Langara Open Student Scholar Prize 2020
First Place Winner

Gender and Healthcare – Annotated Bibliography
Kaylee Korol
Class Submitted For: WMST 2270 – Manisha Singh
Open Education Statement:
Between my classes on globalization and women’s studies, I’ve been learning so much about power,
hegemony, and exploitation. It’s honestly been hard to keep positive mental health during these studies.
However, there is also beauty in all the perspectives that we learn about in our classes. We’ve learned
about indigenous culture which has educated us on gender, family, social organization, and new ways of
understanding our connectedness to the world. We’ve learned about the power women have through
their unique perspective and experience fighting for their rights. And in my project, I show how the
perspective of transgender people is key for providing effective medical care which we are currently
denied exactly because there are so few of us in academia. The list goes on and open education is about
giving all these beautiful perspectives a voice to learn and solve the problems we all face together with
unique understandings that others might overlook. Through open education, we can collaborate
between cultures and undo the wrongs of history and colonialism through the sharing of knowledge and
opening of access to those who have been disempowered by it. Education is our front line against
inequality but if education is limited to those who already share hegemonic perspectives we lose the
perspectives of those who need a voice the most. Getting an education doesn’t help just oneself but all
those around you and the more perspective we have the better we can tackle new problems that arise.
With global warming looming the knowledge and perspectives of the indigenous people who know the
lands and have a culture of reciprocity with nature will be vital. That we’ve not only lost but suppressed
so many voices only does us all a disservice when we could do so much together. The perspectives that
can be given a voice through open education can bring us all a brighter and happier future.

Annotated Bibliography
Gender and Healthcare
Kaylee Korol
Feb 13th 2020
WMST 2270

Academic sources:
Van Meter, Q. L. (2019). Bringing Transparency to the Treatment of Transgender Persons.
Issues in Law & Medicine,​ ​34(​ 2), 147–152.
This article discusses the two common pathways for treatment for transgender people. It lays
out the two common practices. The first takes a wait and see approach where the goal is to treat
“undercurrent depression, anxiety or dissociative thought.” rather than treating dysphoria directly
in hopes that the patient will come to accept their biological gender (Van Meter, 2019). The
second approach is to try and ameliorate dysphoria through GAT (Gender affirming therapy).
The patient goes through a psychological evaluation and provided they have nothing impeding
their judgment can begin puberty blockers, hormones, and eventually GCS (Gender confirming
surgery). Van Meter through his research finds that the first approach is safer and “is actually
affirmation of the patient’s biological sex” (Van Meter, 2019). He finds that on top of these
benefits the second approach is more dangerous and only has temporary effects that lasts
about 10 years (Van Meter, 2019). Despite the evidence he produces he finds a concerning
disregard of the first approach in the healthcare community and especially WAPTH (World
Professional Association of Transgender Health) who is a firm proponent of the second
approach. He finds these large organizations are dismissive and marginalize those who express
their concerns about the second method and suggests that GAT should be reduced until proper
discussion has taken place and a proper evaluation of the benefits of the wait and see
approach.
This source is important to our research because it highlights how disgustingly ​TRANSPHOBIC
peer-reviewed academic papers can be even so recently as fall 2019. This article exemplifies
the lived experiences of disrespect that trans and GNC people report in the following sources. In
particular the misgendering of transgender patients is blatant and seen as a good thing. Further
more Van Meter goes out of his way to use outdated terms that are harmful to transgender
people and takes the time to carefully go through this history. I could understand how this might
get through the multiple peer reviews as they are not necessarily academic errors however
Meter’s 10th source ​Sex Reassignment Surgery for the Treatment of Gender Dysphoria ​which
doesn’t state an author, was funded by a private company, and was not properly peer reviewed
as far as I can tell. This paper states in it’s abstract that it is researching the effects of GCS
specifically. Meter finds in this article that GCS can have diminishing effects after 10 years but
words his paper so that he implies all forms of gender confirmation following the second
approach are ineffective (Medical Technology Directory, 2018). Meter also attempts to
undermine Alfred C. Kinsey by introducing him as an insect biologist first and a sex researcher
second as if Kinsey is not qualified to speak about gender because of his initial focus on insects

when he has a “doctor of science degree” in the department of applied biology (Brown and Fee,
2003). This source is a prime example of how transgender and GNC perspectives are left out of
academic consideration and academic peer review systems. This article passed multiple peer
reviews including; “Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board
Reviewed; Expert Peer Reviewed; Peer Reviewed”. This gap highlights exactly how
transgender and GNC communities are marginalized by academia which directly effects our
lived experiences with healthcare. Lastly, this was the first source when searching “gender and
health care” (sorted by relevance) showing how irresponsible academic writing can popularized
in a way that directly negatively impacts the lives of transgender and GNC patients (EBSCO).

