Beyond a Teleology of Transition: Re-Imagining gender transition through a trans Buddhist auto-ethnographic account

Self-assessment of healthcare workers regarding the management of trans people in a university hospital

Trans theory (also known as transgender studies) is a rapidly expanding interdisciplinary field in which activism, scholarship and lived experience are coalescing around questions of embodiment, personhood, and intersections of race/ethnicity/class/ability/gender/sexuality. Trans-themed research, whether explicitly located in trans theory or not, is a growing area of academic exploration. As a trans researcher and trans person, I am interested in two questions: how does autoethnography fit within trans and queer theory, and how can people who do not live in trans communities undertake ethical trans-related research? A symbolic interactionist perspective informs my understanding of trans theory and the social construction of identity and embodiment. I explore my own femme transmasculinity through autoethnography, and also consider my experience interviewing other trans people as part of researching masculinity. I suggest that researchers who are not trans (who are cisgendered, meaning they identify with the sex/gender they were assigned at birth) must accept that trans people have what Talia Bettcher (2009a, 2009b) terms First Person Authority over their embodiment, experience, and narratives. Having established this, I examine self-identification and intersubjective recognition in relation to my own experience of femme transmasculinity, asking what is femme incoherence and how does this relate to queer and trans theory/politics?

Background and context This paper wishes to help heal the lack of trans people’s representation in art therapy research that coincides with the lack of art therapy literature theorising body tracing. Approach Supervisor, art psychotherapist and service user have come together to offer a research process that questions power dynamics and uses lived experience to explore an approach of body tracing that differs from body mapping and so contributes a further approach in this field for working with people whose identities question the status quo of power. Outcomes Specifically, we wish to demonstrate the relevance of body tracing as a tool for facilitating the gender transitioning process. We explore how it offers a lived experience in the here and now that promotes agency and an internal locus of control over what is to be modified and what is to be maintained. Conclusions It creates an embodied space for a new identity to be shaped. We examine how the contextualisation of creative process modalities (sensory experience, formal decision-making and symbolic meaning) within the resulting body-space aids the integration of states of self and bodily awareness and connectedness. Implications for research We hope to inspire further research in this field that can support an institutionalised adoption of body tracing within an art therapy setting for gender transitioning service users. Plain-language summary Art therapists have only written a little about working with trans people. The same is true of the technique of body tracing. This paper speaks about both of these areas. The service user has taken the role of lived experience author in order to work together with the art therapist and her supervisor, so that all three voices can talk on equal terms about their experiences in these areas and explore a way of using body tracing that they believe can empower people who are gender transitioning. A technique called body mapping already uses body tracing to help people who feel disadvantaged because of their identity (for example, their sexual orientation, the colour of their skin, religion, nationality etc.). Our research offers an additional approach with some distinct features. The lived experience author describes how the act of drawing around the body and then being able to modify this outline promoted a sense of control over his body, leading to a feeling of greater control over his life. This helped him reclaim ownership of his body at a time when other people were deciding the hormones he took and the options available. Our method integrates bottom-up and top-down processes to help a person feel more connected with their body. Working on the body tracing involves many physical sensations that vary for each of the four stages of the process. Memories and thoughts may also come to mind connected with lived experiences and fantasies. The physical feelings in the body can be filtered thanks to the images and colours in the representation of the body on the paper. We hope that other people will join our research so that institutions supporting trans people can offer this service to their users.

