Trans Pregnancy: new articles on conception and pregnancy loss

Cross-posted from the Trans Pregnancy project blog.

We are delighted to announce that the first two peer-reviewed articles on findings from our research interviews are now available. Both draw on an analysis of 51 interviews with people who had concieved. One looks at experiences of pregnancy loss among a subset of research participants, and the other explores routes to conception.

More information on each of these articles can be found below, along with links to open-access versions which are free to read.

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Men, trans/masculine, and non-binary people’s experiences of pregnancy loss: an international qualitative study

Abstract text for the article. Follow the link to read it.

Published in BMC Pregnancy and Childbirth (BioMed Central). The article is fully open-access and free to read.

This article examines male, trans/masculine and non-binary gestational parents’ experiences of pregnancy loss, an experience that more broadly affects millions of people every year. We found that, like cisgender parents, our research participants often faced grief following a pregnancy loss, and like heterosexual cisgender men in particular, they often faced barriers to support.

However, the research participants also reported experiences specific to pregnancy loss among male, trans/masculine and non-binary gestational parents, including difficulties in accessing inclusive healthcare, and resistance to “failed” or “wrong” body narratives. We therefore make recommendations for healthcare providers regarding the importance of appropriate language, and the need to sensitively attend to emotions attached both to the loss itself and to the possible desire to attempt another pregnancy.

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Men, trans/masculine, and non-binary people negotiating conception: Normative resistance and inventive pragmatism

Abstract text for the article. This can be read by following one of the links to the full article.

Published in the International Journal of Trangender Health (formerly the International Journal of Transgenderism). An open-access version of the article can be read for free here.

This article explores how men, trans/masculine and non-binary people navigated different social norms and/or practical obstacles to conception. It shows that individuals engage in diverse practices that normalise their experiences of conception, while also highlighting the unique needs and challenges they can face.

The article will also form part of a special issue of the International Journal of Transgender Health that we are editing which will be published in full in early 2021. This special issue will more broadly explore issues of fertility, reproduction, and sexual autonomy among trans and non-binary people. Two other great articles from the special issue have also already seen advance publication:

Administering gender: Trans men’s sexual and reproductive challenges in Argentina, by Andrés Mendieta & Salvador Vidal-Ortiz.

“Just because I don’t bleed, doesn’t mean I don’t go through it”: Expanding knowledge on trans and nonbinary menstruators, by A.J. Lowik.

There is of course a lot more to come – watch this space for more new research findings from both ourselves and our colleagues in the field.

Free talk: Making Trans Pregnancy Possible

This Friday (25th September) I will be presenting findings from the Trans Pregnancy Project at the LGBT Foundation’s Future of Trans Healthcare conference. Topics under discussion will include men, transmasculine and non-binary peoples’ experiences of conception, the impact of testosterone, and the language of reproductive health services.

The conference runs for two days through Thursday and Friday, and is free of charge. It’s possible to drop in and out or attend the whole thing. My session is scheduled for 1pm on the second day.

Read more and register to attend here.

Beyond the TERF Wars

For the past couple of years, I have been working quietly on a new edited collection with my colleagues Sonja Erikainen and Ben Vincent. It is titled TERF Wars: Feminism and the fight for transgender futures.

Cover of the Sociological Review Monograph: TERF Wars.

TERF Wars is being published as part of the Sociological Review monograph series. This means it is available digitally as a special issue of the century-old journal The Sociological Review, and will also be available to buy as a reasonably-priced paperback book.

Digital special issue
(available now with a subscription to The Sociological Review)

Paperback pre-order
(Europe only for now – more and better links coming soon!)

Read the Introduction for free

Our aim has been to provide a critical, scholarly response to the growing circulation of both “pro-trans” and “anti-trans” ideas within feminism, especially in the academic context in which we work. As the “trans debate” has grown ever more extensive and complex, newcomers often express confusion around why this has happened, what the fiercely contested language actually means, and how it has all become so polarising.

The collection therefore addresses a range of issues, including (but not limited to) definitions of sex and gender, trans/feminist histories, racism, autogynepilia, “rapid-onset” gender dysphoria, detransition, access to public toilets, and contestation over the “TERF” acronym (“Trans Exclusionary Radical Feminism”) itself. We have been privileged to work with a range of amazing authors, including Jay Bernard, Lua da Mota Stabile, Jen Slater, Charlotte Jones, B Camminga, Rowan Hildebrand-Chupp, Florence Ashley, Julia Serano, María Victoria Carrera-Fernández, Renée DePalma, Emi Koyama, Cristan Williams, and Sally Hines.

