Well, to start, let me explain what transmedicalism is.

Transmedicalism is, in a more sophisticated context, defined by the notion that transgender identity should be treated as a pathological concern or a medical issue.

Usually, what this manifests as is the belief that aspects of being trans that are considered more medical in nature, such as physical gender dysphoria and medical, hormonal, and surgical gender transition should be considered crucial to being trans. Transmedicalists carry the belief that transgender people who do not meet this medical criteria cannot be considered to be "legitimately" transgender and often hold their convictions under the idea that people who don't meet this criteria "make 'normal' trans people look like a joke".

In simple terms, transmedicalists, often shortened to "transmeds" or derogatorily nicknamed "truscum" (though many of them have reclaimed this term) believe that, often in their own words, that gender dysphoria and/or medical transition serves as a requirement for being a valid transgender person.

Now, there are a whole range of caveats and additional points to mention:

• 1. Transmedicalists often strongly cite neurological arguments as the best way to explain the "cause" of one being transgender, meaning that, in essence, they hold the belief that a trans woman, for example, possesses a "woman's brain but in a man's body" and vice versa for trans men.
• 2. Transmedicalists often are highly exclusionary and discriminatory towards non-binary people, often making the argument that they are not valid in labeling themselves as trans people. However, not all transmedicalists hold strictly enbyphobic views, but the ones who do "include" non-binary people are very conditional about how they go about their "acceptance", just as they are with binary trans people.
• 3. Transmedicalists sometimes have disagreements over how much one needs to transition in order to be considered adequately trans. For instance, some would say that trans people who do not want gender reassignment surgery (such as vaginoplasty for trans women and phalloplasty for trans men) are not to be considered "acceptable" trans people regardless of how much otherwise they did to transition. Some transmedicalists say that non-op trans people, however, are valid as trans people.
• 4. Transmedicalists tend to display vitriol towards GNC trans people, even if they are binary, such as butch trans women and effeminate trans men.
• 5. Transmedicalism serves as a form of respectability politics (beautifully done video essay by Caelan Conrad on this subject matter as a whole), which is a conscious effort they give to have trans people assimilate into the most acceptable way a trans person can be in the lens of a cisheteronormative society.
• 6. Transmedicalists have a tendency to say that the definition I gave where I started with "In simple terms..." is all they truly have in common as transmedicalists, but this is highly misleading as many of them, for example, are still grossly opposed to non-binary people, even the ones who do have dysphoria and medically transition.

There are more things I can mention really. They're a whole bunch of "interesting" people, but to provide a counterpoint to each bullet:

• 1. The neurological arguments they cite are not as set in stone as they think they are. There is no set "definitive male brain" or set "definitive female brain". There are commonly overlapping patterns within brain structure related to gender sometimes, but there is no inherent, one-size-fits-all way to have a male brain or a female brain. This scholarly review covers the subject in much broader detail. The differences in brain structure tend to be marginal and not absolute, and this neuroessentialist take is about as sensible as saying "5 feet, 10 inches is the definitive male height and 5 feet, 4 inches is the definitive female height.".
• 2. Most enbyphobic transmedicalists recycle the typical conservative Christian transphobe's arguments you'd hear against trans people in general. It's not shocking for transmedicalists to say things like "They're just doing it for attention!", "They're being influenced by ideology!", and other arbitrary statements that your average transphobe could just as easily supply in an attempt to invalidate the transmedicalists who say these things. There is no sound argument they can supply for why they are valid as binary trans people but non-binary people are not valid simultaneously. It's effectively trying to have your cake and eat it too.
• 3. This proves how arbitrary transmedicalists setting their criteria can be, and I think that's what a lot of them do not realize. It's a very semantic concern that hinges on defining the term "transgender" in a certain way, but it really is wholly inaccurate on how said definition can relate to material experiences with gender. Transmedicalists do not realize that words are defined by how we use them, and their very niche and deliberately exclusionary definition of the term "transgender" is not commonly supported by any major LGBTQ+ advocacy group, medical/scientific/psychological organization, casual or colloquial usage, or even commonplace dictionaries.
• 4. This one's ironic and contradictory on their part because transmedicalists often strive to state that gender identity should relate to physical concerns with dysphoria rather than social gender roles, often being the quickest to say that non-binary people who socially transition but do not medically transition are better described as "gender-nonconforming cis people" rather than trans people.
• 5. All people who deviate from their sex assigned at birth are existing in a state that contradicts cisheteronormative structures. Trying to reinforce them under the notion that one can be validly trans, but only in a context that cishet people accept is inherently contradictory and entails a lot of cognitive dissonance. The Gender Accelerationist Manifesto by Eme Flores and Vikky Storm talks about this in greater detail.
• 6. Their definition, even if taken at face value, has no reason to be rooted in truth. For instance, some trans people transition due to them not necessarily experiencing discontent with their assigned sex at birth, but rather, because they'd be happier with living as a different gender regardless. This is known as undergoing transition on the basis of gender euphoria (book by Laura Kate Dale which focuses more on euphoria to contrast the common trend of focusing explicitly on dysphoria within trans discourse) as opposed to dysphoria. Some truscum also grasp at straws and will make needlessly pointless semantic attempts at justifying their flawed claims by saying things like "Wanting to transition because of gender euphoria is a form of gender dysphoria!" which is very weak on their part because euphoria, in terms of literal definition and the way it is being materially interpreted in this context, doesn't have to entail distress or suffering, and it's possible for one to not hold negative feelings about their assigned sex while still holding positive feelings about their identified gender. It's similar to how someone can be happy with having short hair but still like having long hair better. Not to forget, if you try to justify transmedicalism by pathetically dubbing every form of gender incongruence as a form of gender dysphoria, you are effectively rendering it redundant and materially ineffective to argue, and there's no reason to identify with it as an ideology at all at that point.

There is so much I can say about this subject matter. I'm non-binary, and I'm transgender, period. I've been hurt by transmedicalism a ton unfortunately. I have gender dysphoria, and I am medically transitioning through things like hormones and surgeries, but despite that, transmedicalists still wish to devote so much time to invalidating me and taking me as the enemy. Transmedicalists have used no true Scotsman arguments against me (i.e. "You're non-binary and dysphoric? This means you're either lying about being non-binary or lying about being dysphoric!"), and some have done goalpost movements (i.e. "You're non-binary and dysphoric? Well, fuck, I guess I gotta change the criteria for being trans, knowing that the ones I tend to endorse are still capable of validating enbies!").

Transmedicalism tries to manipulate a concept as uncertain, intricate, varied, and personal in nature as gender identity and condense it down to one sole way it is "allowed" to manifest, and it's no coincidence that truscum just so happen to do so by supporting an idea of trans people that might do the best job at convincing cis people that we're not "icky", and even then, not really. Like I said, it's a form of respectability politics.

Transmedicalism is a form of niche and terminally online discourse, so you're not going to find a lot of formal writings deconstructing it, but thankfully, a non-binary YouTuber named Milo Stewart constructed a playlist that covers the best video essays tackling this problem in extensive detail.

Have this one as a bonus. It is honestly the best takedown of transmedicalism I've seen so far.

This subject, unfortunately, is one that I have analyzed far more thoughtfully than I should have to because, considerably, transmedicalism shouldn't even exist to begin with. It's ridiculously flawed and illogical, but being trans doesn't make you immune to shortcomings like wrongness I guess.

In short, it's the fallacy that you're not trans unless you transition medically and socially and that those things should match. But this is bullshit because it privileges binary genders and requires that you choose one of a narrow set of configurations for your body/social gender when in reality you should just do things with your body and social transition that make you happy.