Dissertation Title: In Transition: Politics of Transgender Healthcare in China

Committee: Kristen Schilt (chair), Kimberly Hoang, Zhiying Ma (Social Work), Tara Gonsalves (Columbia), Yan Long (Berkeley)

Global health initiatives often generate unintended consequences for local societies. But how do local healthcare systems absorb and remake global health initiatives? My dissertation examines gender-affirming care—healthcare services institutionalized by international standards to support individuals’ gender identity—and the efforts to integrate these services into Chinese medical institutions. Drawing from two years of multi-sited ethnography and 125 interviews, I explore the social and political conditions shaping healthcare delivery and experiences for transgender people. I found that the activism to promote gender-affirming care in China has successfully expanded medical procedures and influenced state policies. However, to legitimize gender-affirming care in China, clinicians gatekeep care based on transgender people’s perceived ability to reintegrate into normative social orders, particularly by securing familial support and maintaining economic productivity. This gatekeeping forces transgender individuals to rely on a mix of formal and informal healthcare services, resulting in health inequalities related to gender, social class, and community networks. Based on these findings, I argue that adapting global health guidelines locally can create new exclusions and inequalities. My work thus extends the literature on global health by showing how transnational and local processes reproduce barriers to healthcare for socially marginalized communities.