Advances in Trans Studies: Moving Toward Gender Expansion and Trans Hope: Volume 32

This chapter explores age-based variations in the healthcare experiences of transgender people. Specifically, we outline how transgender people narrate their experiences with coming out and transition in later life as well as possibilities for future research and clinical practice concerning older transgender populations. To this end, we begin with a review of the limited literature on older transgender populations including the ways such findings converge and diverge from studies of younger transgender populations. Then, we analyze data gathered from older transgender people throughout the United States concerning their experiences with health events, healthcare providers, and healthcare settings. For this empirical analysis, we draw on over 250 qualitative responses from transgender people over the age of 40. The findings of this chapter demonstrate the importance of adjusting existing healthcare protocols to provide adequate care for aging transgender populations. Specifically, our analyses highlight gaps in access and quality of healthcare delivery as well as issues related to medical education, trans-inclusive protocols, and sex-gender segregated medical traditions. The implications of our work here reveal important possibilities for expanding transgender healthcare access as well as existing barriers to such access. We specifically utilize the case of our respondents and the existing literature to illuminate gaps in needs assessment and healthcare delivery concerning older transgender populations. We will conclude the chapter with recommendations for bridging such gaps in research, education, and system operation.

Transgender people experience significant health and healthcare disparities in comparison to cisgender people. Limited access to quality, trans-competent healthcare in the USA is a central social determinant of these inequities. In this chapter, we expand on the burgeoning literature on accountability structures and transgender healthcare through an analysis of individual interviews with cisgender medical providers about their and their colleagues’ capacity to provide trans-competent healthcare. First, we find that providers report unfamiliarity and uncertainty concerning transgender people, their healthcare needs, and related issues. Although providers regard such ignorance as a structural problem within medical education and practice, the solutions they proffer rely on the benevolence and personal initiative of individual providers to seek out trans-specific information and training. This upholds the boundaries between what is considered “normal” (i.e., cisgender centered) healthcare and trans-competent healthcare. Second, we find that cisgender medical providers who want to provide quality healthcare to transgender people engage in emotion work that prioritizes the comfort and ignorance of their cisgender colleagues and inhibits institutional change. In sum, we argue that, regardless of their intentions, cisgender providers engage in practices that maintain healthcare as a cisnormative accountability structure and, in turn, contribute to the persistence of transgender health and healthcare disparities.

Over the past decade, there has been an increase in the number of transgender adolescents that receive gender-affirming hormones. While the long-term repercussions of taking hormones are understudied, it is possible that one of the impacts is infertility. Although infertility is not definite, healthcare professionals are still responsible for discussing fertility preservation with transgender adolescent patients, which encourages a population of young people to determine whether or not they want to biologically have children in the future. Drawing on in-depth interviews with healthcare professionals, parents, and transgender adolescents, this study explores the thoughts and perceptions pertaining to fertility and how these three groups work with one another throughout transition. My findings show that (1) adult participants (parents and healthcare professionals) have mental barriers, which include fear of regret and grief over the loss of anticipated biological motherhood, (2) there is a delay in the conversation happening between the healthcare professionals, parents, and trans adolescents, and (3) trans adolescents reject fertility, but are open to building a family. I argue that cisnormative and transnormative ideologies overshadow these conversations, which could result in limiting the potential for queer biological parenthood. The chapter ends with suggestions for how to make conversations pertaining to fertility preservation more expansive to dismantle transnormativity.

This chapter examines the surgical body modification experiences of transgender and cisgender people in the United States. It analyzes how surgery consumers with different gendered histories pursue “enhanced” embodiment. Both cisgender and transgender people obtain similar surgeries, but their procedures are differently regulated. Based on 40 in-depth interviews, this chapter compares the presurgical and postsurgical experiences of transgender and cisgender people. The findings show that cisgender and transgender people felt similarly about their bodies before surgery and reported corresponding cosmetic and psychological motivations for surgery. Both groups also had comparable postsurgical outcomes and used surgery to actualize a more desirable gendered embodiment. Ultimately, surgery resulted in changed gendered embodiment that enhanced the self for both groups. It could be psychologically transformative for cisgender people and provide more of a cosmetic effect for transgender people. These findings complicate disparate regulations of transgender and cisgender surgeries. They highlight surgeries as body technologies that enhance gendered embodiment allowing both cisgender and transgender consumers to articulate gendered concepts of the self.

