Negotiation and Medicalization of Transgender Identities at a Thai NGO

In this article, I examine how Thai kathoey – who are variously labeled “second-kind-of-woman,” “third gender,” or “male-to-female transgender” – embrace or resist medicalization of their identities in the context of Thailand’s medical tourist boom for gender reassignment surgery (GRS). Though Thai kathoey are often described as male-to-female transgender because they experience incongruence between their birth sex as males and gender identity as females, their identity has historically not been understood to be a medical/psychiatric condition. In contrast, Western concepts of transgender identity are heavily medicalized, beginning with the diagnosis of “gender dysphoria” defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and extending to the notion that dysphoria can be alleviated through mental health counseling, hormone therapy, and/or surgical interventions. Here, I interrogate how the medical therapies outlined in the “Standards of Care,” a set of guidelines published by the World Professional Association for Transgender Health (WPATH), have influenced the perception of kathoey identity as a psychiatric/medical condition, a perception that has been formalized through the 2009 Thai Medical Council ruling that patients seeking GRS must provide letters from two psychiatrists confirming a gender dysphoria diagnosis. Through participant observation at a kathoey-led Thai NGO that works to guarantee legal rights for their community and in-depth interviews with 12 Thai kathoey, I demonstrate how the influence of a “globalized” transgender identity in Thailand has created multiple valences of transgender as a medical identity, both reframing the medical decision-making processes for Thai kathoey and introducing new struggles with stigma that bleed into domains such as family relationships and careers.