Indigenous

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International Trans Studies Conference Day 3: gaming, representation, and transnationalism

This is the fourth in a series of blog posts about the 2nd International Trans Studies Conference in Evanston (4-7 September 2024).

Read Part 1 here.
Read Part 2 here.
Read Part 3 here.

I started writing this posted back in bonnie Scotland! Back to work, back to endless emails, back to doing my absolute best that all the masters dissertations are marked in good time. I finished it on an aeroplane to Lisbon, for my second major international event of September: the 2024 World Professional Association for Transgender Health Scientific Symposium, and am posting it from a conference centre in Lisbon.

As such, and as you might have noticed, I have slowed down with my writeup from the International Trans Studies Conference. Still, I have plenty more notes and reflections, and hope to continue writing these up over the next week or two.

My conference account left off halfway through the morning of the third day. After the sheer emotional onslaught of the session on political economy (no, really) I decided to slow the heck down and not rush off to the next talk. I went to the front desk where I managed to catch two of the conference organisers, Avery Everhart and Erique Zhang. I’ve known Avery and Eri online for years and long admired their work from afar, but we’d never previously met in person. I have really, really missed making these deeper human connections at conferences. Much as the organisers were clearly exhausted from firefighting technical and access issues to keep the conference running, it was wonderful to meet them and take time for a chat.

I therefore missed the first two papers from the next session I attended. This was a bit of pity given how amazing the rest of the session was, but self-care is important, and I regret nothing!


B{ending} Trans Game Studies

I don’t really do any work in game studies, so chose this session mostly because it seemed fun, and interesting. An opportunity to expand my horizons. This was the right choice – I had an incredible time. 

I turned up partway through a presentation from Madison Schmalzer of Ringling College of Art and Design (USA), titled Circuit Bending, Trans Play, and the Death of Game(!) Schmalzer introduced circuit bending as a practice of “tinkering and seeing what happens”. Examples from her art, research, and teaching included rebuilding children’s keyboards, and messing with old Mario games to create something entirely new. Controls shifted, the sky changed colour, characters ran unexpectedly across the screen. Through the destruction and reconstruction of corporate entertainment products, students discovered entirely new modes of play.

Analysing this process, Schmalzer drew parallels between digital games and social constructs including gender and race. She argued that circuit bending raises important questions about digital products, such as: why does this game exist? whose interest does it serve? And finally: how might we “bend” other social systems in the same way that we might do with games?

Some possible responses to these questions were offered in the next paper: “We Can A̶l̶w̶a̶y̶s̶ Never Tell”: Giggling Faces, Gender Machines, And Un-Recognizing Play, by PS Berge of the University of Albert (Canada). Berge introduced the concept of “ludoarsony”, which variously refers to breaking, burning, or destroying a game (including technical or cultural rule sets), or to playing with fire, creating and playing through the act of destruction. Berge posited that ludoarsony, like play more generally, is a trans thing to do: “play and transness are of kin: both are transformational movements that weave in and out of rigid cultural and computational systems that they are ultimately ambivalent to”.

Berge’s paper drew on a number of case studies in which trans people play with the claim commonly made by transphobes that “we can always tell”: the notion that trans people are inherently clockable as such, that we are always reducible in behaviour and appearance to our sex assigned at birth. The first of these was Giggle for Girls, the now-defunct trans-exclusionary social networking app “for females” (recently central to the groundbreaking discrimination case Tickle vs Giggle…no, really).

Giggle’s verification system for female users relied on so-called gender-recognition technologies. Berge observed that on launch, Giggle was not simply criticised by trans people, but also played with. Examples included trans women testing the verification system (“I’m proud to announce that apparently I’m cis now. I’d like to thank Satan”), and revelling in negative reviews from cis women who were not recognised as such (e.g. “I can’t even access this app […] I was so looking forward to a female-only space, but now I just feel alienated. Thanks for that.”).

Further undermining the logic of “we can always tell”, Berge discussed the work of algorithmic artist Ada Ada Ada, showing us an example of a video in which the artist changes the response of facial recognition software in real time by pulling different expressions. Ada Ada Ada followed this up with “The Misgendering Machine”, an app available to anyone with a phone camera or webcam, which encourages people to play with how they are gendered by the machine.

