Side Affects: On Being Trans and Feeling Bad
Hil Malatino
University of Minnesota Press, $21.95 (paper)

Hil Malatino’s Side Affects explores the distinctive ways that “being trans feels bad.” Malatino is determined to provide both a more textured and unvarnished view of transition—from the exhaustion of those trying to offer support to other trans people, to the often-unspoken interpersonal envy that ruptures communities, to the rage that everyday encounters of transphobia foment (and which is then pointed to for justification of further phobia). The book provides an insider’s view of the bleaker and more frustrating aspects of transition, too often downplayed since transgender people were forcibly enlisted as combatants in the so-called culture wars.

This hostile climate has left many trans people putting on a brave face, to make themselves seem “presentable” and to portray transition as an unqualified force for good in their lives. The result is a predictable set of narrative moves—playing up misery prior to embarking on transition, brushing aside aspects of sacrifice or dissonance—that too often smooths over a complex and tangled ethical process, for unclear political gains.

The bleaker and more frustrating aspects of transition are too often downplayed now that transgender people have been forcibly enlisted as combatants in the so-called culture wars.

As its title suggests, Side Affects is also primarily a work of affect theory, a field of cultural studies that explores emotions, sensations, and subjective experiences on their own terms, and takes feelings to be central to politics. So doing, Malatino builds on the work of queer scholars such as Sara Ahmed, Kathleen Stewart, Heather Love, and the late Lauren Berlant and Eve K. Sedgwick.

In its exploration of negative feelings in trans life, Side Affects uses examples from a wide range of sources—including documentaries on trans-male experience, YouTube videos, the lively young trend of translit, and academic theory. Drawing from the heights of feminist high theory (Judith Butler’s reading of Spinoza’s habitus receives an illuminating gloss), hopeful ephemera pulled from political movement archives, and works which willfully blend theory and memoir (Paul Preciado’s musings on queer sex with suburban housewives), Side Affects roams with prodigious fluency across form and genre to scope out the underbelly of transgender experience. The book’s primary concern is the persistent negative, those intractable troubles which for trans people can come to feel at once defining and unmentionable. Following the work of cultural theorist Sianne Ngai, Malatino is keen to capture the “ugly feelings” often downplayed as strategically inconvenient to linger on: the ways in which life does not get better. (Like Ngai’s book, Side Affects discusses these negative emotions one chapter at a time.)

Side Affects is markedly informed by both radical politics and their failure. The ambivalence toward feminism that Malatino addresses recalls the title of an essay by Noah Zazanis he engages with: “On Hating Men (And Becoming One Anyway)” (2019). In other words, Malatino’s aim is neither to deny developmental complexities that generally play out across transitions, nor to allow them to invalidate the progression of trans lives into becoming as much. In this way, Side Affects captures these awkward moments and persistent bad vibes that accompany gender transitions—usually without truly discouraging those committed to them.

Malatino is both candid and droll in recounting his own experiences and feelings: he confesses career envy he once felt toward trans male rivals in academia for enjoying the fruits of both hormonal and career success; recounts the confusion caused at a work meeting when he’d still not yet legally changed his name; and admits to his own ambivalence about the effects of hormone replacement therapy (HRT). “Did I want to be more masculine? Yes,” he writes. “Did I want back hair? Not so much.”

YouTubers are tacitly required to produce content which is almost calculated to irritate and confound academics.

Malatino’s strength is most on display when doing detailed historical work, drawing together materials from movement and clinical records to make surprising connections with present struggles. For example, the book’s fifth chapter, “Beyond Burnout: On the Limits of Care and Cure,” outlines an unexpected genealogy of the term “burnout.” While now fully incorporated into corporate lingo, that usage of the word first appeared in the social scientific literature in the 1970s to describe the nervous collapse of volunteer workers in U.S. countercultural free clinics. Such clinics were then experiencing a heyday, and sought to provide free medical care—especially mental health care—to those underserved by the U.S. for-profit medical system. Malatino explores how the term uniquely indexed the wall hit by clinic staff faced with the impossibility of overcoming systemic problems through personal devotion. He then traces the very similar development (and affective outcomes) of “gender workers,” trans people who use knowledge gained from experience to help others navigating medical care. As Malatino puts it, in the context of transition:

The boundaries between who is carer and who is recipient of care are pretty radically blurred in such a situation; any act of caring is simultaneously an act of maintaining those minimal networks of support that sustain you. Trans collectives and communities are deeply interwoven and interdependent, enmeshed in a way that makes distinguishing between the roles of carer and recipient difficult—they’re rotating, interchangeable, and reciprocal.