I am proud of what we have achieved, and hope the collection will serve to move some of these debates forward. However, I also believe it is important to emphasise that trans people face far more significant issues than debates within feminism.

I have long felt that the “TERF wars” are a distraction from the endemic discrimination and gross inequalities faced by trans people in all areas of public and private life. There is a reason that my own research and activism has focused primarily on healthcare, both before and during the editing of this collection (which I have very much treated as a side project). Arguing with strangers about sex and gender on Twitter won’t reduce waiting lists or stop doctors from sexually assaulting patients. Equally, it becomes harder to concentrate on the task in hand when vicious anti-trans columns are constantly published in the mainstream media, and when your research plans are derailed by a malicious Freedom of Information requests from anti-trans campaigners hope to access your work emails.

There is no easy solution to this conundrum. However, I urge readers to consider how they, personally, might aim to move beyond the TERF wars. My main hope for this edited collection is that will be helpful for people to better understand this particular realm of transphobic discourse, and to counter harmful and inaccurate arguments. Having done so, I urge you to turn to the real tasks of trans liberation: fighting sexism, racism, and ableism, protecting personal autonomy, building collective solidarity and mutual aid networks, providing services to our communities, and imagining new worlds.

Public lecture: Clinical Discourse and Becoming Trans

“Who is the gender expert? How did they get to be a gender expert?”

Last year I undertook a research visit to Aotearoa New Zealand, to learn more about trans activism and healthcare provision, and speak about my own work. During the visit, I gave an invited lecture at the University of Waikato, titled The Gender Experts: Clinical Discourse and Becoming Trans.

I drew on my PhD research to explore how understandings of what it means to be trans, and what it means to be an expert on being trans, are shaped by power relations in medical contexts.

My talk was recorded using lecture capture software, so is now publicly available for anybody to watch!

 

A Methodology for the Marginalised

This is a deeply strange time to have a new peer-reviewed article out. I’ve been on strike for weeks, and otherwise on annual leave, planning a move south (for my new job) which may well be indefinitely postponed. It’s hard to comprehend the enormity of the COVID-19 crisis, nor the fact that the most helpful thing I can do right now is stay put.

The article was originally drafted in 2018, and based on experiences I had during fieldwork and while disseminating my research between 2013 and 2017. With the pandemic upon us, this previous decade feels like deep, distant history. Here in the UK, the true, awful toll of the illness is yet to become apparent; yet cities are beginning to turn silent as we self-isolate, political axioms are turned on their head, and all conversation turns eventually to the virus.

In this context, it’s easy to wonder if any of the work we did a month or more prior could possibly still be relevant. And yet.

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Cover image of the journal Sociology.My new piece is titled A Methodology for the Marginalised: Surviving Oppression and Traumatic Fieldwork in the Neoliberal Academy, and it is published in Sociology, the journal of the British Sociological Association. I use my experiences as a trans academic as a case study to talk about the huge inequalities endemic within universities, and how these disproportionately impact those who already experience forms of social marginalisation. My aim is not simply to chronicle the harms of marketisation, transphobia, sexism, and racism, but to also propose a way forward. We need to start thinking and acting more collectively; in addition to workplace organisation and union activity, this is relevant to how we design and implement our studies.

My proposed “methodology” involves bringing questions of solidarity and mutual support to the procedure of research design. Universities have long been bastions of privilege, with mechanisms of exclusion are unthinkingly built into every aspect of academic life. The only way we can possibly open up higher education is through creating systems of support which acknowledge and account for pre-existing inequalities, and these must be embedded within the process of knowledge creation itself.

My article uses the example of suicide within trans communities to illustrate this principle. Suicide ideation and suicide attempts are especially common among trans people. As such, it is highly likely that any given trans academic will either be suicidal, or will have friends who are. Consequently, if trans people are to stand a reasonable chance of surviving within the university, this is something that should be accounted for in research design and funding proposals as well as in wider institutional support structures.

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It’s impossible right now to know when and if the world will return to “normal”. I have seen some contend that this cannot be possible given the devastating number of predicted deaths, the shock to our economic and political systems. Others observe that the prevailing social order has survived before, and argue that any emergency measures to support workers who have lost their livelihood and/or increase police powers will inevitably be reversed in the long term.