Berge concluded by arguing that there is play in the unmaking, and to find play in the unplayable helps us find life in the unliveable: “we do not play in spite of the world being on fire – we play because the world is on fire”. Central to this is a project of mutual recognition: “we can never tell”, an acknowledgement of the ways in which we are all fundamentally unknowable, a promise not to rat each other out.

My horizons suitably expanded, I headed out to grab lunch.


Picturing Trans: Studies of Trans Visual Culture

In the afternoon I again wanted to attend a session that offered a different perspective to the material I normally encounter in my work on trans healthcare, both to expand my horizons and take something of a break from the slow creeping horror of my own area. So I want to a session on trans visual culture.

The first two talks offered radically different perspectives on trans people’s self-representation: one looked at self-portraits of trans bodies, and the other very intentionally looked at why we might avoid portraying our own bodies. The third talk then looked at how we might be represent and be represented by other trans people.

In Beyond Representation: Photographic Methods in Trans Myth-making, June Saunders of Washington State University (USA) offered a beautiful, poetic reflection on trans photography and representation that elides direct representations of our bodies. Saunders presented numerous images of landscapes, buildings, and everyday medical paraphernalia to accompany her talk. She encouraged us to be present in the moment without our devices, reflecting the themes of the presentation.

Sanders focused on how we might sit within and create photography that captures specific experiences and moments in time, without simply using this to produce commodifiable content. She examined the tension between the power of self-representation and exploration on the one hand, and the use of images in the service of surveillance and control on the other.

Ace Lehner of the University of Vermont (USA) looked instead at bodily self-portraiture in Transing Identity in Contemporary Photography: Zackary Drucker and Rhys Ernst’s Relationship. Noting that trans visual culture has played a crucial role in political representation and social change since the 1990s, Lehner looked at the “accidental” historic art project undertaken by Zackary Drucker and Rhys Ernst as they depicting their transition and relationship. Echoing Berge’s morning presentation on trans play, Lehner argued that trans visual culture can enable us to challenge dominant cultural logics that assume seeing is uncomplicated, and that we can easily read gender, sexuality, and race onto images.

Given the enormous number of contemporary visual transition diaries posted online by transmasculine people, it was interesting to hear Lehner argue for the importance of work by artists such as Drucker and Ernst in the 1990s, when transmasculine individuals were often ignored or erased in the media. Of course, as Lehner noted, transfeminine people have hardly benefited from historical media interest in bodies, which are sensationalised as objects of heightened sexualisation, and non-consensually aligned with dominant cultural ideologies.

The final presentation in this session was by AC Panella of Santa Rosa Junior College (USA), titled I Got 99 problems and Objects of Trans Memory Are Some of Them. Panella asked what we are teaching each other about what it means to be trans and “do” transness, especially given the limitations of existing trans archives. Said archives are typically derivative of lesbian and gay archives in their approach, and/or subsumed within wider LGBT collections, leading to misguided ideas about trans history. They can also contribute to US-dominated approaches to trans history, with celebrations of Pride (for instance) often marking Stonewall, rather than localised celebrations of trans uprising. These issues are compounded by the economic insecurities experienced by many trans people, with housing issues (for example) meaning individuals are less likely to hold on to items from their past. This spoke to a conversation I recently had with a fellow activist who lost much of her personal archive during a period of homelessness.

Panella outlined how these issues might be addressed through localised community projects, and the involvement of artists. The presentation included several examples of Latinx trans projects in Mexico and the west coast of the USA. They incorporated approaches including community storytelling through writing and arts workshops, intimate portraits of people in their homes, and memorial or celebratory pieces (e.g. fashion displays) based on the lives of community members that activists felt were important to remember. In this way, it is possible to create archival material which captures the complexity and nuance of local experiences, tying these both to cultural history and to contemporary struggles.

