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The field of trans health is more robust than ever, generating critical insight into the lives of trans people and possibilities for improving the delivery of gender affirming care. However, as healthcare needs and approaches have become more visible, an ideological backlash has escalated globally, presenting significant threats to the health and well-being of trans communities.
This Collection of articles on transgender issues and experiences, published in the journal Culture, Health and Sexuality, provides a timely reminder of the value of responding to these threats by investing in critically-engaged, locally-situated and community-partnered analyses of the social dimensions of gender, culture and health.
Transgender and gender diversity are umbrella terms describing people whose gender is different to that presumed for them at birth, including trans men, trans women, and non-binary people of all kinds. There are many variations in understandings of gender diversity across countries, including Indigenous and culturally specific gender identifications (e.g. hijra and travesti) and gender systems that do not fit easily with Western constructions of gender.
In this editorial introduction, while we use the term ‘trans’ as a shorthand, we recognise the incredible diversity of experiences and expressions that extend beyond cisnormativity – the societal and institutional privileging of cisgender experiences as the default norm – around the world.
Looking across this collection of articles, it is possible to identify three themes which offer both challenges and hope for better ways to meet the care and inclusion needs of trans people across different contexts. The first theme recognises how trans experiences can produce institutional and social transgression, particularly in areas of health and social service provision which are highly gendered, such as ‘women’s’ health.
For example, Birdenbaum-Carmeli et al.’s (2021) qualitative study of people undergoing fertility preservation in the USA and Israel includes four transgender men with a deep desire for genetic parenthood who faced a range of additional barriers to making that possible, depending on local health services policies and the particular forms of family and social support they could access.
Gibson et al.’s (2022) paperFootnote1 also focuses on a reproductive health issue, analysing how key informants working in Australian cancer prevention, sexual and reproductive health, and trans advocacy imagined an approach to cervical screening that could engage all those at risk of cervical cancer. This paper and that above demonstrate how much cultural and language work is involved in shifting the powerful social imaginary that limits reproductive health concerns to cisgender bodies.
However, transgressions of gender norms are not only discursive, as we can see in the paper from Lane et al. (2022). While period poverty – the lack of access to menstrual hygiene products, facilities, and education – has become more widely recognised as a social and public health issue, this paper makes clear that trans men and non-binary people who menstruate can face additional inequities, transgressing the common social assumption that menstrual products and disposal bins are only required in women’s toilet facilities.
The importance of creating inclusive spaces is also the focus of Linander et al.’s (2019) paper, which explores the perceptions and experiences of physical and psychological safety of trans people in Sweden, with a focus on the built environment. The analysis provides an important reminder of the powerful impacts space can have on experiences and feelings of belonging in everyday life.
A second theme in the Collection explores gender experiences as translations, recognising the distinctiveness of local expressions and practices, and the creative ways in which different frames of reference are translated (and mistranslated) across local and global imaginaries.
Hossain (2017) explores conceptualisations of rights and recognition for hijra communities in Bangladesh, including the complex relations between local governments and international NGOs revealed in the contest over who gets to determine the classifications, definitions, and forms of gender difference that constitute hijra identity. In a similar vein, the paper by Sevelius et al. (2019) demonstrates why careful attention to local forms of gender expression and identification, such as those typical of travestis in Brazil, is essential when providing HIV care, given the potential for mistranslation and misrecognition when global categories of identity are used in different contexts.
Social concepts of gender are always being (re)translated, integrating historically available narratives with self-understandings throughout the life course. Hilário et al. (2020) stress the creativity that is brought to this process, describing how young trans people in Portugal strategically draw on a range of medical and social frameworks to explain and enact gendered embodiment. Complementing this perspective, Li et al. (2022) analyse biographical interviews with older trans adults in the USA to explore how ‘authenticated social capital’ is fostered. Such a move involves translating experiences of navigating often unsupportive social networks and spaces to secure the conditions that will support flourishing in later life.
