Taking as its theoretical premise the assumption that the world is 'storied', the thesis aims to understand the narrative processes through which both the medico-psychiatric profession, and 'trans' women make sense of transsexualism. In order to Understand the ways in which stories are told about transsexualism it is important to recognize the ways in which a complex set of power dynamics work in order to hierarchialize story-telling, whereby authority is given to the stories of some, whilst the stories of 'Others' remain silenced.;Drawing upon a range of documentary sources, as well as questionnaires and semi-structured interviews with GPs and 'gender specialists', the initial aim of the thesis is to explore those stories produced within the medico-psychiatric domain, which attempt to make sense of transsexualism and trans becoming, at different historical moments. Imbued with this is an analysis of the extent to which medico-psychiatric discourses inform clinical practice.;As a necessary juxtaposition, the thesis seeks to complement the analysis of those stories produced within medico-psychiatry with an analysis of the stories told by 'trans' women, in order to account for the ways in which transsexualism is subjectively experienced and understood. Here, the aim is to become the ways in which 'trans' women understand and makes sense of their becoming as well as how they position themselves in relation to medico-psychiatric discourses. Moreover, by suggesting that 'trans' women were active agents in the construction of a trans identity from around the turn of the nineteenth century, the thesis suggests new ways of thinking about the relationship between medico-psychiatry and trans-subjectivity. Finally, it is through an analysis of the ways in which 'trans' women negotiate their own becoming, as well as their position within the sex/gender binary, the thesis problematizes the assumption of a grand 'turn to Transgender.

Introduction: gender dysphoria causes much distress and confusion. Some individuals who experience this are known as transgender (trans), an umbrella term describing individuals who identify their gender as different from the sex assigned to them at birth. With the growing prevalence of gender dysphoria in the UK, policy makers and service providers require up-to-date information about the needs of individuals affected by this, especially about trans men as research about their specific needs is sparse. This study aims to develop a better understanding of the transitioning experiences of trans men, individuals who were assigned a female sex at birth but experiences their gender as male in order to support the development of policies and services to meet their specific needs. Method: semi-structured interviews were employed to collect data from eleven trans men and analysed using a constructionist grounded theory approach. Results: the theory generated suggests that that trans men experience the process of transitioning as complex, and that making the decision to change is influenced by a desire to achieve a sense of authenticity as they feel they have been pretending to be someone they are not, trying to fit into the social roles expected of them. Additionally, having the information and knowledge in order to support making such a decision is vital as this enables individuals to discover who they are and that transitioning is possible. Discussion: the theory shares much commonality with pre-existing theories of transgender identity formation and transitioning, and was integrated with these theories to offer a deeper understanding of individuals' experiences. The findings suggest the need for more flexible treatment approaches that take into consideration individual needs. Future research into the experiences of less accessible trans men would be helpful in identifying possible coping strategies and barriers to help-seeking.

This thesis is concerned with the social construction and formation of transgender identities, the impact of gender transition upon intimate relationships and the practices of transgender care networks. The research is linked to the ERSC research group Care, Values and the Future of Welfare (CAVA) and the focus of the project is in line with CAVA's enquiry into contemporary shifts in family, partnering and parenting practices, and the implications of these for future policy. The thesis is based on in-depth qualitiative interviews with thirty trans me and women who were purposely selected to reflect the diversity of transgender identity positions and experiences of gender transition. The overall theoretical concern for the thesis relates to transgender as a site through which to theorise gender identities as lying on a continuum of structure and agency; to signify identity as a fluid and contested concept, but one which also 'matters'. The study is developed from a queer sociological perspective, which is influenced by social theories of identity and engages directly with poststructuralist cultural theory. Additionally the study aims to bring a sociological analytic to the growing field of published literature within transgender studies. The work relates to contemporary sociological studies of identity, the body gender, sexuality, and practices of intimacy and care, and contributes to current debates about embodiment, reflexivity, agency and cultural difference. Located on the intersections of social theory, queer theory and transgender studies, the study represents the first UK empirical sociological study of transgender practices of identity, intimacy and care.