Emerging from feminist and queer theory, trans theory asks us to challenge essentialist and heteronormative understandings of gender, sex, and sexuality. Trans theory teaches us to critique essentialist and binary models of embodiment by attending to and centering the body in theory and in the world. In the early 21st century, trans people are more visible than we have ever been. There is an increasing appetite from “mainstream” readers for trans memoir, larger numbers of trans characters on screen and in the media, and out trans people now hold high-ranking political positions, teach in schools and universities, and act on stage and screen. Rather than the demand for trans stories being driven by scopophilia, curiosity, or voyeurism, it appears that there is a desire to genuinely understand trans lives, bodies, and lived experiences. Visibility comes with a price though, and we must be wary of tracing a simplistic progress narrative in relation to trans and gender diverse people and communities. When we appear in public, we gather our own communities, as well as allies and sympathizers, but these appearances also make us vulnerable to those who still fiercely deny our right to exist—the Vatican City’s thirty-one page statement discussing gender theory in education (2019), where we are told that trans people are “annihilating nature,” is a perfect example of this. While the term “trans” (more often than not) refers to transgender people, it is also a prefix that means “across”; trans denotes movement, going from one to the other, and change. Because we can find trans people across all times, places, and populations, we can also trace a complex, rich, and ever-expanding archive of trans writing, histories, and stories. It is through troubling the idea that trans people are a “modern” invention, that we are the living embodiment of political correctness gone mad, that we can begin to find each other in text, gather together, and work toward making significant social, political, and cultural change.

Waiting is a common experience in medicalized gender transition. In this article, I address subjective experiences of medicalized gender transition through a temporal lens, focusing on personal narratives of wait lists, setbacks, and other delays experienced by trans patients. I consider administered waiting as a biopolitical practice of governance, one that has subjectifying and somatic effects on individuals and that speaks to the role of time in the administration of bodies, sex/gender, and biomedical citizenship. I ground my discussion in narratives created by trans people that chronicle their gender transitions; I analyze a set of gender transition vlogs appearing on YouTube, focusing on temporal aspects of medicalized transition and experiences of waiting. My discussion recognizes that the temporal modes of gender transition are multivalent, but these social media narratives also suggest being made to wait is an experience of power relations, one that is capable of producing submission, weariness, and precarity.

Preventing transition “regret”: An institutional ethnography of gender-affirming medical care assessment practices in Canada

Preface: Understanding Women’s Lives and Trauma Through Narrative Research and Analysis

Disclosure: D. Stroumsa: None. E.E. Marsh: None. P.N. Pfeiffer: None. C. Jiang: None. A. Vrolijk: None. M.B. Moravek: None. Bridging the Gap: Utilization of Emergency Services by Transgender People in the United States, 2006-2018Introduction: Transgender or nonbinary (Trans) people face significant health disparities, including in access to primary and preventive care. These disparities are driven by structural, interpersonal, and individual stigma, which lead to barriers accessing care and avoidance of primary care, and to increased reliance on emergency care. We aimed to characterize ED use by Trans patients, and changes in such use over time. Methods: Data was obtained from the Nationwide Emergency Department Sample (NEDS) , which is a weighted stratified sample of hospital-based ED visits. Using gender-dysphoria related ICD-9 and ICD-10 diagnostic codes, we compared visits among trans people to those without such a diagnosis, adjusting for age, region, urbanicity, primary payer, and income quartile. We evaluated rates of chronic condition and mental health conditions as primary diagnosis at presentation and at admission. Presence of chronic conditions was assessed using the ICD-9 Chronic Condition Indicator for 2006-2014. Results: There was a rapid temporal increase in the proportion of visits with a trans-related diagnosis, from 0.001% of visits in 2006 to 0.016% in 2018. There were significant demographic differences between trans people and others. Trans people were significantly more likely to be admitted, adjusting for payment, age group, region, income and mental health condition (overall 52.4% vs. 17.3%, adjusted OR= 7.368 95% CI (6.771, 8.017)). A large proportion of ED visits by trans individuals was associated with a mental health diagnosis (28.7%, compared with 3.9% for others, p<0.001; adjusted OR =2.01, 95% CI 1.91-2.11) and/or with a chronic condition (58.2% vs. 19.2%, p<0.001; adjusted OR =3.65, 95% CI 3.61-3.69). Similarly, hospital admission among trans people was much more likely to be linked to a mental health condition (37.2% vs. 5.3% , p<0.001; adjusted OR = 2.78, 95% CI 2.44-3.16) or chronic condition (67.3% vs 41.3%, p<0.001; adjusted OR = 2.21, 95% CI 1.78-2.75) Discussion: The high admission rates, and high proportion of trans people with a chronic condition or with mental illness, may represent worse overall health due lack of primary care, or a delay in seeking emergency care among Trans people. Lastly, these findings could be a manifestation of a higher likelihood of a trans-related diagnostic code being charted among trans people at admission, or bias towards higher likelihood of trans people receiving a mental-health related diagnosis. There is a need for increasing access to affirming primary and mental health care among trans people, and increased training of emergency clinicians. Presentation Date: Saturday, June 17, 2023

