“What if I’m not trans enough? What if I’m not man enough?”: Transgender young adults’ experiences of gender-affirming healthcare readiness assessments in Aotearoa New Zealand

Abstract

Background

A growing body of transgender health research reports that transgender people often feel pressure to conform to a dominant narrative during gender-affirming readiness assessments. In New Zealand, however, no study to date has specifically examined transgender people’s experiences of readiness assessments for gender-affirming healthcare.

Aims

This study aimed to explore the experiences of transgender young adults (aged 16-30) during gender-affirming readiness assessments in New Zealand. We also sought participants’ views on improving transgender healthcare provision.

Methods

Thirteen transgender young adults took part in individual interviews or focus groups. Participants were asked to describe how they felt about the questions asked during readiness assessments and how the readiness assessment process could be improved. We used thematic analysis to identify patterns of meaning across the dataset.

Results

We identified two themes. Firstly, proving gender explores participants’ views of readiness assessments as designed to establish whether they were “trans enough” or “truly” transgender, and why readiness assessments are conducted in this manner. Secondly, the trans narrative describes the pressure participants felt to adhere to a dominant transgender narrative in order to gain access to the healthcare they needed.

Discussion

Our findings call attention to the importance of a trans-affirmative approach and the need to clarify the purpose of gender-affirming healthcare readiness assessments in New Zealand.

Keywords:

• Gender-affirming care
• New Zealand
• qualitative research
• readiness assessments
• transgender

Acknowledgments

We would like to thank Franziska Pöschl and Sam Duffy for their work coding transcripts for this project. We would also like to thank InsideOUT, Gender Minorities Aotearoa, RainbowYOUTH, and all our other community partners for their guidance over the course of this research, and the Youth Wellbeing Study team for their feedback and support.

Notes

1 Here, we use Gender Minorities Aotearoa’s (2017) definition of “trans” as an “umbrella term for people whose gender identity and/or gender expression differs from what is culturally typically associated with the gender/sex they were assigned at birth” (p. 3). We acknowledge that people under this umbrella may describe themselves using a wide variety of possible terms, and that some people who fit this definition may not consider themselves to be trans or identify under the trans umbrella. We use “New Zealand” and “Aotearoa” interchangeably throughout this paper — “Aotearoa” is the indigenous Māori name for New Zealand.

2 An indigenous Māori term that historically meant “intimate companion of the same sex” (Williams, 1871, p.147), but has been reclaimed to refer to all non-heterosexual, non-cis, and/or intersex Māori people (similar to rainbow; Kerekere, 2017).

3 A Pasifika umbrella term for rainbow identities: Mahu, Vakasalewa, Palopa, Fa’afafine, Akava’ine, Fakaleiti (leiti), Fakafifine (PrideNZ, 2011).

4 For example, the website noted that real life experience (“living and working full time for at least two years as a woman/man”) was required to access hormones and surgery. Wi-Hongi and colleagues (2017) point out that “attempting to be read as the correct gender without appropriate medical support can have negative consequences” (p.156). These include exposure to physical and sexual violence, high social anxiety due to hypervigilance, and physical problems such as back pain and compressed ribs from binding one’s chest too tightly, or bladder infections as a result of avoiding public bathrooms. Due to these potential negative consequences, real life experience was removed from the WPATH Standards of Care in 2011.

5 These guidelines have since been updated, but readers interested in seeing the guidelines that were posted at the time of interviewing can visit http://web.archive.org/ and search the website captures from February 2018.

Additional information

Funding

This work was supported by the Rule Foundation.