I think you demonstrate a certain amount of confusion about the concept of gender. I come from a medical background, and I’m very interested in the research being done. There is increasing evidence every day that gender, in fact, has a biological basis in the brain. Having said that, socialization does come in to play. For many of us, including myself who transitioned later in life, it took a considerable amount of time to understand how our socialization covered up our true inner identity.

I absolutely agree that gender exists on a spectrum. I can intellectually understand those who are non-binary or gender fluid, but emotionally it is not something I can relate to because it is not who I am. I am a binary trans woman. That does not mean that others can’t be somewhere between the two binary extremes. Psychologists have identified something like 52 separate gender identities which are equally valid. I’m sure more will appear with more research and experience. Does that mean that those who are not on the fixed binary are not truly trans? Of course not. If gender is a spectrum, there could be any number of variations between the two extremes.

The issue is clouded even further by the fact that some people start out thinking that they are gender nonconforming, gender fluid or non-binary, often taking decades for them to understand that they are more binary than they think. Some people never reach that point. I know hundreds of trans people of different types. I have watched with interest the evolution of many of them from the early days when they were more gender confused than truly non-binary. This is a common journey for many.

I understand people’s fear of the medicalist point of view and the return to the days of gatekeeping. I think this is a legitimate concern, but frequently overstated. Let people be who they want to be. But I also am a believer in differentiating those who truly have a trans nature from those who are merely unhappy with their lives and adopt a trans identity to deal with a different underlying mental health challenge. That can often be difficult to discern , which is the reason that the major medical associations demand such intensive mental health therapy before considering irreversible surgical procedures.

At the end of the day no one wants to get it wrong. Fortunately, the level of transition regret among those who have undertaken irreversible procedures is extremely small, which indicates that for the most part, the professionals get it right. The $64,000 question, as it were, is to prevent people from doing something or adopting an identity which is not real. If they have a different mental health issue, they will be the happiest and most fulfilled when their problem is properly identified and resolved.