Our capitalist society starts socializing and training every person very early in life to be consumers, to be obedient, to be productive men and women in our society.  Men and women, this is the first thing that they teach us, the first restriction on our personal freedom.  The moment a child is born the declaration on their sex and subsequently their gender is proclaimed by a doctor who has been trained to see only boys and girls and to see them as different.  This doctor takes one look at the genitals of the baby and subscribes a set of characteristics on them.  The development of this false male/female dichotomy starts to be developed with in seconds of birth.  People in our society have been socialized into believing in this dichotomy and ultimately needed to relate to other persons based on this false dichotomy, as a result the parents, family and friends from that first moment of declaration start treating the child differently.  

If this child is special enough to have been born with genitals that aren't as clearly defined as the medical community would like, often lies are told to reassure the parents that they have a 'normal' boy or girl and that the medical community just needs to do a little reconstruction to make their baby healthy.  In other words babies genitals are cut so they fit into the false binary sex system.  Size seems to matter right from the first moment, if a baby 'girls' clit is too large, ie over .5 inches, this is apparently socially unhealthy.  So instead of allowing this child to grow up with an 'enlarged' clit, the doctors cut it off.  They cut these children everyday in the western world, causing many people to lose all sensation from sexual organs.  Now if there is a baby 'boy' who's penis is too small, ie less then 1.5 inches, well this is a problem too.  That would destroy his masculinity, so emergency procedures take place, sometimes they give him hormones, sometimes they give him enlargement surgery but most of the time, they cut it off and make him into a girl.  

The cutting and creation of vaginas in these babies is done with the assumption that there are only two sexes, two genders and those have to be in sync.  It comes with the assumption that a male must have a large enough penis to penetrate a women and that a women has a large enough vagina to be penetrated by an average size penis.  Not to mention that her clit should not get in the way of this heterosexual missionary sexual intercourse, let alone challenge some males masculinity with a size war.

These surgeries are done to maintain the heteronormative structures we are all socialized in.  They are seen as successful when the children grow up to have 'healthy' heterosexual relationships that result in marriage.  They are seen as medically necessary so children don't suffer abuse in the locker room from the other children who are socialized into believing these false binary structures.  The child's relation to their own body is irrelevant, just is their future sexual pleasure, the only consideration in terms of their sex lives is the hope that they can have 'normal' heterosexual sex.

This form of child abuse and genital mutilation occurs everyday in the western world.  Since the concept of a male/female gender is central to our society's traditions then it is ok.  In countries like the states where they have male FGM illegal they still allow these operations to happen since they are seen as medically necessary.  In other words the African procedure is barbaric, ours is necessary.

Now the contradiction in how the medical community deals with people later in life who wants to transition is ironic.  At birth without consent the medical community makes the choice to cut bodies and construct the sexed body.  Yet latter in life if you want to do this yourself, well you must be crazy.  Literally.  In order to get coverage to pay for sex change operations you first must declare that you have a disorder, that you have a mental malfunction, that you have gender dysphoria.  This is a mental health condition for someone who wants to be a sex other then the one that years earlier a doctor declared by looking at their genitals.  

The entire system of challenges one has to go through in order to have operations on their breast or genitals in order to change their gender are based on the same lies of binary systems and the heteronormative structure.  If you are a 'man' and want to become a 'women' you have to live your life as a women, which in the eyes of the medical community is high feminine.  No jeans and t-shirts and short hair for you, you best be pulling out those heals, handbags, learn how to wear make-up, perhaps get a job in the care profession.  Not that anyone who does something as 'radical' as a gender operation would ever be allowed to be near children.  And if you are transitioning into a male, you better start talking and watching sport and perhaps get a job in manual labor; you must be a man's man.  This 'real life' test maintains an oppressive connection between sex and gender and reinforces a false opposition between genders.  Not that there is anything wrong with a feminine women or a masculine man, as long as they are given the choice how they want to express and perform their gender


Now if you wanted to live in between these strict structures - no luck on getting that covered.  You don't make sense even with in the gender dysphoria team of medical practitioners.  Even people who deal with changing people's sex for a living can only do so from one to the 'opposite'.  There is nothing in between.  There are only polar opposites and the medical community after destroying your sense of self and autonomy will only work within these structures.  They are in the business of maintaining the heteronormative structures.  In our society you can be a woman and get breast enlargement or breast reduction.  But is you want to remove your breast, well you better start acting and looking like a man.  You can't be women without breasts, or a man with them.  Transgender activist like Leslie Fienberg and Kate Bernstein live their lives in-between these categories as do many people.  They work to challenge the essentialist ideas of sex and gender that are prevalent in our society and medical community.  

Although the debates are not clear, it is clear that patholagizing this group of people is very destructive.  Some see this pathology as their only way to have such an expensive operation covered and attempt to dissociate themselves from the structure.  On the other hand not everyone has the access to alternative theories and knowledge's of gender and trans liberation.  Leaving people not to be able to choice their performance of gender under their own terms but rather under the terms of a structure that sees them as deviant, .  The result of the medicalisation of trans people results in high levels of suicide.  

With the internet more people have access to alternative ideas which can help them maintain dignity through this highly controlled and humiliating categorization.   

It is important not to conflate the two issues of intersex and transgenderism.  These are two very separate issues, one that can be seen as a child abuse issue and the second of freedom of choice.  Yet both issues demonstrate how our society depends so strongly on these false categories of sex and gender and how our society's institutions are in the business of maintaining heteronormativity that doctors with the backing of the government are willing to mutilate babies and pathologize individuals who want to live outside the norms.  

If we are to have true gender liberation, we cannot concentrate only on creating equal society for both men and women, we have to include space to challenge the categories of men and women all together.  This may be one of the most difficult things to unlearn since from our first breaths we are socialized and encouraged to maintain these structures.  On our paths to living in a free society we must attempt to have complete freedom, which includes over our bodies, genders and sexuality.