While specialized care laborers in their own right, due to the niche nature of this indispensable work, “gender workers” are typically undervalued (and often unpaid). As with community health clinics, this dynamic produces an unmistakable turnover in personnel, as systemic problems confound and exhaust these “gender workers” for much the same reason as their free clinic predecessors.

Before the advent of the Internet, one of the principal vehicles for this kind of community-based care work was magazines and newsletters, almost always produced on a shoestring budget, mailed confidentially, and stuffed to the gills with hard-won advice from other trans people. In its analysis of some of these periodicals, Side Affects argues that in the name of instructing readers on how to avoid medical scamming and neglect, these resources often succeeded mainly in instructing their trans readers on how to become better consumers. So doing, they actually buttressed the for-profit health care system that had, on its own, been detrimental to trans health.

In this way, Malatino’s nuanced treatment of trans care workers and community writers builds up one of Side Affects primary analytic concerns: what he terms “transnormativity.” Transnormativity has been a longstanding bête noire for Malatino, and what he offers in Trans Affect is a modest reprise of an argument from his first book, Queer Embodiment: Monstrosity, Medical Violence, and Intersex Experience (2019). There, Malatino glosses the canon of radical trans theory (Dean Spade, Julia Serano, and Paul Preciado) next to the case notes of clinical sexologist John Money, concluding that transnormativity is the governing principle behind both intersex and transgender health care. Though it maintains the same theoretical commitments, Side Affects is more strictly focused on trans experiences. Instead of theorists and sexologists, it homes in on popular (though mostly unnamed) transmale YouTubers to demonstrate the prevalence of the transnormative today.

Since 2005 YouTube has offered a platform to almost anyone able to upload videos. For many years it enjoyed a preeminent position among free streaming sites (more recently challenged by rapid-fire TikTok and game-streaming service Twitch). The relatively low overhead and lack of institutional hurdles helped make YouTube a popular site for vloggers wishing to document their transitions. The most popular trans YouTubers attracted hundreds of thousands, even millions, of followers.

Malatino’s concern is that the most successful of these vloggers tend to be relatively gender-conforming. They represent their transitions in terms of a predictable checklist of achievable changes, emphasizing medical transformations and physical recompositions. It’s surely true that, for all the hopes that social media would introduce a much broader selection of perspectives, economic conditions have led to the success of a quite predictable set of faces. That is, YouTube is dominated by those with the material means, spare time, and expensive equipment required to compete with however million other hopefuls.

Can the approach to transition taken by YouTubers be termed “transnormative” at all? In their candid discussion of medical transformations, they operate exactly at odds with the still widespread perspective that transition should remain a private struggle.

However, as a specific exploration of trans affect, this argument seems to fail on several levels. Malatino’s unfavorable comparison of vloggers to sex columnist and provocateur Dan Savage’s It Gets Better project seems to fall flat: Savage was a middle-aged gay man inspired by the suicide of a teenager after homophobic bullying, remarking, “If I could only have talked to that kid for five minutes, maybe it would have made the difference. . . . If I could have shared I was in a similar place, at his age.” However cloying their optimism in medical technology may be, YouTubers (and their viewers) skew closer to the age of those Savage hoped to save.

Moreover, little attention is paid to the relevant form of YouTube videos: the reduction of affect’s texture down to a facial expression mimicking a classical Greek theatrical mask in their thumbnails, the copious use of punchy exclamations and jump cuts, or their repetitive mantras to “Hit ‘Like’ and ‘Subscribe’!” In short, YouTubers are tacitly required to produce content which is almost calculated to irritate and confound academics. It’s the task of humanities scholars to demonstrate a probing and delving perspective, as well as a refined detachment prioritizing skilled application of concept, mobilizing personal narratives only to shore up broader points (if at all). Contrastingly, YouTubers with flourishing accounts typically rely on displaying exaggerated and unmistakable sentiments, to draw audiences based on a lowest common denominator of raw humanity. (This applies with yet more exaggeration to adepts of YouTube’s newer rival TikTok, where the recommended video length is 21–34 seconds.)

