i Non-Binary Gender Identity Negotiations: Interactions with Queer Communities and Medical Practice Benjamin William Vincent Submitted in accordance with the requirements for the degree of doctor of philosophy The University of Leeds School of Sociology and Social Policy October 2016 ii The candidate confirms that the work submitted is their own and that appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from this thesis may be published without proper acknowledgement. © 2016 The University of Leeds, Benjamin William Vincent The right of Benjamin William Vincent to be identified as Author of this work has been asserted by Benjamin William Vincent in accordance with the Copyright, Designs and Patents Act 1988. iii Acknowledgements A doctorate is a piece of work that can isolate as one grapples with writing, but also depends greatly upon the support of others. I would like to start by thanking Dr. Sally Hines as my primary supervisor. Sally has provided consistently warm and approachable support throughout, together with her fantastic experience as a foremost scholar of transgender studies. Dr Ana Manzano has also given great guidance not only with nuanced discussions of methodology, but with support and co-authorship of my first formal academic publication. My thanks also go to Professor Anne Kerr for her role as my supervisor during my first year. I am grateful to many academic staff within and beyond Leeds for various opportunities and forms of support – Meg-John Barker, Sharon Elley, Kris McLaughlin, Richard Tavernier, and Matthew Wilkinson – thank you all. I wish to specifically thank the non-binary individuals who gave of their time and energy to this project. This work is ultimately for them and the non-binary community, and would obviously have been impossible without them. My thanks to my fellow PhD students – particular shout-outs to Sonja Erikainen, Gill Mooney, and Inga Reichelt. Also thanks to the nerd crew – John Craige, Zach Gradwell, and Kris Jones – you made Leeds for me. I also thank my friends around the world for moral support at all hours – Dang Nguyen, Ray Quintana, and S. W. Underwood. Thanks also for the help and friendship at the end of the PhD from Onni Gust, CN Lester, Ruth Pearce, and Allison Washington. Thanks to James Livesey for the privilege of being involved in the struggles you overcame. To Harry Harris, you were a dear friend who left us all too soon, and the world is poorer for it. I hope that this work does honour to your memory. And to the most indispensable of people: Kine Häkkinen, my partner, your quiet belief in me is a continual source of strength. I am so grateful for all the uncountable ways you have supported me throughout. Let it be written that when we move, we can get the cats you crave. To my mother, Sally Vincent – words do not do justice to the consistency and indispensability of your emotional support. The ritual of telephoning on the walk to and from university made all the difference. Finally to my father, David Vincent - your generosity and unwavering belief in me are what allowed me to do this. I still miss you deeply, and trust this would have made you proud. iv Abstract Over the last decade, studies of trans people have somewhat shifted away from essentialising and pathologising narratives, whilst recognition of gender plurality has grown. However to date, gender identities outside of the binary of male/female have received little specific sociological attention. This thesis considers negotiation of non- binary gender identities, in a UK context. Examining how non-binary individuals are involved with and integrated into LGBTQ communities exposes important nuances. This is also true regarding the negotiation of medical practice by non-binary people in relation to gender transitions, and more generally. Eighteen participants with non-binary gender identities were recruited to record ‘mixed media diaries’ for a four month period. These diaries allowed participants to use any methods they wished to express themselves. Follow-up semi-structured interviews were then conducted with the same participants in order to discuss their experiences and views, relating to broad conceptions of queer communities and medical practice. The objectives were to understand how non-binary people are integrated into queer communities and negotiate medical practice, as well as what the emergence of non- binary gender identities implies for these contexts. Symbolic interactionism provided the project’s theoretical framework, as this effectively allowed space for a multiplicity of participant interpretations resulting from interactions with the social world. The findings of this study illustrate both commonalities and difference between binary and non-binary trans experiences. Non-binary identities can present in static or fluidic forms, which may be associated with differential needs. Access to gender affirming medical services is varied, and not always pursued. Non- binary identities may be associated with discourses and practices of reduced legitimisation in both medical contexts and some queer communities. The study concludes that the improvement of a wide range of medical policies and practice is needed, together with community support initiatives to better recognise and serve non- binary people. v Table of Contents Acknowledgements ............................................................................................ iii Abstract .............................................................................................................. iv Table of Contents ................................................................................................ v Abbreviations ................................................................................................... viii List of Tables...................................................................................................... ix List of Figures ..................................................................................................... x Introduction ......................................................................................................... 1 Voices from Beyond the Gender Binary .......................................................... 2 Definitions and Terms ..................................................................................... 3 Non-Binary Medical Encounters ...................................................................... 9 Chapter Outlines ........................................................................................... 12 Chapter 1 – Transgender and Medicine ............................................................ 15 Introduction.................................................................................................... 15 From Medical Sociology to the Sociology of Health and Illness .................... 17 The Construction of the Transsexual, through to Non-Disordered Gender Complexity..................................................................................................... 25 Sociological Consideration of Transgender and Medicine ............................. 35 The Roles of Manuals and Guidelines in Medical Practice ............................ 41 Conclusion..................................................................................................... 46 Chapter 2 – Moving Beyond the Binary in Transgender Studies....................... 47 Introduction.................................................................................................... 47 The Ethnomethodological Approach to Gender ............................................. 48 Feminism and Transgender – from Radical Exclusion to Queer Embrace .... 52 The Sociology of Transgender ...................................................................... 57 Transgender Rights – The Law, and Activism ............................................... 67 Non-Binary Articulations of Transgender ....................................................... 69 Conclusion..................................................................................................... 75 Chapter 3 – Methodology .................................................................................. 77 Introduction.................................................................................................... 77 Epistemology of Symbolic Interactionism ...................................................... 78 vi Research Objectives ..................................................................................... 81 Mixed Media Diaries – Adding New Dimensions to Participant Voices ......... 82 Semi-Structured Interviews – Collaborative Construction of Data ................. 84 Research Design – Data Collection Strategy and Practicalities .................... 86 Recruitment of Participants ........................................................................... 88 Reflexive Positioning ..................................................................................... 91 Ethical Considerations ................................................................................... 92 Building Rapport Throughout the Project ...................................................... 94 Participant Demographic Information ............................................................ 95 A Multi-Method Analytical Strategy...............................................................