(Re) Making gender in the clinical context: a look at how ideologies shape the medical construction of gender dysphoria in Portugal

Ana Patrícia Hilário

doi:10.1057/s41285-019-00102-3

Abstract

The act of diagnosing gender dysphoria (GD), as in the act of diagnosing any other condition, is structured by socio-cultural, political and economic factors and is conducted by social actors. Drawing upon in-depth interviews with practitioners who work with trans people in Portugal, the study reveals the nuances and complexities surrounding the diagnostic attribution of GD and the ways in which the ideologies regarding gender shape this attribution. Practitioners’ accounts show a diversity not often acknowledged within sociological and transgender literature. We extend previous studies by demonstrating that practitioners who operate under a social model of gender are opening space for trans people to be treated as experts of their bodies and identities by accepting the existence of those who identify beyond gender binaries. While it might not be true for practitioners who can be positioned within a biological model, thus attributing an essentialist explanation of gender, we found evidence that practitioners who follow a social model are allowing room for the self-definition of gender identification. The study provides another lens for understanding the diagnostic attribution of GD by paying attention to the accounts of practitioners who work with trans people and reveals their openness towards a collaborative model of care.

Highlights

Trans people in Portugal (Pinto and Moleiro 2012) and in other countries with a welfare state (Linander et al 2017a) need to obtain a diagnosis of Gender Dysphoria (GD) to access gender-confirming medical procedures (i.e. hormoneVol.:(0123456789)A
The current study aimed to provide a better understanding of gender subjectivities within the diagnostic attribution of gender dysphoria (GD) by practitioners who work with trans people in Portugal
Practitioners’ accounts on the attribution of the diagnosis of GD show a diversity not sufficiently acknowledged within sociological and transgender literature— there have been a few exceptions (Whitehead et al 2012; Shuster 2016). We further extend these studies by demonstrating that practitioners who operate under a social model of gender are opening space for trans people to be treated as experts of their bodies and identities

Summary

Introduction

Trans people in Portugal (Pinto and Moleiro 2012) and in other countries with a welfare state (Linander et al 2017a) need to obtain a diagnosis of Gender Dysphoria (GD) to access gender-confirming medical procedures (i.e. hormoneVol.:(0123456789)A. Trans people who do not correspond to the heteronormative ideal of female-bodied women and male-bodied men challenge heteronormativity, presenting a contradictory embodiment (Connell 2012), so they are placed in a less privileged position than those who correspond to the imaginary of gender binary (Johnson 2015) Within this light, trans people might feel the need to do transgender (Connell 2010) to obtain the diagnosis of GD and thereby access trans-specific healthcare and/or legal gender recognition (Dewey and Gesbeck 2017; Hilário 2017). Within the diagnostic attribution of GD, practitioners tend to place an unnecessary burden on trans people to define themselves in accord with the gender binary imaginary and to be certain about undergoing gender-confirming medical procedures to align their assigned gender at birth with their gender identity, i.e. to correspond to the authentic trans ideal (Johnson 2015; Davis et al 2016)

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Results

Conclusion