Stani Bjegunac lays out the ways a planned economy could contribute to the project of transgender liberation, focusing on the issues of bathrooms and medical transition. Reading: Marina.

A party at the Institute for Sexual Science, one of the pioneers in medical research on transgender issues.

The end of the patriarchal family and gendered division of labor, which involves reorganizing reproductive labor on a completely new basis, including child-rearing, is an important socialist objective. It is an integral part of doing away with gendered oppression in general, taking aim at its material root. This is what it means to “abolish gender,” which is not so much “abolished” — gone in one stroke — as transitioned out of, much like how the state which begins with the dictatorship of the proletariat withers away.

For this reason, giving people the means to liberate themselves as individuals from the family unit, thereby undermining its social importance, is a key measure in facilitating this transition out of gender. If a child could freely choose to emancipate themselves from their parents and live in public housing while still being able to have their health, educational, nutritional and psycho-social needs met, they could also free themselves from an abusive situation. This would also massively help gender non-conforming and trans youth who often find themselves limited by their family who refuses to accept their “gender non-conforming” behavior and their demand to transition. The CPGB (PCC) already has this provision for independent youth living as part of their program of “immediate demands” (effectively their minimum program).¹

Housing, nourishment, education, etc., are universal needs that socialist planning will have to provide to everyone. This alone will help those suffering the worst aspects of the gender system. But what about uniquely transgender needs like Hormone Replacement Therapy (HRT) and sex-reassignment surgeries? Furthermore, how do we go about implementing transgender activists’ demand to have access to inclusive gender-neutral bathrooms in a world where sex-segregated bathrooms are the norm? Wouldn’t socialist planning just be a bland “bread and butter” provision of universal basic needs without taking into account diverse people? On the contrary, socialist planning can help to provide for these diverse and minority needs. The purpose of this text is to sketch out some ideas on how this could be done.

Gender-Neutral Bathrooms

There are various ways of implementing gender-neutral bathrooms in different facilities, including individual single-occupant bathrooms without a gender marker, a third, gender-neutral facility next to existing male and female ones, or a regular restroom with both stalls and urinals and no gender marker on it. The latter is common in Seoul, Korea (but these are really an adaptation to space constraints in a bustling city).

Unfortunately, in recent years, transgender people using existing male or female bathrooms according to whichever they think suits them best has been the basis of a reactionary moral panic that claims transgender people are perverts and sexual predators, despite a complete lack of empirical evidence for these claims.² In absurd moments it is precisely these conservative vigilantes who have been revealed as the real creeps as they police who can and cannot use gendered bathrooms.³ These reactionaries have been joined by so-called “radical feminists” who cannot see the irony in defending one of the last legally accepted bastions of sex-based segregation (at least in the advanced liberal capitalist countries) in the interest of preserving the safety of “women,” which they always define as those with child-bearing reproductive parts against the transfeminine Other.

It is not enough for the socialist left to remain on the defensive and simply dismiss conservative moral panics as absurd and untrue. We must propose our positive vision for socialist bathrooms, and, if we believe in the overcoming of gender, assert that accessible and safe gender-neutral bathrooms are the inevitable result of our maximum program. One article in Jacobin serves as a good example. But how does a dictatorship of the proletariat, after taking power, seizing the commanding heights of the economy, and subjecting them to basic measures of economic planning, spread gender-neutral public bathrooms around the world?

Proposals

The first step is to take stock of the current situation. A widespread project of data collection needs to be undertaken on existing washrooms, both distinct public facilities as well as those within major buildings (e.g. hotels, apartment complexes, libraries, airports, stadiums, train stations). This spatially-referenced data will be collected, managed, viewed, analysed and acted on with the help of Geographic Information Systems (GIS).⁴ Obviously the scale and detail of such a program will be unprecedented, but it is possible with the technology we have (smartphones with satellite positioning chips, GIS, internet, etc.) and it is not hard to teach large numbers of people to use a web-enabled app on their smartphone to capture photos and map these things as they go about their daily lives. People worry about phone-gazing unemployed youth having nothing to do; why not recruit them into a labor army of mappers?

