Puberty blockers, or gonadotropin-releasing hormone agonists, were first approved by the U.S. FDA in 1993 for children undergoing puberty too early. For trans adolescents experiencing gender dysphoria, or distress from a mismatch between their gender identity and sex assigned at birth, these medications can be critically important for their well-being. Far from being experimental, the medications have strong evidence for their overall beneficial effects for trans youths.

Christine Jorgensen was the first American to undergo what was then called “sex change” surgery, in Denmark in 1952, making headline news. Doctors in other parts of the world also started to gain clinical expertise in vaginoplasty, sparking global networks of transgender health care. For instance, surgeons in Thailand developed their own techniques in the 1970s for Thai trans women.

Soon, trans people from other countries learned of Thai surgical techniques and began to travel to Thailand for care. With strong government support, Thailand has become a global hub for gender-affirming services. Subsequently, foreign travelers “crowded out” some Thai trans people from quality care as the market shifted to accommodate medical tourists.

For some health travelers, services are more affordable in Thailand than in their home country. Traveling for health services can also provide greater anonymity. For those in the U.K. seeking gender-affirming care, traveling abroad is an alternative to long wait times.

Medical tourism is more dire for those living in countries where trans people face criminalization, such as Brunei, Lebanon and Malawi, or where gender-affirming surgeries are religiously prohibited, such as Saudi Arabia.

Globally, trans people experience issues accessing culturally competent and equitable health care services, both generally and for gender-affirming services. Trans and gender-diverse people experience greater mental distress and everyday violence and discrimination than their cisgender peers.

A 2019 report of nearly 200 health organizations around the world found that 93% do not recognize trans people in their work on gender equality, and 92% do not mention trans health in their programmatic services. Decolonizing global health means including marginalized people in decisions and knowledge production around global health. It also includes and addresses the needs of trans and gender-diverse people worldwide.

Global trans health equity means providing resources to target the root causes of gender-based health disparities. This involves legal gender recognition, government support and anti-discrimination laws. While medical and public health support is necessary for trans women, who are disproportionately affected by HIV worldwide, global trans health equity also means addressing other areas that contribute to this disparity, such as poverty, economic exclusion and workplace discrimination.

For countries with universal health coverage, medical and public health researchers recommend that gender-affirming services be included as essential services. They are not cosmetic, but are necessary for those who want them.

Amid everyday injustices, violence and vulnerabilities are countless forms of trans resilience and resistance, activism, collective care and knowledge sharing. There are even some “bubble[s] of utopia,” or clinics and health care settings where trans people can access services with reduced delay. These alternatives open the possibility for transgender bliss, or liberation from restrictive colonial gender constructs, and transgender joy, or improving one’s quality of life and forming meaningful connections by embracing a marginalized identity.

How can policies, institutions and society cultivate trans bliss and joy worldwide?

All human bodies are “sociocultural artifacts.” How they are expressed and lived in is determined by social contexts and shaped by available resources. Sex and gender are points in a vast “multi-dimensional space” of anatomy, hormones, chromosomes, environment and culture. Global health equity for trans people holds accountable the institutions and decision-makers responsible for the health and safety of all human beings. It is oriented toward the freedom to flourish in a world that celebrates sex and gender diversity as a natural fact of life.

This article is republished from The Conversation, an independent nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Reya Farber, William & Mary. The Conversation has a variety of fascinating free newsletters.

Read more:
Transgender people of color face unique challenges as gender discrimination and racism intersect

Transgender men and nonbinary people are asked to stop testosterone therapy during pregnancy – but the evidence for this guidance is still murky

Reya Farber received funding from a National Science Foundation Graduate Research Fellowship under Grant No. DGE-1247312, Boston University Graduate School, Boston University Sociology Department Morris Funds, and William & Mary Summer Research Grant.