TY - JOUR
T1 - Doing and undoing transgender health care:
T2 - The ordering of ‘gender dysphoria’ in clinical practice
AU - Kreukels, Boudewijntje
AU - Moyer, E.M.
AU - Gerritsen, Karl
AU - de Boer, W.
AU - Molewijk, Bert
AU - Bremmer, Marijke
AU - Kreukels, Baudewijntje P. C.
AU - Gerritse, Karl
N1 - Publisher Copyright: © 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.
PY - 2023
Y1 - 2023
N2 - A formal Gender Dysphoria classification— as outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders— is a prerequisite for the reimbursement of both gender-affirming medical care and transgender mental health care in the Netherlands. Gender Dysphoria and its conceptual precursors have always been moving targets: moving due to research, policy, care practices and activism both within and outside of medicine. This raises the question of what Gender Dysphoria is exactly. To elucidate this question, we turn to the people who use the concept in clinical practice to come to a diagnosis and treatment indication: mental health professionals working in gender-affirming medical care and transgender mental health care. Using a material semiotics approach, we reflect upon how Gender Dysphoria is done in clinical practice. Based on an analysis of seventeen practice-based interviews with clinicians as well as an examination of clinical guidelines and texts, we describe four modes in which Gender Dysphoria is ordered. These modes of ordering illustrate that Gender Dysphoria is not one, but multiple. We illustrate how in the mode of isolating, Gender Dysphoria is something which is carefully isolated from mental disorders, while in the modes doing the future and narrating, Gender Dysphoria is done as a continuous and predictable object of care. Such orderings of Gender Dysphoria potentially conflict with a fourth mode of ordering: the doing of diversity in transgender health care. The study’s findings provide empirical insights into how transgender health care is currently done in The Netherlands and provide a foundation on which ethical debates on what good transgender health care should entail.
AB - A formal Gender Dysphoria classification— as outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders— is a prerequisite for the reimbursement of both gender-affirming medical care and transgender mental health care in the Netherlands. Gender Dysphoria and its conceptual precursors have always been moving targets: moving due to research, policy, care practices and activism both within and outside of medicine. This raises the question of what Gender Dysphoria is exactly. To elucidate this question, we turn to the people who use the concept in clinical practice to come to a diagnosis and treatment indication: mental health professionals working in gender-affirming medical care and transgender mental health care. Using a material semiotics approach, we reflect upon how Gender Dysphoria is done in clinical practice. Based on an analysis of seventeen practice-based interviews with clinicians as well as an examination of clinical guidelines and texts, we describe four modes in which Gender Dysphoria is ordered. These modes of ordering illustrate that Gender Dysphoria is not one, but multiple. We illustrate how in the mode of isolating, Gender Dysphoria is something which is carefully isolated from mental disorders, while in the modes doing the future and narrating, Gender Dysphoria is done as a continuous and predictable object of care. Such orderings of Gender Dysphoria potentially conflict with a fourth mode of ordering: the doing of diversity in transgender health care. The study’s findings provide empirical insights into how transgender health care is currently done in The Netherlands and provide a foundation on which ethical debates on what good transgender health care should entail.
KW - gender dysphoria
KW - gender incongruence
KW - material semiotics
KW - modes of ordering
KW - ontology
KW - transgender
KW - transgender healthcare
UR - http://www.scopus.com/inward/record.url?scp=85175296347&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/1467-9566.13727
DO - https://doi.org/10.1111/1467-9566.13727
M3 - Article
C2 - 37897708
SN - 0141-9889
JO - Sociology of Health and Illness
JF - Sociology of Health and Illness
ER -