Trans temporalities: imagining a future in the time of anticipation

This chapter explores Jess Bradley and Francis Myerscough's ‘time of anticipation’ as a form of trans temporality. Temporality refers to ‘the social patterning of experiences and understandings of time’. It is not simply about the passing of time, but about how time is felt by individuals and shaped through social circumstance. The chapter shows how an engagement with temporality can help us to better understand discourse around patient experience and the operation of the UK's gender identity services. It begin by outlining several theoretical interventions, including Jack Halberstam's description of ‘queer time’, Julian Carter's analysis of ‘transition time’, and Laura Horak's observations on ‘hormone time’.

Trans health in practice: conditions of care

This chapter focuses on UK healthcare provision in the 2010s. It describes the material context of the author's research project in terms of both public and private healthcare provision, making visible the systems that trans patients must negotiate to access care. It outlines the medical pathway and extensive assessment procedures for the trans ‘condition’ with reference to clinical guidance and public health documents, while also examining the challenges faced by patients outside of trans-specific services. It shows how this context has been shaped by recent political events such as the passage of the Equality Act 2010 and the Health and Social Care Act 2012, as well as by international guidance such as the World Professional Association for Transgender Health (WPATH) Standards of Care. The discussion is framed by a description of the power differentials that persist between practitioner and patient.

Condition or movement? A genealogy of trans discourse

This chapter offers a genealogical account of the discursive repertoires of trans as condition and trans as movement. It describes the negotiation of differing positions on trans condition and movement by health professionals and radical feminists as well as trans patients, activists and academics. In addition to providing a roughly chronological history of ideas, it explores how contemporary trans possibilities have emerged through categorisation and contestation, and explains why medical discourse has played a particularly important role in this process. It looks at how recent sociological studies incorporated condition-oriented identities within broadly movement-oriented accounts of trans community, focusing on Surya Monro's concept of ‘gender pluralism’. It shows how recent interventions from health professionals have sought to acknowledge movement-oriented trans identities and experiences.

Introduction: coming to terms with trans health

This chapter provides an overview of the book's main themes. This book asks two key questions about discourses of trans health: (1) How are ‘trans’ possibilities produced, reified and legitimated through health discourses and practices? (2) How are discourses of trans health negotiated within and between trans community groups, trans activists and health professionals? How are they disseminated, and how are they contested? These questions aim to uncover how trans identities and experiences, along with conceptualisations of trans health, are understood in multiple contexts. The purpose is to grasp the social processes at play in encounters where trans patients feel marginalised, misunderstood, and/or discriminated against.

Towards affirmative care

This chapter summarizes the book's arguments. It also takes a further look at the discursive power wielded by gender identity specialists, and relates this to the manner by which ‘trans health’ is constituted through the operation of this power. It argues that the power invested in — and actively wielded by — gender clinic gatekeepers has significant consequences for the possibility of ‘trans’ subjectivities, as well as for the wider terrain of trans health. To make this argument, the chapter first revisits the original stated aim and questions for the author's research project, which aimed to uncover how both ‘trans’ and ‘trans health’ are understood in multiple contexts, in order to grasp the social processes at play in encounters where trans patients feel marginalised, misunderstood, and/or discriminated against.

The politics of trans health: negotiating credible knowledge

This chapter analyzes ‘epistemic politics’: that is, the politics of knowledge production. It focuses particularly on the process of trans patient advocacy, looking at how individual interventions may contribute to collective efforts for discursive and material change. Drawing on examples from the depathologisation movement, it further examines how trans activists have sought to challenge the practitioner/patient power differential in both the micro-setting of the healthcare encounter and the macro-setting of medical discourse. It demonstrates that these challenges are most successful when trans knowledge are reproduced and established as credible through continual acts of mutual recognition and iterative citation across multiple spaces and contexts.

(Re)defining trans

This chapter looks primarily at how a considerable number of the ideas and conflicts discussed within Chapter Two remain relevant, as the discursive repertoires of trans as condition and trans as movement continue to operate within the contemporary settings of trans health in the UK. It examines how trans possibilities are both constructed and constrained within and between health services and trans community groups. It draws upon the concept of cisgenderism to show how some trans narratives are rendered impossible within certain healthcare settings, due to the power differential between practitioner and patient. It links this process to the challenges that many trans patients encounter in accessing treatment in a range of settings, with reference to the discursive clashes that can occur when health professionals and trans patients subscribe to different notions of trans possibility.