In this chapter we will, through an autoethnographic approach, explore belonging as a bodily and emotional experience. The study’s theoretical perspectives are based on Merleau-Ponty’s (1945/2009) understanding of the body as the basis for human existence and for human emotional experiences. In addition, we incorporate Merleau-Ponty’s (1945/2009) and Zahavi’s (2003) perspectives on intersubjectivity and Goldie’s (2001) understanding of the intentionality of emotions. The purpose of the study is to explore the following overall research question: How to conceptualize belonging as a bodily and emotional experience? An autoethnographic approach consider personal experience as an important source of knowledge in and of itself, as well as a source of insight into cultural experience. On this background the empirical material of this study consists of the researchers’ narratives and critical reflections of belonging as a bodily and emotional experience. The material is analysed thorough a model of sentimentalisation which includes the concepts of intentionality, intersubjectivity, bodily feeling and bodily traces. Based on the results of the study, we will discuss what significance it might have for the teacher’s responsibility to meet the pupils’ need for belonging as a pedagogical ambition. Exploring belonging and emotion in the framework of sentimentalisation is an innovative angle and paves the way for more research into various areas of belonging

How technology creates new possibilities for transgender people, and how trans experiences, in turn, create new possibilities for technology. Mainstream technologies often exclude or marginalize transgender users. Trans Technologies describes what happens when trans people take technology design into their own hands. Oliver L. Haimson, whose research into gender transition and technology has defined this area of study, draws on transgender studies and his own in-depth interviews with more than 100 creators of technology—including apps, games, health resources, extended reality systems, and supplies designed to address challenges trans people face—to explain what trans technology is and to explore its present possibilities and limitations, as well as its future prospects. Haimson surveys the landscape of trans technologies to reveal the design processes that brought these technologies to life, and to show how trans people often must rely on community, technology, and the combination of the two to meet their basic needs and challenges. His work not only identifies the role of trans technology in caring for individuals within the trans community but also shows how trans technology creation empowers some trans people to create their own tools for navigating the world. Articulating which trans needs and challenges are currently being addressed by technology and which still need to be addressed; describing how trans technology creators are accomplishing this work; examining how privilege, race, and access to resources impact which trans technologies are built and who may be left out; and highlighting new areas of innovation to be explored, Trans Technologies opens the way to meaningful social change.

In Western societies the sex–gender binary informs individual experiences of gender transitioning. As with every passage of status, gender transition is regulated by formal and social norms aimed at re-establishing the ‘proper’ correspondence between sex and gender. In Italy, national legislation regulates the formal process of transforming one's gender, identifying medical science as the ‘proper’ social authority to manage gender transitioning in society. Only trans people who conform to social standards of sexual ‘normality’ are allowed to officially change their gender. However, in everyday life, alternative modes of gender transitioning exist and constitute a solid foundation to claim formal recognition by the State. This study is based on a qualitative sociological investigation of the process of gender transitioning in Italy that was carried out in Turin between 2008 and 2010.