Due to a need for regular and provocative updates, those committed to being YouTubers—especially those hoping to derive income from it—face an imperative to render major personal milestones in the form of “content”: “Six months on testosterone!” or “Finally got top surgery!” or “Horrible encounter with transphobic doc ☹,” as well as breakups and new partners, engagements and divorces, moving house and redecorating, childbirth and grief. Above all else, vloggers are obliged to produce content which generates responses: subscribes, likes, comments, shares to social media with an approving (or scathing) gloss. It’s in this context that trans YouTubers operate, and are interpreted by audiences. Their role is not to serve as authorities on transition, but to generate powerful reactions, sparking ad hoc distribution by thousands to millions of viewers bearing precious clicks. YouTube does not attract the leaders amongst men, but rather bright personalities in sweaters.

Understood within their proper context, it seems unsubstantiated that the approach to transition taken by these YouTubers can be decisively termed “transnormative” at all. In their candid and completely public discussion of medical transformations, they operate exactly at odds with the still widespread perspective that transition should remain a private struggle. Many transitioners avoid disclosure wherever possible, and especially avoid public exposure (never mind regular video output), at least until visible transformations have been achieved. By their nature, these covert approaches are less easily seen than noisy social media accounts—yet “low-key transitions” remain widespread worldwide.

Those who pursue deep-stealth transition aim to reduce those aware of their life history to the bare bones of medical professionals and closest confidants. This often requires relocating across cities or countries. To maintain a close relationship with a deep-stealth transitioner tends to mean respecting this self-imposed imperative of discretion. Stealth approaches were once a measure recommended by medical practitioners, as Malatino mentions in his treatment of “professional transsexual” Rupert Raj’s refusal to do so in the 1970s, in favour of more open advocacy. Even stealth trans people at peace with older friends or colleagues knowing their former self still go about making a new life relatively furtively. In workplaces they tend to reference treatments and surgeries vaguely, or with outright euphemisms (birth control, hernia operation, lost a fight with a dog).

Contrastingly, YouTubers tend to provide a blow-by-blow account of their transitions, producing videos covering topics like unwanted menstruations and top-surgery scarring. Much like Malatino, their formal imperatives compel them to expose the aspects of transition that stealth usually smooths over. Making an entire career from openly discussing the finer points of hormonal and surgical changes could not be further from the clandestine ethos that still prevails among many trans people.

Naturally, it’s hard to tell which vying approach prevails numerically, as those who try to keep their transitions clandestine generally avoid being counted. And it’s unclear which position is more “privileged” in broader society. While it certainly attracts less attention from transphobes, discreet transition also prevents easy access to community resources that necessitate at least some disclosure—for instance, Facebook groups with visible member lists, or feminist events which declare themselves open only to “women and trans people.”

Which approach to transition is more “normative”? I’m inviting you to consider that it doesn’t matter. That these are diametrically opposing ways of coping with the same set of harsh circumstances. And that any emancipatory movement worth mentioning will have time and place enough for both the downlow and the vlogger.

Contrastingly, Side Affects’ critique of transnormativity seems to distract rather than further its introduction’s aim to provide a “warts and all” understanding of transition. Ironically, Side Affects can seem to imply that gender transitions should reject the “normal,” and instead conform to the strict mores of critical theory.

There further seems an obvious, unstated commonality between the work of the “autotheoretical” gender studies scholar and that of the trans YouTuber. Are these not variations, high and low, of putting oneself on display? Aren’t both trans theorists and vloggers beneficiaries of today’s broader acceptance of transition, while further facilitating that progress by openly sharing knowledge that would otherwise be inaccessible? Certainly, whatever divergence of form exists between Side Affects and the YouTube channels discussed in it, both have significantly more in common with one another than with stealth transitioners.

I’m not saying that YouTubers are better affect theorists than academics could ever hope to be, but they do seem to be direct competitors.

To put it bluntly, HRT is not reducible to ideology.