Each public toilet facility will have its own Building Information Model (BIM).⁵ With a BIM of each public toilet, the facility can be broken down into parts: electrical components, plumbing, structure, etc. A user of the integrated GIS-BIM software interface should be able to disaggregate the facility to the point of individual construction materials: e.g. this bathroom contains x number of tiles, y number of bricks, z number of doors. This helps make the decision of whether to modify buildings in some way or to just knock it down and start again based on what is most efficient. The intermediate result is a design of the new form, which is proposed as a new BIM, embodying functional principles of design allowing for equal inclusive access, safety and combining it with privacy and “public luxury.”⁶

These BIM-facilitated decisions will generate the proposed inputs (e.g. number of bricks, timber, tiles) these constructions/reconstructions require. These inputs then become goals for the larger social plan to produce. Just as a building can be disaggregated into its components (bricks, mortar, timber, pipe), these components can also be disaggregated (e.g. the concrete is made of x amount of aggregate, y amount of fly ash …) and planned for. The overall economic plan will work on a principle of nestedness: aggregation and disaggregation, simply because the production of any physical product of human labor requires given quantities of other items which themselves are made up of given quantities of other items, and so on.⁷ Once it is known what is needed, targets will be set and then met through production. Those who doubt that socialist calculation can make rational decisions should actually see engineers at work calculating all the materials required to produce and scheduling the duration of a new apartment building. Yes, the goods are bought on the market, but the quantities purchased are planned beforehand without which the budgeting to achieve a final projected cost and obtaining project finance is impossible!

Aesthetic inputs can be incorporated into design after the initial BIM decision. Local councils can commission artists and architects for the best-looking designs. The design process can go through multiple iterations before the local council or a popular vote approves it.⁸ With that completed, all the required inputs are submitted to a computer system governing the larger economic plan so that overall production targets can be set and worked on. We deserve not only functional gender-neutral bathrooms but aesthetically pleasing and luxurious spaces balanced with safety, privacy, and accessibility.

Medical transition

How markets fail

Artificial sex hormones and drugs are produced by pharmaceutical companies for a range of reasons, the most significant use being contraceptive drugs for cis women and HRT to manage health problems associated with menopause. Depending on medical needs, either female sex hormones or testosterone are used by people with certain intersex conditions or health issues associated with the endocrine system. The use of sex hormones and sex-altering drugs for transgender people is quantitatively insignificant compared to the sum of all other uses, and therefore represent a tiny portion of the pharmaceutical hormonal market. The hormone market is not fundamentally made for a tiny minority of the population, as exemplified by estradiol pills, which are often prescribed to trans women and to cis women, despite injectable estrogen being more effective for trans HRT. A consequence of this in 2016–17 was that an injectable estrogen shortage forced trans women to go onto less effective HRT regimens.⁹

The general situation of poverty, social exclusion, and repressive family environments that transgender people face restricts access to HRT and surgery, even if they are made available for free by a public healthcare system. Trans liberation is inseparable from the problem of the family as a social reproductive unit. Furthermore, arbitrary gatekeeping by medical professionals often determines which transgender people are “genuine” enough to be deserving of transition-related healthcare.

The market fundamentally does not work well for HRT provision due to these factors. If we take as true the premise that markets self-regulate due to supply and demand, we will see a glaring failure in regards to HRT. Demand is not need, but instead is need with the ability to pay for it. As far as a pharmaceutical company’s sales data and “price-signals” are concerned, a transgender person who is too poor to afford HRT does not even exist. Furthermore, due to being available only by prescription, the gatekeeping of medical professionals effectively excludes from the market even those transgender people with enough money to afford treatment. The result is that many transgender people turn to DIY HRT, buying hormones from overseas suppliers and online pharmacies, and occasionally using birth control pills as a poor, ersatz HRT. Of course, problems then arise around the management of quality and doses. An effective and safe HRT regime requires monitoring of blood samples for hormone levels and effects on the organs. Forcing trans women to use potentially unsafe DIY methods is an indictment on the current system of HRT distribution. However, the Gender Identity Clinics (GICs) in the UK, which operate under the NHS, shows that even state-run public health systems are not a panacea. There the GICs act as strict gatekeepers to trans healthcare. Centrally planned oppression is no less bad than the impersonal oppression of the market.

