Genetic determinism (GD) functions as a limiting factor to transgender and nonbinary (trans) people’s healthcare and has been used as justification for eugenic practices, including sterilization and experimental medical treatments. GD is a dominant framework in public health that irresponsibly uses DNA as the “blueprint of life” and reinforces the idea that genomic information serves as the “objective truth” in determining an individual’s identity. The translation of GD into public policy poses an inherent risk to trans people by creating additional pathways for oppression and a narrow lens of the trans experience. Using the Movement Advancement Project as a foundation to characterize the policy environment, we conducted a discourse analysis of US state-level policies regarding legal gender marker changes on identification documents (IDs). We identified how GD was used to perpetuate eugenic practices and restrict trans rights. A large portion of states require individuals receive a surgical procedure (“sex reassignment surgery”), genetic testing, or “appropriate medical treatment” as certified by a “licensed medical provider” prior to changing IDs. Eight states discuss the relevance of genetics and biology in defining sex; however, definitions of sex are inconsistently used in policies and courts across the US as they apply to defining one’s gender in legal identification. Further, policies that prescribe the ultimate authority to providers fundamentally strip trans people of their autonomy. These policies facilitate systematic discrimination against trans people in legal and medical contexts, limiting access to health services based on incongruence between genotype and phenotypic characteristics and fueling eugenic practices.
Authors: Emerson Dusic, University of Washington School of Public Health; Helene Starks, University of Washington; Arjee Restar, University of Washington School of Public Health