Malatino’s critique of the so-called transnormative extends to a lingering skepticism toward HRT, which has been widely embraced as a key tool of medical transition. Drawing on gender studies scholar Laura Horak’s writing on what she calls “hormone time”—the narrativizing of transition as a story about the way HRT transforms both the body and life experiences—Malatino writes:

What hormone time does . . . is position biomedical intervention as necessary and fundamental to securing the future one desires, and achieving the promised moment of harmony between the felt and perceived body. . . . It encourages trans subjects to cathect hope for a more livable life to a for-profit medical industry, that too often lacks empathy and sympathy and treats trans subjects as a niche market rife for economic exploitation.

Leaving aside the U.S.-centric orientation of this argument (Britain’s partially socialized health care system has been no more humane in its treatment of trans people for the excised profit motive), this seems an inadequate treatment of the real place hormonal changes have during transition. While surely not necessary for a fulfilling transition, there are plenty of people who do consider both hormonal and surgical interventions to be fundamental to their transition—and not unreasonably.

To put it more bluntly, “hormone time” is not reducible to ideology. It reflects the gradual changes that hormones achieve, thanks to physiological processes around bodily regulation and cell replenishment (cumulative arcs that resist acceleration). Hormone time exists not because HRT is indispensable for the good life, but thanks to its powerful limitations. While more mutable than conservatives claim, the endocrine system allows for purposeful transformations of our bodies more slowly than we would wish (and less predictably). This chaotic quality holds as much for trans people fretting over “results” as it does for the many cis women left dealing with unbearable side effects (or untimely failures) of birth control. Or, indeed, bodybuilders trying to perfect their “cycles”. In many cases, this chaos of clashing inner secretions cannot be actively corrected, and simply has to be waited out. Although gradually introducing more major physical changes than those unfamiliar with transition might easily guess, the work of the hormonal receptors on bodily refiguration doesn’t happen overnight.

Considered without any reflexive suspicion, there’s no reason we can’t have a celebratory view of hormone time. Over the years, willfully sexed expression does tend to win out. Just to consider one commonplace of transition: family rejection often takes the form of relatives sticking to old names and pronouns through some mixture of stubbornness, force of habit, and spite. Courtesy of hormone time, these everyday acts of negation gradually come to seem more and more foolish to those outside the original household. They perhaps even come to cause confusion to those who met this abuse’s target more recently. In this context, casual cruelty becomes not only harder to justify, but inscrutable. The conduct of the family members who just wish their adult child to “be normal” comes to seem truly eccentric. For the transitioner, what began as pleas for respect can, thanks to hormone time, then become a bemused, “Get over it!” No doubt hormone time would be less important if fewer households rejected trans people, but why paint this progression as sinister in the meantime?

It is worth asking why the normative has become such a bugbear for radical theorists. Is normativity really a peril, to be avoided wherever possible? Who will be advantaged most by this?

It is worth asking why the normative has become such a bugbear for radical theorists. A previous generation of queer militants developed the concept of “heteronormativity” as part of an idiom intended to unsettle what they variously called heterosexual society or the heterosexual regime. To undermine the straight world, the assumed had to become the named. But as the prospects of gay liberation have ebbed, a new generation has developed variations on the term—“homonormativity,” “transnormativity”—and these often seem to misplace the direction toward which “heteronormativity” was once aimed. Now it seems that the normative is the principal target for radical scholarship, rather than the heterosexual.

But is normativity really a peril, to be avoided wherever possible? Are some normative qualities even possible to avoid, in any act of human organization? Was the intention in naming “heteronormativity” not to demonstrate how existing society had naturalized features of life which actually arose historically (and through active imposition), rather than to extend us into thoroughgoing opposition to normativity as such? We need to reconsider whether identifying the normative as intrinsically sinister truly serves us, either for any emancipatory political end, or a fuller understanding of trans affect. Are lateral judgments of transitions between trans people truly avoidable through elevating these questions into a theoretical idiom? Who will be advantaged most by this move?

