stef shuster - "Managing Ambiguity While Working in a Glass House: Provider Perspectives on Transgender Healthcare"
As transgender medicine developed over the course of the 20th century, transgender people have advocated for more flexibility in treatment protocols, and removing the gate keeping function of mental health professionals who historically had to assess if a transgender person was a qualified candidate for hormone therapy and surgery. The standardization of transgender medicine runs parallel with a medical model of care that provides assurances to the scientific community, insurance companies, and providers that “appropriate” treatment plans are employed. Providers gave voice to the idea that transgender people have unique healthcare needs that may not be met in a system structured by binary modes of thought and thus, are weary of standardizing transgender medicine. In these contexts, providers must learn to balance their professional ethical responsibility for “doing no harm” while the notion of “harm” is itself ambiguously defined. How a provider adjudicates these decisions is partly based on ethical principles about the best course of treatment. Coupled with these concerns, providers spoke about the many challenges that arise in working with trans* clients. It is evident that providers make these decisions carefully - under intense scrutiny from competing stakeholders - and actively deploy strategies to weigh competing sources of “evidence.”
This project is from a chapter in my dissertation, entitled “Medicine and Meaning-Making: The Construction and Regulation of Gender in the Lives of Transgender People.” I used a mixed-methods approach including the analysis of archival documents from the Kinsey Institute in Bloomington, Indiana, in-depth interviews with 40 transgender-identified people and 23 healthcare providers, and participatory observations in community spaces.