A trans healthcare system

Throughout this book, I have shown what it is like to navigate cisnormative healthcare systems as a trans person. But what would it look like to navigate a healthcare system that presumed a trans patient? Even if it is just a healthcare system that acknowledges the possibility of a trans patient there would be some major differences. As a standard across health services titles would be written in just like names and would not be changed by admin staff upon seeing the patient's gender marker. Names and titles would also be easily changed. In terms of gender markers, sex and gender history would be recorded with more detail or perhaps there would be no need to record a patient's sex and/ or gender at all. Relevant body parts (that is, cervix, prostate, breast tissue) would be included in forms to offer correct cancer screenings and other care and these records would be kept up to date following any surgeries. It would be common practice to ask for or consult notes to determine a patient's pronouns before consultations. In general there would be less multiple choice and more open- ended questions on forms and in appointments. There would be flexible ward assignments in hospitals. Most importantly, however, transness would not be considered a disorder and transition related healthcare services would be provided on an informed consent basis. It is this idealistic but nevertheless easily imaginable scenario that I describe in the following section.

The tension of demedicalization

In Chapter 4 I unpacked the medicalization of transness and the harm it causes through stigmatization and creating barriers to healthcare access, while in Chapter 5 I addressed some of the axes of power that are at play because transness is medicalized. I outlined the gatekeeping practices, bureaucratic processes, long and uncertain wait times for care, and gendered spaces which all put up further barriers between trans people and good health outcomes. It is on this basis that I argue for demedicalization, where transness would cease to be labeled as a disorder and transition related healthcare would no longer be provided under the banner of ‘treatments’. Here is where the central tension of this argument lies.