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Judith Butler: Gender Trouble (1990)

In Gender Trouble (1990), Judith Butler wrote that there is no gender identity behind the expressions of gender: according to her, that identity is performatively constituted by the acts themselves. It is philosophy, not an empirical discovery, and therefore no basis for medical decisions about children. For those decisions the evidence counts, and according to the Cass Review that evidence is weak.

Gender Trouble (1990): performativity

Butler's claim is that gender is an effect of repeated social acts, not an inner core. She uses the terminology of J.L. Austin's speech act theory (source) and discusses, among others, Michel Foucault. In the book, as an application of a sentence by Nietzsche about the "doer" and the "deed", she writes: "There is no gender identity behind the expressions of gender; that identity is performatively constituted by the very 'expressions' that are said to be its results" (source). See also performative speech act.

Logical tension with the activism that claims her

Critics point to a tension in contemporary activism: some refer to Butler (gender is a social construct), others assume an inner gender identity. These two positions are logically hard to reconcile: either gender is a social act, or it is an inner core. See essentialism versus constructionism.

Butler on performativity after 1990

In Undoing Gender (2004), Butler revisits and refines her notion of performativity, in reflections on gender, sexuality and the medical treatment of intersex people (source).

Philosophy and medical evidence

Butler's work is philosophy in a continental-philosophical idiom. It is not meant as an empirical theory and yields no testable predictions — see unfalsifiable. Medical practice is judged on evidence. The Cass Review (2024) calls the care for young people with gender dysphoria "an area of remarkably weak evidence" (source). The Swedish SBU (2022) found the evidence insufficient to assess the effects of puberty blockers and hormones on gender dysphoria and psychosocial well-being (source), the NICE reviews (2020) rated all outcomes as very low certainty (source), and according to the Cass Review the Finnish guideline (2020) advocates extreme caution with puberty blockers for under-18s (source).

The debate

Kathleen Stock, a philosopher at the University of Sussex, resigned in October 2021 after a controversy over her views on gender identity (source). Dhejne et al. (2011), a Swedish register study of 324 adults who underwent sex reassignment surgery between 1973 and 2003, found an adjusted hazard ratio of 19.1 for death by suicide compared with controls; the authors conclude that sex reassignment may alleviate gender dysphoria but may not suffice as treatment (source). The study did not involve minors. See also detransition research.

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