Transgender individuals represent one of the most marginalized and underserved populations in healthcare. Issues such as discrimination, lack of practitioner experience and knowledge, and a deficiency of services have contributed to the healthcare barriers experienced by transgender individuals. There is a lack of literature demonstrating how primary care services are delivered to transgender individuals and a need for research that helps advance our knowledge about the delivery and implementation of primary care services for this population. This thesis explores how primary care services are delivered and implemented from a perspective that acknowledges the complexities of the healthcare needs of the transgender population. A multiple-case study design was used to explore the implementation and delivery of primary care for transgender individuals in Ontario within different delivery models of primary care and through diverse roles of primary care team members. Normalization Process Theory, an implementation theory and conceptual framework, was used in this study to understand and explain the dynamic processes that occur during implementation of interventions in healthcare, and guide data collection and analysis. Three cases representing different models of primary care delivery in Ontario were identified, all of which provide primary care services to transgender individuals. These models included a solo physician Fee-For-Service practice, a Family Health Team and a Community Health Centre. The multiple sources of data collection strategies used were interviews, a survey, documental evidence, and field notes. Participants included multiple members of the primary healthcare team, such as practitioners, clinical support staff and executive directors. This study helps to advance our knowledge of the delivery and implementation of primary care services for transgender individuals. Implications for nursing practice, including highlighting the need for curricula changes and understanding the nursing role, are discussed. / Thesis / Doctor of Philosophy (PhD) / Primary care, such as a family doctor, is where people get day-to-day healthcare. Worldwide, transgender individuals encounter barriers to appropriate healthcare, in particular access to practitioners who understand their health needs. This thesis aims to explore how primary care services are delivered to transgender individuals in Ontario, through a study that examined different ways services are provided, from a family doctor working alone in a clinic to a clinic with a team of practitioners (e.g., family doctors, nurse practitioners, nurses, counsellors). Interviews with practitioners, a survey, and clinic documents showed that primary care for transgender individuals is part of regular primary care services; whether delivered via a rapid access specialty clinic or embedded into regular primary care services, study participants were easily able to integrate primary care for transgender individuals into their routine work. However, evidence also highlighted the need for practitioners to obtain specialized knowledge of transgender needs.

This study considers the case of representation of transgender people and issues on American fictional television from 2004 to 2014, a period which represents a steady surge in transgender television characters relative to what came before, and prefigures a more recent burgeoning of transgender characters since 2014. The study thus positions the period of analysis as an historical period in the changing representation of transgender characters. A discourse analysis is employed that not only assesses the way that transgender characters have been represented, but contextualizes American fictional television depictions of transgender people within the broader sociopolitical landscape in which those depictions have emerged and which they likely inform. Television representations and the social milieu in which they are situated are considered as parallel, mutually informing discourses, including the ways in which those representations have been engaged discursively through reviews, news coverage and, in some cases, blogs. / Media & Communication

Thesis (M.A.)--York University, 2006. Graduate Programme in Interdisciplinary Studies. / Typescript. Includes bibliographical references (leaves 55-60). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR19661

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Black transgender men are exposed to systems of oppression such as racism and cissexism at unique intersections of marginalized racial and gender identities, yet their experiences within such systems are not well understood. In this qualitative study, 10 Black transgender men were interviewed and six major themes were identified: developing an empowered view of self, navigating double consciousness, having a target on your back, strategies of resilience, culture of silence, and finding quality care.

Black transgender men are exposed to systems of oppression such as racism and cissexism at unique intersections of marginalized racial and gender identities, yet their experiences within such systems are not well understood. In this qualitative study, 10 Black transgender men were interviewed and six major themes were identified: developing an empowered view of self, navigating double consciousness, having a target on your back, strategies of resilience, culture of silence, and finding quality care.

