Paradigm and power shifts in the gender clinic

Trans ¹ people seek access to surgical, hormonal and psychotherapeutic treatments, but seek to avoid pathologisation and stigmatisation – this is a defining characteristic, perhaps the central dilemma, of their relationship with clinicians. This tension underlies contention around different approaches to clinical practice and gender variance. In medicine generally, relationships between clinicians and their clients have changed dramatically over the last 50 years in Western societies, as have sociological conceptions of those relationships. In the 1950s, the dominant model was Parsons’ ‘sick role’ – the patient passively accepting medical authority. Now the emphasis is on autonomous clients or ‘consumers’ who actively organise their health, and the medical clinician is only one source of information, albeit with regulated powers to prescribe medical interventions (Rogers and Pilgrim 2005).