‘A little bubble of utopia’: constructions of a primary care-based pilot clinic providing gender affirming hormone therapy

ABSTRACT

The provision of gender affirming hormone therapy for transgender and non-binary people is a rapidly developing area of gender affirming healthcare. While research indicates the benefits of providing gender affirming hormone therapy through interdisciplinary primary care-based models, less is known about how service users and providers construct their understandings of affirmative approaches. In this paper, we present findings from a discourse analysis of four service users’ and four healthcare professionals’ talk about a primary care-based pilot clinic providing gender affirming hormone therapy in Aotearoa New Zealand. Participants employed notions of pathologisation, time, and agency in their talk to construct the clinic as a personal setting which gave service users time to make their own health decisions, while constructing hospitals as impersonal with lengthy wait times. The assessment-driven nature of best practice guidelines that governed clinicians’ decision-making was constructed as constraining users’ agency. Findings highlight the ongoing importance of aligning gender affirming hormone therapy with other non-disease types of healthcare, and suggest new ways for achieving this through affirmative approaches to healthcare.

KEYWORDS:

• Gender affirming hormone therapy
• primary health care
• transgender
• medicalisation
• depathologisation
• discourse analysis
• informed consent

Acknowledgements

The authors thank participants for sharing their experiences, the Sex and Gender Diverse Working Group and Mauri Ora staff who were involved in the pilot clinic, students who gave feedback on the clinic, Jemima Bullock, NGOs who support gender diverse communities in Aotearoa NZ, and the anonymous reviewers for feedback on earlier drafts. We also thank the Faculty of Health at Victoria University of Wellington for funding a research position for this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).