Though ciscentric discourses often claim that genitals alone define gender, public disciplining of gender deviance suggests a move toward a broader and less genital-focused concept of gender, even among people who explicitly object to the normalization of trans people in society. In this chapter, I explore genital focused and holistic concepts of embodied gender in public discourses about cisgender celebrities and then in trans writings about gender and fatness emerging around the time of the transgender tipping point of 2014. I argue that hyperfocus on genitals in ciscentric discourses about trans bodies not only misunderstands trans experiences of gender but also misrepresents the role of genitals in post-millennium discourses about cisgender bodies.

Over the past decade, legal recognition of trans, non-binary, and intersex individuals has occurred in a number of countries with diverse relationships to gender categorization and (settler) colonialism. This attention to trans and non-binary rights has translated into the addition of a third option for declaring gender: X. Heralded by some as a sign of progress and recognition of non-binary individuals by the state, the development of the X marker may also be interpreted as facilitating state regulation of gender-diverse individuals. Drawing on scholarship in trans studies and legal studies, this chapter critically examines the X marker as an intervention that works within and simultaneously resists state recognition of non-binary identities. By analyzing data gathered through semi-structured interviews with trans, non-binary, and genderqueer individuals who have obtained – or are in the process of electing – an X marker in legal documents, this chapter critically explores the tensions and complexities of the X and mobilizes the concept of opacity to demonstrate how individuals graft their own meanings onto this non-binary marker. While acknowledging the problematic use of identification documents as biopolitical instruments, this chapter asks if we can nonetheless use them as tools of resistance and radical self-determination to transgress the controlling power of the state.

In this chapter, I address how criminal justice policies, and discrimination and prejudice within the US criminal justice system, negatively affect trans men. By focusing on trans men’s unique incarceration experiences using 15 in-depth interviews, I recommend four key policy changes for correctional facilities: (1) allow trans men to choose the gender of the correctional facility in which they are housed; (2) allow trans men to wear undergarments that align with their gender identity; (3) provide trans men access to trans-appropriate healthcare; and (4) implement harsher penalties for non-compliance of Prison Rape Elimination Act Standards. These four policies would improve the life chances of trans men during their incarceration and post-incarceration.

In this chapter, we explore the lived experiences of transgender and gender non-conforming (TGNC) prisoners, arguably the most vulnerable minority in the prison estate, using the data from our correspondence study with transgender women and non-binary individuals incarcerated in male establishments in England and Wales. We provide a brief review of the extant literature, describe the English prison system and the regulations concerning transgender prisoners, and analyze two axes of vulnerability of TGNC prisoners: social (stemming from relationships between prisoners) and institutional (resulting from the prison regime). Along the social axes, we find, in contrast with prior research, that our respondents defied the stereotypes of trans prisoners as submissive to males in a hypermasculine prison society and as involved primarily in abusive relationships. Along the institutional axes, we find that, despite the progressive by international standards transgender prison regulations, prisoners were subject to vicissitudes in treatment that negatively affected their ability to express their gender and their health. Focusing on access to gender-affirming items (clothing, prosthetics, make-up) and gender-affirming medical treatment, we develop recommendations for the prison service that could improve the conditions of confinement for TGNC prisoners.

Trans students at New College of Florida provide overwhelmingly positive assessments of their campus culture as related to issues of gender identity, a stark contrast to existing literature on gender-nonconforming collegians. This chapter examines the interactional processes that create a context supportive of all genders – the ways students are expected to act toward one another and how they hold each other accountable to these norms. I draw on interviews with 24 students with diverse identities to argue: (1) there is a trans-inclusive understanding of gender that is dominant on campus, (2) the students have norms that reflect the inclusive understanding and provide direction for when and how gender should enter interactions, and (3) swift responses to breaches of interactional norms serve to support gender-nonconforming students and affirm the identity of the community as unwilling to tolerate transphobia. This analysis demonstrates an alternative cultural context, one in which community members are held not to conventional expectations associated with assumed sex category, but to an understanding of gender that does not take identity for granted. In so doing, it highlights how shifts in shared understanding can create more inclusive interactional practices. Additionally, the focus on the meaning underlying social processes suggests that shifts in how people think about gender could similarly lead to alteration of organizational structures that would help trans students thrive.

