9. Photovoice: Empowering Transgender And Gender-Expansive Youth

Abstract

Transgender and gender-expansive youth have unique healthcare needs; however, they often eschew visiting health centers given a history of misinformation and discrimination. Photovoice, a community-based participatory research method, is an apt technique to engage this population. This study sought to learn from the unique perspectives of transgender and gender-expansive youth on what may challenge or facilitate gender identity affirmation to improve healthcare usability for those receiving care at a gender affirming clinic. We recruited 16 transgender and gender-expansive youth from a gender clinic at a children’s hospital. Eleven transmen and five transwomen (ages 16-21) participated in an initial session that discussed photography techniques, safety, and ethics. Participants were prompted to take photographs for one month to explore how their gender identity affects their social relationships including their clinical care. After one month, all participants engaged in critical reflection of their photos and an in-depth interview with a study member. Of the 16 participants, 6 also participated in a focus group. Interviews and the focus group were audio recorded, transcribed, and analyzed using Grounded Theory. Three key themes emerged: positive effects of care, gender representation, and advocacy. Participants described many ways that transition and gender affirming care had positively affected their physical, emotional, and social health: “Transitioning has been my process of finding safety and of finding affection, both within and without myself.” Participants also emphasized the importance of representations of gender and trans identity. They confronted how idealized masculine or feminine gender expression should not be an expectation: “I see it so much with the celebrities that are trans and open about it. They present so femininely and it’s a hyper-femininity that not everyone can attain or even wants to obtain.” Other participants mentioned being disregarded by peers, family, and health providers by not presenting convincingly enough or by experimenting with makeup, clothing, or other gendered activities. Some emphasized that being trans is only one part of their identity and they rebuked social relationships or healthcare services that exoticized them as trans above all else: “A really important part of my transition and my journey is [that] another person wouldn’t see me as an object or an oddity.” Lastly, participants expressed the importance of advocacy on behalf of others and recognized that they receive gender affirming care others are not able to access: “If you are in a place of privilege, it is your responsibility as someone who has power in society to stand up for the people who don’t.” Transgender youth identified many opportunities to improve the quality and accessibility of gender affirming care. Their narratives revealed that youth experience and express gender in complex ways, and experimentation should not impact a person’s ability to affirm their gender identity. To further improve gender affirming care, providers need to take this complexity into account in their provision of comprehensive health services.