As a practitioner who specializes in pelvic floor therapy studying East Asian Medicine, with a background in sports medicine-informed care, I often reflect on what our medicine truly offers beyond symptom relief. Can it offer belonging? Can it meet the complexity of gender-diverse bodies—especially those impacted by trauma, transition, performance demands, or erasure?
In my clinical work, I see the ways that identity and embodiment are inseparable from function—how gender expression affects breath, posture, pain patterns, and energetic flow. East Asian Medicine provides a powerful lens for understanding these intersections, but only if we’re willing to challenge the historical biases that have shaped both theory and practice.
Gender Isn’t New — But Erasure Is
“Gender fluidity” may sound modern, but diverse gender expressions have existed across cultures for centuries. What’s recent is the systemic pathologization of these identities.
Up until 2018, the World Health Organization classified trans identities as mental disorders. Even now, the DSM continues to label “gender dysphoria” as a clinical pathology (Douglass, 2020). And as Zena Sharman notes in The Remedy, medical providers often code gender as a non-modifiable risk factor — subtly erasing the experience of trans and nonbinary individuals in clinical care (Sharman, 2016).
Beyond Binary: Rethinking Yin and Yang
Charlotte Furth’s analysis of the Huangdi Neijing reveals two ways ancient Chinese thought approached yin and yang:
- A complementary model — equal, dynamic, interdependent
- A hierarchical model — where yang (male) dominates yin (female) (Wu, 2022)
The problem wasn’t yin and yang — it was how hierarchy replaced harmony.
Much of classical women’s medicine (fuke) was authored by male physicians and rooted in assumptions about reproduction. Yet texts like The Golden Mirror noted that women’s diseases were fundamentally no different from men’s — except when it came to childbirth.
This is a powerful reminder that gendered assumptions in medicine are cultural, not clinical.
The problem wasn’t yin and yang — it was how hierarchy replaced harmony. [Yishan]
Identity Lives in the Dan Tian
Claudia Lumenello reframes gender identity through TCM’s energetic map of the body. She ties gender and sexuality to the Three Dan Tian:
- Upper Dan Tian (Fire/Shen): Gender identity
- Middle Dan Tian (Earth/Qi): Cultural conditioning
- Lower Dan Tian (Water/Jing): Natal sex and embodiment
The repression of gender identity can lead to Shen disturbance, Qi stagnation, and eventually physical illness. In clinical practice, this often shows up as anxiety, fatigue, digestive issues, and chronic pelvic symptoms.
When one layer is suppressed — spirit, culture, or body — the whole system suffers. [Lumenello]
Sports Medicine Meets TCM: Seeing the Whole Athlete
In sports medicine, we focus on function: alignment, mobility, recovery. But when gender identity is not affirmed, movement becomes compensatory and protective rather than powerful.
Examples seen:
- Binding-related rib compression limiting breath and zong qi
- Core/pelvic imbalances in patients tucking or post-surgery
- Chronic pain syndromes from scar adhesions or unresolved dysphoria
- Loss of proprioception due to trauma or dissociation
In east asian medicine terms, this is stagnation of Ren Mai, Dai Mai, and Chong Mai. In sports medicine, we’d call it fascial restriction, loss of breath dynamics, or functional instability.
Emotional invisibility often leads to physical dysfunction — especially in athletes and high performers.【Lumenello, 2020】
Sexuality, Not Just Fertility
TCM has traditionally reduced sexual health to:
- Men: Jing depletion from excessive sex
- Women: Fertility issues, cold womb, liver constraint
But sexuality is more than reproduction. It’s pleasure, connection, and rootedness. Many patients — particularly trans and nonbinary folks — experience dysfunction that goes unrecognized because it doesn’t fit those binaries.
Hormonal therapies, surgical changes, or prolonged dysphoria can all impact fluid metabolism, libido, and the emotional connection to one’s body. If we’re not addressing this, we’re not treating the whole person.
Figures 5 & 6: Ebb and Flow of Yin/Yang in Sexuality
Free-flowing qi supports vitality. Obstruction creates illness. 【Lumenello, 2020】
Clinical Approaches
My integrative approach pulls from both east asian medicine and functional anatomy. Whether I’m supporting someone post-hysterectomy, recovering from binding trauma, or simply seeking gender-affirming care, I consider:
- Extraordinary vessels (Ren, Du, Chong, Dai) for identity and embodiment
- Pelvic floor assessment for hypertonicity, scarring, or hypoactivation
- Neural therapy for surgical scars affecting qi/blood flow
- Somatic dialogue around trauma stored in the tissues
- Herbal formulas for Shen disturbance and hormonal transitions
- Qigong-informed rehab to restore breath and pelvic-lumbar coordination
It’s not just about where the pain is — it’s about what’s been unseen.
Final Thoughts
Chinese medicine teaches us that healing is about harmony. But harmony isn’t sameness — it’s balance among differences.
When we recognize the energetic, structural, and emotional needs of gender-diverse individuals — especially those engaged in athletic or physically demanding lives — we don’t just treat symptoms. We restore the patient’s right to inhabit their body fully.
And that is medicine at its deepest level.
References
- Douglass, P. (2020). Assessing Different Communities’ Current Knowledge and Confidence Regarding Nutrition and Healthcare for Transgender and Gender Non-Binary (TGGNB) Clients
- Sharman, Z. (Ed.). (2016). The Remedy: Queer and Trans Voices on Health and Health Care. Arsenal Pulp Press
- Kleinplatz, P.J. (Ed.). (2012). New Directions in Sex Therapy: Innovations and Alternatives (2nd ed.)
- Bevan, D.J. (2019). Transgender Health and Medicine: History, Practice, Research, and the Future. Praeger
- Wu, Y. (2022). Sexing the Chinese Medical Body. In Routledge Handbook of Chinese Medicine
- Lumenello, C.J. (2020). Gender and Sexuality in Chinese Medicine. Singing Dragon
- Bartlik, B., Espinosa, G., & Mindes, J. (Eds.). (2018). Integrative Sexual Health. Oxford University Press
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