Yes, even cis people want to modify their sexed traits.
and yes those modifications are gender affirming.
One important fact that is lost in the current flurry of gender denialism is that cis people have gender too. Gender is mundane and simply inescapable.
I am reminded of this multiple times a week when I walk the 8 blocks between my apartment and downtown Santa Monica. On my walk, I pass at least 4 fitness centers - each swarming with gym bros. These men spend countless hours at the gym because the physical gains are part of the vision of archetypal manhood that they want to project. While returning home on the same route, I notice 3 salons, each filled with women seeking to embody traditional feminine beauty aesthetics.
To be clear, gender is morally neutral. There is nothing wrong with someone wanting to embody masculine fitness aesthetics in a healthy way. Just as there is nothing wrong with getting a mani/pedi. And if neither of those are your thing, that’s fine too!1
We all make constant decisions about how to express ourselves based on our internal understanding of our gender - regardless of gender identity or embrace of “gender ideology.” The standards we use to construct our gender expressions are the result of our cultural norms and the opportunities (including financial) available to us. To understand these dynamics within oneself and others is to conceptualize gender in four dimensions, as suggested by Kate Bornstein. Gender evolves with each new experience and each new decision.
A subset of our gender decisions come in health care settings - whether in a doctor’s office, in licensed clinic, or outside of these sanctioned marketplaces if necessary. These decisions largely involve the modification of sexed traits. Since sex is a multi-faceted and largely ambiguous term, these modifications are similarly wide-ranging (e.g. changes in sex hormones, alteration of reproductive organs, cosmetic changes to the face or chest, etc.). For trans people, these services are usually termed “gender affirming,” emphasizing the mismatch between the person’s sex assigned at birth and identified gender.
Unacknowledged by the medical linguistics, the cis patient/client is also receiving gender affirming care. By this, I mean the care is intended to reinforce their internal perception of gender too. These procedures are often the same as or analogous to procedures that trans people seek. Ultimately, they relieve mild symptoms of gender dysphoria. It’s just that there is no crossing (or trans-ing, if you will) of the sex/gender binaries.
consider the following clinical interventions that cis people can access to fortify sexed traits:
Puberty blockers (to treat precocious puberty in cis adolescents)
Estradiol hormone therapy (mainly to relieve the symptoms of menopause, as hormonal birth control, or to treat osteoporosis)
Testosterone hormone therapy (mainly to build muscle mass, boost libido, and treat depression)
Progesterone therapy (mainly to relieve the symptoms of menopause)
Hair removal (laser or electrolysis) to remove unwanted hairs
Voice training
Breast augmentation and/or breast reduction (including for gynecomastia in cis men)
Cosmetic procedures on the face including face lifts, botox, and lip fillers
Hair loss prevention and hair growth supplements
Erectile dysfunction medication like Viagra
Brazilian butt lifts and other butt augmentations
And those are just the procedures that I could think of! (If I missed any, please let me know in the comments.)
Clearly, there is broad interest among cis people for these procedures including for hormone therapies. In fact, telehealth companies like Hims and Hers are now offering hormone replacement therapies for cisgender people (which is fundamentally related to its misleading promotion of semaglutide weight loss drugs). Hormone therapy is a proven way to relieve uncomfortable menopause symptoms yet prescriptions are hard to obtain. By providing compounded hormones, companies like Hims and Hers are seeking to circumvent traditional pharmacies and meet consumer demand.
on mar-a-lago face
Someone’s politics has no bearing on whether they seek sex trait modifications. Take, for example, US Secretary of Homeland Security Kristi Noem whose gender affirming transformations have played out in public. Today, she has what some have called “Mar-a-Lago face,” a surgically assembled aesthetic designed to portray traditional sexed characteristics to an audience of one (Donald Trump). Noem, who has a history of anti-trans discrimination, would surely bristle at the suggestion that she received “affirming care.”
For Noem, her cosmetic alternations are a way to reinforce her femininity while advancing her political career. As San Diego State politics professor Ronnee Schreiber told Mother Jones, Mar-a-Lago face and hyperfemininity aesthetics reinforce the “norms and differences between femininity and masculinity” in ways that allow women like Noem to wield power without threatening the patriarchal order of the administration.
Again, to be clear, I don’t fault Noem for seeking procedures to affirm her femininity. I do fault her for allying herself with fascism for the sake of accumulating power within a corrupt regime (and for, before that, killing her dog).
It’s safe to say that Noem’s aesthetic gambit worked. Within a month of Trump’s inauguration, Trump sent Noem to star in a $200 million ad campaign that consists of her publicly thanking him for “closing the border.” In doing so, he explicitly told her “I want your face in the ads,” likely because he finds her face more appealing and softer than, say, “border czar” Tom Homan.
As the inhumanity of the Trump administration’s immigration policies have come into the public view, Noem continues to make propaganda as if it’s viral content. On March 26, she visited CECOT, the El Salvador prison which the US is renting to house people they have deported. While there, she made a haunting video in front of a cell block filled with incarcerated people, discouraging undocumented people from entering the US (all while wearing a $50k Rolex). For Noem, the incarcerated human lives piled behind her were merely props for her ethnonationalism — just as she is a prop for Trump’s fascism.
affirmed gender and power
What should we make of someone like Noem whose sex trait modifications walk the line between affirming procedures and naked accumulation of political capital for cruel and inhumane purposes? I don’t have all the answers, and I doubt that anyone can fully separate these distinct motivations that drove her behavior.