However, what we do know is that universities have historically been remarkably resiliant – as have the inequalities in our society. Whatever happens next, we must continue to fight for a better world, and that includes within academia.

We can already see this beginning to play out in the UK as universities scramble to shift their activities online. Managers are relying on staff to carry on teaching, conducting research, and undertaking assessment and monitoring activities such as the REF. Meanwhile, most of us struggle to balance working from home with looking after partners, housemates, and/or families, wrestling with IT systems that have been heavily undermined by cuts as shiny new buildings stand empty on our campuses. We cannot possibly expect to carry on as normal.

It is in this context that I invite you to read my new article, as and when you find the time and mental energy. It is one of the most difficult and vulnerable things I have ever written. I am really proud of it. It helped me think through some small ways in which I might change my work patterns and practice of solidarity, as part of a far larger push for change. I hope that in turn, it might help you also.

A Methodology for the Marginalised:
Surviving Oppression and Traumatic Fieldwork in the Neoliberal Academy

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Update 17 July 2020: the article has now been published in Volume 54, Issue 4 of Sociology, and is also now available free to read on the journal’s website. I have updated the links to reflect this.

New job with the Trans Learning Partnership

I am very excited to announce that I will soon begin work on a new project. From the beginning of April I will be working full-time with Spectra as Research Coordinator for the Trans Learning Partnership.

The Trans Learning Partnership is a groundbreaking collaboration between trans and non-binary community representatives, academics, and four organisations who work to directly provide community services: Spectra, Gendered Intelligence, Mermaids, and the LGBT Foundation. The aim of the Partnership is to drive the development of a robust service and advocacy-oriented evidence base, enabling trans services and their service users to have needs-based, impactful services.

This also means that I will be leaving the Trans Pregnancy Project at the University of Leeds, but rest assured that I plan to continue supporting my colleagues from that project in writing up and publishing our findings. We have a number of academic articles currently in the pipeline, along with a themed special issue of the International Journal of Transgender Health.

I will of course continue to update this website periodically with information and reflections on all of my ongoing research.

The Trans Learning Partnership feels like such an important opportunity to design and undertake research intended to directly improve people’s lives. I can’t wait to get started!

 

Fighting back in the precarious academy – FWSA address 2019

On 16 October I spoke at the 30th Anniversary event hosted by the Feminist and Women Studies Association UK and Northern Ireland (FWSA). This is the text of my short talk.

Thank you for having me, I am very honoured to be here today.

I was invited to speak about doing feminism in the academy through my research on trans experiences. I am a trans woman known for my research on trans health.

I am interested in how discourses of consent, autonomy, sex and gender circulate between patient communities, activists, and professionals, and how these are shaped by power relations. I also work on new approaches to healthcare that might centre patient knowledges, rather than patriarchal medical authority. At present, I am part of an international study of pregnancy and childbirth among trans men and non-binary people.

This research stems from my wider interest in gender, sexuality, and power relations within institutions. I have published empirical work on equality schemes in Higher Education, focusing specially on Athena SWAN. My research with Charoula Tzanakou shows how Athena SWAN places a burden on the very women it is supposed to help, through expecting them to participate in the extensive work of self-assessment.

I also have been involved in anti-casualisation campaigns, especially while working on hourly-paid contracts for six years at the University of Warwick. I feel it is important to recognise this as feminist academic work too, an argument I expand on shortly.

I am very often invited to speak about trans health. At least as often, I am invited to speak about being a trans woman.

I am very rarely been invited to speak about my wider feminist research or activism.

I know why this is. While our numbers are growing, there are very few trans people and especially trans women working in universities. I am used to being the only visible trans person in the room. I am painfully aware that I am frequently present as a token. I am also aware that if I am not present, often no trans voices are heard at all, let alone trans women’s voices.

I know it is important to talk about how a vast majority of trans staff and students face substantial barriers in Higher Education. These include rigid administrative procedures, plus high rates of verbal abuse, physical and sexual assault. I know it is important to talk about how transphobia is tied closely to misogyny, racialisation, ableism and class, and how the challenges we face are especially compounded for trans people who face intersecting forms of marginalisation, such as Black trans women and disabled trans people.