While there’s good reason to treat the medical establishment as antagonistic to trans people, Side Affects is prone to overstating the authority clinical professionals have over transition. For example, Malatino writes, “the newly consolidated trans medical industrial complex had begun to actively recruit trans subjects . . . in order to grow the private practices of trans medical specialists.” It’s important to be clear that medical professionals have only ever presumed to direct transitions, rather than truly achieving this mastery.

Clearly, our contemporary understanding of hormonal regulation comes in part from clinical contexts, and today much of the authority of doctors certainly stems from their formal control over legal access to these treatments. But the earliest relevant breakthroughs were actually achieved by biological theorists, especially through animal experimentation. The earliest use of “virilizing” extracts from animals was by eccentric Mauritian physiologist Charles-Édouard Brown-Séquard in the 1880s, using extracts from the gonads of captive animals drawn and injected still decades before testosterone was first isolated as a molecule.

Side Affect’s final chapter touches upon this history, but it frames this phase of hormonal understanding solely as interlocked with eugenics, drawing on the work of historian of sexuality Jules Gill-Peterson on Austrian physiologist Eugen Steinach, who relied on notions of temperament as a tiered response to climate while theorizing animal behavior. As it appears here, it’s a one-sided account of a scientist better known for his breakthroughs confirming the “lability” of sex. This leaves us with an account of trans health care’s history as primarily one of the medical profession’s managerial impulses run amok, capturing or coopting the needs of transgender “subjects.” This downplays the wider context of scientific advancement within which this struggle for position took place.

Side Affects is masterful at tracing how U.S. trans health care shifted from university clinics—which were interested in developing “cures”—to, by the 1990s, for-profit clinics focused on providing a slate of services. Malatino notes that this trend of “biomedicalization” coincided with Reaganomics, which he fingers for the shift from a modality of care confined to treatments to one extending into bodily enhancements. It is an interesting connection to make, but another instance in which Malatino’s laser focus on the clinic leads him to miss a bigger point—namely, that these kinds of self-transformational practices have a century of history behind them, mainly outside of clinical spaces. Brown-Séquard’s stated intentions for injecting animal androgens was not curing an ailment, but easing fatigue during long hours in his laboratory. The same aim was pursued in the 1920s by Steinach with his “Steinach’s operation,” a half-vasectomy intended to focus more viriziling hormones on sustaining manliness rather than sperm production, therefore avoiding symptoms of ageing. (Before being discredited, this procedure was performed on celebrities on both sides of the Atlantic, including W.B. Yeats).

Although preclinical interventions were primitive and even pointless from today’s perspectives, they demonstrate the persistant and broad appeal of bodily “enhancement” through endocrinological intervention. While something of a detour from the question of affect, the stakes in correctly recounting this bio-technical history are considerable: conspiratorial perspectives on medical transitions are quick to frame them as an elaborate plot to inflate Big Pharma profits. In this context, being clear on the role played by clinicians and their accompanying industries during the development of these technologies is imperative. Let’s not mistake professional pretensions for actual creative preeminence, or medical meddling for any truly generative role.

Conspiratorial perspectives on medical transitions are quick to frame them as an elaborate plot to inflate Big Pharma profits. In reality, hormonal treatments don’t belong only to doctors, nor are they fully under their control—and they never have been.

In reality, much of HRT has its roots in regimes pioneered through cis self-experimentation, regimes which were then only ever partially subsumed into the clinical context—and with all manner of endocrinological experiments prevailing beyond it. Pervasive scientific changes have been underway since the breakthroughs in hormonal isolation, which took place rapidly during the first half of the twentieth century. And bodily transformative dosing on “inner secretions” was a temptation even earlier, with lively (if controversial) trends of self-administration widespread by the end of the nineteenth century. Technologies now more readily associated with transition—or, for that matter, bodybuilders taking testosterone to get impossibly ripped—were originally pioneered by elderly cisgender scientists, hoping to cheat mortality by extending their working lives a few extra years. In other words, hormonal treatments don’t belong only to doctors, nor are they fully under their control—and they never have been.