Transnationalizing Trans Studies: Building a Truly Global Field

The final session of the day was a plenary panel in the main conference hall. Titled “Transnationalizing Trans Studies”, it offered a refreshing alternative to the North American perspectives that dominated much of the conference, but also once again highlighted the limitations of the conference’s internationalism. We were meant to hear from a scholar-activist in Zambia – the only planned plenary speaker from Africa – but unfortunately she was unable to join us due to energy shortages. I truly hope future events can address this oversight: a matter addressed by the chair, Francisco Fernandez Romero (University of Buenos Aires, Argentina) in his introduction.

The panel therefore featured three speakers who responded to questions from Romero: Madi Day of Macquerie University (located in what they intentionally highlighted as the occupied territories named “Australia”), Alyosxa Tudor of the School of African and Oriental Studies, University of London (UK), and Michelle Ho of the National University of Singapore (Singapore).

The discussion opened with a question from Romero about what trans studies looks like across these contexts. Day began by explaining that, as an Indigenous scholar, they approach the field from an Indigenous studies perspective. They emphasised that Indigenous studies should not be understood as the study of Indigenous people, but rather as a critical examination of the colonised world. This approach understands settler colonialism as a global apparatus, with some Indigenous lands directly occupied (as with Australia), and others exporting their resources to the colonial centre (as Romero described earlier in the day with reference to Argentina). In this context, “colonialism is the condition of possibility”. Day therefore distinguished between white settler trans studies in Australia, and Indigenous trans studies. They spoke to the importance of drawing (appropriately and with due credit) on Indigenous approaches in trans studies, to better address the problem of material from the Global South being always used as data, and never as theory.

Tudor spoke to their context as an academic of Eastern European heritage living in the UK. They argued for a transnational approach to trans studies that goes beyond the “national” in understanding global-local connections, and embraces anti-nationalist principles, insisting that transnationalism is “not about all the small nations sitting down with the big ones for a nice chat!” This is important for interrogating discourses of Eastern European exclusion in trans studies: simply creating a series of national sub-fields is not an adequate solution. Relatedly, Tudor emphasised that a transnational trans studies cannot escape the current moment of genocide in Gaza, and must name the violence inflicted on the Palestinian people.

Ho discussed questions of multiple marginalisation. Citing the TSQ: Transgender Studies Quarterly special issue “Trans in Asia, Asia in Trans”, she observed that trans studies remains marginal in Asian studies, just as Asian experiences are marginal within in US-dominated trans studies. She also emphasised the difficulties of difficulty of translation in terms of both language and experience, with an enormous diversity of “trans” possibilities present across the Asian continent.

Romero followed these comments with questions that followed up on the topics of translation and transnationalism. Day argued that if trans studies is to be truly transnational, the goals and ambitions should be determined the global Southern majority. The problem in only calling on Indigenous knowledge when it’s directly relevant to Indigenous experiences is that you maintain a colonial viewpoint: if you are a white settler leading a research project, group, or institution and are not actively resisting settler colonialism, you are conducting a white settler project.

Day highlighted how shared experiences across Indigenous communities in different parts of the world have informed shared resistance and productive modes of thinking, and asked: “what would happen if we started thinking of transness as an identity rather than an identity?” But to be in a community, you need to act like a community. Community is non-extractive, and if you have more of something, you need to use it to help others.

Tudor returned to the question of nationalism. Contrasting with Day’s account of community, Tudor argued that nationalism rests on logics of opposition and competition, and resists complexity. In additional to critiquing white, Western nationalisms, they observed that decolonial, diasporic, and minoritised nationalisms also deserve scrutiny, as contemporary counter-hegemonies may become future hegemonies. That is to say: a people’s historic experiences of violence and oppression may not present future violence against others in the name of a new nation, as seen in the example of Israel. Tudor suggested that queer and trans studies might offer a vehicle to highlight the violence of nationalism, through challenging and deconstructing categories, from gender to nation. In this context is important that decolonialism is a mode of action, not a metaphor. Tudor noted they have used their platform as an academic speaker to highlight the growing death toll on Gaza, but this kind of speech act alone is insufficient: “it is clear none of my previous papers have saved a single life”

Ho focused especially on the topic of translation, exploring what might get lost through simply assuming that the language of one context might adequately explain another. She emphasised that to be adequately in conversation with a context, we need to learn their language and culture. This creates real problems for “international” publishing in the English language. Echoing Day’s comments earlier in the plenary, Ho noted the pressure to use Western theory to analyse Asian case studies, and described how a peer reviewer insisted that there were too many “non-English words” in her manuscript: the implication being, “can you do something to avoid alienating your largely US readership?”

