Transgender Rights to Health Care 

A couple of years ago I was invited to talk with a group of male to female transsexuals (MTF) at a Latino organization in New York City. The vast majority of them—who had female presentations, surgical reconstructions (to varying degrees), and ascribed femininity—identified themselves as “gay.” Even though the group met under a “transgender” identity category, when asked who was gay in the room, they replied, “We are!” They described the three nontranssexual men there—myself and two of my colleagues—not as gay, but as punkas, a feminine form of punks in Spanglish. Using the word punkas enabled them to distinguish themselves from men who, like them, desired men but, unlike them, did not cross dress or see themselves as women. (Some social scientists have written about this in the sexualities literature.) Their other remarks indicated that punkas described men who have sex with other punkas, rather than with presumably heterosexual men. From the perspective of the members of this group, gay and transgender seemed to have similar meanings.

Recent developments within social service provision employ common terms to identify sexual minorities: gay/lesbian describes those attracted to people of their own sex; transgender describes those whose gender identity contradicts their biological sex. (Bisexuality continues to challenge, at times, the very premise of these terms, but because of space, I won’t discuss it in this article.) Many communities are not attuned to this type of distinction, however. Transgender people identify in different ways, some of which can be attributed to their racial and socioeconomic backgrounds. Thus, social service provision assumptions about gender and sexuality for “trans” people need to be examined.

Transgender, as a category, offers possibilities in breaking from the notion of two sexes or two genders. Yet the participants in this group identified as gay, a word that is often divorced from the realm of transgenderism and transsexuality. The end result is that neither Harry Benjamin’s standards of transsexual care (an international set of suggested guidelines for a healthy physical, social, and emotional transition) nor the break from gender categories in recent transgender organizing are suited to the group’s gay identification. Social service provision follows a community based model that often privileges assumptions about class, race, and socioeconomics, and it asserts such privilege by naming this identity transgender. Providers, though, must also be aware of and adjust to the self-identification of the patients or service seekers in order to better reach to them. A reexamination of naturalized terms—gay as a type of sexual orientation and transgender as one gender identity—is needed.

This does not mean that people of color, the poor, or those less educated never use transgender as a category of self-identification. This does mean, however, that the ideas and language of diverse groups could move us away from traditional pathological categories of identity (for example, the use of “true transsexual” as a diagnostic category) to broader service provision that reconsiders the experiences—not merely the identification—of those service seekers.

Activists and scholars, in general, must look beyond educating people on so-called proper categories of identity. At the organization where I led this discussion, participants used terms that destabilize sexual orientation and gender identity as defined by grassroots activists and social scientists. It would have been unfair for me to “colonize” their space by imposing a different language, a different set of categories. I didn’t assume the participants had adopted a false consciousness, or a pretranssexual identity. Instead, I began to see how certain positions of social scientists and social service providers are inherently superior to that of the clients, as I felt tempted to “educate” them about their identities, using traditional social sciences’ distinctions between sexual orientation and gender identity. It would be a daunting task for social scientists and social service providers—who often assume their role is to educate the disadvantaged—to adjust to, and claim, diverse terms. This requires a shift in service provision. It also requires an examination of who, in clinical, activist, social service, and academic circles, has the power to give names to certain experiences.

This critique extends to the use of identity politics, where people are often forced to adhere to a particular set of identities in order to access services. As international organizing increasingly takes place along the lines of sexual orientation and gender identity, and as more funding and services are offered from this perspective, especially from “developed” countries, categories of identity are often forced onto populations elsewhere. People take on these forced identities in many different spheres—from immigrants seeking political asylum in the United States for fear of being hurt or killed because of their sexual orientation/gender identity, to people who access health services at a local gay/lesbian clinic.

The use of the term “gay” by the group I spoke with—and their use of the word punkas, to describe non-transsexual men at the meeting—offers an alternative way of thinking about the relationship between sex, gender, and sexuality, which could potentially push the boundaries of service provision beyond top down approaches. A critical analysis of identity categories will continue to call for a broader understanding of sexual minorities that focuses less on neatly contained identities and more on experiences in relation to service provision and community building.

Salvador Vidal-Ortiz is assistant professor of sociology at American University in Washington, D.C. His grassroots based experience includes HIV/AIDS prevention and services research, Latino queer organizing, progressive philanthropy, and program and organizational development. His academic interests include U.S. race and ethnic studies, Puerto Rican/Latino studies, and studies on the relationship between racialization and sexuality discourses. He is currently working on a book about sexual minorities and the practice of Santería in the United States.