Saturday, February 6, 2016

Gender Affirmation and Body Modification among Transgender Persons in Bogotá, Colombia

This paper examined structural, social, and personal characteristics that shape the processes of gender affirmation and body modification among transgender persons (assigned male at birth) in Bogotá, Colombia. Qualitative data from life-history interviews (N=14) and a focus group (N=11) explored research questions concerning the ways in which the internal psychological and external contextual processes influence individuals' decisions and behaviors concerning hormonal treatment, injections, or surgery. Research questions concerning practices and consequences of treatment performed without medical supervision were addressed through qualitative data, as well as quantitative data from 58 transgender participants. Findings indicated variation in ways participants conceptualized gender (e.g., binary or fluid), but an increased feminine presentation was a strong personal desire expressed by many and often encouraged by romantic partners and transgender friends. Transgender individuals within participants' social networks were frequently instrumental not only in providing information about hormones and contouring injections, but also in carrying out procedures—sometimes with negative consequences. Body modification procedures occurred primarily outside the health care system, due to limited access to or awareness of medical care, societal stigma, social norms within the transgender community, and personal decision-making. Public health approaches to protect the health of transgender persons undergoing body modification were suggested.

…Colombian government policies aimed at increasing health care coverage for the general population have been instituted; however, discrepancies in care remain substantial (), and administrative, economic, and bureaucratic barriers to care are common (). Our findings suggest that in Colombia, such barriers lead to body modification procedures outside the medical system, as has been found elsewhere (e.g. ; ; ; ; ). Only two participants in the life history interviews had received medical feminization treatment, and they had specific characteristics (medical condition or status as internally displaced) that enabled them to receive care.

Personal and social factors shaped the motivation to engage in a body modification. The desire for change was often driven by the emotional distress arising from the discrepancy between sex at birth and self-perceived gender. Consistent with previous research (; ), findings from this study highlight the importance for transgender women in Bogotá of being affirmed in their gender identity by themselves and by others. It has been suggested that in addition to reducing emotional distress, gender affirmation procedures also result in stigma reduction by allowing transgender persons to “pass” in the general population (). However, “passing” may not be the goal for many transgender persons.

Results of this study also indicated that social peers—be their partners or other transgender persons—constituted an important source of encouragement and acceptance. In contrast, stigma associated with gender non-conformity and rejection from family were common social challenges to gender affirmation.

Although transgender peers often encouraged body modification, the consequences of their influence were not always as positive as their intentions. Consistent with previous findings (; ), results suggested that other transgender persons were often misinformed, and therefore they conveyed inaccurate information about hormone use or injections. In addition, they frequently were actively involved in the process of injecting substances in the breasts or buttocks for each other, and their mutual lack of knowledge concerning possible short- and long-term negative effects contributed to increased risk of health complications, as did the use of non-medical-grade fillers. It was also alarming that some participants were unaware of the need for medical supervision of hormone treatment or injections. Thus, in addition to barriers to medical access, lack of knowledge served to increase the potential for health problems…

Full article at:

Address correspondence to Rodrigo A. Aguayo-Romero, Psychology Department, The George Washington University, 2125 G Street NW, Washington, DC 20052. ude.uwg.liamwg@oyaugar

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