Galvanising criticality: Analysing trans health policy in a hostile political context

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INTRODUCTION: Pathologisation has long provided the architecture for governing access to gender-affirming medical care. An explicit orientation towards human rights in the latest revision of the World Professional Association for Transgender Health’s (WPATH) Standards of Care is an important success in achieving trans depathologisation. This development is the result of sustained efforts by trans activists who have been dismantling pathologising structures and practices in the face of intensifying opposition and vitriolic attacks. METHODS: We present findings from the comparison of approaches to depathologisation in the WPATH Standards for Care, version 7 (SOC-7), and an alternative best-practices guide created by the Spanish Network for Depathologization of Trans Identities (the Guide) using the What’s the Problem Represented to be? (WPR) approach to policy analysis. This WPR analysis is informed by trans and First Nations policy workers, scholars, and activists. This methodological–conceptual approach is used to explore uncertainties about the limits of a liberal rights model in the Guide. FINDINGS: Situating rights in the broader field of governing logics indicates that, although this approach seeks to replace harmful practices, it does little to address underlying colonial mechanisms. Noticing uncertainty supported consideration of the dynamic ways that medicalisation and rights, liberalism and neoliberalism, and colonial power are sustained in trans health policy. CONCLUSION: In an increasingly hostile context, when uncertainty about the transformative capacity of human rights necessarily shifts focus, returning to trans analytics provides solid ground for deepening interrogation of the colonial conditions of care to enable full depathologisation to unfold.