Transgender women, or transwomen, are classified as male at birth but identify as female (Operario, Soma, & Underhill, 2008). They undergo a transition process to change sex and gender, typically involving medical intervention from health services. This thesis comprises a literature review of factors that affect the psychological wellbeing of transgender people, and an empirical paper which is a qualitative research paper investigating transwomen's experience of transitioning in health services in the UK. The first part of the literature review provides background to gender identity disorder. The second part outlines themes identified in the literature as factors that affect transgender people's psychological wellbeing these were; mental health issues, sexual health, transphobia (see Appendix I Glossary of Terms), employment issues and barriers to healthcare access. The empirical paper is a qualitative study that investigates transwomen's experience Of transitioning in the health service. Three superordinate themes were identified; 'Meaning and Description of Transition " 'Journey to and through Transition', and 'Experience of Transitioning in Health Services '. The findings from this research indicate a need for more training and awareness around transgender health issues, and the need to promote 'culturally competent' care by health professionals, particularly General Practitioners (GPs). Evidence of involvement with mental health services and clinical psychology were absent from pa11icipants' narratives, despite description of mental difficulties. Clinical Psychologists have a future role in introducing care that is 'culturally competent' through psychotherapy provision, training and consultation with other professionals, in order to improve transwomen's experience of transition inside and outside of health care service.

Background: Gender Variance (GV) is an experience that the gender assigned at birth is different to one’s preferred gender identity. It includes the possibility of a preferred gender identity being different to either male or female. It is reported that around 4000 people per year access care from the NHS in relation to GV (Gender Identity Research and Education Society (GIRES), 2009) and both the physical and psychological elements of these experiences is well documented. However, little research specifically explores how Gender Variant (GVt) people make sense of their experiences and construct meaningful expression of their preferred identity. The aim of this study is to further the understanding of GV with a view to considering the implications for service provision to this population. Methodology: The study employed a qualitative method that explored the narratives of the participants. A purposive sample of seven participants self identified as GVt was recruited for a single interview. The interviews used a topic guide to elicit the narratives that these people tell about their experiences. All interviews were audio-recorded, transcribed, and analysed using a narrative approach to explore what the participants said and the way they said it. This was then situated within the local and broader social contexts within which the narratives exist. Analysis and findings: The findings are presented through a global impression of each of the individual narratives and then through discussion of the similarities and differences in relation to the collective storylines. Particular attention is paid to the identity construction and the emotional experiences that take place during the interviews. These two elements are told within and through each of the storylines. The local and wider narratives available to the participants are used to contextualise the analysis and findings, and so are reported within the analysis. The analysis offers the following findings: i) their first experiences of understanding GV was important, leading them to find others who felt the same to gain a sense of hope of a normal life ii) sharing their experiences with others was an anxiety provoking time and was part of a decision making process about treatment and establishing an acceptable gender expression iii) relationships with family, friends, peers and members of their social context influence sense making and identity constructions of GVt people and typify the challenges faced within their GVt experiences. Some of these challenges were reported as ongoing and illustrated throughout the stories of the day to day lives of the participants iv) for these participants distressing emotional challenges were often situated in the past and participants spoke of ‘overcoming’ challenges. This offered a counter to the more dominant isolation and loneliness narratives within the literature on GVt experiences The findings of the study are discussed in relation to its clinical implications, the strengths and limitations of the methodology, and directions for future research.

National Health Service (NHS) statistics show that 4000 people in the United Kingdom are receiving help for gender concerns (DH, 2008). Research has highlighted the importance of romantic relationships during early adulthood and an association with mental health (Fincham and Cui, 2011). The experience of romantic relationships among transgender people in ‘emerging adulthood’ (Arnett, 2000, 2006) is an under-researched area. The decision making process concerning, and construal of, romantic relationships among this group have yet to be investigated using Personal Construct Theory (PCT). This study uses qualitative and quantitative methods of inquiry from PCT to investigate the experiences of transgender people encountering romantic relationships. Overarching themes emerging from the participants in this study were of identity validation through romantic relationships, having a bi-gendered lens of the world, facilitating greater understanding in society, and learning from past relationships. Participants’ experiences are analysed individually, as well as as a group. Clinical significance of this, limitations and future research are also discussed.

