‘I Just Need to Get to Know You’: A Foucauldian Genealogy of Health Care Assessments of Trans and Gender Diverse Youth

Despite the importance of transition related health care (TRHC) for many trans and gender diverse (trans) youth, there are many barriers to accessing this care, including assessment protocols that limit youth’s autonomy. This research seeks to interrogate how and why current assessment practices in pediatric TRHC in Ontario have come to be. Drawing on the theories of (trans)normativity and governmentality, the project applied a Foucauldian discourse analysis to analyze interviews with five clinicians currently practicing in TRHC in Ontario. Analysis identified six sources which influenced clinicians’ assessment practices: clinical guidelines, more experienced clinicians, other experience in pediatric care, evolving research and evidence, perspectives of youth and families, and external legal and social pressures. Additionally, analysis interrogated the evolution of mental health assessments from the realm of psychology and psychiatry to an embedded part of clinical care; the oft-repeated intention of clinicians to “get to know” youth; and the conditional decision-making authority, granted to some, but not all, trans youth. Findings discuss how these discourses obscure the ways in which power is enacted within the clinic. Finally, this project explores the implications of these findings for provider training, clinical practice, and theory. This research is put forward in the hope that, in the future, all trans and gender diverse children and youth will have access to the affirming TRHC that they need and deserve.