Ho concluded by reflecting on the difficulties in attempting transnational approaches to trans studies in Singapore. What compromises are necessary in a very conservative society? She described the example of trying to get funding to bring in a trans studies scholar to speak at her institution, noting that the question is in part one of framing: “I could invite Jack Halberstam to come, and say ‘Jack Halberstam is an established scholar in cultural studies’”. However, given how Western-centric “transnational” scholarship is, this strategy is more effective with US academics than, for example, experts from India. Ho ended with two open questions for us to consider: if trans studies is effectively underground in a specific context, can it be considered trans studies? And how can Western scholars learn from people in these contexts?

The following Q&A session included some interesting reflections on the binary of Global North / Global South given the experiences of Indigenous people in settler-colonial nations. On this note, Day stated their appreciation for the Trans Studies Conference operating within established protocols for Indigenous engagement, for example through inviting Indigenous contributors to speak first: this could be seen both in Kai Pyle’s opening statementson the first day of the event, and in the structure of this very plenary.

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Conference report: International Trans Studies Conference, Day 1

REPENT.

The messages greeted me as soon as I left the ancient, rattling commuter train from central Chicago, chalked onto the sidewalk all along Church Street on the walk to my hotel. They seemed oddly out of place in Evanston, a leafy college suburb with an extremely chill vibe; a strange contrast to the low-key cool of the bars and restaurants, and turquoise blue calm of the inconceivably vast Lake Michigan.

At first I misread the final word of every message as “repeat”, as in (for example): “Praise the Lord – repeat”. I thought someone was simply very enthusiastic about sharing their values. “Repent”, however, feels a lot more aggressive and also quite pessimistic, assuming the reader’s guilt and their urgent need to make amends.

I am here for the 2nd International Trans Studies Conference, held at Evanston’s Northwestern University, in the original homelands of the Council of Three Fires (the Ojibwe, Potawatomi, and Odawa peoples). In the opening plenary of the conference, the political scientist Paisley Currah argued that we are living in a crisis moment for trans politics: not because we are necessarily facing more discrimination than ever before, but because more people are paying attention to our existence. Many of these people hope we might repent our trans identities, our gender deviance, our very existence. And yet, here we are, gathering from around the world to discuss trans knowledge and trans ideas, and to imagine trans futures.

Over the course of the conference I am attending numerous talks and meetings across a dizzying array of topics and themes, taking in both theory and evidence from researchers based in the humanities, social studies, and physical sciences. I plan to blog regularly, sharing information I have learned as well as critical reflections on the event. There are literally hundreds of talks taking place over up to 11 simultaneous sessions at any one time, so please do not expect an exhaustive account! Still, I hope these posts will be of interest to people unable to attend the conference, as well as fellow attendees.


The opening plenary: ‘The State of the Post-Discipline’

The conference began on the evening of Wednesday 4th September, with a two-hour opening plenary titled ‘State of the Post-Discipline’, reflecting the official theme of the event. Across four talks, this session aimed to set the tone for the conference and introduce a series of key ideas for consideration in the coming days.

I felt the plenary very much reflected the ambition, the importance, and the limitations of this conference. Each of the speakers emphasised the importance of a materialist approach to trans studies, in which our research can speak helpfully to the reality of people’s lives. This necessarily involves grounding our work in practical examples of trans realities, and understanding our histories in order to better tackle the challenges of the present and future. The speakers were perfectly blunt about the enormous harms that trans people have faced across time and in many places, while maintaining an optimism for how we might productively learn together.

At the same time, it felt strange that together, these four opening commentaries reflected a very limited geographic perspective, with three of the speakers being based in the United States. Similarly, it was disappointing to see just one trans woman on the stage, the Mexican biologist and philosopher Siobhan Guerrero Mc Manus.