This study builds on existing research to explore how transgender and non-binary people navigate complex terrain when it comes to strained and ambiguous relationships with families of origin. This chapter draws on 23 in-depth interviews with trans and non-binary adults (ages 19–41) to examine the ways that respondents navigated ambiguous and complex family relationships marked by mixed messages and contradictory behaviors from parents regarding their sexual and gender identities. I find that respondents engage in a range of strategies – correcting, conforming, and concealing – to bargain for belonging within families of origin through their work to preserve family ties. Beyond experiencing the emotional costs of ambiguous parental support, I find that some respondents also experience financial strain and inadequate housing, stemming from unstable, distressing relationships with their parents. This chapter demonstrates that ambiguous support from family and complex familial relationships may contribute to a cycle of precarity for trans and non-binary adults. Finally, I show that for respondents, connections to local queer and trans communities and supportive partnerships buffered the negative impacts of familial ambiguity. However, not all respondents had access to community support, intensifying their experiences of marginalization. This chapter contributes to the literature working to destabilize the support versus rejection binary used to characterize LGBTQ experiences and has implications for better understanding the pathways into poverty that trans and non-binary people experience.

Sociological research on transgender and gender nonconforming (t/gnc) people has emphasized the interplay between identity and institutional contexts as constraining through dominant ideologies on sex and gender. In contrast, feminist research focused on embodied trauma has demonstrated numerous prospects for healing. In bridging these two fields of study through a socio-phenomenological lens, this research shows how consciousness emerges, facilitating the development of bodily agency. Empirically, the paper examines whether t/gnc people can use movement-based activities for healing, and how that healing occurs in particular spaces. In reflection of the impacts of insidious traumas on both the body and mind, this paper radically re-centers the body to consider the potential for healing through movement. Through an analysis of in-depth interviews with t/gnc people on their engagement with movement-based activities, I argue that participation in movement, on one’s own terms, enables a practice of bodily freedom. Moving beyond constraint and regulation, bodily agency requires a degree of bodily awareness (consciousness) that can emerge through participation in movement-based activities in t/gnc-centered and “personally-public” spaces. These results show that movement-based activities support t/gnc people in healing from the impacts of insidious traumas. These findings have empirical importance, exemplifying the power of fostering intentionality through movement practices, as well as theoretical implications for understanding the role of the body when exercising agency in processes of healing from embodied oppression outside of formal therapeutic landscapes.

This study explores the health-seeking process for queer and/or trans people, and factors involved in their healthcare negotiations and decisions to seek care. The data included 20 semi-structured interviews of people who identify as queer and/or trans in the southeastern United States. Qualitative analysis was conducted using constructivist grounded theory to inductively analyze accounts of healthcare events, behaviors, and experiences of queer and/or trans people. Participants’ ages ranged from 18 to 57, with a majority identifying as trans/gender nonconforming (65%) and those remaining identifying as queer, cisgender individuals (35%). Both queer and trans identities can overlap, therefore, I use the term “queer and/or trans.” Categories generated through the coding process were as follows: (1) mental health concerns, (2) negotiating gendered and heteronormative assumptions, and (3) significance of participants creating a bed of knowledge. My analysis asserts that these data indicate that queer and/or trans participants manage not just healthcare decisions, but the hopelessness attached to seeking this type of help.

This chapter aims to analyze the sociabilities, information-sharing behaviors, and types of social support among users of French non-mixed trans Facebook groups. First, our national survey (N = 405) reveals that the different uses of these groups (information retrieval, emotional support, etc.) vary according to the age and education levels of their trans users, or according to their progress on the transition pathways. Second, we perform a lexical analysis of the messages (N = 70,488) posted, since 2013, in a sample of 24 groups, in order to identify the main topics of discussion. This analysis leads us to emphasize the diversity of social support provided by trans people to one another, via posts and comments. These findings deemphasize the benefits of institutional support because they suggest, alternatively, that trans people are organizing themselves to avoid challenges associated with medical institutions and the French “therapeutic shield.. Such individuals use Facebook to this end, sharing information or support in order to create a safe space managed with a transfeminist ethic, and allowing themselves to make gender-related choices more autonomously, far away from normative judgements (in particular those expressed by the medical profession).