“The Right Story”: Discursive Strategies in Gender-Affirming Healthcare Access

Despite strides towards a less pathological and diagnostic-centered approach to transgender healthcare, many policies continue to present barriers in accessing gender-affirming medical support that may provide individuals with greater ease in their embodiment. Research on transgender speakers’ linguistic practices in healthcare interactions has shown that practitioners’ prerequisites for granting access to this kind of care remain largely based on criteria presented in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This practice of evaluation has led to an impression within trans communities that accessing gender-affirming care is a test, where patients must “do” their gender or present their identity in a particular way. Meeting this expectation may feel especially imperative and dehumanizing for non-binary transgender people, as individuals who do not identify as either, or exclusively, masculine or feminine. Presenting a gender positionality outside of the binary has historically meant losing access to care, and as a result, non-binary patients often find themselves using different language to describe their experience than they would in other contexts, simply to gain access to much-needed care. As an intervention in the inequity of doctor-patient communication in this setting, this dissertation considers the metalinguistic (“talk about talk”) observations of non-binary people regarding their gender-affirming healthcare interactions in Ontario. Rather than considering non-binary patients’ practices as straightforward acts of capitulation to medical expectations, their performances in these high-risk interactions are a means to contest their marginal status within the healthcare system. Participant-collaborators express numerous strategies to simplify or obscure their non-binary identities in their pursuit of care, such as the flexible use of identity labels, vocal pitch modulation, the intensification and historicization of experiences of suffering related to gender identity, and avoiding asking questions about their care so as not to compromise doctors’ impressions of their certainty about medical transition. This dissertation thus shows how linguistic performances are a crucial part of the gender-affirming care process; in other words, whether patients get the access that they need often depends not just on what they say, but how they say it, and what they strategically omit.

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