A Trans Clinic: De-institutionalized Networks of Care

Abstract

Access to gender-affirming medical care remains contested across the settler-colonial states of Canada and the United States. Carceral and medicalized institutions have regulated gender nonconformity through shifting categorizations of deviance: immorality, crime, disease, and disorder. These legacies shape the medicalization of transness in the contemporary system, through which medical practices often adhere to (cis)normative narratives. Alongside legislation restricting and prohibiting access to gender-affirming medical care, the mainstream healthcare system remains inadequate in addressing the medical needs for trans individuals seeking care. These practices are reflected and reproduced within the design of the conventional western medical institution. This thesis proposes design as a potential strategy for providing low-barrier access to gender-affirming care outside of the cisheteronormative gaze. This call contains three parts: it advocates for a network of gender-affirming healthcare spaces distinct from the institution; it requires the deconstruction of the spatial mechanisms which regulate gender nonconformity; and it supports a model of medical practice which centers gender self-determination. Through literature review and historical analysis, this research traces the shifting category of gender nonconformity in carceral and medicalized institutions as well as the contemporary medical, legislative, and spatial barriers faced by people accessing gender-affirming medical care. In contrast, it pieces together models for demedicalizing transness, strategies for collective and horizontal care practices, case studies of grassroots alternative networks of care, and theories of trans architecture. Using a design-as-research approach, I propose a network of gender-affirming care untethered from the institution and which centers access to resources, knowledge-sharing, horizontal care, and self-determination. Through approaching this research first as an examination of regulation in the institution and second as a proposal which unbuilds its spatial vestiges, this thesis offers a speculation on alternative spaces for gender-affirming care outside of the medical institution.