Este trabalho se compõea partir de levantamento bibliográfico na base de dados do Portal da Biblioteca Virtual de Saúde (BVS), utilizando marcadores específicos sobre a pesquisa em transexualidade. A produção científica será discutida de forma críticano objetivo de explorar de que formas a instituição saúde no corpo teórico reflete suas práticas, sob quais perspectivas tem pensado e descrito o fenômeno da transexualidade, se no campo da doença e das técnicas de intervenção sobre esta, ou se vendo possibilidades de cuidado no campo humano, articulando argumentos do ponto de vista social. Tendo em vista que a genealogia da transexualidade está diretamente ligada à uma instituição clínica, sua instituição como categoria nosológica reflete diretamente na implantação de novos aspectos subjetivos no campo do gênero, e requer constantemente pensar como se dão as estratégias de análise do tema, e se, enquanto categoria clínica, têm se pensado mecanismos de compreensão sensíveis para além do viés patológico. / This work has been written over bibliographic revision over Virtual Health Library Search Portal (VHL) database, trough specifical book markings on transsexuality research. Scientific production will be critically discussed in order to explore which ways health institution in a theorical corpus reflects its practices, under which perspectives it has been thinking e describing the transsexuality phenomenon, if in the field of illness and the interventions over it, or seeing possibilities in human care field, articulating arguments of a social standpoint. Considering that the genealogy of transsexuality is directly linked to a clinical institution, its institution as a nosological category reflects directly on the implementation of new subjective aspects in the field of gender, and constantly it requires thinking about how are the strategies of analysis on this theme, and if, as a clinical category, sensitive mechanisms of comprehension have been thought for beyond the pathological bias.

<p>The aim of this study was to explore transsexuals’ identity formation and experiences related to cross-sex hormone treatment, as well as to become absorbed in the narrative approach. To be able to participate in transsexuals’ identity formation, life stories were well suited as a theoretical approach. Life stories can be seen as socially situated actions according to Mishler, where individuals’ identity formation can be seen as both identity performances and identity claims. These narratives are seen as identity performances, where we construct and perform our identities. The stories are viewed as co-constructed between the respondent and the co-constructors in a relational context, where the interviewers are seen as visible subjects. The results showed that hormone treatment, contributing especially growth of male beard, as an important factor for the respondent in passing as biological male in heterosexual contexts. The respondent’s identity expressions also showed that his identity claims and identity performances as male varied depending on relational and social contexts. The findings in the empirical data also showed that gender roles and gender stereotypes, played an important part in what identity claims and identity performances the respondent chose to portrait.</p>

The aim of this study was to explore transsexuals’ identity formation and experiences related to cross-sex hormone treatment, as well as to become absorbed in the narrative approach. To be able to participate in transsexuals’ identity formation, life stories were well suited as a theoretical approach. Life stories can be seen as socially situated actions according to Mishler, where individuals’ identity formation can be seen as both identity performances and identity claims. These narratives are seen as identity performances, where we construct and perform our identities. The stories are viewed as co-constructed between the respondent and the co-constructors in a relational context, where the interviewers are seen as visible subjects. The results showed that hormone treatment, contributing especially growth of male beard, as an important factor for the respondent in passing as biological male in heterosexual contexts. The respondent’s identity expressions also showed that his identity claims and identity performances as male varied depending on relational and social contexts. The findings in the empirical data also showed that gender roles and gender stereotypes, played an important part in what identity claims and identity performances the respondent chose to portrait.

There is a dearth of research that explores the lives and experiences of trans-identified parents. The goal of this study was to explore the experiences of trans people who sought or accessed AHR services in Ontario between 2007 and 2010. Qualitative data that was collected from 7 qualitative interviews with 9 trans people and their partners was analyzed for the present analysis. Results from this study indicate that AHR providers do not possess sufficient knowledge about trans people, trans identities and trans lives to adequately address the needs of trans service users. Specific provider practices that trans people experienced as being unhelpful are illuminated and implications for improving clinical practices are discussed.