This unfortunately reflected the wider dynamics at play within trans studies. As conference organiser TJ Billard noted in their opening comments, trans studies has historically been dominated by US and (to a lesser extent) European voices. Moreover, all four of the field’s major journals are effectively based in the United States. The 2nd “International” Trans Studies Conference is inevitably dominated by US scholars and perspectives, even as there are an impressive range of people present from the rest of the world. I’ve also frequently observed the minoritisation of trans women with trans-oriented conferences and research projects, even given the enormous influence of key figures such as Susan Stryker (who will be speaking in a later plenary) and Sandy Stone.

Nevertheless, the conference couldn’t have found a better opening speaker than queer Indigenous historian and literary scholar Kai Pyle. I have long admired Kai’s written work, so it was exciting to finally see them speak.

North American conferences frequently open with a land acknowledgement, in which organisers and/or invited elders of local Indigenous communities recognise the role of Indigenous peoples as the original stewards of lands taken by settler colonists. However, land acknowledgements rarely offer deeper understanding, let alone any form of reparation for the enormous damage wrought by colonialism.

Pyle themself rightly noted that a single talk could not possible begin to account for the violences and erasures of the past and present, and they observed also relative absence of Indigenous academics from the conference space. They further comments that “although I’m speaking on a panel titled ‘The state of the post-discipline’, I’m barely concerned with the discipline at all”: instead Pyle is concerned with a future where indigenous trans people can live.

Nevetheless, it was powerful to begin the event with a talk specifically about the oppression and resistance of Indigenous peoples in the Great Lake region. Pyle also argued that this history is necessary for properly understanding the history of trans studies itself.

Pyle explained that the lands of the Illinois or Inoka people were first invaded by the French in the 17th Century. Subsequent European accounts and travelogues widely reported the presence of gender roles in Inoka society that did not align with European norms: examples included the leadership of women in agriculture, and genders that could not be easily categorised as female or male. The subsequent projection of European understandings and desires onto Indigenous North American peoples informed early pathological accounts of gender ‘deviance’ as physical and mental sickness, which in turn would inform inform diagnostic categories from the 19th century to the present day. Indigenous people themselves, meanwhile, were subject to immense colonial violence, including coercive conversion to Christianity, removal from their homelands through forced marches such as the Trail of Death, and cultural destruction through the Indian residential school system.

Turning to the early 20th century, Pyle told the story of Ralph Kerwineo, an individual of Potawatomi and Black heritage who successfully ‘passed’ as a man and married two women while living in his ancestral homelands. While Kerwineo might today be understood as a trans man, there is no evidence of any engagement with the traditional gender roles of his people. Pyle noted that this stands as evidence of both enormous alienation but also resistance: Kerwineo successfully lived a gender ‘deviant’ life in the Chicago are a hundred years of attempted elimination of his people.

Finally, Pyle reflected on the emergence of the two spirit movement in the early 1990s, in parallel with the emergence of the contemporary US trans movement, as well as trans studies.

The second talk was by Paisley Currah, who argued for theorising “trans rights without a theory of gender”. He posited that trans studies has been increasingly “stepping aside from just doing theory” over the last decade, as seen for example in the creation of the journal Bulletin of Applied Transgender Studies. In this context we can potentially separate questions of social justice from questions of what sex and gender might actually be.

Currah illustrated this argument with the example of campaigns around sex classification policies in New York City. Attempts to introduce a system of self-declaration in the 2000s and early 2010s were complicated the fact that some city bureaucrats supported the proposed changes, and others opposed them. This was summarised by a legal argument made by the city government: “the existence of difference approaches to similar problems does not render an agency’s rule irrational”.

In this context, Currah argued that sex/gender is in practice a “decision informed by law”, and by the needs and interests of lawmakers. For example, in many jurisdictions it is fairly easy to change a sex/gender marker on a driving license. This is because in practice driving licenses are used by the state primarily for tracking and surveillance, and it is therefore in the state’s interest for the license to reflect what people look like and how they live. By contrast, it has historically often been more difficult to change sex/gender for the purpose of marriage: that is because this would entail a disruption of the heteronormative biological logic for property transfer across generations.