BackgroundIn Colombia, health care for people with trans life experiences is characterised by countless barriers to health services and care. Commonly, trans people have experienced stigma and discrimination among health professionals, a lack of services and professionals specialized to guarantee affirmative processes from non-hegemonic gender perspectives, and there exists a marked pathologization and medicalization of services. Therefore, it is necessary to provide affirmative health services to improve health and well-being from the recognition of their needs and experiences. The article describes life narratives about health care for the gender transitions of trans women in Colombia.MethodsA qualitative narrative study was conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups were conducted between June 2019 and March 2020. Data were analyzed using thematic analysis and the Atlas Ti cloud program. National and international ethical guidelines were followed in the development of the research.ResultsThis research provided an overview of the health experiences of Colombian trans women. They reported their experiences of pathologizing approaches to transgender healthcare, stigma, discrimination, and barriers to accessing preventive, specialized, and regular healthcare services. For this reason, they opted for self-medicated gender transition processes and self-management of health care. An important aspect to consider within healthcare is that not all women want binary gender transition processes.ConclusionParticipants felt that in Colombia there is a lack of affirmative health care for transgender women and that there are many limitations to care related to the gender transition processes. This exposes them to more situations that violate their rights and influences their lack of confidence and their search for professional health care. In Colombia, it is important to develop strategies for education, information, and communication, as well as a handbook for health workers on specialized healthcare for trans women.

Indicators associated with gender transition will have a positive effect on the mental health of trans people. The effect of the duration of the transition on mental health will vary according to the level of internalized transphobia. To examine the impact of the gender transition process on the perception of mental health among Chilean trans people. A total of 377 participants were recruited. A self-administered questionnaire was used, including measures related to the transition process, internalized transphobia, experiences of discrimination, connection with the trans community, and perception of mental health. The data were analyzed using multiple linear regression. The indicators examined showed a significant correlation with the perception of mental health. When evaluating their contribution in the presence of other variables, the unique contribution of some variables was not significant. Satisfaction with the transition process was associated with a better perception of mental health. Among participants who scored high in internalized transphobia and had been in the transition process for a short time, the perception of mental health was lower. Experiencing discrimination was associated with a worse perception of mental health. People assigned male at birth had a better perception of mental health than those assigned female. The gender transition process, together with indicators of the Minority Stress Model, uniquely impacts the mental health of trans people in Chile. Uderstanding its unique contribution enables healthcare providers to adopt culturally sensitive care tailored to the specific needs of this population.

ABSTRACTDespite improvements in access to transition-related medical care, many transgender people still face numerous barriers to paying for gender-affirming procedures. Crowdfunding websites have gained immense popularity as a strategy for trans people to raise money for transition-related healthcare expenses. Using descriptive statistics and thematic content analysis, this paper illustrates how fundraising campaigns for medical gender transition both reveal and reinforce health and social inequalities. Although trans people crowdfund for a variety of transition-related needs, the majority of online campaigns are used to fund chest surgeries among young, white, binary-identified trans men in the United States. Most campaigns fall dramatically short of their fundraising goals. In addition, campaigns use medicalized, normatively gendered transition narratives that privatize inequality in marginalized communities. The article concludes with a consideration of how to incorporate a ‘revolutionary etiquette’ in crowdfunding for transition healthcare.

A dominant media narrative of “getting better” over time is often projected onto LGBTQ people’s personal life experiences. In this research study, I examine this narrative’s role in transgender people’s emotional well-being throughout transition. A “getting better” narrative was pervasive in my qualitative analysis of 240 Tumblr transition blogs and 20 interviews with bloggers, signaling that it impacted people’s self-concept both as presented on social media and when talking about their experiences. This narrative causes undue emotional harm given contrast between one’s post-transition reality, which may involve distress (despite greater congruence between one’s body and identity), and a dominant cultural expectation of happiness. I argue that an intersectional approach to understanding trans people’s emotional well-being—by considering multiple salient identity facets and life transitions—makes trans lives more livable by complicating the cultural imperative to feel better, and to present a unilaterally positive self-image online, post-transition. Even though trans people on average feel better after gender transition, everyday realities are often in contrast to the dominant narrative’s positioning of gender transition as a process with a single, simple goal of feeling better. Challenging the “getting better” narrative gives trans people the freedom to live and exist in their post-transition identities, whether or not they feel “better.”