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A postcolonial critique of gender-affirming healthcare
Beginning in 2015, the emergence of gender-affirming healthcare as a new approach in transgender medicine seemed to mark a key turning point in the field. Across the globe, clinicians, patients, advocates, and activists articulated visions for care that emphasized shared decision-making and responsiveness to individualized experiences of gender. Yet the promise of gender-affirming healthcare failed to materialize for many trans and gender diverse people. In Global Trans Medicine, Alyssa Lynne-Joseph argues that ideas about expertise, gender, and race forged through colonialism challenge efforts to advance gender-affirming healthcare globally. Adopting a transnational approach that encompasses Thailand and the U.S., Lynne-Joseph argues that two knowledge hierarchies—one between Global North and Global South and the other between professional and lay expertise—converge to sustain dominant ways of knowing related to gender nonconformity and medicine.
Examining the movement of medical knowledge across national borders, Lynne-Joseph shows that a multidirectional flow of knowledge between the U.S. and Thailand exists, but that U.S. knowledge is endowed with greater transnational mobility due to perceptions about its universality. The standardization of care around Global North knowledge, and a hegemonic notion of white, binary transgender identity, stymies gender-affirming approaches to care in both the U.S. and Thailand.
Drawing on over 80 interviews, observations at transgender health conferences, and content analysis of medical journals and clinical practice guidelines, Lynne-Joseph offers a postcolonial critique that shows how the dominant forms of knowledge in transgender medicine work against the aims of gender-affirming healthcare on a transnational scale. Ultimately, Global Trans Medicine urges us to consider how the institution of medicine could look different if it reckoned with the inequalities in knowledge processes that shape interactions between experts across cultural contexts as well as professional and lay domains.
"Lynne-Joseph has written an extraordinary ethnography of global transgender healthcare. Following clinicians, patients, advocates, and activists across multiple countries and institutional settings, she uncovers the complex negotiations through which medical authority is constructed, contested, and circulated. Global Trans Medicine is a profound contribution to our understanding of gender-affirming care, demonstrating that questions of healthcare are always also questions of power, coloniality, and whose lives are imagined as possible."
"Global Trans Medicine offers a sharp account of how power shapes whose knowledge counts in gender-affirming healthcare. Comparing the United States and Thailand, Lynne-Joseph shows how professional authority and global inequalities determine which forms of expertise travel, which are dismissed, and which come to guide medical practice. This incisive book challenges familiar assumptions about medical knowledge and where innovation comes from."
"This detailed postcolonial critique of gender-affirming healthcare is what’s been missing from trans studies. Lynne-Joseph skillfully shows us how trans medical discourse and practice in the U.S. are privileged throughout the world in ways the perpetuate trans violence in the Global South. It is a powerful must read."