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I almost never see people talking about middle ground between having a transmedicalist ("truscum") position and a more inclusive, mainstream stance, but it's really not hard to be a binary trans person who integrates the two points of view.
I conceive of my transition in medical terms. I experienced discomfort about the feminized parts of my body, realized this discomfort might be gender dysphoria, sought masculinizing HRT treatment, and this treatment relieved my symptoms.
I know this is a common trans experience, and that transition is the only known treatment for gender dysphoria. But, what if someone doesn't experience gender dysphoria and pursues medical transition? Well, that would be their choice, not for me to judge or interfere with.
What if someone's gender dysphoria is adequately addressed by social measures like a pronoun or name change, and doesn't pursue medical transition or seek to "pass". Again, their choice, and honestly using the least intervention necessary makes sense, medically.
What if someone feels themselves between/outside binary gender categories? Well, medically sex is complex, so it makes as much sense on a biological level as anything, and again not something I should be judging or interfering with if I respect individual self-determination.
I do have some opinions that are slightly outside the mainstream- I generally think that you can be something outside of your identification with it. (For instance, I think you can be trans and lie about it, or not know it yet.)
However- and this is crucial- I don't think I've got any special ability to know what someone's medical condition/gender identity is. There's no test for it. So, in practice, just believing what people says is the closest anyone can come to knowing whether they're trans or not.
My more medical, more material view doesn't come into practical conflict with someone who emphasizes the socially constructed aspects of identity because listening to what people say and believing them is more accurate than any other test we have.
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