There is a dearth of research that explores the lives and experiences of trans-identified parents. The goal of this study was to explore the experiences of trans people who sought or accessed AHR services in Ontario between 2007 and 2010. Qualitative data that was collected from 7 qualitative interviews with 9 trans people and their partners was analyzed for the present analysis. Results from this study indicate that AHR providers do not possess sufficient knowledge about trans people, trans identities and trans lives to adequately address the needs of trans service users. Specific provider practices that trans people experienced as being unhelpful are illuminated and implications for improving clinical practices are discussed.

Purpose: The purposes of the present study consisted of primary, secondary, and tertiary purposes: 1) to determine what factors that can be addressed in speech therapy are the most important for female-to-male (FtM) transgender individuals in passing as their true gender, 2) to determine what factors may contribute to these individuals seeking speech therapy services and to the importance that they assign to speech therapy as part of the transition process, and 3) to determine awareness of this population in regards to the availability and scope of speech therapy services relative to transitioning or passing as their true gender. Method: A 38-item survey was developed to address these research questions and a link to the online survey was distributed via email to various listservs, organizations, and personal contacts to assist in the electronic distribution of the survey link. The responses of the final participant pool of 63 respondents were evaluated. Results: Overall, the participants ranked voice characteristics as the most important for passing followed by nonverbal communication and social language use. These broad categories rankings are generally supported by the existing literature. Within category rankings revealed rankings that are in accord with the existing literature, others that oppose the existing literature, and others that have not been explored in the literature. The following factors stood out as possibly contributing to how important FtMs find speech therapy as facilitating their ability to live as their true gender: desire to pass, satisfaction with hormone related pitch changes, current overall presentation, and whether speech/language contribute to instances of not passing. Factors that appear to possibly contribute to how likely FtMs are to have sought speech therapy include: satisfaction with hormone related pitch changes, voice prior to transition, and if aspects of speech and language contribute to instances of not passing. Overall, FtMs have little awareness regarding speech therapy as part of the transition process, particularly for FtMs. / text

Working at the intersection of medical sociology and the psychology of health, language and communication, in this PhD I use thematic analysis (TA) and conversation analysis (CA) to provide an insight into various aspects of doctor-patient communication that may be considered, or are constructed as, challenging and/or delicate for either the patient, doctor or both at a Gender Identity Clinic (GIC) in the UK. This project involves the secondary analysis of two existing data-sets: (i) 21 recorded telephone interviews between my PhD supervisor and transsexual patients who attended the GIC; (ii) 156 transcribed audio-recordings and 38 video-recordings (total = 194) of psychiatrist-patient consultations in the GIC. The first original research paper uses TA to investigate the views and experiences of transsexual patients regarding their communication with psychiatrists at the GIC. An important finding was that patients actually appreciated being challenged in this setting, subsequently the implications of this are considered with regards to the achievability and desirability of patient centred communication. The second research paper uses CA to consider how patients overtly challenge psychiatrists in the GIC in ways that have not been shown in conversation analytic research on medical interactions to date. Analysis of the data corpus revealed that there were three common ways in which patients challenged psychiatrists at the GIC, which are (1) by problematising their questions; (2) by disagreeing with statements that are made regarding their treatment; (3) and by initiating complaints. The findings of this study are considered in relation to the implications that they have for clinicians and for the persistence and desirability of asymmetry in clinical interaction in light of the current debates surrounding the concept of patient-centeredness. The final research paper also uses CA, in this instance to study how the topic of weight, which is often constructed and orientated towards as delicate in talk-in-interaction, is occasioned and discussed by psychiatrists and patients at the GIC. Whereas previous CA research on this topic has focused on how this is constructed by speakers as a moral issue, this paper is concerned with focusing on how psychiatrists (1) establish with patients that their weight is an issue, (2) encourage patients to lose weight by informing them that this is their responsibility and (3) offer advice on the behavior changes associated with weight loss. The results of this paper are discussed with regards to the implications that they have for clinicians who discuss the potentially delicate topic of weight with patients in a number of different settings. This project contributes towards the growing debates regarding the achievability and desirability of patient centred communication and the persistence of asymmetry in clinical interaction. It also contributes to medical conversation analytic literature to date on asymmetry and talk about weight in clinical interactions.

