Reconceiving the body: A surgical genealogy of trans-therapeutics

In this essay I contrast two models of trans- therapeutics – one focused on the sex-changing efficacy of genital surgery and the other on the sex-changing efficacy of facial feminisation surgery (FFS) – to attend to how conceptualisations of ‘sex’ and ‘gender’ are employed in the design and assessment of trans- surgical practices. I argue that as ideas shift about what kind of things sex and gender are, so do the interventions required to ‘change’ them. Using the case of facial feminisation surgery (FFS) I argue that the therapeutic logics of trans- medicine are proliferating as claims to the nature of sex include not only individual and genital-centric models, but also a growing engagement with performative models that locate sex not in the body of individual people, but in the forms of recognition that that body produces. Foregrounding the narratives of patients who undergo FFS and the surgeons who perform their operations, I argue that FFS is emblematic of a changing landscape of trans- medicine in America, one that is moving away from a myopic focus on genitalia as the location of bodily sex, and towards an understanding of sex as a product of social recognition.