What is the first thing you think of when you hear “trans health care”? Many of us would probably say hormones, surgery, maybe even mental health therapy. This is problematic and I will explain why.
Centering gender affirming care solely on medical transition denies us the whole reality of our wellness needs. But isn't medical transition important? Of course! So is dentistry, physical therapy, oncology, and even acupuncture. Trans and gender expansive people also get back pain, diabetes, bunions, IBS, and sports injuries. We want bodywork, corrective lenses, night guards, and getting our weird moles checked out. Practitioners of all disciplines should be obligated to provide affirming and safe care to people of all genders whether or not they are assisting in medical transition.
Gender affirming care must also be actively anti-racist and anti-colonial. Colonization prioritizes white washed ideas of gender over racialized experiences. What identities, roles, and expressions did we have before colonizers attacked our ancestors? Colonizers in places like the Philippines persecuted people who did not fit European binary gender constructs. Even if we are including options beyond a gender binary, are these still framed by a white-centric experience?
So where do we go from here? Don't just start a book club and suddenly invest in cultural competency training. These are meaningless without processes for accountability and structural changes. White supremacy can show up as over-intellectualizing issues into performative ally-ship – talking the talk, but not walking the walk. Open-mindedness and invitations are not enough. They're a cover-up for structural inequities. Can you show me that you're doing the work without telling me you're doing the work? Can you do it without a DEI or values statement? When I'm seeking care I look at the relationships a practitioner has built to see who they are accountable to. Who do they redistribute resources to? I look at the language used in communications, website, social media, and intake forms. Is ally-ship stuck at pronouns are have we moved beyond that? I look to see that there is deep ongoing work rather than a shallow static checklist.
Years ago I used to collaborate with a yoga studio run by white queer folks in a predominantly BIPOC neighborhood. On the surface everyone was very trans and queer inclusive – there some QTBIPOC teachers and students. We did workshops together and referred clients back and forth. Months later in response to increasing coverage of police brutality, I find out the studio owners started organizing “fireside chats”...with cops. The idea was that friendly chats between BIPOC and cops would resolve the violence. The message was that BIPOC needed to be more civilized, that this was about an interpersonal dispute rather than institutional, white supremacist violence. We know that BIPOC, especially Black trans women, are particularly targeted by cops. Gender affirming care also intersects with abolition and racial justice. This was just one grievance at the studio wrapped up in an environment of “love and light”.
At the time I was so hungry for a space that promised queer and trans safety I ignored my initial cringe at these white queers teaching yoga. There is so much nuance involved in understanding what gender affirming care ought to be. We are much more than a tangle of genitalia and hormones disconnected from experiences of race. If we choose not to actively engage in these nuances, they are already at play in how we participate in each other's wellness and what we are complicit with. I look forward to envision what our care could be, but I also look back. My ancestors thrived before Capitalism, colonization, and the medical industrial complex and they also made me.
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My blog on decolonizing medicine