Diante das marcadas discussões sobre a diversidade sexual e de gênero no Brasil, as transexualidades têm sido foco de produções científicas e assunto recorrente da mídia. Apesar de ainda ocupar o lugar de abjeto, suas conjugalidades são exemplos de um deslocamento. O objetivo foi compreender quais são os processos que constituem essas conjugalidades transexuais e como esses são vividos nessa relação. Para se aproximar dessas respostas, essa Tese se divide em quatro artigos. No primeiro, disserta-se sobre o conceito de transexualidade em quatro áreas do conhecimento científico: biologia, medicina, psicanálise e ciências sociais. O conceito é explicado a partir de questões relacionadas à anatomia, genética, diferenças cerebrais, teoria fálico-edípica, psicopatologia, ao conceito de sexo como discursivo, de gênero como performatividade e expressão da diversidade em conflito com a heteronorma. No segundo artigo, foram revisados de forma sistemática os artigos que tratassem de demonstrar empiricamente as conjugalidades transexuais. Os aspectos relacionados às conjugalidades foram divididos nas categorias: atividade, excitação e orientação sexual; desafios sexuais dos casais; papeis de gênero e desafios do relacionamento conjugal. Houve um aumento na complexidade da conceptualização dessa diversidade conjugal. No terceiro artigo, o tema foi revisado somente em publicações nacionais e junto das travestilidades. Os resultados dos trabalhos encontrados apontam para um número variado de nomenclaturas dessas parcerias, com uma aparente fusão emocional conjugal que funciona como mantenedor das identidades de gêneros das/os participantes. Entretanto, encontra-se respostas criativas que permitem a quebra do efeito halo entre identidade de gênero e desejo sexual, conduzindo à autonomia identitária e ao prazer. No último artigo foram feitas entrevistas com três casais de homens e mulheres transexuais e seus cônjuges cisgêneros, analisadas a partir dos Estudos de Gênero (Queer e pós-estruturalistas). Os resultados demonstram que as conjugalidades transexuais descritas são mais um território que tenciona e desafia as normas de gênero e possibilita desfechos flexíveis, não direcionadas a nenhum dos extremos da heteronorma. Essa configuração específica pode possibilitar a desestabilização dessa tensão e permitir direções alternativas à lógica binária principalmente nos campos das performatividades sexuais, das divisões de tarefas cotidianas e das relações com as famílias de origem. / In view of the recent discussions about gender and sex diversity in Brazil, transsexualities have been the focus of academic development and a subject in the media. In spite of still being placed as abject, their conjugalities are an example of a displacement. The goal was to comprehend what are the constitutional processes of this transsexual conjugalities and how they are lived within these relationships. In order to come closer of these processes, this Thesis is divided in four articles. In the first one, the transsexuality concept is dissertated in four scientific knowledge areas: biology, medicine, psychoanalyses and social sciences. The concept is explained from issues regarding anatomy, genetics, brain differences, phallic-oedipal theory, psychopathology, sex as a discursive concept, gender as performative and as a diversity expression in opposition with the heteronorm. In the second article, a systematic review was done in relation to the transsexual conjugalities theme based on empirical evidence. Conjugal aspects were divided into the following categories: sexual activity, arousal and orientation; couples’ sexual challenges; gender roles and couples’ relationship challenges. There was an increase in the complexity of the conceptualization of this conjugal diversity. In the third article, the same theme was only revised in Brazilian publications, and the travestilidades theme was added. The results of the papers found show a variety of forms to denominate these partnerships, with an apparent conjugal emotional fusion that works as a maintainer the participants’ gender identities. However, there are creative responses that allow an interruption in the halo effect between gender identity and sexual desire and lead to identity autonomy and to pleasure. In the last article, three interviews were made with transsexual man and women and their cisgender partners. They were analyzed using the Gender Studies (Queer and post-structuralism studies). The results show that the transsexual conjugalities described are another territory that put into tension and defy gender norms and make flexible outcomes possible, not directed to any of the heteronorm extremes. This specific configuration may destabilize this tension and enable alternative directions to the binary logic mainly in the fields of sexual performativities, household tasks sharing and the relationship with family of origins.

