Health rights for trans people vary widely around the world – achieving trans bliss and joy requires justice, social respect and legal protections
While transgender people are more culturally recognized than ever in America, visibility is not the same as justice.
Transgender is an umbrella category that emerged in the United States in the 1990s to encompass diverse gender identities that do not fully match a person’s assigned gender at birth. Although local communities worldwide have adopted this term, it can also erase and collapse other distinct gender identities that people have used across time, place, and culture.
People labeled trans, non-binary, and intersex today have existed around the world for centuries. Trans people’s rights have not always been an issue in mainstream society, and non-normative gender and gender categories appear in ancient Buddhist texts as well as in Jewish rabbinic literature. Yet colonial conquests have violently eradicated sexual and gender diversity worldwide.
The right of trans people to exist has been challenged in a variety of ways over time and around the world. Globally, trans people face inequalities in many areas, including access to health care, legal support and economic security. Governments, global organizations, and the legacy of colonialism also exert high levels of violence and stigma against them.
At the same time, 95% of global health organizations fail to recognize or address the needs of people of different genders in their work, leading to an “almost universal exclusion” of trans people from health practices and policies. There is also a lack of holistic trans-inclusive research worldwide. Searching for the word “transgender” on the website of the Institute for Health Metrics and Evaluation, the Bill and Melinda Gates Foundation global health metrics giant that works with the World Health Organization to improve global health data, currently returns zero results.
As a sociologist, I study how health outcomes are influenced by various social conditions, including global economic policies, institutions, and cultural values. In particular, I analyzed how government-sponsored medical tourism or health-related travel has affected Thai transgender women. Broadly speaking, I am trying to understand how the body functions as what the French philosopher Michel Foucault calls an “inscribed surface of events”, shaped by an ever-changing social context of resources, rights, recognition and power may grant or withhold.
With their health and well-being shaped by social contexts around the world, transgender people’s bodies are no exception.
History of Gender-Affirming Nursing
Medical institutions and authorities are an important path to health and life in his body. They define, classify and pathologize a range of human conditions from male pattern baldness to obesity.
The German physician Magnus Hirschfeld coined the now antiquated term “transvestite” in 1910 to define those who wished to speak out against their birth-assigned gender. At his institute for sexology, Hirschfeld offered hormone therapy to people and performed the first documented genital transformation surgery. Adolf Hitler considered Hirschfeld “the most dangerous Jew in Germany,” and the Nazis burned down his research center after he fled for his life.
Despite this violence against transmedicine, endocrinology in the US and Europe made strides in the 1930s with the use of synthetic testosterone and estrogen for the medical transition. Estrogen was first purified in 1923 and used for hot flashes, prevention of bone loss, and other reproductive health issues. Testosterone was isolated and synthesized in 1935 and first used to treat hypogonadism in men and tumor growth in women.
Puberty blockers, or gonadotropin-releasing hormone agonists, were first approved by the US Food and Drug Administration in 1993 for children who hit puberty too early. For trans youth who experience gender dysphoria, or distress due to a discrepancy between their gender identity and the gender assigned at birth, these medications can be critical to their well-being. Far from being experimental, the drugs have strong evidence of their overall beneficial effects on trans youth.
Christine Jorgensen was the first American to have a so-called “sex reassignment surgery” in Denmark in 1952 and made headlines. Physicians in other parts of the world also began to develop clinical expertise in vaginoplasty, sparking global transgender healthcare networks. For example, surgeons in Thailand developed their own techniques for Thai trans women in the 1970s.
Soon, trans people from other countries learned about Thai surgical techniques and began traveling to Thailand for treatment. With strong government support, Thailand has emerged as a global center for gender-affirming services. As a result, foreign travelers “forced” some Thai trans people out of quality care as the market shifted to medical tourists.
For some healthcare travelers, the services in Thailand are cheaper than in their home country. Traveling for health services can also provide more anonymity. For those in the UK seeking gender-affirming care, traveling abroad is an alternative to long waits.
Medical tourism is worse for those living in countries where trans people are criminalized, like Brunei, Lebanon and Malawi, or where gender-affirming surgeries are religiously forbidden, like Saudi Arabia.
What does global health equity mean?
Globally, trans people face challenges in accessing culturally competent and equitable health services, both general and for gender-affirming services. Trans and gender-segregated people experience greater psychological distress and everyday violence and discrimination than their cisgender peers.
A 2019 report of nearly 200 health organizations around the world found that 93% do not recognize trans people in their gender equality work and 92% do not mention trans health in their programmatic services. Decolonizing global health means including marginalized people in decision-making and knowledge production around global health. It also considers and accommodates the needs of transgender and gender-balanced people worldwide.
Global trans health equity means providing resources to address the root causes of gender inequalities in health. This includes legal gender recognition, government support and anti-discrimination laws. While trans women, who are disproportionately affected by HIV worldwide, need medical and public health care, global trans health equity also means addressing other areas that contribute to this inequality, such as poverty, economic exclusion and discrimination in the workplace.
For countries with universal health coverage, medical and public health researchers recommend including gender-affirming services as essential services. They are not cosmetic but necessary to those who want them.
Better alternatives for everyone
Amid everyday injustices, violence and vulnerability, there are myriad forms of trans resilience and resistance, activism, collective caring and knowledge sharing. There are even some “bubbles”.[s] of utopia” or clinics and health care facilities where trans people can access services with shorter delays. These alternatives open up the possibility for transgender happiness, or liberation from restrictive colonial gender constructs and transgender joy, or enhancing one’s quality of life and forging meaningful connections by embracing a marginalized identity.
How can politics, institutions and society cultivate trans bliss and joy worldwide?
All human bodies are “sociocultural artifacts”. How they are expressed and lived is determined by social contexts and shaped by available resources. Sex and gender are points in a vast “multidimensional space” of anatomy, hormones, chromosomes, environment and culture. Global health equity for transgender people commits the institutions and decision-makers responsible for the health and safety of all people. It aligns with the freedom to thrive in a world that celebrates sex and gender diversity as a natural fact of life.