Marisa

Heading.

Be the trans-double bind.

The purpose of medicine is to improve health and reduce suffering.

In general, the state should not subsidize healthcare that does not increase QALYs.

A rational healthcare system would ration care based on ranking all available treatments by QALYs saved per dollar and funding all treatments above a cut-off determined by the budget.

The US healthcare system has a very creative interpretation of reality, but other countries like the UK at least attempt to do this.

To receive gender-affirming treatment, trans people must argue that such treatment alleviates suffering.

This argument helped establish gender medicine in the 20th century.

But in fact, the claim being transgender involves suffering and requires medical treatment is very controversial within the trans community.

This is surprising, because disputing this claim threatens to undermine access to trans healthcare.

Moreover, this controversy explains why trans people do not appear to accurately report their own motivations for transition.

Subheading Motivations to Transition

There are three possible sources.

1.

Biological 2.

Psychological-cognitive 3.

Social

These can co-occur and interact.

Society at large recognizes only, one, as legitimate.

Trans people know this.