HRT is relatively accessible, however, compared to expensive sex-reassignment surgeries which are rarely covered by private health insurance. Furthermore, there are relatively few doctors with the skills to perform these surgeries. With this level of monopoly, it is not surprising that, without insurance coverage, the price of sex-reassignment surgery is so high. Even if money were no object, the lack of surgeons creates long queues for surgery and carries with it the risk of the expertise not being adequately passed on to the next generation of surgeons.

Proposals

Given the above, the following proposals can be seen as a “minimum program” for trans liberation:

The immediate state-confiscation of the commanding heights of the economy by the dictatorship of the proletariat, including the chemical and pharmaceutical industries. This is the precondition for the provision of hormone therapy according to need and the base on which the following proposals rest.
The removal of the health insurance industry and the instituting of free universal healthcare.
Immediate end to all gatekeeping practices. Practitioners who continue to do this are to be blacklisted from medical practice. Anyone who wants HRT can have it; all that is required is to ask for a prescription, then the necessary tests can be conducted.
The direction of more resources into research and development of better products and practices for transgender health. From this, the creation and updating of international standards of trans healthcare. Transgender people are vastly under-researched in medical science.
A society-wide medical database which collects everyone’s medical records in a secure matter sensitive to individual privacy. Aside from being important to a modern health system it would help gather statistics required to plan the production of HRT products. People could privately indicate wanting HRT on their own record and this data will make its way into the production plan for estrogen, testosterone, progesterone, etc. However, while this works for rough aggregate estimates, there is the issue of specific dosages and forms of administration (e.g. testosterone can be provided in gel form or as an intramuscular injection).
- To deal with this, prescriptions written by medical practitioners will be electronically recorded in that person’s medical record. This more detailed data will inform the specific production plans.
- To deal with the obvious fact that people’s hormonal dosages vary, the production plan numbers are based on what the average dosages are for each respective form of the hormones or drugs. These averages can easily be calculated from what quantities are typically prescribed as this data is already recorded in the database.
For more specific logistical issues, the medical records will record the approximate geographic location of someone’s residence and thus the specific production plans and distribution for different regions can also be calculated.
The dictatorship of the proletariat must break the power of the guilds of medical practitioners, effectively stripping them of their petit-bourgeois privileges and reducing the artificial scarcity of doctors which they enforce through the establishment of high barriers to entry. This is, of course, inseparable from the transformation of higher education, including making it free for all.
Programs will be established to spread the knowledge of these highly specialized medical procedures to the rest of the surgical profession through publishing literature as well as training general surgeons to acquire these specialized skills.
The creation of representative bodies for patients to communicate with medical professionals. This would facilitate innovation in addressing trans healthcare by making it a more bi-lateral affair between patients and professionals. For example, we have already seen some trans people taking the initiative to ask for non-standard genital reconstruction surgeries.¹⁰ This would also, in the long run, assist in the transition of non-binary people who desire transition healthcare and procedures that are currently experimental or have not yet been developed.¹¹

Conclusion

The end-goal of the implementation of the above measures, along with broader social measures to decenter the family unit, is to open up the Pandora’s Box of gender in which transgender liberation is integral to the tearing down of patriarchy. As can be inferred from some of the proposals, this is not just a matter of pure planning but of class struggle (e.g. breaking the guilds of doctors, seizing the chemical industry), which continues on a qualitatively different level under a dictatorship of the proletariat. For the here-and-now, in other words for immediate demands, some of these proposals may guide what reforms we can fight for (e.g. to put pressure on medical institutions to end gatekeeping), but without this larger perspective and a revolutionary movement to fight for it, such reforms may be short-lived. We live in a strange world where attitudes towards transgender people have generally improved while simultaneously a consistent “ratchet to the right” has taken place in the political realm (e.g. Trump, Brexit).¹²

