Chapter 2: Maintaining Cisnormative Accountability: Medical Providers’ Negotiation of Transgender Healthcare

Transgender people experience significant health and healthcare disparities in comparison to cisgender people. Limited access to quality, trans-competent healthcare in the USA is a central social determinant of these inequities. In this chapter, we expand on the burgeoning literature on accountability structures and transgender healthcare through an analysis of individual interviews with cisgender medical providers about their and their colleagues’ capacity to provide trans-competent healthcare. First, we find that providers report unfamiliarity and uncertainty concerning transgender people, their healthcare needs, and related issues. Although providers regard such ignorance as a structural problem within medical education and practice, the solutions they proffer rely on the benevolence and personal initiative of individual providers to seek out trans-specific information and training. This upholds the boundaries between what is considered “normal” (i.e., cisgender centered) healthcare and trans-competent healthcare. Second, we find that cisgender medical providers who want to provide quality healthcare to transgender people engage in emotion work that prioritizes the comfort and ignorance of their cisgender colleagues and inhibits institutional change. In sum, we argue that, regardless of their intentions, cisgender providers engage in practices that maintain healthcare as a cisnormative accountability structure and, in turn, contribute to the persistence of transgender health and healthcare disparities.