Esta pesquisa teve por objetivo compreender como se materializa, no cotidiano, o acesso e o consumo de ações e serviços de saúde para travestis e pessoas transexuais no Sistema Único de Saúde, considerando os programas e as políticas de saúde existentes e os desafios que as travestilidades e transexualidades representam para essas. A partir de uma abordagem etnográfica, e utilizando os conceitos da saúde coletiva e do campo das relações de gênero e sexualidade, articulando-os às questões interseccionais, foram analisados os relatos de travestis e pessoas transexuais em relação ao acesso e à utilização dos serviços de saúde no SUS. Foram analisadas ainda as concepções que embasam a formulação das políticas de saúde direcionadas à população de travestis e transexuais no SUS, bem como as práticas dos/as trabalhadores/as em relação a esse grupo populacional. A partir do estudo, ficou evidente que as trajetórias de travestis e transexuais nos serviços de saúde costumam ser marcadas por situações de preconceito e discriminação, fatos que expressam o elevado grau de transfobia presente nos estabelecimentos de saúde. Além disso, percebeu-se que as ações em saúde destinadas para essa população, contempladas em programas e políticas de saúde – tais como o uso do nome social e a ampliação do Processo Transexualizador – ainda carecem de institucionalidade. Também verificamos que as ações em saúde para esse grupo têm sido priorizadas no âmbito da atenção especializada (nos níveis ambulatorial e hospitalar), sendo poucos os investimentos com relação à atenção básica. Por fim, percebemos que, para a efetivação dos programas e das políticas de saúde – os quais se dão a partir do encontro entre os/as usuários/as e os/as trabalhadores/as – é fundamental investir na formação destes/as últimos/as, para que o acesso às ações em saúde se dê de forma acolhedora e humanizada. / The main goal of this article is to have a better understanding on how the policies of health care are being used and how they have been taking place on a daily basis for transsexual, transgender, and transvestite people considering the existing health care policies and the many challenges that transvestism and/or transsexualism/transgenderism represents to them. From an ethnographic approach, and using concepts from the fields of public health and sex and gender relations, articulating those concepts with intersectional issues, portraits of transvestites and transsexual/transgender people were analyzed regarding their access and use of the services provided by SUS (Sistema Único de Saúde), the Brazilian universal health care system. Also, the conceiving ideas that promote health care policies for transvestites and transsexual/transgender people at SUS were analyzed, as well as the practices adopted by the workers of health care providers towards this population. From this study, it became evident that transvestites and transgender/transsexual people's path in the health care system in Brazil (SUS) is marked by discrimination and prejudice, facts that express the high levels of institutionalized transphobia present in the health care service providers. Moreover, it was noticed that the health care action programs intended for the trans population, promoted by health care policies, such as the use of the social name and the expanding of the transsexual procedures, are still in need of institutionalization. It was also verified that the health action programs for the transvestite/transsexual/transgender population have been prioritized only at the specialized care level (clinic and hospital levels), but few investment has been made at primary care level. At last, it was noticed that the accomplishment of the programs and health care policies happen from the encounter between the users and the providers, being of bottom line importance the last group to have training, so that the access to health care be welcoming and humanized.

