Files and links (1)
Free to read and download, Open Access
As transgender medicine developed in the course of the 20th century, medical professionals have slowly followed the lead of their clients. Patients during the early decades of transgender medicine sought to switch from one gender to another. Medical providers developed treatment protocols to guide this transition. In recent decades patients are no longer as quick to desire a switch from one gender to another. Rather, many younger transgender patients are more likely to explore the ambiguities of gender and adopt a gender-fluid identity. Healthcare professionals have, for the most part, accommodated their patients' changing ideas about treatment outcomes. But these currents towards a patient-centered approach are in contrast with transgender health organizations that seek professionalization through treatment protocols and standardization. Examining these socio-historical processes reveals how a nascent field of medicine negotiated the sometimes competing demands of standardization and patient desire.
Three questions guide my research: 1) How do trans-identified people experience and resist social sanctioning, make meaning of a transgender identity within a limiting transnormative narrative, and actively seek to create new identities? 2) How do healthcare providers construct scientific discourse and make meaning of gender in the process of working with transgender people in this emergent field of medicine? And 3) How has the history of medical and mental health interventions shaped the contemporary experiences of providers? I used a mixed-methods approach including the analysis of archival documents from the Kinsey Institute in Bloomington, Indiana, in-depth interviews with 40 transgender-identified people and 23 healthcare providers, and participatory observations in community spaces.
In part one of my dissertation I consider the nuances of transgender identities and the consequences of living in a society as a transgender person. Our society is organized in a two-gender system - individuals are either women or men. While some transgender people identify within these binary categories, as trans women or trans men, others resist a binary gender identification. Instead, they construct diverse gender identities like "genderqueer" or "genderfluid" that lack culturally agreed-upon definitions. Despite the diversity of identifications within transgender communities, most social scientific accounts adopt the binary model and position transgender people as moving from one gender to the other. This limits our understandings of transgender people and their own self-perception. Additionally, "transitioning" is understood as a process in which individuals move neatly from one stage to the next, and passing as women or men becomes the ultimate goal. Transgender people are creative in negotiating their identities within this system. Some resist binary systems and strategically deploy cultural resources to redefine gender categories in ways that fit their self-understanding.
In part two of my dissertation, I consider the emergence of transgender medicine, the ways that scientific discourse shapes medical practice, and how providers - who are situated within this dialogue in several distinct ways - must work with conflicting interests. The standardization of transgender medicine runs parallel with many contemporary currents related to the changing structure of our healthcare system. Evidence-based medicine has become ubiquitous in systems of healthcare, and is coupled with the creation of professional guidelines for standardizing healthcare. However, providers gave voice to the idea that transgender people have unique healthcare needs that may not be met in a system structured by binary modes of thought and in general, are wary of standardizing transgender medicine. In these contexts, providers must learn to how to balance their professional responsibilities and client-driven needs, which sometimes are in contradiction.