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This article traces the multiple enactments of sex in clinical practices of transgender medicine to argue against the presumed singularity of 'transexuality'. Using autoethnography to analyse my own experience as a trans patient, I describe my clinical encounters with doctors, psychiatrists and surgeons in order to theorise sex as multiple. Following recent developments in science and technology studies (STS) that advance the work of Judith Butler on sex as performatively reproduced, I use a praxiographic approach to argue that treatment practices produce particular iterations of what sex (and transexuality) 'is' and how these processes limit and foreclose other trans possibilities. I consider the ethical, political and material-discursive implications of treatment practices and offer a series of reflections about the effects and effectiveness of current clinical practices and the possibilities for intervening in such processes in order that, following Annemarie Mol, we might (re)make sex (and transexuality) differently.

This article argues that medicine misunderstands the necessarily complex ways trans people experience sexuality. Despite revisions to treatment guidelines and diagnostic descriptions, transgender medicine continues to be based on a paradigmatic narrative of ‘being born in the wrong body’. This narrative performatively reproduces sex, gender and ‘gender dysphoria’ as static, predetermined and independent of medical encounters. It also constructs trans sexualities as limited by and dependent on gender/genital ‘alignment’, which necessarily neglects many trans people’s sexual lives. By mobilising critiques of singularity from science and technology studies (STS), which emphasise how discourses and practices produce both what is knowable and materially possible, this article explores how medicine understands and constitutes ‘transexuality’ as a singular phenomenon that limits trans sexualities. By analysing contemporary medical guidebooks alongside the foundational text of trans medical treatment – Harry Benjamin’s (1999 [1966]) The Transsexual Phenomenon – I argue that medicine constitutes transexuality and understands trans sexualities via four axioms: 1) Transexuality is a disjuncture between mind and body; 2) Transexuality is hating having the wrong genitals; 3) Transexuality is painful and debilitating; and 4) Transexuality is resolvable with hormonal and surgical body modifications. In so doing, medicine flattens out the complexities of trans people’s experiences of gender and sexuality, and simultaneously disavows many trans people’s sexual lives.

Clinical expectations that trans people will be so filled with self-loathing that sexual interactions will be limited if possible at all fail to take into account the heterogeneous ways trans people experience their own bodies and sexualities. In this essay, I extend recent work in science and technology studies (STS) that attends to material practices by examining the work of narrative and argue for a new paradigm in situating trans sexualities. I analyse trans men's autobiographical stories to show some of the many ways that trans men make sense of themselves (and enact maleness) as sexual subjects. By focusing on how sex-gender is enacted and hangs together in narrative-practices, we can more fully understand and appreciate the realities of trans lives and the inadequacies of clinical diagnosis.