I know it is important to talk about how we currently face an unpreceded rise in open transphobia. Cis academics talk about stripping our legal rights in public lectures and newspaper columns. Trans studies scholars face constant abuse and harassment on social media, malicious freedom of information requests, and threats of legal action. I know it is important to talk about how anti-feminist talking points from the religious right, such as the supposed threat of ‘gender ideology’, are laundered through anti-trans groups.

Still, there are times I want to talk about other things.

There are times I want to talk about being a woman more than I want to talk about being trans. There are times when I want to talk about solutions as well as problems, about collectivity and solidarity rather than division.

New postgraduates frequently ask me for advice on surviving in departments where they are the only out trans person. My advice is always the same – build alliances across difference. You may be the only trans PhD student, but you will certainly not be the only student who faces marginalisation.

To quote Patricia Hill Collins: “Who has your back, and whose back do you have?

In 2015 the University of Warwick faced scrutiny over TeachHigher, a proposed wholly-owned subsidiary designed to facilitate the outsourcing of teaching at universities. These proposals were defeated by organised resistance within numerous academic departments, led primarily by casualised staff.

Our campaign relied on recognising how the economic precarity of casualization is also about the myriad ways in which many of us are additionally oppressed. As my comrade Christian Smith passionately argued, “TeachHigher is sexist, and TeachHigher is racist”. We knew that women and people of colour are disproportionately represented within the pool of casual labour on which our institutions rely. We knew that increased casualization only exacerbates conditions in which those who are already the most privileged are most likely to thrive. This was a feminist campaign, an anti-racist campaign, a campaign about class, a campaign against ableism, homophobia and transphobia.

In my department, where over 40% of teaching was undertaken by people on hourly-paid contracts, we organised a teaching boycott. None of us would sign up to teach the following year unless the department took an active stance against TeachHigher. This could only work if all of us agreed to openly sign a letter announcing the boycott – otherwise, we could be played off against one another. It took many careful meetings and discussions to organise. Many of us relied on this work to pay our bills, and in some cases, look after families.

In response to our letter, the Head of Department disparaged us in a departmental meeting, calling us “childish”. He proposed replacing our labour with PhD students from other universities. He said we would never win, that the university would never back down.

A week later, the university backed down.

So how do we claim space for feminism in the precarious academy?

By remaining aware of our differences, working with and across them to build alliances.

By campaigning through formal and informal unions as well as our research.

By speaking out and supporting our colleagues, especially if we are in a more secure position than them.

The university is not built for us. We know this in our hearts when we see the statues and paintings of worthy men around campus. We know this in our bones when we the climb steep steps to lecture theatres designed to centre a patriarchal pedagogy. We know this in the sharpness of our breath when men known for sexual abuse talk over us and claim responsibility for our work in departmental meetings.

It’s time for change on our campuses. Let’s make that change together.

EHAOIH6W4AAdiCi.jpg

Of trans fathers and male mothers – the importance of centering experience

By Ruth Pearce, Sally Hines, Carla Pfeffer, Damien W Riggs, Elisabetta Ruspini and Francis Ray White. Cross-posted from the Trans Pregnancy blog. An article based on this piece has been published in The Conversation.

On Wednesday 25th September the UK’s High Court ruled that Freddy McConnell, a man who gave birth to his child, does not have the right to be registered as a “father” on his child’s birth certificate. The court also ruled out the possibility of registering him simply as the “parent”. McConnell, who is trans, has indicated his intention to appeal.

We feel that this is a disappointing outcome, with concerning consequences for the dignity of trans parents and the safety of their children. The law will continue to require that people who give birth to a child in the UK are always registered as the “mother” – even if they are legally men. For example, McConnell’s legal team noted that, “Freddy is legally a man and his legal papers display the same.”

Most importantly, the verdict wrongs the human rights of the complainant and his child, through failing to provide them with consistent legal documentation and intruding on their privacy. More widely it is wrong in terms of its failure to legally recognise diverse family forms and contemporary practices of intimacy, which question traditional gendered reproductive certainties.

Yet, paradoxically, the ruling brings into being a new legal category of “mother”, which is based on reproductive experience, rather than the traditionally sex/gendered body. From today, a ‘mother’ is not defined through binary sexed characteristics. And so, a man may be a a mother as much as a woman.

