Ensuring an inclusive, trans-led future for the field of trans health

Introduction

Historically, research in the field of trans health has been fraught because it has predominantly adopted what Tuck (2009) refers to as a ‘damage centered approach’, which is often pathologizing. Damage centered research has typically focused on trans people as a marginalized group, emphasizing poor physical or mental health outcomes, and has overlooked the strengths of trans people. This damage centered framing is predominantly written from the gaze of cisgender researchers, leading to non-neutrality in terms of how trans people are described to experience the world and our bodies. Pathologizing research has blamed trans people for any challenges faced, either by depicting being trans itself as a pathology, by failing to recognize the harms caused by cisgenderist healthcare systems, or by reinforcing harmful rhetorics that devoids trans people of our full humanity. Moreover, trans health research has often failed to adequately account for contextual factors like ableism, classism, and racism in addition to cisgenderism. Although taking a comprehensive intersectional focus by addressing the interlocking nature of all systemic and social forces which simultaneously privilege and oppress along lines of social difference is not required in every individual piece of trans health research, authors are encouraged to consider the diversity of experiences within and among trans communities when planning research for submission to the International Journal of Transgender Health.

Increasingly, both damage centered and pathologizing approaches to trans health have been challenged through research that seeks to take into account trans people’s lived experiences of health and healthcare. This includes research that is led by trans people or research where trans people are consulted as advisory group members before, during, and after the data collection and analysis where cisgender researchers are leading a particular study. Nonetheless, it remains the case that cisgender people conduct a majority of trans health research, and damage centered approaches or research that solely focuses on harm, dominate the field. Cisgender people are the main beneficiaries of health research investments, such as governmental and philanthropic grant funding, and are viewed as neutral and objective intellectual authorities on trans health simply due to being cisgender. While it is important to focus on the very real harms that trans people face, it is also vital to acknowledge that harm, marginalization, and poor physical and mental health outcomes are only part of the story. An equal focus on resilience, strengths, and joy is needed and encouraged for submissions to the International Journal of Transgender Health.

In this editorial we explore what we as a group of the editors of the International Journal of Transgender Health hope for the journal going forward, mindful of the above. We speak to the types of submissions we seek, the importance of the involvement of trans people in research about our lives, and the ongoing need for researchers to be mindful of the language that we use in trans health research and more widely. This editorial is not intended to be prescriptive, but rather to provide those seeking to submit manuscripts to the journal with some guidance about what is most likely to result in a positive outcome of the peer review process. Most importantly, we contend that trans health research should directly benefit and be of service to the trans communities it aims to serve by being with, by, and for trans people following the mantra of decolonizing methodologies (Smith, 2021).

The journal remit

At present, the stated aims and scope of the International Journal of Transgender Health includes a primary focus on medical research on trans health. Yet what is published in the journal is largely social scientific accounts of trans health. This is most certainly a positive. Research that centers trans people’s voices from every corner and culture globally is the ultimate aim of the journal. Going forward, our interest in publishing medical research remains, but we wish to encourage the submission of manuscripts that report on new techniques in gender affirming care, or which provide contextualization for medical procedures (i.e. impact on wellbeing), or which challenge the status quo in terms of how trans healthcare is practiced. In other words, we encourage the submission of medical research that is critical, in the sense that it challenges taken for granted ways of thinking about trans health.

Overall, we encourage submissions that are critical of the status quo in trans health research. In terms of social scientific research, we would encourage researchers who seek to submit manuscripts to the journal to go beyond established research topics or paradigms. Too often we receive manuscripts that repeat known issues about topics we have already published about. While the health of trans communities may often be improved by repeated study of the same or similar topics, we strongly encourage authors who are revisiting topics previously published to explore both theoretical and methodological innovation. We also receive a high volume of systematic reviews, often on topics we have already published about extensively, or with very small numbers of articles reviewed. In our continued openness to systematic reviews, we will be most interested in those that explore new areas or offer something new, again in the way of theory or method. In terms of empirical social scientific research, we call for submissions that challenge existing paradigms or go beyond damage centered accounts. For example, we often see the use of minority stress theory without adequate problematization of its core tenets (Tan et al., 2020). We also receive submissions of research that claim to utilize Braun and Clarke’s (2023) approach to thematic analysis, without actually engaging with their recent advancements to the process of reflexive thematic analysis.

