Dr Cal Horton

Trans scholarship and trans perspectives have historically been marginalised from mainstream academia. There is value in ongoing theoretical exchange between sociology and the evolving post-discipline of applied trans studies. This article introduces three prominent theories within applied trans studies, namely cisnormativity, pathologisation and gender minority stress, considering the strengths and limitations of these theories. The author then highlights the need for a greater theoretical focus on cis power, drawing from scholarship on white supremacy to articulate and introduce a theory of cis-supremacy. Within the UK cis-supremacy manifests in experiences of control and coercion; problematisation; toleration of trans harm; and cis institutional dominance. A theory of cis-supremacy calls attention to the forces and systems that actively oppress trans people, perpetuating systemic and sustained injustices. Recognition of cis-supremacy is important for understanding intersectional inequality, and a vital component of any movement for trans liberation.

Abstract

Background

Since 2016 trans people in the UK, and particularly trans children, have experienced a sustained and escalating campaign to roll back trans freedoms, rights and access to healthcare. A series of legislative, politicized and media-driven campaigns have resulted in the year-by-year worsening of access to affirmative healthcare for trans children in the UK.

Aim

This study examines publications from the NHS-commissioned ‘Cass Review’ into children’s gender services, seeking to better understand what is happening in trans children’s healthcare in the UK.

Methods

Inductive and deductive reflexive thematic analysis was applied to a collection of Cass Review publications related to trans children’s healthcare published between January 2020 and May 2023.

Results

Four concerns are presented and explored: (1) prejudice; (2) cisnormative bias; (3) pathologization; and (4) inconsistent standards of evidence. Each of these concerns impacts the Cass Review’s approach to trans children’s healthcare, with negative repercussions for trans children’s healthcare rights and well-being.

Discussion

The Cass Review itself can be understood as an example of cis-supremacy, within a cis-dominant healthcare system lacking accountability to trans communities. These findings draw attention to systemic barriers to effective healthcare policy, with relevance for trans healthcare across and beyond the UK.

Background

Trans healthcare has traditionally been dominated by the perspectives of cis clinicians, with trans and service user voices side-lined. The voices and perspectives of trans children are rarely centered in clinical literature, with potential consequences for the design, delivery and evaluation of pediatric trans healthcare services.

Aim

This article examines literature on the association between social transition and mental health in trans children, exploring the inclusion or exclusion of child reported data.

Methods

Modern research studies on the relationship between social transition and well-being in trans children are examined, investigating what data sources underpin each analysis. A recent clinician authored article on the relationship between social transition and mental health is then reviewed in greater depth. This article is evaluated, drawing attention to data limitations and reflecting on the implications of the study’s approach to data.

Results

Data limitations related to social transition are identified, exploring the omission of trans child perspectives on 1) social transition 2) name change and 3) ease of social transition. Mental health data limitations are reviewed considering 4) the combination of research with clinical assessments. Additional limitations relate to the absence of 5) child or family perspectives on mental health 6) data on euphoria and 7) data on gender minority stress.

Discussion

The reviewed article’s approach to data is critiqued, highlighting the limitations of a reliance on clinician reported measures and the consequences of the exclusion of child reported measures. The article calls for greater prioritization of child and service user perspectives in healthcare research.