Standardizing Injustice in Transition-related Medicine?: An Institutional Ethnography of How Assessment Protocols Coordinate Inequitable Access to Hormones and Surgeries in Canada

Transgender (trans) people experience barriers to transition medicine such as cross-sex hormones and sex reassignment surgeries. In response, standardized care protocols, such as the World Professional Association of Transgender Health standards of care (WPATH-SOC), are recommended to improve gaps in care. To better understand how standardized care protocols shape access to transition medicine in Canada, I draw on institutional ethnography as a critical research strategy. In this dissertation I thus explicate how the main protocols used to assess trans people’s psychosocial readiness for hormones or surgeries serve a powerful coordinating function. Although significant advocacy targets the Diagnostic and Statistical Manual for Mental Disorders for pathologizing trans identity through the gender dysphoria diagnosis, my research demonstrates that the WPATH-SOC standardizes an entire model of care based in pathologization. This research project uses data obtained through talking with twenty-two trans people, clinicians, clinician-educators, and hospital administrators, observing clinician-education workshops, and analyzing pertinent assessment protocols and healthcare policy texts. My dissertation makes three substantive contributions to the areas of public health, trans studies, and health professions education research. First, I show that standardized readiness assessments previously understood as innocuous instead contribute to inequities and further pathologize trans people. Second, I argue that in the absence of trans health in the formal health professions education curricula, standardized assessment protocols serve as a form of curriculum, coordinating how health professionals learn and teach this clinical sub-specialty. Third, the results of this research hold the potential to bolster trans health advocacy efforts by identifying how assessment protocols rule health professionals’ and trans people’s resistance practices. In the spirit of activist institutional ethnography this dissertation concludes with a discussion on recommended future advocacy and systems change in the areas of policy, education, and practice.

Department dc:contributor.department

Dalla Lana School of Public Health

Year dc:date.issued

2019

Author dc:creator

• MacKinnon, Kinnon Ross

Advisor dc:contributor.advisor

• Ross, Lori E

• health professions education
• hormone therapy
• mental health
• transgender studies
• transition-related surgery

Handle dc:identifier.uri

http://hdl.handle.net/1807/102765

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/102765