The 'gender experts': clinical discourse and becoming trans

Some trans people seek to change their sexed bodies through medical interventions such as hormone therapy, hair removal and surgeries, in a process known as physical transition. In the UK, trans patients wishing to access these services on the National Health Service must usually do so through a Gender Identity Clinic (GIC). Before they can begin a physical transition, however, they must be assessed by psychiatric gatekeepers at the GIC, who determine whether or not they are a ‘suitable candidate’ for care. This process imbues gatekeepers with an enormous amount of power over patients’ sexed bodies, gendered appearance, and interpersonal relationships with family members, friends and co-workers.

In recent years, an international campaign against the pathologisation of trans identities, bodies and experiences has led to changes in the medical landscape. In countries such as Canada, Australia and the United States, the ‘gender affirming’ and ‘informed consent’ models of care have increasingly centred patients’ stated desires and needs rather than gatekeepers’ expert assessments. This paper will examine contemporary debates and the politics of trans depathologisation in the UK, drawing on an extensive ethnography of the contemporary trans health landscape. It will show how contemporary patient activism and clinical politics represent a struggle for control over the body itself, with consequences for our understandings of sex and gender.