Bulletin of Applied Transgender Studies

A publication of the Center for Applied Transgender Studies

Volume 3, Issue 1-2

Cover of Current Issue

Volume 3, Issue 1-2

Summer 2024

ISSN 2769-2124

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Prioritizing Trans Autonomy over Medical Authority in Gender-Affirming Care: The Role of Risk and Uncertainty

Kai Jacobsen

Historically, gender-affirming medical care has been provided through an assessment-based model of care that prioritizes the clinician’s expertise and authority over the trans individual’s desires or lived experience, whichhas been widely critiqued by trans communities. More recently, informed consent approaches that de-emphasize formal mental health assessments are becoming increasingly common in gender-affirming care. However, previous research has found that many gender-affirming care providers continue to practice gatekeeping despite using the language of informed consent. In this article, I analyze the tensions between medical authority and patient autonomy in the recently updated 8th edition of the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC-8). I find that while the SOC-8 generally supports informed consent models, when faced with heightened risk or uncertainty, the SOC-8 reverts to an assessment-based model of care that reinforces medical authority and compromises trans people’s autonomy. I argue that without deconstructing the assumed authority and expertise of healthcare providers, we cannot achieve fully equitable and accessible gender-affirming care. Specifically, gender-affirming care providers must practice epistemic humility and value trans peoples’ lived experience as legitimate sources of knowledge. I suggest strategies for teaching clinicians to value trans people’s autonomy and embodied knowledge.

Original Article

Psychological Wellbeing of Trans and Nonbinary People Assigned Female at Birth in the US: Gender Minority Stressors, Social Support, and Gender-Affirming Behaviors

Charlene Johnson , Veanne N. Anderson , Ryan Steiner

Trans and gender diverse people live in a cisnormative society where their minoritized status compromises their psychological health. We examined associations between social support, intimate relationship satisfaction, gender minority stressors, gender-affirming behaviors, and psychological wellbeing in a convenience sample of 81 predominantly white trans and nonbinary people assigned female at birth and living in the US. Gender non-affirmation, negative expectations for the future, nondisclosure, and transnegativity were associated positively with anxiety and depression, and negatively with life satisfaction. Overall social support correlated negatively with psychological distress. Gender-affirming behaviors (e.g., hormone use, gender-affirming surgeries) did not predict anxiety and depression. However, life satisfaction scores were higher in those who underwent gender-affirming surgeries and legal gender marker changes. Gender non-affirmation scores were lower in those who had made legal gender marker changes in the total sample and in trans men who took hormones. Compared to nonbinary participants, trans men were more likely to be using hormones and to report lower gender non-affirmation scores. These results support other research on the associations between gender minority stressors and psychological wellbeing. Social support may ameliorate these stressors. Furthermore, people with nonbinary gender identities may differ in important ways from those with binary trans identities.

Original Article

Trans Birth Parents’ Experiences of Domestic Violence: Conditional Affirmation, Cisgenderist Coercion, and the Transformative Potential of Perinatal Care: Conditional Affirmation, Cisgenderist Coercion, and the Transformative Potential of Perinatal Care

Ruth Pearce , Carla Pfeffer , Damien W. Riggs , Francis Ray White , Sally Hines

Transgender people face disproportionately high rates of violence, including domestic violence. Like cisgender survivors, trans survivors typically report a pattern of coercion and control on the part of abusers. Drawing on the findings of an international qualitative study with trans parents who have conceived and carried their own children (i.e. trans birth parents), this article describes power and control tactics experienced by survivors, and how these may depart from the “public story” of domestic violence. The article reports on two thematic contexts of coercion and control that are particularly relevant for this population. First, conditional affirmation is a form of identity-related abuse that can be utilised by abusers to gain and maintain access to vulnerable individuals who may otherwise feel they have no other access to gender affirmation in their lives. Secondly, abusers may use pregnancy as a site of cisgenderist coercion, in which trans birth parents are deprived of autonomy through being socially and interpersonally feminized and ascribed into womanhood in the context of pregnancy. We then discuss how perinatal care can function as a site of heightened risk or mitigation for the impact of these forms of violence. The article concludes with recommendations for practitioners in healthcare, education, and domestic violence services, emphasising the importance of gender affirmation, trauma-informed services, and training around what domestic violence looks like for trans people.