Finally in terms of the journal remit, we receive a growing number of submissions that report on large, publicly available datasets. Obviously, such datasets are important as they demonstrate the extent to which findings from smaller datasets hold true in larger samples of trans people. However, too often it is the case that ­analyses of large datasets are published many years after collection and in a piecemeal fashion, only very incrementally increasing knowledge. Further, the utility of some of the large datasets with public use files, such as those from health surveillance systems and similar data collection efforts, may be overstated since these datasets are not often specifically tailored to the priorities of trans people. We welcome empirical work with these kinds of large datasets that also attends to their theoretical, methodological, or ethical limits in meaningful ways. Moreover, we encourage innovative data collection and study designs that address less studied aspects of trans health, especially those which can shift the damage-based narrative of trans research to a more community strength centered approach. Going forward, we encourage authors to consider whether the submission of multiple papers to the journal from the same large datasets is likely to make a meaningful contribution. This is especially true when the datasets are now a number of years old or have already been widely analyzed across the literature.

Terminology

Using language that is rooted in the principles of respect, equity, safety and cultural relevance is essential in ensuring the dignity, rights and well-being of all trans people. Too often, the field of trans health has been marked by the use of outdated language, or the use of language where the meaning is problematic or vague in its level of precision. The history of the title of the journal itself is an example of this. While we recognize the gap that often exists between language used in communities and language used in academic writing, we seek to ensure that the language used within the journal reflects the views of trans community members as best as possible. This is vital given that how trans communities are described has a direct impact on how people outside of trans communities understand trans people’s lives.

Going forward, we thus encourage authors to think carefully about the language used. It is unlikely that there could ever be consensus around language when seeking submissions that challenge the status quo of trans health, and indeed language is deeply wedded to context in terms of place, time, and audience. Indeed, within the editorial board there may not be a consensus on best practices for language. Instead of prescriptive accounts of what language is best, or a list of terms that should and should not be used, we encourage authors submitting to the journal to be clear about how they use language and at every stage. For primary research, what is often most important is fidelity to how participants describe themselves. Beyond this, transparency around what language was used for recruitment, how it is reported, and how it fits with or challenges the existing literature is also important.

To illustrate we offer some examples around language we often see both in submissions to the journal and in the literature more broadly. We have seen an upswing in the use of the phrases like ‘gender diverse’, ‘gender creative’, and ‘gender expansive’. We encourage researchers to think about what these terms mean. Are they used by trans participants? Are they used as a catch-all for people who do not have a binary gender? For example, when the phrase ‘trans and gender diverse people’ is used, does that mean that ‘trans’ refers to people with a binary gender, and everyone else is subsumed under the label of ‘gender diverse’? And when using the terms ‘gender creative’ or ‘gender expansive’, does that imply that all trans people are creative or are expanding gender, particular during childhood?

Similarly, we often see submissions that use the language of assigned sex (e.g. AMAB, AFAB). We appreciate that there may be times where this is necessary. But we encourage authors to think about if this language is really necessary, and to explicitly explain why it is being used. In terms of acronyms, we too often see acronyms used where the full words are more appropriate. For example, referring to trans women as ‘TW’ might save a small number of words, but it can also be reductive and objectifying. While there are some commonly accepted acronyms (e.g. LGBTQ), we encourage authors to avoid using acronyms to describe diverse groups of trans people. Finally in terms of language, we would encourage authors to consider what it means to refer to ‘the trans community’, as though trans people constitute a homogenous entity. Certainly, trans people constitute a collective due to shared experiences of cisgenderism, but there is also immense diversity within trans communities. As such, we would encourage authors to refer to trans communities in the plural.

Additionally, we feel strongly that as a specialist journal we are a long way past authors needing to provide a basic definition of who trans people are. Too often we receive submissions where the first sentences or paragraph of the paper defines who trans people are. Frequently these definitions themselves are cisgenderist and damage centered. Going forward, we emphasize that authors should not provide a definition of trans people in their manuscripts. Obviously, if a particular group of trans people are the focus of the manuscript, such as those from cultures whose identities and social contexts are still largely overlooked in mainstream trans health literature, it is appropriate to provide an explanation of this group. However, it should not be the default to include a general definition of being trans.