Judge Sir Andrew McFarlane is explicit on this point in his ruling. For example, in his concluding comments, he states that, “the term ‘mother’ is free-standing and separate from consideration of legal gender, thus in law there can be male mothers and female fathers” (noteably, there is no distinction between “sex” and “gender” in UK law).

This is why legal cases around gender recognition are so important. Even when they seem to fail the individuals who bring them to court, they very often also radically chip away at normative understandings of gender in unforeseen and unintended ways. Such paradoxes and contradictions are subsequently brought to light, unpacked and, very often, readdressed at appeal stages.

McFarlane’s ruling, then, may be seen as the first step in the legal undoing of binary understandings of reproduction and gender, sex and the body, wherein all families of all genders and all bodies will be recognised.

This is particularly important for the trans and non-binary birth parents we have spoken with for this research project, who seek forms of legal recognition that are consistent with how they experience gender in their everyday life.

Promotional image from the film Seahorse. Photo by Mark Bushnell.

Continue reading

Trans pregnancy study – new article and podcast

Over the last year I have been working on the largest international study of conception, pregnancy and childbirth among trans men and non-binary people: the Trans Pregnancy project. We have now undertaken fifty interviews with trans and non-binary people about their experiences in Australia, Bulgaria, Canada, Germany, the UK and US, plus further interviews and focus groups with young people and healthcare professionals.

In this post, I share a new peer-reviewed commentary and podcast from the project.


Article: Beyond the pregnant man: trans pregnancy in A Deal With The Universe

Our first published academic article is now available in the journal Feminist Media Studies, authored by myself with my colleague Francis Ray White. This is a short commentary on the representation of trans pregnancy in the media, centring on a review of Jason Barker’s autobiographical film A Deal With The Universe.

Click here to read the article in Feminist Media Studies.

If you do not have access to this journal through an institutional login (e.g. through a library) or personal subscription, I have uploaded an “open access” version of the article to this website. Click here to read the article for free.


Podcast: Making Space for Trans Pregnancy

In November 2018, Francis and I presented initial findings from the project at the Gendered Intelligence Transforming Spaces conference in London, UK.

This presentation was recorded, and is now available as part of the Transforming Spaces podcast series.

Topics under discussion include:

  • cultural amnesia around trans pregnancy
  • contradictions in UK law and policy
  • the importance of trans “possibility models”
  • the myth of testosterone and infertility
  • gendering in pregnancy
  • trans birth parents in international guidelines


Looking forward

There is a lot more to come! Over the next few months, we will be undertaking our final interviews and focus groups, conducting an in-depth analysis of these, and publishing a law and policy report focusing on the European Union.

Early next year we will discuss our research findings in a report and free conference. We are also planning to write many more academic articles on a range of topics, which will be published gradually over the next few years.

We are hugely grateful for everyone who has shared their story with us so far – thanks to your contributions, we have an enormous amount of material to work with. We very much look forward to sharing more of our work with you.

This post is based on material originally written for the Trans Pregnancy website.

You can also follow our research through the Trans Pregnancy Twitter account.

 

Rainbow resources from Aotearoa: accessibility, takatāpui, and healthcare

This is the second in a short series of posts on my recent trip to Aotearoa. See also:
Part 1: Trans health and rainbow futures.


During my April/May visit to Aotearoa (New Zealand) I picked up a lot of amazing resources. In this blog post, I share some brief reflections on three great documents which contain an enormous amount of interesting and useful material produced by and for Rainbow communities (takatāpui, lesbian, gay, bi, trans, intersex and queer people), on topics that include disability, Māori experiences of gender and sexuality, and affirmative care.

These documents will be of interest to people who want to know more about rainbow activism, communities and healthcare in Aotearoa, but also clearly have a wider relevance and importance. In writing about them, my intention is to highlight the expert contribution of the authors. As a UK-based scholar and activist, I learned a great deal and it is my hope that readers will too.


All of Us

59b7fa1e4a1c5a438395612258da“Imagine how engaged our communities would be if we were curious about our strengths and values, rather than our limitations.”

This beautifully illustrated guide addresses topics such as structural stigma, intersectionality, accountability, minority stress and (de)colonialism from the perspective of a queer disabled politics. It promotes a mode of solidarity and understanding that recognises and works with difference.

All of Us was created by Stace Robertson, a queer trans man of Pākehā (European or non-Māori) descent who lives with Cerebral Palsy.

