Review of Trans Medicine: The Emergence and Practice of Treating Gender. stef m. shuster, New York: NYU Press, 2021, 240 pp.

Trans Medicine: The Emergence and Practice of Treating Gender. stef m. shuster, New York: NYU Press, 2021, 240 pp.

Mel Ferrara

Stevens Institute of Technology

In Trans Medicine: The Emergence and Practice of Treating Gender, stef m. shuster traces the emergence of contemporary transition-related medicine with acute attention to the ways in which authority over gender has been constructed through the labyrinthine administrative practices of modern Western health care. With their focus on examining the “social life of evidence” (p. 167), shuster’s analysis attends to questions that are not only core to thinking about trans medicine, but also to anthropologies of health more broadly: In what ways might we understand medicine as “the place where science and value meet” (p. 3)? How does someone gain authority as a “credible” physician, especially in an emerging area of specialization? To what extent has evidence-based medicine (EBM) reconfigured the dynamics of patient-centered care? Through this analytical move, shuster challenges “trans exceptionalism,” a normative perception of trans patients that proposes their health care is drastically distinct from that of their cisgender counterparts (p. 5). Put differently, shuster’s framing of trans medicine as a field that cannot be understood as divorced from the broader matrix of dynamics within health care, and its administration can be read as an epistemological intervention in and of itself.

In terms of methodology, shuster explores their central research questions through a mixed approach. In the first half of the book, they draw heavily from the archive, examining correspondences between health care providers who worked with trans patients in the mid-to-late 20th century. shuster couples this historical evidence with two sets of contemporary qualitative data: 23 in-depth interviews with U.S.-based physicians and therapists “from a variety of specialties and theoretical orientations” (p. 12) and observations from their attendance at various health care conferences that focused on trans medicine. In this way, shuster artfully weaves a narrative about trans medicine from the 1950s to the present moment such that it is both attentive to temporal specificity and to the lasting impact of these historical dynamics on contemporary health care practices.

A core theme presented in Trans Medicine is the question of authority and, by relation, credibility and expertise. Previous works on the topic of trans medicine have addressed the ways in which trans patients have frequently been discredited within health care, framed as duplicitous, erratic, and even psychotic. In keeping with existing literature on this topic, shuster explores how the trope of the “trickster” trans person has contributed to medical gatekeeping, especially for those who do not fit into the characterization of the otherwise “credible” patient (i.e., white, gender binary, heteronormative, employed, non-disabled, and neurotypical). In a historical sense, shuster compellingly argues that this scripting of trans patients can be understood as one component of “the messy and complicated pathways by which medical professionals traverse an emergent area of medicine permeated by uncertainty and lack of consensus” (p. 50). More specifically, the author situates these dynamics within an increasingly administrated health care system, one in which many providers “scramble[ed] to assert and retain power” amid “intense legitimacy wars” between physicians and mental health providers “in a power grab over trans medicine” (p. 50). For shuster, delegitimizing their patients’ authority became a tactic by which providers could assert their own credibility and expertise over the otherwise seemingly ungovernable landscape of gender diversity.

In the second half of the book, shuster addresses contemporary trans medicine and the continued shift away from “doctor knows best” decision-making models toward patient-centered care (p. 9). Amid these changes, the author argues that the question of uncertainty—and, thus, tension around professional credibility—has not faded from the field of trans medicine. Instead, they contend that providers’ desire for a professional consensus on trans health care has encouraged further reliance on EBM. On the one hand, shuster acknowledges the multi-faceted logics—both practical and professional—that contribute to the desire for medical standardization. Nonetheless, they push back against this epistemological impulse, arguing that through EBM, “[n]ormalizing trans patients remains prevalent in medical decision-making but has been refashioned in more covert ways and sanitized under the guise of evidence-based discourse” (p. 100). In effect, shuster contends that EBM should not be unequivocally lauded as a marker of progress for trans medicine; instead, this approach must also be held accountable for the ways in which it may reduce transness to a monolithic experience.

At a time in which trans medicine is becoming both increasingly normalized and subject to fierce legislative challenge, shuster’s manuscript importantly attends to the politics of health care administration and its impact on both medical knowledge production and patient experience. Of note, shuster’s analysis could more rigorously attend to the racialized dynamics of trans medicine. The author discusses how race and other social factors such as socioeconomic status have contributed to the unique typology of the trans “trickster.” Still, the unique intersections of the administration of race and gender within medical discourse felt underexplored in the book as a whole. In terms of scope, the manuscript focuses largely on U.S. health care, importantly noting the central role that this country plays in the globalization of best practices for trans medicine.

Overall, shuster’s book is an engaging exploration of the histories of trans medicine with an emphasis on health care administration and politics. The author’s tone is clear and comprehensive, building on a wealth of theoretical concepts in anthropology, trans studies, feminist science and technology studies, and health communications in a way that remains very approachable. For this reason, shuster’s book would be an excellent addition to the classroom, including for upper-level undergraduate courses in the aforementioned fields. Further, as shuster acknowledges, “trans medicine is often confined to a single ‘diversity day’ in medical residency programs” (p. 90). Thus, Trans Medicine holds immense value for medical school and continuing education programs and would promote fruitful dialog about inclusive, accountable, and just health care practices.