Original Article

"It's Not the 'Being Trans,' It's Everything Around That": Trans Community Perspectives for Suicide Prevention

Anne V. Kirby , Emily Krebs , Laurel Hiatt , Anna Docherty , Nicole L. Mihalopoulos , Brooks R. Keeshin , Elese Peifer , Marlee Craker , Michael Staley , Amanda V. Bakian , Hilary Coon

Trans people are at significantly elevated risk of suicide death, suicide attempts, and suicidal ideation than their cisgender peers. Suicide prevention efforts are needed that address the most important issues to the trans community. In this qualitative study conducted in the United States in 2021, we aimed to broadly explore trans community member perspectives on suicidality and suicide prevention needs. We conducted four virtual focus groups—including one exclusively for trans people of color. We also solicited additional online responses to the same focus group questions. A total of 56 trans individuals with a history of suicidality participated. We utilized reflexive thematic analysis to develop themes to inform suicide prevention efforts for the trans community. The themes were multicontextual, representing needs across healthcare, legal and political arenas, workplaces, community groups, and interpersonal relationships. The central organizing theme identified as crucial for suicide prevention was “Having (Real) Rights and Respect.” Supporting themes were “Being in Control of Our Own Bodies,” “Being Safe as Ourselves,” and “Feeling Support and Acceptance,” which also included a subtheme of “Embracing Diversity within the Trans Community.” We provide suggestions and directions for suicide prevention, which build on these themes.

Original Article

Attitudes of Medical Students on Transgender People in Vietnam: A Survey of Medical Students at Hanoi Medical University

Eric Ardman , Vu Minh Anh , Dao Thi Dieu Thuy , Le Minh Giang

The transgender community faces disproportionate healthcare disparities; stigma and poorly trained providers are likely factors. The objectives of this study were to evaluate the attitudes and opinions of medical students regarding transgender people and to examine which demographic variables correlate with positive attitudes towards transgender people. This cross-sectional study surveyed 561 medical students, across all years of study, at Hanoi Medical University (HMU) in Hanoi, Vietnam. Students were surveyed in December 2018. The survey included demographic data collection and Attitudes Towards Transsexualism Survey. The survey demonstrated adequate internal consistency with a Cronbach’s alpha of 0.86. Overall, 78.6% of participants held positive or very positive attitudes towards transgender people. Most students reported there should be more LGBT-related content added to the curriculum. On multivariate regression, identifying as female and wanting more LGBT topics in the school curriculum were significantly associated with positive attitudes towards transgender people. Medical students at HMU held positive views of transgender people. They would benefit from, and widely accept, more LGBT content, particularly regarding transgender health, in HMU’s curriculum.

Original Article

Toward Proactive Support for Transgender and/or Gender Nonconforming Students in Teacher Education: Initial Findings of an Action Research Study

Airton Lee , Michelle Searle , Sofia I. Melendez , Katrina Carbone , Beck Watt , Kel Martin , Natalie Lefebvre

Despite a relatively supportive social and legal context, and growing societal awareness of gender diversity, transgender and/or gender nonconforming (TGNC) people remain woefully under-represented in the Canadian teaching profession. Many Canadian teacher education programs are taking steps to improve supports for TGNC teacher candidates given the recent addition of gender identity and gender expression protected grounds in almost every piece of Canadian human rights legislation. However, a “reactive” approach dominates, meaning that barriers faced by TGNC teacher candidates tend to be addressed after harm has occurred. Our action research project aims to collaboratively shift a teacher education program at a mid-sized Ontario university toward a “proactive” stance where known gender-based barriers are mitigated before TGNC teacher candidates encountering them. This article shares findings from the project’s first phase, focusing on barriers identified and mitigated four program areas: recruitment, application and orientation; practicum; career planning; and certification and graduation.

Super Straights: Heterosexuality, White Supremacy, and Transphobia without Transphobes

Brandon Andrew Robinson

This article turns to super straights—a sexual identity adopted by straight people who claim that they are not attracted to transgender people—in order to more broadly examine discourses around how people engage in transphobia without wanting to be seen as transphobic. In analyzing over 200 online discussion threads on Reddit, this article documents how in this moment of trans visibility, some people are using bioessentialist frames of biological sex, “born this way” ideologies of sexual identity, and personal preference discourses to construct heterosexuality as superior and to position their desires and ideologies as not transphobic. Notably, as constructions of biological sex, inherent sexual identities, and personal preferences have meanings rooted in racism and eugenics, this article situates these super straight discourses and strategies within this white supremacist history. Ultimately, this article argues that understanding more covert, and at times progressive and liberal, ways that transphobia operates is crucial in addressing trans antagonism and working toward gender liberation.