The Political Economy of Gender Politics in Trans-Related Healthcare: Between Medical Knowledge and the Global Market

This paper will examine access to healthcare related to “gender change” mobilizing a perspective that intends to reveal the political economy associated with (trans)gender politics. In the history of ‘transsexual healthcare’ the relationship between medical knowledge and financial profit was never linear. Since medical technologies, such as feminizing and masculinizing hormonal therapies and surgeries, became available and medical protocols were established (in some countries already in the 1950s), accessing gender transition has been facilitated, namely to those fitting the diagnostic criteria of “transsexualism” and “gender identity disorder” (substituted by “gender dysphoria” in DSM V). Simultaneous, however, treatments were made costlier for those not matching medical definitions and diagnoses of transsexuality. Two fundamental reasons underpin the inequalities in the access to trans healthcare. On the one hand, the rigid psychiatric categories for understanding gender variance, and the entailed protocols for “gender change”, contributed to exclude some individuals. On the other, the historical decline of the welfare state made medical procedures inaccessible for lack of coverage by national health systems or insurances. Consequently, and along class lines, opportunities for expanding a global market of privatized trans medical-care filled the gap, reproducing inequality at the expenses of a political economy for social and gender justice. Drawing on a comparative analysis (ERC funded project Transrights, http://transrightseurope.com/) between five European countries (Portugal, France, United Kingdom, the Netherlands, Sweden), we will explore how the connections between medical gatekeeping and the commodification of health at the global level impacted institutional protocols and standards of care. Following a genealogical method and aiming at analysing the political economy behind trans healthcare, we will resort to medical literature, policies adopted by medical teams, international and national reports and recommendations and claims from trans-activists. Surveys on trans-related health and in-depth interviews with trans-people and institutional actors will also be analysed.