Transgender Healthcare Does Not Stop at the Doorstep of the Clinic

Transgender healthcare is political because trans lives are political. Many countries seeing lawsuits trying to curtail access care for transgender people and, in the United States, some states have proposed bills that would criminalize offering transition-related medical minors. Although these efforts so far been unsuccessful, they speak prevailing atmosphere of hostility toward people. Clinicians working with patients should not only be aware broad-strokes politics their practices but also impact politicization on patients. Prejudice, discrimination, and violence directly physical mental health individuals.1Hendricks ML Testa RJ. A conceptual framework clinical work gender nonconforming clients: an adaptation minority stress model.Prof Psychol Res Pr. 2012; 43: 460-467Crossref Scopus (817) Google Scholar,2White Hughto JM Reisner SL Pachankis JE stigma health: a critical review determinants, mechanisms, interventions.Soc Sci Med. 2015; 147: 222-231Crossref PubMed (561) ScholarA history pathologization paternalism looms large over practice.3Spade D Mutilating gender.in: Stryker S Whittle The Studies Reader. Routledge, New York, NY2006: 315-332Google Scholar, 4Riggs DW Pearce R Pfeffer CA Hines White F Ruspini E Transnormativity psy disciplines: constructing pathology Diagnostic Statistical Manual Mental Disorders Standards Care.Am Psychol. 2019; 74: 912-924Crossref (21) 5MacKinnon KR Grace Ng Sicchia SR Ross LE “I don't think thought I was ready”: how pre-transition assessments create inequities complex Canada.Int J Health. 2020; 49: 56-80Crossref (10) Scholar Ending engagement communities at threshold clinic, though welcomed by traditional professionalism, fails reflect deeply aspects healthcare. Trans practitioners engage beyond doors clinic strive ideal community-engaged clinician-advocate. benefits this approach fourfold: 1) it positions as knowers subjects own healthcare; 2) fosters strong therapeutic relationship; 3) grants otherwise inaccessible information; 4) responds social determinants health. After reviewing benefits, we discuss what fruitful look like. has long dominated pathologizing paternalistic approaches care, which unfortunately remain day.4Riggs Scholar,5MacKinnon Instead viewing self-determining seeking clinicians viewed them disordered. They tried discourage from being trans. gatekept transition exclude those really Until recently, were overwhelmingly excluded knowledge production Thus, learning about solely through sources unwittingly perpetuates disenfranchisement communities. In ethics, known hermeneutical injustice: socially disadvantaged group left out knowledge-production themselves.6McKinnon R. Epistemic injustice.Philos Compass. 2016; 11: 437-446Crossref (40) By engaging terms, can position within life. clinician-patient relationship, predictor outcomes, suffers wake gatekeeping. rightfully struggle trust providers them.5MacKinnon As Dean Spade puts it, “No one trusts doctors place things out.3Spade Scholar” Widespread lack mutual between professionals patients, key component relationships, serves impediment optimal Patients who expect mistreated or denied less likely seek preventive emergency Engaging outside trust. talk. Local organizations often maintain lists trusted serve space informal whisper networks. Social media invites audiences communicate another important source recommendations. reputation politically communities, perceived “in trenches,” appreciated good listeners, finely attuned realities people, reverberates into practice. does end clinic's doorstep. positioning cis (not trans) limits health.7Ashley F. Surgical informed consent recognizing perioperative duty disclose care.McGill Law 13: 73-116Google do experience world same way person, rich diverse ways cannot reduced singular archetype.8Rider GN Vencill JA Berg DR Becker-Warner Candelario-Pérez L Spencer KG affirmative lifespan (GALA): competent nonbinary clients.Int Transgend. 20: 275-288Crossref (17) Scholar,9Bradford NJ Syed M. identity development: master narrative approach.Sex Roles. 81: 306-325Crossref (25) historical exclusion means abundance information integral yet reflected education scientific literature. Missing translates ignorance reliance mistaken cisnormative assumptions fill gaps. Some most blatant examples such include beliefs all women must love dresses, hate beard, wish vaginoplasty (and vice versa men) non-binary merely confused allowed medically transition. arises more insidious subtle ways. Novel appear before making literature: low-dose hormones among surgical procedures resulting both penis vagina it. evolve alongside learn best meet patients’ needs. Involved vanguard abstracted sociopolitical environment. Best controversial, jurisdictions attempting prohibit even interventions part standards care. Debates insurance coverage mired importance worthiness lives. Interpersonal mistreatment, structural institutional privilege cisgender transphobic violence, harassment cognitive affective processes lead poorer people.2White You can't treat patient avoids settings past traumatic experiences expectations mistreatment. help if doesn't cover unable pay pocket. take dead. Insofar factors determine invested well-being step boundaries professional role advocate uniquely well placed support amplify voices, credentials affords significant authority. Fruitful humble, attentive, supportive. Without humility realities, attentiveness movements, extra-clinical preserves elements fulfil promise community empowerment, alliances, communal knowledge, effective change. Humble assumption know health, needs much engagement. Humility entails decentering oneself, deferring perspectives, resisting urge inject views, technical jargon, medicalized perspectives spaces. bring comfort joy rather than discomfort community. Attentive react defensively judgmentally, eagerly listen say trans-specific realities. Attentiveness utmost when members offer feedback criticism. Supportive terms use power promote voices rising When diversity experience. monolith. live desire across inexhaustible range identities, embodiments, expressions. decenter able-bodied, affluent, skinny, white, actively prioritize intersection multiple axes marginalization.8Rider concrete connect local events open them, including marches, conferences, meet-and-greets. reach to, cite, collaborate researchers. Those may find helpful local, regional, national online, mindful ethical concerns associated interacting potential actual media. doorstep clinic. supportive contributes depathologization lives, improves patient-provider enhances competence, embodies whole-person Taken together, modes address immediate needs, community-minded