatedly tells people that peace lies on the other side of intervention, when insecurity is cultivated and monetised, we must ask who benefits.

Capital is very good at spotting vulnerability. It knows how to turn longing into a market. Lifelong treatments, corrective procedures, certifications of authenticity. The body becomes a project. The self becomes a subscription.

What gets lost is the radical idea that a person can be whole without being corrected.

Medicalisation insists that legitimacy must be earned through treatment. Indigenous knowledge insists that legitimacy comes from being recognised as human. These are very different starting points.

To say that trans people do not require surgery to be complete is not to deny anyone care. It is to refuse a hierarchy where the most medicalised body is treated as the most authentic one. It is to push back against a world that keeps asking, what will you do to yourself in order to belong?

Perhaps the most dangerous lie medicalisation tells is that before intervention, there is a lack. And perhaps the most radical thing a trans person can say, quietly and without apology, is this.

I was never broken.