Le parcours de soins des personnes transsexuelles relève d’une prise en charge multidisciplinaire comportant des aspects médicaux, sociaux et juridiques. Ces trois pôles agissent en interaction et en complémentarité.En France, le protocole établi par la Sécurité sociale en 1989 impose un suivi psychiatrique des personnes d’au moins deux ans avant qu’elles puissent prétendre à une prise en charge de l’opération de réassignation sexuelle ; ceci dans le but, entre autres, d’évaluer la qualité de leur demande. Ces consultations sont souvent décriées par les personnes transsexuelles qui les trouvent stigmatisantes parce qu’elles associent ouvertement leur trouble à la maladie psychiatrique. Les personnes transsexuelles considèrent que le suivi psychiatrique imposé est une atteinte à leur dignité dans le sens où leur parole se trouve remise en question par des questionnaires et des évaluations, établis par un personnel médical qui ne peut ressentir ce qu’elles vivent. Actuellement, beaucoup de personnes transsexuelles ne suivent pas ce protocole médical recommandé par la Haute autorité de santé (HAS), qu’elles estiment trop rigide et éloigné de leurs besoins ; elles organisent elles-mêmes leur parcours ayant parfois recours à des actes chirurgicaux pratiqués à l’étranger. Pour finir, ce parcours de soins serait incomplet s’il n’était validé par une modification de l’état civil ; ainsi le parcours médical de transformation de la personne se trouve lié à un parcours juridique garant de l’intimité et des droits de la personne.Les origines psychologiques, psychiatriques, biologiques ou génétiques du transsexualisme sont encore discutées, sans qu’actuellement aucune réponse ne puisse être donnée de façon reproductible et fiable ; seules des interrogations sont posées. Dans ce contexte d’incertitudes, les paroles que nous avons recueillies font apparaître une réalité du terrain où la personne est, par la force des choses, au centre de l’acte de soins et heurte la conception scientifique de la médecine par ses choix et ses attitudes. Ces différents parcours de vie nous ont montré combien le respect de la personne dans sa différence, non quantifiable et inclassable, était important. Le respect de l’expertise acquise de la part du patient, le respect de sa vérité, de sa décision et de ses choix, sont des revendications qui sont apparues régulièrement. Par ailleurs, au-delà de l’aide médicale demandée, le besoin d’aide psychologique, de soutien moral et financier dessine le profil de personnes vulnérables qu’il convient de soigner et dont il convient de prendre soin. Toutefois il ne faut pas oublier la violence des actes demandés, les interrogations qu’ils suscitent chez les patients et les praticiens concernés. La décision d’entreprendre tous les traitements médicaux et chirurgicaux nécessaires au bien-être de la personne, si elle est présentée comme une décision personnelle, entraîne dans sa dynamique de nombreux acteurs. Certains choisissent d’adhérer à cette transformation, d’autres se trouvent parfois contraints de l’accepter / The care of transsexual patients calls for a multidisciplinary approach, involving medical, social and legal areas of expertise. These three areas both interact with and complement each other.The French national healthcare system drafted its standards of care in 1989, which require at least two years of psychiatric evaluation before the patient can request that their sex reassignment surgery be paid for by the health system. The purpose of this follow up is to evaluate, among other things, the merits of their request. These consultations are often criticized as stigmatizing by transsexuals, given the overt link these evaluations imply between their condition and mental illness. Transsexuals think that the mandatory psychiatric follow up is an attack on their dignity because their word is put into question by tests and evaluations performed by medical personnel who have no empathy for what they are going through. Currently, many transsexuals do not follow these standards of care, even if recommended by the HAS (Haute Autorité de Santé – the official French health standards organization), as they are considered both too rigid and too disconnected from their real needs. Therefore, transsexuals organize heir own healthcare process and sometimes have their surgery performed abroad. Last but not least, the healthcare process would be incomplete without it ending with the change in their legal identity. The medical transformation is linked in this way to a legal process, which is necessary to guarantee the individual’s privacy and personal rights.Psychological, psychiatric, biological and genetic origins of transsexualism are still subject to debate, and there are no reliable or reproducible answers, only question marks. In this uncertain context, the testimony we have gathered underline the reality of life where the person is inevitably both at the center of a series of medical treatments and a challenge to the scientific conception of medicine, both in their choices and their attitudes.These different life stories, demonstrate how important respect for the difference, unquantifiable and unclassifiable, of these people is. Respect for the expertise that the patient has acquired, respect for his or her sincerity, choices and his decisions are requests that have arisen regularly. Moreover, beyond the medical treatments that are requested, the need for psychological, moral and financial support is part of the profile of that can be drawn of a vulnerable population that needs to receive care and be cared for. We must not forget the “violence” of the procedures that are requested, as well as the questions raised by patients and practitioners. The decision to undergo medical and surgical procedures is necessary to the well being of the person. Even if this decision is presented as a personal choice, many other people are inevitably involved. Some choose to freely embrace this transformation, while others sometimes feel forced to accept it.

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