Challenging a sacrosanct tradition? Analysing the governing of gender through policies for trans healthcare

Abstract

Concentrating on approaches to depathologisation in trans health, this thesis compares the World Professional Association of Transgender Health (WPATH) Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, version 7 (the SOC-7) to the Best Practices Guide to Trans Health Care in the National Health Care System (the Guide), created by the Spanish Network for Depathologization of Trans Identities. The analysis demonstrates how the SOC-7 advances a logic of medicalisation for governing access and enacting depathologisation. The SOC-7 undermines attempts to rework a gatekeeping position by pressing people into status relations established and maintained by psy-professions, Western medicine, law, and citizenship. In contrast, the Guide problematises the entire illness-based paradigm arguing that the Western, medico-scientific model of sexuality, the body, and gender has colonially conditioned trans health. It offers an alternative policy for the Spanish health system and a proposal to formulate multiple responsive, place-based, non-pathologising protocols through an alternative yet liberal logic of rights. The analysis shows how the Guide’s approach could disrupt the state-securing colonial conditions governing gender highlighting limitations of a liberal reconfiguring of practices, relations, and structures of governing access. This thesis argues that without ongoing critical scrutiny of the colonial power that operates within the existing approaches, the possibility of total depathologisation of gender self-designation and the realisation of positive transformation in trans health policy is politically limited. This critical engagement with trans health policy in international and national contexts contributes to continuing scholarship, activism, and healthcare practice by showing how policy can generate productive uncertainty about strategies to depathologise and disturb the operations of colonial power.