The involvement of trans people in trans health research

Ultimately, we seek to encourage submissions that are trans-led. We are, however, also mindful of the burden on trans people to lead research, and the challenges that trans people face in securing academic employment in the context of systemic cisgenderism. Nonetheless, we encourage cisgender researchers working in the field to at minimum engage with trans people in the development, implementation, and reporting of their research. This engagement can be achieved through means such as advisory committees and other forms of stakeholder involvement alongside required ethics approvals, which increasingly encourage this kind of consultation. We also note that ideally this engagement should be remunerated beyond just covering things like travel expenses, and that this remuneration is reported in the manuscript. In addition to these ethical concerns, which are enough on their own to warrant meaningful involvement of trans stakeholders, some authors have suggested that there are methodological reasons for involving trans people in data collection, especially in qualitative research (e.g. Katz-Wise et al., 2019; Servais et al., 2024; Veale et al., 2022). Others argue that trans people’s involvement from study design to data collection to dissemination of results deepens the nature of the insights that can be gleaned. Ways to involve trans communities at every stage of research on trans issues have been laid out by authors before (e.g. Bouman et al., 2018; Katz-Wise et al., 2019; Noonan et al., 2018; Servais et al., 2024; Veale et al., 2022; Vincent, 2018).

Relatedly, we are increasingly requesting authors to provide positionality or reflexivity statements, and this is true for all forms of research, not just qualitative research. Knowing who is involved in research and the depth of their relationship to the field is important, and it helps us all to monitor the extent to which trans people are involved in research or limited to being participants. Importantly, such statements do not need to hinge on disclosing the lived experiences of each author. Certainly this can be done, but it can also be the case that broad statements are made about the research team, without focusing on individual authors. Regardless, any statement should not simply be a list of identities. Instead, positionality statements should aim to describe why people are working in the field, what they bring to the work, and how their involvement contributes to the centering of trans people.

Conclusions

As members of the editorial board of the International Journal of Transgender Health, we strive to center the voices of trans people, as evidenced by our composition. The same is true in the manuscripts we send for review, and the reviewers we approach. This approach is not intended to be exclusionary, but rather is intended to counter the often harmful effects of a field that has been led by cisgender people and often continues to be dominated by cisgenderist perspectives. The suggestions and requests included in this editorial are the starting place in a conversation about what we want the field of trans health to look like into the future. We welcome ongoing conversations and hope that this editorial is taken in the constructive spirit in which it is intended. We look forward to receiving submissions that center trans voices, challenge existing paradigms, and ultimately improve the health and wellbeing of diverse trans communities internationally.

While we appreciate that this editorial may seem somewhat directive, and even activist in its orientation, we would remind our readers that scientific pursuit should ultimately feed into or indeed be a form of direct action. As researchers we are not neutral participants in the world around us. Rather, what we write about and how we write actively contributes to shaping the world. While some authors may adopt an explicitly activist approach to their work - and we welcome this - other authors who do not see themselves as activists should nonetheless be mindful that their work is itself an action, and one that impacts the world. When our work is used to defend against anti-trans legislation, or to advocate for better services for trans people, our work is part of a broader tapestry of activism. When this work is led by trans people, or at the very least undertaken alongside trans people, then there is a greater likelihood that the agendas of trans community members will be addressed.

Damien W. Riggs
College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
[email protected]
A. J. Lowik
Faculty of Medicine, University of British Columbia, Vancouver, Canada
Arjee Javellana Restar
Department of Behavioral and Social Sciences, Yale University, New Haven, CT, USA
Avery Everhart
Department of Geography, University of British Columbia, Vancouver, Canada
Elle Lett
Health Systems and Population Health, University of Washington, Seattle, WA, USA
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Ada S. Cheung
Department of Medicine, The University of Melbourne, Melbourne, Australia
Manvi Arora
Department of Education, University of Delhi, New Delhi, India
Gareth J. Treharne
Department of Psychology, Ōtākou Whakaihu Waka - the University of Otago, Dunedin, New Zealand
Shoshana Rosenberg
College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia

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