‘Bye-bye boobies’: normativity, deservingness and medicalisation in transgender medical crowdfunding

Abstract

Transgender individuals experience multiple barriers to accessing care related to medical transition, including a shortage of providers as well as health insurance programmes that categorically exclude the provision of gender-affirming hormones and surgery. Like people seeking financial support for health care related to illness or injury, many transgender people utilise web-based crowdfunding to help pay for medical transition costs. Although a growing body of research finds that medical crowdfunding individualises the effects of health inequalities, little of this research has focused specifically on trans crowdfunding. A dataset of 410 crowdfunding campaigns for medical transition was created. The majority of online campaigns were used to fund chest surgeries among young, white, binary-identified trans men in the USA. On average, campaigns raise only about 25% of their fundraising goal. Using thematic narrative analysis, I find that campaign narratives exhibit several main themes: trans 101, biological essentialism, insurance access, deservingness, normative transition and notions of progress. These themes illustrate how transgender medical crowdfunding is a response to inequalities but also has the effect of reproducing them.

Keywords:

• Crowdfunding
• gender transition
• inequality
• social media
• transgender

Acknowledgements

Many thanks to Elly Higgins for their help in coding the campaign narratives and to Chris Kitzmiller for his assistance in creating the initial dataset.

Declaration of interest statement

No potential conflict of interest was reported by the authors.

Notes

1 Shortly after beginning this study, in May 2016 the US Department of Health and Human Services (HHS) issued regulations on the non-discrimination section of the Affordable Care Act (ACA). This guidance prohibited the categorical exclusion of trans-specific care from insurance policies administered through Medicaid, Medicare, state-based health-care exchanges and any private insurer that also maintained a product in the exchange market. In other words, trans-specific care would no longer be subject to blanket exclusions for a majority of insured persons in the USA (see https://transgenderlawcenter.org/archives/12908). However, in December 2016, a federal judge in Texas granted a temporary injunction to prevent the enforcement of the regulations, opening the door for states to disregard the HHS guidance. The Trump administration has announced its intention to officially roll back non-discrimination protections under the ACA.

2 Because these are publicly available data that are accessible without creating an account, they are not considered human subjects as defined by institutional review boards. However, I follow the ethical guidelines set out by the Association of Internet Researchers Ethics Working Committee (Markham and Buchanan 2012) by changing any personally identifiable details such as the recipient’s name, location, race or the title of their campaign. I also conducted a web search with all direct quotations to ensure that they would not reveal the original campaign from which they were excerpted.

3 The vast majority of participants specifically stated their current gender identity and sex assigned at birth in their campaign narrative. Only 7 fundraisers (1.7%) were unable to be coded for gender identity based on the information in the page, and 4 (1%) were unable to be coded for sex assigned at birth. It is possible that a higher percentage of people crowdfunding on the site identify as nonbinary but choose not to indicate it. Whether or not the recipient was a person of colour was more difficult to code. An imperfect solution was to code ‘yes, stated’, ‘yes, guessed’, ‘no, stated’, ‘no, guessed’ and ‘unclear/insufficient data’ based on the text, photos and name of recipient. Coding for race in this way is inherently problematic but nevertheless important to estimate in order to identify potential racial inequalities in crowdfunding. It is possible that the proportion of people of colour is over- or under-estimated.

4 The importing of the webpages into MaxQDA did not lend itself to the calculation of accurate inter-coder reliability measures, as we were unable to neatly select sections of the text to compare among coders (Van Den Hoonaard 2008).

5 In-depth quantitative findings on factors predicting a successful campaign (e.g. social media activity) from this data are discussed in a separate paper.

6 These are unstable categories that do not translate easily across time and place, and it is possible that recipients understand their genders in ways that are not represented by the text they used in their fundraising campaign.

7 Here, the recipient is referring to vaginoplasty.

8 It is a common myth that testosterone use among trans masculine people is associated with higher rates of breast and reproductive tract cancers (Deutsch 2014).