Providers and patients as activists: bureaucratic encorpment in two Midwest gender-affirming health clinics

For transgender and gender-expansive people, medical transition is not a single event but a long and complex process involving constant exchanges between people, bureaucracy, and bodies. As patients pursue transition care, they must interact not only with healthcare staff but also with the intricacies of gender-normative healthcare bureaucracy as they move closer to achieving what they envision for their bodies. Further, every individual’s body possesses a unique biological history that shapes the body’s progression through transition. By understanding providers and patients as responsible for bringing bureaucracy into being, I bring the body into view as a key participant in the interactions providers and patients have with gender-normative bureaucracy in two Midwest gender-affirming health clinics with different organizational cultures.

Through ethnographic observation of clinical appointments and routine bureaucratic practice, debriefing interviews with gender-expansive patients, and medical record analysis, this dissertation demonstrates how bodies shape gender-normative healthcare bureaucracy just as bureaucracy shapes patients’ bodies as patients pursue their transition plans. I call this co-embodiment of bureaucracy and the body bureaucratic encorpment. Recognizing the body as an equally active participant in the interactions providers and patients have with healthcare bureaucracy will refine efforts to target healthcare resources to these communities.