Vermeir, E., Jackson, L. A., & Marshall, E. G. (2017). Barriers to primary and emergency
healthcare for trans adults. ​Culture, Health & Sexuality,​ ​20(​ 2), 232–246. doi:
10.1080/13691058.2017.1338757

This source, on the other hand, shows proper research and understands the importance of
hearing transgender and Gender non-conforming experiences. Instead of writing an opinion
piece supported by misrepresenting sources, ​ ​relies on their own research into the area of lived
experiences in regards to transgender health care. This paper looks specifically at the
discrimination of transgender and GNC people in the Nova Scotia healthcare system. They
gather qualitative data from eight participants using a convenience sampling strategy (Vermeir &
Marshall, 2017). They interviewed each participant in a one on one interview and found four
common reported sources of barriers to treatment. First, participants felt that their healthcare
professionals were not properly educated on transgender issues. Second, participants
experienced disrespectful attitudes from healthcare staff. Third participants reported physical
barriers including lack of gender-neutral washrooms and access to healthcare confidentiality in
rural areas. Fourth participants reported feelings that healthcare as a practice neglects to
properly understand them and often holds untrue beliefs about transgender issues (I wonder
why… VAN METER!?!)(Vermeir & Marshall, 2017).
This study is a great source for our project as they do a great job of listening to the lived
experiences of transgender and GNC people. It describes common key barriers that
transgender people face in the healthcare system making it a strong base to build off of for our
project. It also serves as a good source as it is based in Canada and so can speak more closely
to the experience within the Canadian healthcare system. Often pride is taken in the current
healthcare system when compared to the United States but this study does a good job of
showing that there are issues with discrimination here as well. Thanks to the qualitative data it
also gives us real stories that we can bring into our project to make it more connected to the
lived experiences and provide empathetic stories to our readers and audience. There are
however some limitations to this source such as convenience sampling not being ideal, and only
having eight participants means that they weren’t able to get a wide range of participants and in

particular the experiences of racial diversity. This is where the next source will be able to shine
more of a light on a wider range of experiences.

Goldberg, A. E., Kuvalanka, K. A., Budge, S. L., Benz, M. B., & Smith, J. Z. (2019). Health
Care Experiences of Transgender Binary and Nonbinary University Students. ​The
Counseling Psychologist​, ​47​(1), 59–97. doi: 10.1177/0011000019827568
This study expands upon it’s prodecessor by gathering both qualitative and quantitative
feedback from 509 participants among transgender and GNC university students in the United
States (Goldberg, Kuvalanka, Budge, Benz & Smith, 2019). Another key aspect of this study is
that it distinguishes between mental health care and physical health care which allows for a
more holistic understanding of participants’ experiences when combined with the previous
source. They found that 84.5% of participants struggled with mental health and over 50% had a
mental health diagnosis (Goldberg et al, 2019). They are careful here to distinguish that many
participants did not attribute their struggles with mental health to their gender identity. However
others and in particular those with depression, anxiety, and eating disorders tended to feel a
connection between their mental health struggles and gender identity (Goldberg et al, 2019).
One-quarter of respondents explicitly stated they struggled with mental health surrounding
society’s response to their identity and the threat of potential violence (Goldberg et al, 2019).
This is a fascinating finding for our project as it shows how healthcare for patients is not limited
to professionals but also improving societies views of patients as a whole. The study further
goes on to explore more qualitative data on participant experiences working with mental health
providers.
Altogether this source expands on previous research and importantly brings a focus on mental
healthcare which is very much tied to our exploration of transgender health. Through a larger
sample and a mix of qualitative and quantitative data, they provide a wealth of information on
the struggles around health care for transgender and GNC university students that we can bring
into our project both as stories of participants lived experiences. Furthermore reliable
quantitative data provides us with data to show just how widespread these issues are.

