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 (Comisión de Regulacion en Salud, 2012), and
administrative, economic, and bureaucratic barriers to care are common (Abadia & Oviedo, 2009). Our findings
suggest that in Colombia, such barriers lead to body modification procedures
outside the medical system, as has been found elsewhere (e.g. Clements-Nolle et al., 2001; Garofalo et al., 2006; Rotondi et al., 2013; Sanchez et al., 2009; Xavier et al., 2007). 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 (Morgan & Stevens, 2012; Sevelius, 2013),
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 (Sevelius, 2013).
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 (Pitts et al., 2009; Winter & Doussantousse, 2009), 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: http://goo.gl/xUp3bl
By:
Address correspondence to Rodrigo A. Aguayo-Romero, Psychology Department, The George Washington University, 2125 G Street NW, Washington, DC 20052. Email: ude.uwg.liamwg@oyaugar
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