This point has become unmistakable with the recent rise of autodidact Internet communities that provide extensive resources—from dosing guides to online pharmacy directories—for those denied conventional access to treatment. Nor is this expanded access anything truly new. That trans people have long been securing medication without medics is attested to in Side Affects’ own historical work, which features a censorious “community leader” discouraging readers of pioneering trans magazine Chrysalis Quarterly from relying on illegal mail-order medications. Clearly, gender workers have always existed alongside (and at odds with) those who’ve taken other, less legitimated approaches. These clandestine actors presumably established their own normative standards, and practical understandings—which have yet to be fully explored. With this considered, any intuitive conflation of HRT with the medical profession seems much more reflective of white (or suburban) trans experience historically, than an overarching account of how trans people writ large have secured access to these life-enhancing drugs.

Elsewhere in Side Affects, Malatino models a less fraught approach to trans affect and “bad feelings” by engaging extensively with the trans literary canon. The book’s treatment of the bad feelings widespread in trans lives are greatly aided by immersive readings of novelists Kai Cheng Thom, Torrey Peters, T Fleischmann, and Casey Plett.

The best of these sees Malatino review Plett’s darkest work, Little Fish (2018). The novel follows a depressive spiral of its protagonist Wendy, whom we follow (barely) surviving one winter in her Winnipeg hometown—a season featuring her return to sex work, the death of her close friend to suicide, an abortive romance with a northern Englishwoman tourist, a harrowing encounter with self-administered medroxyprogesterone (a synthetic hormone and known carcinogen), and Wendy’s gradual confrontation of her blackout-inducing alcoholism. Malatino argues that Little Fish primarily addresses numbness, with both Wendy’s drinking and revived working life requiring her to set aside intuitive responses. This gentle suppression matches the harrowing conditions of her harsh climate:

Little Fish vividly documents the ways in which trans folks, and trans women specifically, cultivate emotional numbness when feeling nothing seems preferable to the impingement of affective response one has learned to expect. The practice of becoming insensate.

Dissociation has been a prominent theme for trans lit, with Imogen Binnie’s 2013 breakout hit Nevada following its checked-out protagonist through antics that include breath play and road-tripping in a semi-stolen car, all of which fail to break through her brain fog. But while Nevada’s dissociated protagonist proves incapable of mentoring the possibly-trans person she encounters in her travels, Wendy’s numbing alcoholism allows her to cope with “hatching” a military-veteran client.

The plummeting average age of those embarking on transition has meant that younger transitioners at once find themselves the object of jealousy for older trans people and the primary target of hostile legislatures.

This fictional episode is explored through phenomenologist Maurice Merleau-Ponty’s notion of intercorporeality, which Malatino glosses as follows: “Our bodies are never solely ours but rather coproduced with and through the bodies of others, and this means equilibrium is always and only a temporary achievement.” In this context, the depressant qualities of alcohol allow Wendy to paradoxically stabilize herself—to the extent she can extract a new name from her client (Kaitlyn, “with a K”), satisfy them sexually by screening a porn she filmed prior to her surgery, and then instruct the newly christened Kaitlyn on how to begin anew.

Yet the sacrificial aspect of this act becomes clear in the book’s next scene, as Wendy is ultimately left drunk and without phone charge, wandering through a frigid wasteland on the verge of collapse. Wendy’s attempts to flag down passing motorists quickly result in her being hassled by police, then exploited by a passing taxi driver. Despite her prevailing cynicism, Wendy is left in a state of disbelief that those driving past her offered no assistance. As Malatino puts it:

We see, in Plett’s juxtaposition of a scene of intercorporeal recognition with a scene depicting a fundamental failure of such recognition, how trans experiences of embodiment are crucially molded by such intensively clashing moments of (mis)recognition.

In this treatment of Plett’s writing, Malatino’s phenomenological approach goes a long way to clearing the cleft between trans fiction and studies, drawing prose richly informed by experience into free and welcome exchange with high theory. One of the book’s most lucid passages unfolds directly in response to one of Wendy’s fictionalized conversations with her friend Sophie about trans life activities, and how they generate a distinctive relation to time. As a reply, Malatino offers his own matching account:

Here’s what the trans people in my life are doing, at the level of the anecdotal: selling crafts to save money for top surgery, crowd-sourcing funds to bring trans Latina activists to academic conference, going through divorces and separations, searching for a job that pays a living wage and comes with trans-inclusive health insurance, asking the internet for advice on how to deal with hostile work and classroom environments, proofreading each other’s writing, growing networks of solidarity and support, making gorgeous art about resilience, feeling disappointed by another Scruff hookup, grumbling about the way their clothes are fitting them, struggling to make ends meet after the passage of FOSTA-SESTA made it impossible for them to advertise and screen clients effectively, going to therapy, going to recovery meetings, documenting their experience fostering a child on social media. A quick snapshot. Surely cis folks are doing some, though not all, of these things. At the macro level, though, there are obvious broad-stroke manifestations of poverty, scarcity, insecurity, sickness, fatigue, and anxiety that are so much part of trans lifeworlds that it’s easy not to notice them.

