In Transition: Politics of Transgender Healthcare in China

Global health initiatives often generate unintended consequences for local societies. How do local healthcare systems absorb and reshape global health norms? My dissertation examines gender- affirming care—healthcare services institutionalized by international standards to support individuals' gender identity—and the efforts to integrate these services into Chinese medical institutions. Drawing from content analysis, interviews, and two years of multi-sited ethnography across five Chinese cities, I explore the social and political conditions shaping healthcare delivery and experiences for transgender people. I argue that gender-affirming care has been reconfigured into a normalization project to enable productive citizens for the state, medical institutions, and families. While expanding the scope of care, it also introduces new forms of health inequalities. I illustrate that activism to promote gender-affirming care in China has successfully expanded medical procedures and influenced state policies by inserting the care model into the state' s biopolitical gender regime. However, to legitimize gender- affirming care to resistant medical organizations, skeptical colleagues, and unsupportive parents, activists and clinicians gatekeep care based on transgender people's perceived ability to reintegrate into normative social orders. In doing so, they assign new meanings to gender-affirming care as a therapeutic model that helps transgender people secure familial support and maintain economic productivity. However, these practices force some transgender individuals to rely on a formal and informal hybrid healthcare system, resulting in inequalities stratified by family background, location, class, gender, and community networks. Based on these findings, I highlight that adapting global health guidelines locally can create new exclusions and inequalities. My work thus extends the literature on global health by showing how transnational and local processes reproduce barriers to healthcare for socially marginalized communities.