Monopoly and Power Implications for Trans Health Care Specialists Working in a Centralised Setting: A Qualitative Study

Abstract

In the last decade, the range and number of people accessing trans health care has increased at a faster rate than previously. Globally trans health care is commonly used as a requirement for trans people to access legal gender recognition. In Europe, trans health care is often provided within centralised health systems by a limited number of specialist teams placed in monopoly positions. Through a qualitative study, we sought to understand the relationship and role these teams have with legal gender recognition. We conducted in-depth interviews with a team located in Central and Eastern Europe and consulted with local key informants working in trans health advocacy outside the team. After applying qualitative content analysis emerging themes comprised three sections: the team in context; conceptions of trans health care; and beyond the clinic. Findings indicated that the team conceived trans identities and clinical needs in a medical framework that correlated with the process for legal gender recognition. This followed a similar historical progression across Europe. As the few respected specialists in the country, the team influenced care regulations within the ministry and held a monopoly position. While reform of some regulations was seen as needed, they were met with challenges within the health system and field. These challenges were, however, found to reflect trans health care globally rather than the team itself. Our findings suggest comparisons could be drawn to similar positioned teams throughout Europe regarding decision making, power, and influence. Increased transparency and cooperation between local trans communities and health care providers will be vital.