“A slow and unrewarding and miserable pause in your life”: Waiting in medicalized gender transition

Abstract

Waiting is a common experience in medicalized gender transition. In this article, I address subjective experiences of medicalized gender transition through a temporal lens, focusing on personal narratives of wait lists, setbacks, and other delays experienced by trans patients. I consider administered waiting as a biopolitical practice of governance, one that has subjectifying and somatic effects on individuals and that speaks to the role of time in the administration of bodies, sex/gender, and biomedical citizenship. I ground my discussion in narratives created by trans people that chronicle their gender transitions; I analyze a set of gender transition vlogs appearing on YouTube, focusing on temporal aspects of medicalized transition and experiences of waiting. My discussion recognizes that the temporal modes of gender transition are multivalent, but these social media narratives also suggest being made to wait is an experience of power relations, one that is capable of producing submission, weariness, and precarity.

Trans Youth Talk Back: A Foucauldian Discourse Analysis of Transgender Minors’ Accounts of Healthcare Access

“…Health service inaccessibility prolonged waiting as did the time that participants spent discursively negotiating access. This is consistent with other studies of waiting in medicalized gender transition, which situate the waiting trans patients must do within a broader biopolitical context of profound inequality (Pitts-Taylor, 2019). Accordingly, structures of domination, institutional systems, and socio-structural processes sort, classify, and administer “the inclusion of some [transgender] bodies and subjectivities, while leaving others abject or illegible” (Pitts-Taylor, 2019, pp.…”

“…Spade argues that administrative violence is enacted on trans subjects via overt transphobia as well as through institutional systems and socio-structural processes—such as insurance coding as it functions to operationalize diagnostic criteria (Spade, 2011). Notably, discourses of access had temporal qualities, were framed non-linearly, and were characterized by talk about starts and stops, movement forward and backward, which is consistent with other analyses of how trans patients are made to wait (Pitts-Taylor, 2019). In Figure 2, we map our findings onto the IRTHJ framework and the key Foucauldian concepts we employed in our analysis.…”

“…In other words, aspects of youths' social positions such as race, insurance status, and parental support, for example, operated in conjunction with youths' age as intersecting relations of power that influenced for how long and for what reasons they were made to wait. This has been reflected in other studies that address the subjective experiences of medicalized gender transition through a temporal lens (Pitts-Taylor, 2019).…”

“…Youth and parents talked about the constant and time-consuming negotiation of discursive resources—finding out what to say, who to say it to, presentation of legal documents at court hearings, medical forms to fill out, medical forms to resubmit, and insurance rejections to appeal—which had both temporal and administrative implications. Temporally, these kinds of negotiations required that youth “recalibrate their bodies and psyches to institutional time” (Pitts-Taylor, 2019, p. 657) and were associated with their sense of social recognition—in school settings, for example—or lack thereof. Administratively, these negotiations should be understood as forms of administrative violence at the population level.…”

The untimeliness of trans youth: The temporal construction of a gender ‘disorder’

“…This presumption has a long and highly contested history. Trans subjects are often made to wait for recognition while the authenticity and stability of their identities are measured (Baril, 2016;Bauer and Scheim, 2015;Donati-Bourne et al, 2017;Pitts-Taylor, 2019;Spade, 2008;WPATH, 2017). Clinically imposed delays, such as the Real Life Experience, a requirement to spend months or years in social transition before medically assisted physical transition, have been rejected in the latest standards of care endorsed by trans health advocates, in part because of the link to poor mental health outcomes (see Donati-Bourne et al, 2017;WPATH, 2017).…”