Barred from Transition: The Gatekeeping of Gender-Affirming Care during the Gender Clinic Era

Abstract

Transgender medicine has made great strides in the past century. Biomedical advances in the fields of reconstructive surgery, endocrinology, and pharmacology have expanded the possibilities for gender-affirming care, including surgeries and hormone replacement therapy. Given these impressive medical and technical advancements, it is crucial to analyze the ways in which gender-affirming care has been gatekept. Gatekeeping refers to the practice of limiting health resources and services for certain populations. Transgender individuals have historically and presently experienced gatekeeping of gender-affirming and transition-related services by medical professionals, academic institutions, and insurance providers. In this paper, I draw from archival and scholarly materials to analyze the extent to which transgender individuals experienced care refusals during the 1960’s and 70’s at university-based gender clinics in the United States. I argue that the gatekeeping of care was historically motivated by medical providers’ and gender clinics’ desire to produce productive, heteronormative citizens and that gatekeeping allowed medical providers to shape and alter transgender people’s medical narratives. Ultimately, this analysis locates current biomedical advances in transgender health and medicine in the context of a long history of care refusals, gatekeeping, and acts of resistance in which transgender people attempted to reclaim their narratives. I aim to illuminate the ways in which medical care was gatekept during the gender clinic era of the 1960’s and 70’s in the United States and argue that these practices shaped the kinds of medical narratives that transgender people tell in order to receive care.