Elaborating Embodied Boundaries: Medical Expertise and (Trans)Gender Classification
Tara Gonsalves
Abstract
As coverage for gender-affirming surgery and hormone therapy has expanded over the past two decades, insurers are increasingly tasked with deciding which body modifications are necessary for accomplishing masculinity and femininity. Drawing from extensive records on coverage decisions and national health insurance plans, the author investigates how insurers marshal gender categories to make decisions about medically necessary care. While insurers might be expected to draw on medical expertise to make decisions about gender-affirming care, the author finds that they use standards and stereotypes of normative, “ideal” gender. In doing so, expansions in coverage lead to an elaboration of ideal embodied gender based on a white, thin-bodied aesthetic. Ironically, as transgender people succeed in expanding insurance coverage, normative embodied gender becomes more defined and less ambiguous. In showing how insurers and the medical experts they consult mobilize and reconstitute embodied gender, the author advances theories of classification, embodiment, and expertise.