Here, we are also reminded that in the absence of an affirming context, trans people put enormous effort into finding mutually supportive and safe communities in which to live and connect. Interviewing young trans adults who had moved to the San Francisco Bay area to access care and community safety, Gamarel et al. (2021) explore trans experience as a driver of forced migration. Their work reveals the significant price that many trans people – and trans people of colour in particular – have to pay in order to affirm their gender.
The third theme in the collection recognises the work of trans communities and their allies in mobilising transformations relating to cisgenderism in cultures, systems and settings.
For example, a highly influential paper by Glick et al. (2018) explored a series of ‘dilemmas’ linked to improved data collection and analysis about ‘gender minorities’. While health system reform is slow and frustrating, this paper details both the challenges and some creative strategies being developed to more meaningfully recognise diverse and changing gender experiences and identities around the world. The authors emphasise the need to involve communities throughout the research process, to ensure that ‘these measures and resources will remain timely as gendered language and constructs continue to evolve’ (p 1374).
As made clear by Barcelos et al. (2019), trans communities have also had to work creatively and collectively to overcome the economic barriers to gender affirming care, such as establishing crowdfunding platforms on which to raise the funds needed to pay the cost of surgery. Focusing on top surgery (the removal or reduction of breast tissue and nipple augmentation in order to flatten and/or masculinise the chest), this paper critically reflects on the risk of crowdfunding reproducing structural inequities as well as moral scripts about who is most deserving of these lifesaving interventions.
Finally, Peitzmeier et al.’s (2017) paper reports some of the first internationally robust evidence on the health impacts of chest binding. A pioneering study conducted to address a community-identified need, the authors later published a commentary (Peitzmeier et al. 2022) which criticised the serious misrepresentation of the paper’s findings by anti-trans groups who sought to portray a life-saving practice as a danger linked to gender affirming care.
This Collection can only provide a snapshot of a rapidly expanding body of research aimed at uncovering and understanding diverse experiences and enactments of gender. In line with Culture, Health & Sexuality’s commitment to creating opportunities for thinking and writing across disciplines and issues at the juncture of health, society and rights, we hope to see more interdisciplinary social science research on trans lives being led and authored by trans researchers, especially those at the intersections of ethnicity, class, disability and geography.
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No potential conflict of interest was reported by the author(s).
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Notes on contributors
Christy E. Newman
Christy Newman (they/them) is a professor in the Centre for Social Research in Health at UNSW Sydney, partnering with community, clinical and policy organisations to understand the social aspects of sexual and reproductive health, HIV and viral hepatitis, and queer, trans, and intersex health, rights and inclusion. As a queer/bi + and non-binary person, they integrate lived experience and research expertise in contributing to public discussion on diverse genders, sexualities, relationships, and families.
Anthony K. J. Smith
Anthony K. J. Smith (he/him) is a sociologist of health, gender and sexuality in the Centre for Social Research in Health at UNSW Sydney. He is an early career researcher specialising in HIV prevention, care, and surveillance; sexual health; and data justice, particularly related to LGBTQ + communities. As a gay and queer cis man, he aims to work collaboratively with community partners to generate impactful research and advocacy.
Shannon Harvey
Shannon Harvey (they/them) is a doctoral candidate in the Social Policy Research Centre at UNSW Sydney and Head of Research at Relationships Australia NSW. Drawing on fifteen years of community services research in the UK, USA and Australia, their PhD interrogates the gender binary in family violence services. They prioritise participatory methods, informed by their experience as a disabled, bi + genderqueer person and a commitment to research that enables transformation.
Elizabeth Duck-Chong
Elizabeth Duck-Chong (she/they) is a writer, researcher and filmmaker who works across LGBTQ + sexual health, advocacy, and education. In previous roles, Liz has set up peer-based services, and was the lead writer of transgender health and wellbeing platform TransHub. Liz is also a Board Director of the Trans Justice Project in Australia.
Notes
1 As the first author of this foreword was a co-author of this paper, they did not take participate in the discussions pertaining to its inclusion in this collection.