As well as drawing on an array of trans female novelists, throughout this book “transphobia” and “transmisogyny” (the specific hostility toward those undergoing feminizing transitions) are conceptually distinguished. Malatino emphasizes that transmisogyny is specifically relevant to both workplace marginalization, and street violence. The book’s final chapter even lists Malatino’s masculine presentation as one reason his (positive) personal sentiments toward transition may not be relevant to any broader liberatory ends. Despite this self-effacement, Side Affects is not altogether consistent on transmisogyny. Troublingly, feminist theory has often been considerably cruder than the literary works Malatino works through on these questions—resulting in a tension which is hinted at, rather than openly confronted. In the book’s chapter on envy, Malatino tackles the old saw of trans male penis envy, with Mari Ruti approvingly quoted:

In a society that rewards the possessor of the penis with obvious political, economic, and cultural benefits, women would have to be a little obtuse not to envy it . . . not to want the social advantages that automatically accrue to the possessor of the penis, particularly if he happens to be white.

This is a curious justification for envy to read here, given that Side Affects engages with an array of material exploring exactly how the twinning of anatomy with privilege is far from being as “automatic” as Ruti would have it. In the context Malatino turns the quote to, it also seems to lead us away from the obvious point that many trans men do have a penis, and generally have accrued an unclear “social advantage” from that development.

This misstep is a pity, since an exploration of envy within these circles seems long overdue, given the generational ruptures that have arisen since the rapid expansion of transgender culture in the 2010s. The plummeting average age of those embarking on transition has meant that younger transitioners at once find themselves the object of jealousy for older trans people, and the primary target of hostile legislatures (some Red States seem intent on using the “trans kids” controversy to effectively raise the age of legal adulthood—twenty-five would be the age when trans Missourians could finally decide on their own medical care).

Side Affects closes with a treatment of psychedelic culture and its conflicted interactions with trans history, which Malatino draws into a critique of “euphoria” as a desired outcome for transition (curiously with no reference to the HBO show of the same name). This is one of the book’s historical chapters, and Malatino begins by introducing an exchange of letters between Harry Benjamin (a key figure in the treatment of “transsexuality”, and author of 1966’s influential The Transsexual Phenomenon) and Robert Masters (cofounder of New York’s Foundation for Mind Research, a postwar convergence point for sexology and psychedelic culture). Remaining in contact for some years, Benjamin and Masters speculated that LSD could be used to “cure” trans people—in other words, return them to a stably cisgender state. Their hope seems to have been that the profound revelatory experiences acid users reported would allow for a psychological breakthrough in patients otherwise requiring lifelong hormonal interventions. But from a critical view, their ambition was more like a countercultural twist on conversion therapy. This was far from the first hypothesis of this kind, with breakthroughs in scientific understanding often quickly applied to “solve” minorities as a social problem. Malatino dryly traces this notion through similar proposals to rid the world of homosexuality through the principle that: “the path to enlightenment was routed through the supposedly profound unification of opposites experienced within cishetero penetrative sex” (also posited by psychedelics pioneer Timothy Leary). Interwar Germany had seen similar experimentation with testicle transplants, in an early attempt to rid patients of homosexuality through “virilization”.

It’s easy to see why mystical practices have appealed to trans people, who are already tasked with attempting to traverse what’s often taken to be rigidly fixed.

Simultaneously to Masters and Benjamin’s exchange, LSD was being championed by early radical trans magazine Vanguard, most famous for its militant response to the 1966 Compton’s Cafeteria riots in San Francisco. Malatino rescues this feature of the organization from obscurity, recounting how its seventh issue featured a “dope sheet” with detailed instructions for first-time trippers.

