This is Our Care

This is Our Care: 
Drawing on the Lived Experiences of Transgender and Gender Diverse People to Build Community-Driven Gender-Affirming Care

Watch time: 38:57

This lecture shares results from two studies on transgender health. Healthcare has historically treated transgender people as mentally ill and made it hard to get care. Research discussed in this lecture proves that transgender people's real-life experiences are essential knowledge for healthcare, not just bonus support. Peer support helps people make medical decisions, feel valid in their identities, find community resources, and fight for change. 

In this lecture, Kia argues for "community driven gender affirming care" that employs transgender people as respected professionals with fair pay. She emphasizes including transgender people from all backgrounds, not just token representation.

• Transgender people still face violence, stigma, and unfair treatment in healthcare
• In 2023, over 500 laws were proposed in the US to restrict transgender people's rights and healthcare access
• Anti-trans attitudes exist in Canada too, which threatens future healthcare for trans people
• Without transgender healthcare workers, doctors and social workers miss important information about community resources and support
• Transgender people already help their community for free. This work should be recognized and paid fairly
• Lived experience gives people alternative stories that help them fight back against unfair systems
• Current medical rules still make it hard for people (especially nonbinary people) to get the care they need

Lived Experience as Professional Knowledge

Transgender people's real-life experiences should be recognized as legitimate, valuable professional knowledge in healthcare settings; not just personal stories or extra support. This concept challenges the idea that only formal education and cisgender perspectives count as "real" expertise in providing care to transgender communities.

Related Definitions:

• Community Driven Gender Affirming Care: Healthcare that hires transgender people as professionals who use their lived experience to help others. This includes helping with medical decisions, connecting people to community groups, and working to change unfair systems. Recognizes that gender affirmation happens outside hospitals too, and values transgender workers' knowledge
• Gender Affirmation (Philosophy): The proven idea that supporting people's gender identity (through social acceptance, legal documents, and/or medical care) helps their health and can prevent bad health outcomes
• Transgender Diverse (TGD) People: People who don't fully identify with the sex they were assigned at birth. This includes nonbinary, transgender, transsexual, genderqueer folks, and many other identities

Historical Pathologization and Medical Control

Healthcare systems have historically treated transgender identities as mental disorders and used medical diagnoses to control access to care. Tension between recognizing gender diversity and maintaining gatekeeping practices limits transgender people's autonomy over their own bodies and identities.

Related Definitions:

• Gender Affirming Care (Historical): In the past, healthcare that made transgender people prove they were "trans enough" to get hormones or surgeries. Often forced people to act in stereotypical ways to get care
• Gender Identity Disorder vs. Gender Dysphoria: Gender Identity Disorder (old term) said being transgender was a mental disorder; Gender Dysphoria (current term) focuses on the distress someone feels when their body doesn't match their gender—seen as progress but you still need a diagnosis to get care
• Gatekeeping: When doctors or therapists prevent or delay transgender people from getting transition-related care based on arbitrary rules
• Cisnormativity: The assumption that everyone is cisgender (identifies with the sex they were assigned at birth)
• Trans Normativity: In medical settings, the expectation that all transgender people want the same type of transition (like assuming all nonbinary people want surgery, or that everyone wants to fully transition to the "opposite" gender)

Intersectionality and Community Resilience

Transgender people hold multiple overlapping identities (race, class, disability, etc.) that shape their experiences. Communities built around shared experiences provide strength, resistance, and support. Peer support isn't just helpful, but essential for survival, fighting back against oppression, and creating change.

Related Key Concepts/Definitions:

• Intersectionality: Understanding that people have multiple identities (race, gender, class, disability, etc.) that overlap and affect how they experience discrimination
• Critical Resilience: How marginalized people survive and resist unfair systems while working to change them (not just "dealing with it")
• Peer Support: In this context, support from other transgender people that helps with medical decisions, validates diverse identities, connects people to community resources, and enables political resistance and mobilization for systemic change

SW-TGD Study (Social Work with Transgender Diverse People)

Goal: To understand what makes social work fair and effective when working with transgender people. The main research question was: "What are the key parts of good social work practice with transgender folks?"

Methods: 

• Virtual individual interviews saw participants respond to a fictional story about a transgender person meeting with a cisgender social worker, then share their thoughts on what good social work should look like.
• Researchers read the interviews many times to find common themes (this method is called grounded theory).
• A paid community advisory board of transgender people helped guide the research process.

Findings:

• Social workers need to learn about the history and experiences of transgender people in healthcare systems
• Social workers need humility, self-reflection, and commitment to being good allies
• Recognizing that transgender people's lives are very different based on other identities (race, class, disability, etc.) is crucial
• Social workers must stay open to learning about diverse transgender experiences
• Challenging the assumption that everyone is cisgender needs to happen in personal interactions and in organizations
• Creating structural changes for trans inclusion can transform social work and social services
• Cisgender social workers can never have certain knowledge that comes from lived experience, so the profession needs to hire and keep more transgender social workers at all levels

T-to-T Study (Transgender Peer Support and Resilience)

Goal: To examine peer support experiences and resilience in transgender communities. The main research questions were: "How do transgender people experience peer support?" and "How does peer support help transgender people stay strong and resist oppression?"

Methods:

• Virtual individual interviews conducted with transgender people in Vancouver and Toronto about their experiences getting and giving peer support and how it affected their health and well-being.
• Researchers read the interviews many times to identify common themes (grounded theory method) and looked at how experiences varied based on people's overlapping identities like race, class, and disability (intersectional approach).
• A paid community advisory board of transgender people helped guide the research.

Findings: Peer support experiences among transgender people include four key processes:

• Making themselves visible
  Transgender folks often need to make themselves visible (even in small ways) to connect with others like them. This is risky but can be very meaningful and helpful
• Sharing embodiment, experience, and space
  Peer support lets people connect with others who share their way of experiencing the world, which reduces feelings of being alone
• Imagining and feeling validated
  Peer support helps people imagine what's possible for their lives as transgender people and feel valid in those possibilities. It also supports working together for social and political goals
• Sustaining communities and resistance
  Peer support is essential for building and keeping communities strong while facing multiple forms of discrimination. These communities organize resistance and work for the social and political changes needed to address unfairness affecting transgender people

• Standards of Care
  • Guidelines from the World Professional Association for Transgender Health (WPATH).
• DSM-5
  • Used by clinicians and researchers to diagnose mental health conditions. 
    Of note - This version saw "Gender Identity Disorder" changed to "Gender Dysphoria"

Support Resources:

• Trans Lifeline

Hannah Kia (she/her), is an assistant professor at UBC's School of Social Work. Before teaching, she worked as a social worker in hospital emergency rooms and with people in hospice (end-of-life care). Hannah is a trans woman whose family is from Iran. She talks about transgender health from both her personal experience and her research.

Read Hannah's bio for more.