Robertson explains that the project came about after he noticed that people are often not fully included even in minority communities if they experience multiple forms of marginalisation.

He therefore decided to create a resource that shared the perspective of people with these experiences, drawing on that advise of mentors, and advisory group and 14 people from a range of backgrounds who offered to share their stories in the document.

This resource will be of interest to people who want to learn more about experiences of multiple marginalisation. It will be useful to those who are new to this topic, as well as those who want to understand more about factors such as ableism or migrant status impact LGBTIQ experience and vice-versa.

There is also an excellent easy-read version of the guide available in the second half of the document.


Takatāpui: Part of the Whānau

Screen+Shot+2017-02-26+at+4.12.09+PM“Takatāpui is a traditional term meaning ‘intimate companion of the same sex.’ It has been reclaimed to embrace all Māori who identify with diverse genders and sexualities such as whakawāhine, whakawāhine, lesbian, gay, bisexual, trans, intersex and queer.”

The document was created to provide information and support for takatāpui and their whanau (family), but it will also be of interest to people wanting to learn more about mātauranga Māori (Māori knowledge or wisdom) with regards to sexual and gender diversity. It was written by Dr Elizabeth Kerekere, a renowned takatāpui activist, scholar, and founder/chair of the Tīwhanawhana Trust.

Through colonialism, Aotearoa inherited the sexism and homophobia of the British legal system. Takatāpui narrative were erased through pathologisation, colonial records, and the imposition of the nuclear family model. In light of this, Kerekere highlights the importance of pre-colonial histories, and of contemporary resilience and the importance of pride, family and community support.

In the UK, we have begun to talk more in recent years about how binary gender norms were imposed on many societies by British invaders through colonialism. These conversations can only become deeper and more nuanced through respectful engagement with knowledge produced by Indigenous peoples on this topic, rather than relying on the flawed work of colonial anthropologists. As a white trans woman who experiences both gender marginalisation and unearned privileges afforded by the legacy of colonialism, I am grateful for the opportunity to learn directly from takatāpui perspectives.


Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa New Zealand

Guidelines for Gender Affirming Health low res.pdf“These guidelines are based on the principle of Te Mana Whakahaere; trans people’s autonomy of their own bodies, represented by healthcare provision based on informed consent.”

These guidelines were produced by a coalition of healthcare practitioners, academics and community members, with the support of the Northern Region Clinical and Consumer Advisory Group. They are intended to supplement the World Professional Association for Transgender Health Standards of Care, providing guidance relevant to District Health Boards in providing gender affirming healthcare throughout Aotearoa.

An important feature of the guidelines is the use of Māori health expert Professor Mason Durie’s health framework. The document highlights two key principles for health promotion development: Te Mana Whakahaere (autonomy) and Ngā Manukura (community leadership). There is therefore is an emphasis on trans and gender diverse people having collective control over their own destiny and decisions around healthcare.

Furthermore, Te Whare Tapa Whā, as described by Durie, conceptualises health and wellbeing as the four cornerstones of the wharenui (meeting house). As noted in the guidelines, this model recognises the equal importance of Taha Wairua (spiritual health), Taha Whānau (family health), Taha Hinengaro (mental health) and Taha Tinana (physical health). These four cornerstones provide the structure for the document.

Consequently, the guidelines highlight topics such as Māori and Pasifika genders, minority stress, social transition, health in the family and in schools, and mental health, positioning these as equally important a consideration as physical transition (for those who desire/require medical interventions). This strikes me as a really important move, de-centring hormones and surgery to instead provide a more holistic view on trans health needs.

Like many similar documents, the guidelines are not perfect. I met a number of clinical practitioners in Aotearoa who considered this document to be a good starting point for conversations around improving care, but with some limitations outside of the relatively well-resourced Northern region in which they were primarily written. I have my own concerns around the citation of somewhat inaccurate information produced by cis clinical researchers (for example, Table 5, based on the Endocrine Society Guidelines, underestimates how long it might take for certain bodily changes to take place). I also feel that the definition of “informed consent” used in the document could perhaps benefit from tightening to specify what does and does not constitute appropriate oversight in determining whether or not patients are “adequately prepared” for medical interventions.

Regardless, I am deeply grateful for the work from so many people that goes into producing guidelines such as this, and I hope they can contribute usefully to the ongoing depathologisation of trans health.