Currah concluded by arguing that when we argue for changes to these policies, the existence and diversity of trans people “is enough”. We exist no matter what your theoretical position on sex or gender, and “a world without us cannot be willed into being”. The focus of policy advocacy should therefore be on what we need to flourish, rather than abstract theorisation.

I found Currah’s arguments extremely helpful and well-framed. However, I was surprised to his insights framed as novel, as the approaches he described feel well-established in the UK. Unlike in the US, materialist approaches have been central to trans studies since the 1980s, in the work of key scholars such as Dave King, Stephen Whittle, and Zowie Davy. Meanwhile, the focus on trans people’s practical needs is embodied in the work of organisations such as Trans Safety Network and Trans Kids Deserve Better, who very intentionally centre questions of harm rather than any theorisation around gender. My own PhD thesis (published in 2016!) and later book Understanding Trans Health deliberately set aside the question of sex/gender to focus on how trans healthcare services operate and are experiences in practice. The feminist philosopher Katharine Jenkins has done important work on how what is important about gender varies according to context, and the legal scholar Chris Dietz has extensively considered questions of governmentality in terms of how and why differing aspects of trans people’s lives are managed by different agencies of on the behalf of healthcare systems and the state.

I make this point not to try and undermine Currah or big up UK trans academia specifically. Rather, I want to note how this kind of awareness of what is already being done in different parts of the world highlights why a truly international approach to trans studies is so vital.     

The next talk was by Siobhan Guerrero Mc Manus. Unfortunately I – and many other attendees – missed much of her talk due to an apparent failure by the translation company hired to support the conference. This was an enormous pity given what I did catch felt extremely important, and built on the critiques of Currah that were bubbling away in my brain during his talk.

Guerro Mc Manus emphasised the importance of organising across borders, with the example of taking successful trans liberation strategies from Mexico, adapting these in a Colombian context, and then again in Peru. Conversely, she described the example of how work on reforming the criminal code in Colombia informed trans activism in Mexico. In this kind of organising and exchange of ideas, reflections from the Global South might be combined with insights from the North, without simply reproducing Global North theory in a way that is not necessarily applicable to countries such as Mexico.

I wish I had heard more of these presentation! I feel the International Trans Conference’s investment in both live translators and translation through transcription software is an incredibly important move, and should set the tone for future events in the field (or “post-discipline”, if you prefer). At the same time, it is important to get this right lest non-Anglophone perspectives are further marginalised through technical error. While I just missed large parts of this one talk, attendees who were not fluent in English may have missed much more from the other speakers. I definitely felt for the organisers, speakers, and fellow attendees, and hope these problems will spur future work to further improve our communication across languages and borders.

The plenary closed with a short address from TJ Billard. Billard explained how the choice of conference theme was informed by the “first” International Trans Studies Conference, which took place in Arizona in 2016, “riding the high of the transgender tipping point” just months before the election of Donald Trump. An enormous amount has changed in the last eight years, and the time is ripe for a re-appraisal.

Billard’s use of the term “post-discipline” draws on the work of John David Brewer. Brewer describes post-discipline thinking as knowledge about a phenomena that is detached from disciplinary allegiances, instead emphasising theoretical and methodological pluralism, political investments, and ethical values.

The emphasis is therefore less on academic siloing, and more on real problems facing contemporary society.  This couldn’t be more appropriate for trans studies, especially in the context of the insights shared by the other speakers.


Some final thoughts

The first “day” of the conference was really just an evening: the opening plenary, plus a reception where the in-person attendees got to spend time meeting and catching up with one another (some of the most important academic work!) I am finishing this monster post at the end of the second day of the conference, a true marathon which ran from 8:30am (when registration opened) to 9pm (when a reception and 10th anniversary celebration hosted by the journal Transgender Studies Quarterly theoretically wrapped up). It’s difficult to capture the sheer scope of this event: indeed, this series of posts can only possibly touch upon the vast amount of knowledge and information we are discussing at the conference.

For all that I (and others) have shared several critiques, I am hugely grateful this event is happening, and feel very privileged to attend in person. I couldn’t be happier to be a gender deviant, and hope to repeat the value-based work of resistance over and over.

