Nonbinary and the limits of gender-affirming medical care: towards gender-negative care

This article critically examines the recognition of nonbinary gender within contemporary gender-affirming medical care (GAMC). Reading the DSM-5-TR diagnosis of Gender Dysphoria alongside the nonbinary chapter in WPATH’s Standards of Care 8, and reflecting on my own experiences accessing GAMC in the Netherlands, I show how institutional recognition risks domesticating nonbinary into a coherent, verifiable gender identity. Drawing on Marquis Bey’s theorization of nonbinary as a refusal of gender’s classificatory logics, I argue that nonbinary fundamentally resists such legibility, revealing a paradox at the heart of a care practice premised on affirmation. In response, I propose a gender-negative approach to care, which shifts the focus from validating a presumed internal gender essence to attending to needs, desires, and possibilities. By centring opacity, ambivalence, and (un)becoming, gender-negative care opens a conceptual space for imagining trans healthcare beyond the gender clinic as we know it.