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Getting by Gatekeepers: Transmen's Dialectical Negotiations Within Psychomedical Institutions

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Getting by Gatekeepers: Transmen's Dialectical Negotiations Within Psychomedical Institutions Georgia State University ScholarWorks @ Georgia State University Sociology Theses Department of Sociology 12-4-2006 Getting by Gatekeepers: Transmen's Dialectical Negotiations within Psychomedical Institutions Elroi Waszkiewicz Follow this and additional works at: https://scholarworks.gsu.edu/sociology_theses Part of the Sociology Commons Recommended Citation Waszkiewicz, Elroi, "Getting by Gatekeepers: Transmen's Dialectical Negotiations within Psychomedical Institutions." Thesis, Georgia State University, 2006. https://scholarworks.gsu.edu/sociology_theses/13 This Thesis is brought to you for free and open access by the Department of Sociology at ScholarWorks @ Georgia State University. It has been accepted for inclusion in Sociology Theses by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact [email protected]. GETTING BY GATEKEEPERS: TRANSMEN’S DIALECTICAL NEGOTIATIONS WITHIN PSYCHOMEDICAL INSTITUTIONS by Elroi L. Waszkiewicz Under the Direction of Dr. Mindy Stombler ABSTRACT Transsexuality remains grounded in pathologizing discourses. Mental health professionals largely classify transgender experiences as disorders, and transgender people seeking to alter their bodies typically must obtain authenticating letters from therapists verifying such diagnoses. Physicians usually require these letters to perform transition-related services, and sometimes require additional legitimization. In these ways, psychomedical professionals impose gatekeeping measures that withhold and confer services to transsexuals who desire medical transition. Using qualitative interview data and grounded theory methods with 20 female-to-male transsexuals, this study demonstrates that transmen typically represent informed consumers whom carefully research psychomedical protocol and anticipate providers’ adherence to professional standards. When they encounter gatekeeping, this preparedness informs their dialectical struggles within the psychomedical institutions wherein transmen must negotiate bodies within the confines of pathology. Ultimately, this dialectical process is managed and maintained by the larger regime of truth—the gender binary system. INDEX WORDS: Transsexualism, Transsexuals, Transsexual men, Female-to- male transsexual, FTM, Transmen, Transgender, Psychomedical institutions, Pathologizing discourse, Grounded theory methods, Medical gatekeeping, Gender identity disorder, Gender dysphoria GETTING BY GATEKEEPERS: TRANSMEN’S DIALECTICAL NEGOTIATIONS WITHIN PSYCHOMEDICAL INSTITUTIONS by ELROI L. WASZKIEWICZ A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Arts in the College of Arts and Sciences Georgia State University 2006 Copyright by Elroi L. Waszkiewicz 2006 GETTING BY GATEKEEPERS: TRANSMEN’S DIALECTICAL NEGOTIATIONS WITHIN PSYCHOMEDICAL INSTITUTIONS by ELROI L. WASZKIEWICZ Major Professor: Mindy Stombler Committee: Elisabeth O. Burgess Wendy Simonds Electronic Version Approved: Office of Graduate Studies College of Arts and Sciences Georgia State University December 2006 iv Dedication This thesis is dedicated to all of the people who participated in this study. For the men, transmen, transmales, FTMs, intersexed, gender fluid, and genderqueer people in this project, I extend my sincerest gratitude to your contributions. May this study aid in creating a safer place for all transgender people to access and receive quality health care. v Acknowledgements In creating this thesis, a laborious love, I owe thanks to many people. First and foremost, I thank everyone who participated in this project. Your willingness to share your experiences provided the basis for everything herein. I take full responsibility for this end product, but could not have arrived here without your thoughtful contributions. In addition, I am thankful that part of this research was supported by a grant from the Transgender Scholarship and Education Fund of the International Foundation for Gender Education. I am also grateful for travels grants provided by Georgia State University’s Sociology department that supported preliminary presentations of findings within academic and community forums. I have been fortunate enough to have worked with talented and committed sociologists. Most notably, the faculty that have worked in the Department of Sociology at Georgia State University provided me with endless support and encouragement. My officemates and fellow graduate students also provided intellectual and comical relief. Of all these marvelous sociologists, my deepest gratitude goes to my committee members. Thank you Elisabeth Burgess and Wendy Simonds for your insights and support. And most of all, my most heartfelt thanks and appreciation is reserved for my committee chair, Mindy Stombler. With your constant dedication and inspiring visions, I felt confident in growing as an academic under your guidance. I truly value your commitment to my work and progress, and could not have asked for a more excellent mentor. Thank you for believing in me. And finally, for all of the behind-the-scenes support, understanding, and consolation, I extend warmest thanks to my love, Alyson Stealey. You’re the best! vi TABLE OF CONTENTS Page List of Tables……………………...