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Trans health in Canada: reflections and resources from CPATH

At the end of October I attended the CPATH 2017 (Canadian Professional Association for Transgender Health) conference in Vancouver. It was a fascinating event from which I learned a great deal. I’m keen to share some of my thoughts and experiences with others, as I feel there is a great deal that trans health researchers, practitioners and activists can learn from the progress that’s been made in Canada, as well as the limitations of that progress.

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Poster: “In Our Dream B.C….”, by Drawing Change. Based on Trans Care BC consultation with gender creative, trans, and two-spirit youth and their families..

In this post, I reflect briefly on my impressions of the conference, and link to Twitter threads I wrote during various sessions. You can also read my initial thoughts on the conference here.


CPATH took a broadly holistic approach to trans health

Over 300 people took part in the three-day CPATH 2017 conference and two-day pre-conference. In attendance were GPs, nurses, endocrinologists, psychologists, psychiatrists, therapists and counsellors, social workers, healthcare administrators, peer and parent support group facilitators, academic researchers, lawyers, politicians, and various trans campaigners.

CPATH 2017 treated “health” as a social phenomenon as well as a purely embodied matter, and this made for some very productive conversations. For example, numerous sessions explored how trans healthcare might best be provided in the context of primary health. Gender identity services are frequently provided by GPs with support from external specialists, a model of care that is currently under consideration for England. In some Canadian Provinces, organisations such as Trans Care BC help to connect providers in primary care to relevant specialists, and support trans people in obtaining interventions such as hormone therapy and surgeries.

This approach enables continuity of care in a local context, with family doctors enabled to provide trans-specific care for their patients alongside everyday services. It reduces barriers to access such as waiting times and the necessity of long-distance travel. It also enables GPs to help their trans patients access a wider range of specialist services: for instance, trans people with mental health issues might benefit from a referral to a peer support group as well as or instead of formal therapy (depending on patient desire and need). Many practitioners provide services on the basis of informed consent, rather than using mental health assessments as gatekeeping measures. It was heartening to see generalist and specialist healthcare professionals, social workers, trans activists and others engaged in open discussions about how best to manage care through this kind of system.

I was also particularly struck (and moved) by a session entitled Trans and Two Spirit Youth Speak Back! The 40 or so adults in attendance – mostly healthcare professionals or researchers of one stripe or another – were asked not to speak at all during this workshop. We were instead invited to listen to the stories and experiences of trans and two-spirit young people, who sat dotted around the room and answered pre-prepared questions delivered by a youth group facilitator. This session structurally prioritised the voices of young trans people who are so often silenced, and also offered an opportunity for us to hear how the healthcare needs and challenges faced by these individuals were shaped by their cultural heritage, family life, schools and peer groups.


CPATH took intersectional trans voices seriously

Trans and Two Spirit Youth Speak Back! was just one example of how trans voices were frequently centred at CPATH 2017. As an attendee from the UK, I was very impressed by this! Our trans healthcare conferences, seminars and workshops tend to be organised by and for community groups, researchers or healthcare providers, with relatively little overlap between attendees at these events. Very few practitioners are (openly) trans, meaning that trans people tend to talk to one another at community and research events, but are heard less often at healthcare conferences for doctors, nurses and mental health specialists. Moreover, the speaker line-ups at all these events tend to overwhelmingly prioritise the most privileged individuals, such as white people and men. The only possible exception is cliniQ’s Trans Health Matters conference, and that event too feels like it’s taking the first steps towards something better.

During the opening plenary of the CPATH conference proper, we were informed that around one third of speakers at the event were trans, and around a tenth were Indigenous (i.e. of First Nations heritage). I’m not sure how many people of colour were represented at the event more generally, but the all-white panels which are a norm at UK events seemed few and far between.

Importantly, the trans women, trans men, non-binary and two-spirit platformed as speakers and workshop facilitators were usually also professionals. We weren’t simply present at CPATH to represent a “patient perspective”: rather, we were the experts. This reflects the hard work of individuals in pursuing a career, and the collective work of CPATH in supporting trans professionals; it also reflects the actions of local providers in various parts of Canada who have made an active effort to employ trans people, or secure funding for partnerships with trans-led organisations.

