WITHDRAWN: Determining Trans Health: Self-Advocacy and Resistance in the Medical Industrial Complex

Background and Purpose: Today’s political assault on transgender health rights is part of a historical struggle against medicalized control and regulation of gender nonconformity in Western science, medicine, and the law. Transgender social movements have organized against medicalized violence and for access to affirming providers and biotechnologies, making trans health care encounters a robust site for analyzing power. The research literature related to trans people’s experiences in health care settings has focused significantly on the lack of provider training and consequential barriers to care. This paper offers a critical retelling of these health care narratives. Based in a health justice framework, which aims to transform power structures that create health inequities, and theories of “dispersed resistance” (Johansson & Vinthagen, 2018), this study draws on in-depth interviews to theorize how work to negotiate the terms of their care.

Methods: The study was conducted in the context of a community-based initiative about sexual and reproductive health inequities led by and for transmasculine people (defined broadly to include people who are men, trans, nonbinary, two-spirit, and otherwise gender nonconforming and were designated female at birth). The research design was based on the theoretical-methodological approach of Constructivist Grounded Theory and included interviews with 26 transmasculine adults in Los Angeles County. Participants ranged in age from 20-to-61-years-old and a majority were Black, Indigenous, Latinx, Asian and/or Pacific Islander. Recorded interviews ranged in duration from 50-120 minutes and were collected and analyzed contemporaneously through a process of line-by-line coding, focused coding, memoing, constant comparison, and theoretical sampling.

Results: Consistent with prior research, most participants described negative health care experiences that had ranged in impact from “awkward” to “traumatizing.” Participants prepared, maneuvered, gamed, advocated, and educated in order to change power dynamics to gain agency over the conditions of their care. While strategies were dispersed (in that they were not mass-mobilized), some relied on community interconnectedness and knowledge exchange, such as vetting, counter-research, and boycotting. Other strategies included bringing witnesses, confrontations, refusals, “shapeshifting,” and strategic non/disclosure.

Conclusions and implications:

Through social processes used to gain agency in health care settings, trans participants destabilized binary sex/gender assumptions and medical authority while expanding meanings of “trans health care” in practice. As health equity efforts increasingly look upstream to structural level approaches, this study can equip trans people and community organizations with concrete strategies to challenge existing power structures now. Rather than merely an edifying account of how people navigate adversity, a focus on theories of resistance helps align this study with the bottom-up approaches of social justice movements. In turn, these strategies can inform structural-level interventions.