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Two Steps Forward, One Step Back: A Policy Analysis of the Swedish Guidelines for Trans-Specific Healthcare

Journal article
Authors I. Linander
M. Lauri
Erika Alm
I. Goicolea
Published in Sexuality Research and Social Policy
Pages 12
ISSN 1868-9884
Publication year 2020
Published at Department of Cultural Sciences
Pages 12
Language en
Keywords Transgender, Gender dysphoria, Access to care, Sex reassignment, Mental, health, Policy analysis, mental-health, transgender, gender, standards, Social Sciences - Other Topics
Subject categories Psychology, Law


Introduction Sweden has one of the world's longest histories of providing subsidized gender-confirming medical procedures for people with trans experiences. However, until 2015, Swedish trans-specific healthcare lacked formal guidelines. Methods In this study, we analyse the Swedish guidelines for trans-specific healthcare from 2015 using Bacchi's approach: "What's the problem represented to be?" Following this approach, we analyse problem representations in the guidelines with special focus on evaluation, diagnosis of gender dysphoria and criteria for access to care. Results Three problem representations were identified in our analysis: "the problem of (non)linear gender", "the mental health paradox" and "gender dysphoria as a psychiatric, psychological and psychosocial problem". Together, these problem representations construct gender dysphoria as a psychopathology and allocate the decision-making power to mental health care providers. Hence, the guidelines reconstruct the gatekeeping function among care providers while undermining care seekers' ability to attain self-determination. While the guidelines do allow for non-linear embodiment, they simultaneously reconstruct a linear relationship between gender identity and social gender role. Mental healthiness and, for migrants, having a residence permit seem to be favoured in the evaluation of gender dysphoria and for access to gender-confirming medical procedures, while aspects of gender euphoria are silenced. Conclusions We conclude that the guidelines resemble, and have similar effects to, the psychomedical understandings of gender dysphoria prevalent in medical research and practice. At the same time, the guidelines attempt to depathologize trans experiences and open up space for new subjectivities to be eligible for access to gender-confirming medical procedures. Policy Implication The knowledge from this study can be useful when constructing, revising or analysing guidelines for trans-specific healthcare in several contexts.

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