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“The only true voyage…would be not to visit strange lands but to possess other eyes, to see the universe through the eyes of another, of a hundred others, to behold the hundred universes that each of them sees, that each of them is…” (Proust, 2003, p. 343). This wonderful quote from Proust seems like a fitting place to begin because I wish to take you on an autoethnographic journey of discovery so that you can see for yourself what it was like for the participants and me as we found ourselves in strange and sometimes frightening territory. We realized that we were, sometimes unexpectedly, in positions of support to our friends or lovers who were uncomfortable with the sex they were assigned at birth. Most of us would describe ourselves as lesbian and, when our partners began to explore the possibility of sex reassignment, struggled with our established identity. My friend Christopher was the inspiration for this exploration. We were domestic partners before and during his early transition from female to male. Both Christopher and I were public figures in the small town in which we lived and our lives were somewhat on display. Christopher founded an organization called Trans Connect to provide support to those who present their gender in alternate ways and to provide education to service providers as well as to schools with regard to transgender issues and is well known in that town as well as in the larger gender diverse community as a trans man. Because of this, he has agreed to waive anonymity. The body of this work includes the entire texts of three papers I have written during the course of my studies as I navigated the path to this research. All of these papers have been published in peer-reviewed journals. I have used these papers to illustrate my autoethnographic journey toward the discovery of diverse gender presentations, to describe the state of knowledge in the discipline of nursing regarding this issue, and to demonstrate how autoethnography works. The centre of the work is the novel I have written based upon the stories the participants and I have shared with one another. The novel is written in everyday language and aims to show, rather than tell, the stories of ten women who love and support trans men. In many parts of the dissertation I have used dialogue, both internal as well as conversation among created characters, as a way to bring to life concepts under discussion. This is in keeping with an autoethnographic style. The dissertation is organized into three parts. Part one is a description of the process and methods I undertook in order to arrive at the novel. It consists of eight chapters that are placed in a more or less linear way, although the process was not at all linear, from the beginning of my exploration, to a discussion of the overall voyage. Part two consists of the novel, which is the story of experiences of women living with trans men during their transition or consideration of transition, disguised as having been experienced by fictional characters. Part three contains four chapters that are the analysis, a description of how I managed the information gathered, a discussion of evaluation for such a work as this, and some consideration as to the distribution and future for the study. My research questions were: • What is it like to be in loving relationship with an FTM during and after some of his transition? • What are the effects on the relationship for the female partner during this time? • What happens to the supportive partner’s ideas of her own identity? • Does the balance of power shift during this transition, and if so, how? The novel poignantly addresses all these questions. To be in a loving relationship with a trans man in the early stages of transition can be very challenging, and for the participants and me, often ended in a breakdown of the relationship. It can be a difficult time for women supporters because their adjustments and struggles with identity and sense of self and community are frequently overshadowed by the enormity, and for some, curiosity of sex reassignment. Often the relationship shifts from egalitarian to one that resembles more of a male-female binary where the male exerts power over his partner. Half of the participants in this study said they would not enter into another relationship with a trans man. That leaves the other half who said they would. The novel might serve as a help to those considering such a relationship as well as to those already walking the sometimes slippery, sometimes exhilarating road of partnership with a trans man. There are no easy answers to these questions. My aim is to reveal a glimpse into the lives of people about whom not much is known. / Graduate / 0569 / merryfeather@shaw.ca

This project is an attempt to present a visual representation of gender variation. Not everyone identifies as either "male" or "female." Likewise not everyone's gender corresponds to their biological sex. Gender variation is a difficult concept to both understand and explain, in part because our vocabulary only offers the binary opposites "male" and "female". Words used to describe someone outside this gender dichotomy are confusing, used inconsistently or derogatory in nature. The project proposes that gender is a continuum and offers a possible visual representation. My hope is that this effort will enable us to better conceptualize the in-between experience as a precursor to developing more meaningful language around this topic. The written document includes a review of literature, an explanation of methods used to create the project, discussion of the results, and a final overview. The actual creative project itself is a short video found on the accompanying DVD. / Department of Telecommunications

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