(Re) Making gender in the clinical context: a look at how ideologies shape the medical construction of gender dysphoria in Portugal

Abstract

The act of diagnosing gender dysphoria (GD), as in the act of diagnosing any other condition, is structured by socio-cultural, political and economic factors and is conducted by social actors. Drawing upon in-depth interviews with practitioners who work with trans people in Portugal, the study reveals the nuances and complexities surrounding the diagnostic attribution of GD and the ways in which the ideologies regarding gender shape this attribution. Practitioners' accounts show a diversity not often acknowledged within sociological and transgender literature. We extend previous studies by demonstrating that practitioners who operate under a social model of gender are opening space for trans people to be treated as experts of their bodies and identities by accepting the existence of those who identify beyond gender binaries. While it might not be true for practitioners who can be positioned within a biological model, thus attributing an essentialist explanation of gender, we found evidence that practitioners who follow a social model are allowing room for the self-definition of gender identification. The study provides another lens for understanding the diagnostic attribution of GD by paying attention to the accounts of practitioners who work with trans people and reveals their openness towards a collaborative model of care.

“The Light at the End of the Tunnel”: Experiences of LGBTQ+ Adults in Portuguese Healthcare

“…The situation told by Emanuel is echoed in the narratives of activists involved in making efforts to create effective support networks. The issue is particularly important for what concerns trans and non-binary young people, who are more likely to be exposed to medical violence as well as other forms of discrimination by families and workplaces [ 12 ]. In this regard, finding an HCP prepared to deal with trans and non-binary persons is crucial to guarantee that an already heavily medicalised process can proceed safely and respectfully.…”

“…A third important obstacle to be mentioned is the scarcity of curricula in healthcare careers directed at LGBTQ+-related issues. In Portugal, as it happens in many other European countries, medical doctors, nurses and other HCP can conclude their formative curricula without ever coming in contact with resources related to LGBTQ+ issues or without receiving even basic training on that matter [ 11 , 12 ]. The lack of specific knowledge, together with the social bias to which every HCP is exposed, constitute a major factor of reproduction of compulsory cis-heteronormativity, invisibility and, ultimately, discrimination.…”

Uncertain and under Quarantine: Toward a Sociology of Medical Ignorance

“…When we center ignorance, it becomes clear that although lay expertise is increasingly commonplace, it cannot be read as a uniform challenge to medicine’s cultural authority. Some lay expertise is an overt pushback to medical authority, but there are many cases where it pushes for greater access to medical procedures (Barker and Galardi 2011; Hilário 2019), diagnoses (Madden and Sim 2016), and medical accommodations (Jutel 2014). Lay expertise brings new knowledge and demands into medicine, but by and large, it seeks to harness and bolster rather than challenge medicine’s cultural authority by demanding that ignorance be addressed.…”

Transgender debates and healthcare: A critical realist account

“…The heterogeneity of these clinicians’ views has been explored in Portugal by Hilário (2019). In the UK, divisions about what services are actually doing for patients came to light when many left NHS gender services and some anonymously reported their concerns about the lack of psycho-social sophistication of a routine gender-affirmative approach (Gilligan, 2019).…”