……………………………………………. vii List of Figures……………………...…………………………………………… viii List of Abbreviations………………...…………………………………………. ix Introduction…………………………...………………………………………… 1 Chapter 1: Literature Review…………...………………………………………. 6 Chapter 2—Methodology………………...…………………………………….. 34 Chapter 3—Becoming Informed Consumers……...…………………………… 65 Chapter 4—Psychomedical Gatekeeping…………...………………………….. 99 Chapter 5—Negotiating Bodies within the Confines of Pathology…………...... 154 Chapter 6—Discussion and Conclusion………………….…………………..… 192 References………………………………………………………………………. 196 vii List of Tables Page Table 2.1: Respondents’ Demographic Characteristics 44-45 Table 2.2: Accessing Medical Transition 48 viii List of Figures Page Figure 2.1: Call for Participants—Poster (Final Version) 58 Figure 2.2: Call for Participants—Palm Card (Final Version) 59 Figure 2.3: Code List 7 (Final Version 3-5-06) 60-62 Figure 2.4: Interview Schedule—Final Version 63-64 ix List of Abbreviations APA American Psychiatric Association DSM-IV-TR Diagnostic and Statistical Manual, Fourth Edition, Text Revision FTM Female-to-Male Transsexual GID Gender Identity Disorder HBIGDA Harry Benjamin International Gender Dysphoria Association ICD-10 International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Second Edition LGBTQ Lesbian, Gay, Bisexual, Transgender, Queer/Questioning MTF Male-to-Female Transsexual SOC Standards of Care SRS Sexual Reassignment Surgery T Testosterone Trans Transgender 1 Introduction Years ago, I heard the alarming horror stories experienced firsthand by the transgender people I met while working as a health educator in an AIDS task force. I learned about countless injustices endured by transgender people, especially in health care settings. In addition, my decade-long involvement with the LGBTQ community afforded me the opportunity to meet and befriend many transgender people. While living in New York City, I was very active within feminist and queer activist communities. I met many transsexual men in these contexts, and it appeared that female-to-male transsexual men occasionally utilized these presumed supportive spaces to come out as transsexual. These acquaintances gave me further insight into the discontent surrounding health care for transgender people. Consequently, my professional and personal background fostered my interest in conducting research that would benefit the transgender community. And over time, I have established myself as an ally to and member of the transgender community. As a genderqueer person, I have grown to identify with the transgender community through my own lifetime experiences with gender identity and expression. As a researcher, I believe this membership granted me access to the transmen’s community as somewhat of an insider. Transmen often perceived me as someone that could relate to their experiences to some degree. They also understood that I supported their individual subjectivities without making them defend their identities and decisions. But because I am not a transsexual and do not identify as a 2 man, I was also an outsider to this community. While my outwardly masculine appearance and gender expression sometimes inspire people to perceive me as a burgeoning transsexual, I am comfortable inhabiting a body unaltered by hormones and surgery. In this way, I had no personal experience navigating the transsexual- specific health care services that all of my respondents procured. Thus, my simultaneous insider/outsider researcher relationship to this community afforded me the ability to access information that was sometimes very sensitive and private while maintaining a less informed perspective on the health care experiences I sought to understand. At the start of this project, I believed that my research inquiry would expose an array of inequalities that transmen experienced in accessing and receiving health care. As a marginalized population, I expected that transmen would encounter discrimination in their interactions with providers. Indeed, many transmen in my research sample reported such instances. However, others navigated health care without many problems at all. Using grounded theory methods, I was able to discern that a key factor that informed health care interactions
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