Upon my first reading, I assumed that this dichotomous framing was intended to demonstrate the ambivalence of LSD as a powerful and novel chemical—the pioneering insurrectionaries of Vanguard lionizing the exact same countercultural substances being touted as a “cure” for transsexuality by fusty sexologists. Yet Malatino instead turns this remarkable episode toward a high-handed conclusion, denouncing in the fiercest theoretical register all participation of white trans people in the esoteric practices of counterculture:

Every time a white, trans person charges their crystals during a full moon, moves through an asana, does a tarot reading for themselves or a friend, appeals to the stars for relationship advice, or considers traveling to the desert for a peyote retreat, we become further embedded in this long history of romanticization, piecemeal appropriation, and exoticizing commodification that has consistently resulted in the production of white viscosity.

This argument presupposes that the transcendent face of esoteric practices can be dismissed, an assumption it presses home on too quickly. In other words: many of these traditions offer insights that purport to extend across social division, and provide universal instruction, or solace. These humanistic claims can neither be accepted at face value nor set aside when trying to appreciate their lasting appeal. Indeed, Malatino’s own historical work in this chapter highlights how trans esotericism and the term “transgender” itself share an origin. While “transgender” would later become the basis for a civic emancipatory struggle, its earliest usage was blended with references to trans people as sacred hermaphrodites. Malatino is highly disapproving of this sense of spiritual affinity especially—despite mythological depictions of “hermaphrodites” in premodern visual culture plainly resembling trans women, just as much as they do those with certain intersex variations.

It’s easy enough to see why mystical practices have appealed to trans people, who are already tasked with attempting to traverse what’s often taken to be rigidly fixed. This section of the book seems especially harsh given so much of the content of these spiritual disciplines concerns recognizing and overcoming contingency—unmistakably the same concern as Malatino’s own tradition of social theory. (It’s for this reason that pioneering affect theorist Eve Sedgwick wrote equally lucidly on sexuality and contemporary Buddhism.) It’s also worth noting that some of these traditions undeniably predate the pseudoscientific racial divisions cast up by “colonial-modernity”—and many more of them claim to. There seems little regard in Side Affects for mystical traditions that don’t make inducing euphoria or other joyful states their central concern (for instance, Orthodox Christian traditions have more often directed practitioners toward apatheia, or passionlessness). Nor are fictional translit works exploring mystical themes not written by white American authors referred to for comparison (for instance, Jackie Ess’s recent debut Darryl).

All this considered, this chapter’s work seems more an expression of subjective distaste than a true critique of a heterogeneous set of practices, and beliefs. While they’re not for everyone, there’s no clear reason to hold tantra workshops, Kabbalah reading groups, or tarot decks as politically suspect, any more than the unabashedly exoteric gurnings of goofy YouTube light entertainers.

Instead, sex hormones and psychedelics are both the basis for infinitely contestable sets of practices, which came to be understood on a greatly enhanced level during the twentieth century. Both of these breakthroughs demand fuller historical understanding, and defy any straightforward endorsement or dismissal. Each group of substances seems set to reshape life in the twenty-first century, in ways which remain hard to predict (and, especially in the case of sex hormones, are fiercely resisted by the political right). Whether we’re considering estrogen or ketamine, DHT or DMT, progesterone or pregabalin, trends of clinically administered normalization and ongoing criminalization vary wildly from locality to locality (and often awkwardly coincide, typically distinguished through class relations).

Side Affects provides rich historical and literary readings, which sketches the dense mesh of clinical deployment and far broader underground appeal which defines these chemicals’ current usage. But due to its theoretical commitments, the book does not always help us navigate through this tangle. The “tarrying with the negative” Malatino calls for is an urgent project exactly thanks to the increasing hostility trans people face politically. Side Affects makes quite clear how much stands to be lost through any straightforward account of transgender life as an unfolding sequence of “affirmation,” or pursuit of euphoria. However, many conventions (and hang-ups) of radical academia are reaffirmed here, when the material worked through suggests they would be better dissolved. If the ways we take care of ourselves come to disturb and unsettle the sensibilities of critical theorists, then so much the better.