Some may wonder if transition-related healthcare will be needed once gender is abolished. After all, what meaning will gender dysphoria have when there is no gender to live in reference to? A person born with a penis will not be “male” and a person born with a vagina will not be “female”, and there will be, according to this view, no need to change one’s anatomy. It is hard to tell what people of the future will do, but this line of reasoning asserts some simplistic assumptions. It sees transition as a reaction to a negative state, similar to the way that food resolves hunger, which is an experience of pain, of lack — it almost accepts the same limiting perspective of the trans-medicalists who see gender dysphoria as necessary to be a “real transgender” and see only binary transgender people as valid. But what about a positive motivation, a simple desire to transform one’s body to how one wants it to be, unbound by gendered restrictions? There is already a tendency toward loosening patriarchal bonds, allowing more possibilities to be gender-non-conforming. If we take this to its logical conclusion, we may one day live in a world where it is normal to change one’s sexual characteristics like the sliders on a character creation screen in a computer game and have bodies as polymorphous as our desires: to have transsexuality without gender. Far from wanting a world of bland universal androgyny, we should say: let a hundred sexes bloom.¹³

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“Provision of housing/hostels for youth to enter of their own choice for longer or shorter periods when they lose their parents or choose to leave them.”
https://cpgb.org.uk/pages/programme/3-immediate-demands/
Hasenbush, A., Flores, A.R., Herman, J.L., ‘Gender Identity Nondiscrimination Laws in Public Accommodations: a Review of Evidence Regarding Safety and Privacy in Public Restrooms, Locker Rooms, and Changing Rooms’, Sexuality Research and Social Policy, March 2019, Volume 16, Issue 1, pp 70–83 https://link.springer.com/article/10.1007%2Fs13178-018-0335-z
Trump Supporter Broadcasts Live as She Chases Trans Woman Out of Bathroom’, The Advocate, https://www.advocate.com/transgender/2018/5/17/trump-supporter-broadcasts-live-she-chases-trans-woman-out-bathroom
There is already an Australian website that has a map aids that people in finding the nearest toilet. https://toiletmap.gov.au/
BIM refers to the use of 3-dimensional computer models of buildings to manage building systems (structural, electrical, water, HVAC and so on) through each step of their lifespan: concept, design, preparation, construction, maintenance, use and demolition. These are essentially a combination of Computer Aided Drawing (CAD) and computer databases. BIM also refers to such individual models of the buildings themselves. In the current day, BIM is widely used by engineers, architects and technicians for the creation of new buildings. Source: Eastman, C., Sacks, R., Teicholz, P., & Liston, K. ‘BIM handbook’ (1st ed.). (2013).
Lancaster, Roger, ‘Imagining the Socialist Bathroom’ (2016)
This principle of nestedness is even expressed in video games like Factorio where ingenious players have programmed apps to help them plan how to produce a given quantity of goods per minute. See the following links: https://kirkmcdonald.github.io/calc.html, https://doomeer.com/factorio/
One humourous example of what a poll can produce is naming of a polar research vessel, Boaty McBoatface. https://www.theguardian.com/environment/2016/apr/17/boaty-mcboatface-wins-poll-to-name-polar-research-vessel
https://www.them.us/story/estrogen-shortage-estradiol-valerate; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908424/
Two examples: Molten, Megan, ‘A Patient Gets the New Transgender Surgery She Helped Invent’https://www.wired.com/story/a-patient-gets-the-new-transgender-surgery-she-helped-invent/ Androgynoplasty, ‘I am recovering from a non-standard vaginoplasty: I kept my penis.’ https://www.reddit.com/r/asktransgender/comments/9csb92/i_am_recovering_from_a_nonstandard_vaginoplasty_i/
An example is the desire of certain people who are assigned male at birth (AMAB) to have feminised features while still retaining a flat chest . The drug raloxifene which is used to block estrogen reception in breast tissue might be useful in this regard but it is as of yet experimental so people do this at their own risk. See link: https://madgenderscience.miraheze.org/wiki/Experimental_non-binary_HRT
https://www.transadvocate.com/sorry-haters-americans-increasingly-support-trans-people_n_29107.htm
See The Xenofeminist Manifesto: https://www.laboriacuboniks.net/