Instead, perhaps, Noem (in all her cruelty) is a symptom of a larger set of structures which makes her power grab appear rational to her. This isn’t intended to exculpate her. She’s a grown woman who chose this life, and she is accountable for her actions — just as our sociopolitical system is accountable for the inhumanity and destruction done in its name. That system produced Noem in her current form just as much as her plastic surgeon did.
Noem works within the system of white, patriarchal oligarchy that dominates the United States at the moment. Her hyperfeminine face (which conforms to white beauty standards) and her bourgeois adornments (like the Rolex) were quite literally her price of entry.
Once inside, she serves to emphasize an innate gender binary and lay bare the difference between the powered masculine and the unpowered feminine. By sending Noem to make propaganda videos, Trump clearly doesn’t value her leadership or political acumen — just her aesthetics. But, Noem herself is happy to oblige.
Elective cosmetic surgeries like Noem’s are generally not covered by health insurance, meaning most people pay for the procedures out of pocket. Noem can afford this as her net worth is near $1 million, and her husband’s net worth is at least an additional $1-5 million.
Noem used her wealth, whiteness, and feminity to pursue power, and she now oversees the cruel displacement of innocent human lives as Secretary of Homeland Security. We can’t fully dismantle the system in which produced Noem without addressing the triumvirate of social forces that sculpted her into her present form. This is certainly a tall order.
Noem’s power is fully embedded within an oppressive political system that has existed for generations. But, I’ve now seen first-hand just how similar procedures can foster a different kind of power.
The power of existing at peace within your own body goes by many names, but I first heard it conceptualized by Audre Lorde in “Uses of the Erotic: The Erotic as Power.” Beyond the purely sexual connotation, the erotic is located in the phrase “it feels right to me” which beckons us to explore the source of that feeling of rightness. As Lorde defines it:
The erotic is a measure between the beginnings of our sense of self and the chaos of our strongest feelings. It is an internal sense of satisfaction to which, once we have experienced it, we know we can aspire. For having experienced the fullness of this depth of feeling and recognizing its power, in honor and self-respect we can require no less of ourselves.
I first read these words a few months into my medical transition and found in them the perfect distillation of what transition had unearthed in me. Almost 3 years later, even more of me has changed. I love parts of my body that I never anticipated I would. I’ve (largely) stopped abusing alcohol because I am better able to just sit and be. Where there was despair and loathing, there is now wonder and joy.
I still struggle on many days, but in those moments I seek to reconnect with the erotic power within me. This reconnection has gotten easier over time as my body moves closer to what feels right for me. In doing so, I can better show up for those around me. That is the potential of erotic power, immediately actionable through pleasure activism as proposed by adrienne maree brown
Medicine and aesthetics are definitely not requirements to access the erotic. But for me (and I’m willing to bet many others, both cis and trans), they were a major barrier to doing so. Everyone should have the opportunity to access this power — imagine how society would be transformed if everyone did have that access.
It’s possible to envision a future where the barriers to receiving this care are removed. Perhaps it could look like health insurance plans (or, if you’d prefer, a post-health insurance future) where affirming care is free for all. By increasing access to these procedures for everyone, debate about trans health care would lose some of its salience.
The artificial divide between the care given to a cis person and the same care given to a trans person is partly responsible for our current anti-trans politics. The concept of affirming care (exclusively relegated to trans care) can be derided as something like “chemical and surgical mutilation,” while the same (or similar) treatments given to cis people can proceed unabated. What actually distinguishes a cis person receiving affirming care and a trans person receiving affirming care is merely the magnitude and direction of the alterations involved.
This false dichotomy has negative implications for cis people too. As a transsexual woman fortunate to be living in a state that has enacted protections for trans care (even as our governor pretends otherwise), insurance companies must cover gender affirming care for trans patients people. Currently, some affirming procedures (especially cosmetic procedures) are not covered for cis patients people.
As you might imagine, we are currently moving in the wrong direction. The Trump administration has proposed a rule that would prevent insurance plans offered on Affordable Care Act (ACA) exchanges from covering “sex trait modifications.” This is a clear attempt to prevent trans people who buy health insurance from ACA exchanges2 from seeking transition-related medical care. Yet, the rule is so broad that cis people seeking “sex trait modifications” will be ensnared by the red tape.
(If you happen to be reading this on or before April 11, 2025, you can submit a comment to the Federal Register urging the administration to ditch this rule.)
Now may seem like an odd time to be envisioning the ideal society given the acute attacks launched at us in the present. Eventually, this moment of social destruction will pass, and we will need to rebuild. At that time, we need to decide: What are (re)building? Will we recreate the same structures that let us down in the first place? Or, will we institute something new and improved such that everyone’s basic dignity will be respected?
If we choose the latter, we must make larger changes than just those outlined above. But I believe these changes are valuable as they influence how we collectively value sex trait modifications, gender affirming care, or whatever other term you want to use to describe these procedures. Everyone deserves to feel at home in their own body.
from the archives
Personally, I fall into this group. Although, I have habit of painting my own nails and letting the polish slowly chip off.
It is worth noting that folx buying plans on the ACA exchanges are not receiving health insurance as a worker benefit. Such jobs also tend to pay less. These folx are among the most vulnerable within the trans community.
Great essay. That cis people are engaged in all kinds of gender-affirming care is not how I had thought about it before but it's totally obvious now that you've pointed it out like this, and I won't be able to unsee it. Thank you! I will be working these ideas into casual conversation.
YOU ABSOLUTELY NAILED THIS OMG