Two major perspectives marked the sexological debate on diagnosing trans-sexuality in the 1990s and early 2000s. One strand of the debate, usually rep-resented by psycho-medical professionals, claimed that establishing a case of transsexuality necessarily required medical attendance, whereas the other, mostly cis and trans social scientists and legal experts, leaned towards trans self-determination.44
Defenders of the psychiatric or psychological surveillance of a transition presented several arguments to legitimate their claim. Langer (1995: 265) and Bosinski (2003: 715 f.) argued that the desire for a transition could function as a model solution for various problems with a person’s identity or gender identity.
Therefore, the severity of the desire for sex reassignment and the self-diagnosis alone were not reliable indicators for diagnosing transsexuality.
Moreover, Beier, Bosinski and Loewit suggested that it was a contradiction to on the one hand expect of physicians not to intervene into aspects related to the identity and on the other hand to demand of them significant and irre-versible medical and/or surgical interventions. They argued that such
interven-42 | With regard to the debate on the German Standards in the 1990s and the first decade of the 21st century, these are Augstein, Hirschauer, Lindemann, Kaltenmark, Kasimir, Rauner and de Silva.
43 | The most prominent voices from the medical and psychological communities on diagnosing and assessing trans individuals in the 1990s and the first decade of the 21st century were Langer, Hartmann, Becker, Beier, Bosinski, Clement, Eicher, Hartmann, Kockott, Langer, Pfäfflin, Rauchfleisch, Senf, Seikowski and Sigusch.
44 | However, the contributions of the latter barely influenced the clinical perspective at the time.
tions required a high degree of responsibility, the diagnosis of a disease and a scientifically based medical indication (Beier/Bosinski/Loewit 2005: 378).
Sexologists that followed this line of argument also brought forward prag-matic reasons. Bosinski advised physicians to adhere to the diagnostic route outlined in the German Standards in order to avoid adverse legal consequenc-es. He argued that in the case a patient regretted surgery and sued the surgeon, the latter would be held responsible in the event of insufficiently indicated sex reassignment surgery.
Finally, Beier, Bosinski and Loewit proposed that if a ›transsexual gender identity disorder‹ was no longer considered a disease and a person’s freely cho-sen and self-determined expression of self instead, there was no reason for the community of individuals covered by health insurances to pay for sex reassign-ment surgery. As a result, trans individuals would be asked to pay for such interventions, an outcome Beier, Bosinski and Loewit considered undesirable (Beier/Bosinski/Loewit 2005: 368).
Proponents of the concept of self-determination argued that any decision on behalf of a person’s life contravenes a person’s right to self-determination and human dignity. Kaltenmark, Kasimir and Rauner (1998: 266), Lindemann (1997: 329), and Hirschauer (1997: 337) suggested respecting a person’s deci-sion to transition from one gender to another as a life decideci-sion.
In contrast to Beier, Bosinski and Loewit’s opinion and referring to abor-tion, Hirschauer (1997: 337) and Lindemann (1997: 329) doubted that major and irreversible medical and surgical interventions necessarily required the status of a disease. They argued that individuals who seek abortions do not ask for a medical intervention based on a disease but due to a personal decision.45 They suggested treating transsexual individuals analogously.
In addition, de Silva questioned whether it was in the light of human dig-nity and the right to the free development of one’s personality appropriate for any person to assess another individuals’ gendered concept of self (de Silva 2005: 269). He suggested placing the responsibility for the decision to live in another gender than the one assigned to the person at the time of birth on the trans individual.
Three distinct perspectives emerged among psycho-medical practitioners on the question of the subjects deemed appropriate to decide upon whether an individual may be considered transsexual or not. One perspective suggested psycho-medical expertise ought to be considered authoritative. Another
pro-45 | Becker countered Hirschauer’s and Lindemann’s analogy of sex reassignment surgery and abortion. She argued that an abortion did not preclude future pregnancies. If an abortion was possible as sterilisation only, she assumed that sexology would be more cautious (Becker 1998: 161).
posed trans and psycho-medical expertise be deemed equal when diagnosing transsexuality. Other practitioners were ambivalent about this issue.
Beier, Bosinski and Loewit argued in favour of psycho-medical practition-ers as the only agents entitled to decide on a case of transsexuality in the last in-stance. As pointed out earlier on, they took it for granted that largely irreversible consequences of a medical and surgical sex reassignment treatment require a secured indication. Moreover, they held that only a psycho-medical expert was able to decide whether a person’s distress could be permanently alleviated with medical and surgical means (Beier/Bosinski/Loewit 2005: 377). Hence, Beier, Bosinski and Loewit considered trans individual’s urge to transition physically secondary.
Seikowski however suggested that transsexual individuals are »unusual pa-tients«. In his critique of the German Standards, he argued that transsexual individuals are specialists on issues regarding transsexuality (Seikowski 1997:
351). According to his observations, trans individuals frequently turn to medical institutions after having gone through an adequate process of self-recognition or self-diagnosis. Hence, a transsexual individual’s self-diagnosis and catego-ries of assessment ought to be accrued equal authority and credibility (ibid). To impose a lengthy process of consultation upon such individuals would simply mean to postpone life in the preferred gender (ibid: 352).
Sigusch’s perspective mirrors the conflicts that arise when wanting to ac-knowledge a person’s right to self-determination while feeling the need to obey clinical rules at the same time. He noted,
I always ask myself how I would deal with such situations, if I were affected myself or persons who are closest to me. If I were transsexual, I would with or without consultation insist on the right to decide by myself whether I want to undergo surgery or not. I would not accept that so-called experts determine how I am supposed to live. As an expert however I got to insist vis-à-vis the transsexual on being able to follow my own profes-sional and non-profesprofes-sional ideas, ideas that refer to all the world and his brother and the art of healing and to clinical experience and rules, too, that I imposed upon myself in order not to without further reflection serve irrational patient desires with disastrous consequences of irreversible manifestation. (Sigusch 1991a: 330)
Hence, Sigusch’s perspective was biased towards clinical authority due to his position as a medical practitioner. In contrast to Beier, Bosinski and Loewit however, he problematised the contradictions and the ethical dilemma that go along with such a stance.46
46 | The different perspectives on the issue of expertise are revealed in the assessment of support groups, too. Pfäfflin and Eicher perceived of trans support groups as extra-medical contestations of psycho-extra-medical expertise. According to Pfäfflin, members of