In my previous post I noted that the opening plenary of the conference proper centred Indigenous voices. This included a formal welcome from Musqueam Elder Jewel Thomas, and talks by trans and two-spirit Indigenous educators from different parts of North America. I was happy to see that the plenary session on the second day of the conference continued to centre the voices of individuals who tend to be marginalised within even trans spaces. Two-spirit physician Dr James Makokis and Latina trans activist Betty Iglesias – who discussed issues faced by trans sex workers and migrants – were platformed alongside an Member of Parliament from Canada’s ruling Liberal Party, resulting in a thoughtful and challenging debate.


CPATH (and the rest of us) still have a lot of work still to do

I left CPATH with a very positive impression, but Canada is by no means the promised land for trans health. Professionals and patient representatives alike frequently discussed the challenges they faced in providing gender-affirming services. Transphobia and cisgenderism are still very much prevalent within healthcare provision and legal frameworks, particularly outside of urban areas: there is therefore a great need for better education among trainees and further reform of laws and guidelines. Limited funding and different approaches across the country’s Provinces and Territories also mean that not everyone has the same access to treatment, and waiting lists persist for publicly-funded care. These are challenges that exist across the world, and may benefit from greater international collaboration and strategy-sharing.

At the end of the first day of the conference proper, there was a reception specifically for trans people attending the conference. I later reflected on the experience of attending this reception in conversation with a genderqueer colleague; both of us felt ourselves relaxing enormously upon entering the trans-only space. For all the positives of CPATH, it was a huge relief to step away from cisgenderist expectations and microaggressions that quietly persisted throughout the conference proper. These included a range of unspoken ideas about how we should dress, act, and talk “professionally”, limitations on our ability to name transphobia within healthcare settings without fearing repercussions, and the occasional terrible intervention from self-righteous cis professionals.

As ever, facing down these challenges is hardest for the most marginalised trans people, including (for instance) disabled individuals, sex workers, migrants, and people of colour. I was aware that while CPATH 2017 took a broadly intersectional approach, instances of ableism, racism, sexism and so on persisted: and this could take the form of unexamined prejudices on the part of more privileged trans people too. Moreover, white people were still heavily overrepresented among conference attendees; a phenomenon that was particularly noticeable at an event held in a city as diverse as Vancouver.

What I’m taking from this is a reminder that equality work is never “done”; rather, it is something that we should strive to always “do”. We should aim constant improvement in our relations to one another rather than assuming that solidarity and equality are things that we can simply achieve. It is in this spirit that I’ve attempted to use my own privilege as an academic to bring back lessons from Canada for the UK and beyond.

So, I’ll end this post with a serious of links to Twitter threads from the event. I livetweeted extensively from CPATH 2017, sharing summaries of the numerous talks and workshops I attended. This is by no means a comprehensive summary of any of the sessions I was at, let alone the wider conference (as numerous parallel sessions took place simultaneously). However, I hope the ideas and approaches will be as useful and interesting to you as they are to me.


Pre-conference (training) Twitter threads

Day 1:

Introduction to Gender-Affirming Practice

Pre-puberty/Puberty: Addressing On-coming Puberty

 

Day 2:

Adolescence: Moving Forward With Gender-affirming Care for Youth

Cross Country Health Clinic Practice Panel: Models of Care and Clinical Practices

 

Conference Twitter threads

Day 1:

Plenary: Centering Indigeneity and Decolonizing Gender

Interpersonal Communication Needs of Transgender People

Ethical Guidelines for Research Involving Trans People: Launch of a New Resource

Investigating the Medicalization of Trans Identity

Primary Care Approaches to Caring for Trans Youth

 

Day 2:

Plenary: Fostering Safety and Inclusion in Service Provision, Systems and Sectors

Non-binary Inclusion in Systems of Care

Trans Data Collection and Privacy

Legal, Ethical, Clinical Challenges: Youth Consent to Gender Affirming Medical Care

 

Day 3:

Pregnancy and Birth

Plenary: Supporting Older Trans People