Diante das marcadas discussões sobre a diversidade sexual e de gênero no Brasil, as transexualidades têm sido foco de produções científicas e assunto recorrente da mídia. Apesar de ainda ocupar o lugar de abjeto, suas conjugalidades são exemplos de um deslocamento. O objetivo foi compreender quais são os processos que constituem essas conjugalidades transexuais e como esses são vividos nessa relação. Para se aproximar dessas respostas, essa Tese se divide em quatro artigos. No primeiro, disserta-se sobre o conceito de transexualidade em quatro áreas do conhecimento científico: biologia, medicina, psicanálise e ciências sociais. O conceito é explicado a partir de questões relacionadas à anatomia, genética, diferenças cerebrais, teoria fálico-edípica, psicopatologia, ao conceito de sexo como discursivo, de gênero como performatividade e expressão da diversidade em conflito com a heteronorma. No segundo artigo, foram revisados de forma sistemática os artigos que tratassem de demonstrar empiricamente as conjugalidades transexuais. Os aspectos relacionados às conjugalidades foram divididos nas categorias: atividade, excitação e orientação sexual; desafios sexuais dos casais; papeis de gênero e desafios do relacionamento conjugal. Houve um aumento na complexidade da conceptualização dessa diversidade conjugal. No terceiro artigo, o tema foi revisado somente em publicações nacionais e junto das travestilidades. Os resultados dos trabalhos encontrados apontam para um número variado de nomenclaturas dessas parcerias, com uma aparente fusão emocional conjugal que funciona como mantenedor das identidades de gêneros das/os participantes. Entretanto, encontra-se respostas criativas que permitem a quebra do efeito halo entre identidade de gênero e desejo sexual, conduzindo à autonomia identitária e ao prazer. No último artigo foram feitas entrevistas com três casais de homens e mulheres transexuais e seus cônjuges cisgêneros, analisadas a partir dos Estudos de Gênero (Queer e pós-estruturalistas). Os resultados demonstram que as conjugalidades transexuais descritas são mais um território que tenciona e desafia as normas de gênero e possibilita desfechos flexíveis, não direcionadas a nenhum dos extremos da heteronorma. Essa configuração específica pode possibilitar a desestabilização dessa tensão e permitir direções alternativas à lógica binária principalmente nos campos das performatividades sexuais, das divisões de tarefas cotidianas e das relações com as famílias de origem. / In view of the recent discussions about gender and sex diversity in Brazil, transsexualities have been the focus of academic development and a subject in the media. In spite of still being placed as abject, their conjugalities are an example of a displacement. The goal was to comprehend what are the constitutional processes of this transsexual conjugalities and how they are lived within these relationships. In order to come closer of these processes, this Thesis is divided in four articles. In the first one, the transsexuality concept is dissertated in four scientific knowledge areas: biology, medicine, psychoanalyses and social sciences. The concept is explained from issues regarding anatomy, genetics, brain differences, phallic-oedipal theory, psychopathology, sex as a discursive concept, gender as performative and as a diversity expression in opposition with the heteronorm. In the second article, a systematic review was done in relation to the transsexual conjugalities theme based on empirical evidence. Conjugal aspects were divided into the following categories: sexual activity, arousal and orientation; couples’ sexual challenges; gender roles and couples’ relationship challenges. There was an increase in the complexity of the conceptualization of this conjugal diversity. In the third article, the same theme was only revised in Brazilian publications, and the travestilidades theme was added. The results of the papers found show a variety of forms to denominate these partnerships, with an apparent conjugal emotional fusion that works as a maintainer the participants’ gender identities. However, there are creative responses that allow an interruption in the halo effect between gender identity and sexual desire and lead to identity autonomy and to pleasure. In the last article, three interviews were made with transsexual man and women and their cisgender partners. They were analyzed using the Gender Studies (Queer and post-structuralism studies). The results show that the transsexual conjugalities described are another territory that put into tension and defy gender norms and make flexible outcomes possible, not directed to any of the heteronorm extremes. This specific configuration may destabilize this tension and enable alternative directions to the binary logic mainly in the fields of sexual performativities, household tasks sharing and the relationship with family of origins.