The social context of hormone and silicone injection among Puerto Rican transwomen

Abstract

This paper draws on ethnographic, qualitative and survey data with transwomen in Puerto Rico to examine the social and political-economic context of lay injection with hormone and silicone - common practices within this community. We describe specific practices of hormone and silicone injection, the actors that govern them, the market for the sale and distribution of syringes and the networks of lay specialists who provide services to a population that is neglected by and largely excluded from biomedical settings. Our data derive from ethnographic observations, sociodemographic questionnaires, surveys and semi-structured interviews conducted with a diverse group of transwomen in metropolitan San Juan, Puerto Rico. Our analysis focuses on four overlapping social domains or processes that shape the practices of lay silicone and hormone injection among transwomen: (1) the circulation of gender transitioning technologies within local and global markets; (2) the tension between the social exclusion of transwomen and their resilient sub-cultural responses; (3) the cultural meanings that shape transwomen's attitudes about injection; and (4) the perceived consequences of injection. We conclude with a discussion of the kinds of intervention and policy changes that would respond to the factors that most endanger transwomen's health.

"Just Like Any Other Patient": Transgender Stigma among Physicians in Puerto Rico

“…For Phase 1, we developed a semi-structured in-depth interview guide based on the existing literature on transgender health services and data from our previous research with TW in PR, 5,10,25,44 in which participants reported a number of difficulties in accessing appropriate health care. The guide was designed to examine in depth physicians' knowledge and training in transgender health, stigmatizing attitudes towards TW, willingness to provide services to them, and overall competencies and experience in delivering transgender health care.…”

“…Our previous, formative research with TW in PR showed that, while interacting with health care providers in clinical scenarios, they experienced high levels of transgender stigma accompanied by lack of overall knowledge about transgender health and competencies to interact with them. 5,10,25,43,44 Taking this into consideration, our specific aims reflect four areas related to the provision of care (i.e., physicians' knowledge on transgender health, competencies in treating TW, willingness to provide services to this population, and stigma-related attitudes toward TW).…”

The Use of Non-Surgical Injectable Procedures Among Transgender Communities

“…31 Notwithstanding these known risks and advisories, pumping is often an affirming experience for trans individuals, especially amongst those who face extreme marginalization and abundant political and social barriers to healthcare. 7,8,18,32 Unpacking contextual considerations that may contribute to this practice is a necessary step towards evidence-based, person-centered research with trans individuals who engage in this practice.…”

“…[7][8][9][10][11] This practice, colloquially termed "pumping" with "fillers", has been reported across United States locales including Chicago, Los Angeles, San Francisco, Washington D.C., Puerto Rico and other countries, particularly in Asia. [12][13][14][15][16][17][18] Lack of accessible and affordable healthcare services, transphobia in medicine, medical racism, and poverty often push people to pursue this practice outside of regulated medical settings. 7,8 An unfortunately large body of evidence has documented adverse outcomes experienced by individuals who undergo these underground procedures.…”

A Preliminary Assessment of Selected Social Determinants of Health in a Sample of Transgender and Gender Nonconforming Individuals in Puerto Rico

“…More recently, the focus has shifted to also include individual and contextual health risk practices such as silicon use and hormone injections, 37 and structural factors associated with their wellbeing, including the construction of transgender identities, 38 transmigration, 39 violence, 40 and mental health providers' attitudes, knowledge, and social distance with the transgender community. 41 Nonetheless, further research is needed and particular attention should be placed on the social and structural factors shaped by the political and economic status of Puerto Rico within the United States.…”