Book:
Plath, S. (2006). ​The Bell Jar.​ New York, NY: HarperCollins.
This somber book while fictional is based around themes from Sylvia Plath’s own life dealing
with mental health (Plath, 2006). It recounts the story of a girl Esther who seems to be living a

life of luxury while on a scholarship that provides an escape from her working-class roots.
Slowly life seems to untangle for Esther as she starts to become disenchanted with the world
around her and begins to feel suffocated and isolated from the world which she describes as
being under a bell jar. Becoming more depressed when she returns home she attempts suicide
and is found barely alive days later. Her mother sends her to various mental asylums for
common treatments at the time including shock therapy. She tells the story of how some
practices made her feel worse, while others helped her improve over time (Plath, 2006).
Eventually her mental health does improve as she moves to a kinder mental ward thanks to an
investor who loved her writing, and begins to make tentative friends. While she improves and
returns to society the looming threat of the bell jar falling upon her forever remains (Plath, 2006).
The Bell Jar is a beautiful exploration of mental health and in particular depression. Esther's tale
shows how mental health affects daily life and importantly from the perspective of a woman
diagnosed with hysteria which is an important piece of history in Western mental healthcare.
Her experiences with mental hospitals and practices like shock therapy provide an important
understanding of the history that healthcare must confront and defeat as it realizes the harms it
has caused. Furthermore, The Bell Jar shows us how treatment within the mental healthcare
system takes a very prescriptive approach assuming that it knows what’s best for a patient
leading to forcing harmful, or counterproductive treatments, practices, and establishments upon
patients. This book is even more powerful due to the parallel to the lived life of Sylvia Plath and
her struggle with mental health (Plath, 2006). This book provides vivid and powerful experiences
of the mental healthcare system that we can use in our project to make it more empathetic. It
also provides us a glimpse into the history of how women were treated when dealing with
mental illness as well as the social implications. Last but not least it provides beautiful
metaphors and expressions of mental health that can make these issues more relatable to
readers.

Documentary:
No woman, No cry​. (2010).
No woman, no cry is a documentary focusing on maternal healthcare in developing countries.
They look at stories of women who are struggling to access proper healthcare required for a
safe pregnancy and birth. They discover that the death rate for mothers is extremely high and
99% of these cases are from developing nations. Using WHO’s numbers they gather that nearly
all of these deaths are preventable and set out to bring change in these countries. While on their
mission to provide this much needed healthcare, mothers have an opportunity to tell their
experiences with healthcare in developing nations as well as the positive and negative effects of
global aid.

This source brings a beautiful intersectional perspective to our project by focusing on
developing nations and thus concerns itself with many issues that my other sources don’t focus
on such as race, nationality, and class. Bringing these topics together is really powerful as it
shows how healthcare is entwined with colonialism which is responsible for their poor
healthcare and continues to perpetuate their situation. While this provides a macro view of
issues from a global perspective it stays rooted in the lived experience of women in these
countries and their stories.

Website:
Improving gender-affirming care across BC. (n.d.). Retrieved from
http://www.phsa.ca/transcarebc/

Transcare BC is a resource hub for all transgender care in British Colombia. It provides
information on a variety of topics that are important to those seeking healthcare as well as many
other aspects of transitioning. They also provide key services such as connecting transgender
people to properly educated health care professionals, checking in on patients going through
gender confirmation surgery, as well as connections to support groups for refugees, immigrants
and more. Another important resource that will be important for us is their page for medical
professionals to learn more about improving their practices and understanding of transgender
healthcare. This is a great way to improve transgender healthcare and this also gives us a
glimpse into what information is available healthcare providers.
This website is a key resource for our project due to its focus on BC healthcare as well as it’s
intersectional perspective. Thanks to the resources for health care professionals we will be able
to present their perspective as well in our project to fully flesh out practitioners perspective on
the health care system. By combining this source with the other we will be able to provide not
only a view of the problem but also the most up to date solutions that are being promoted in BC.
Our project will then be able to tie up with a more local and positive note that provides solutions
to the problems highlighted above. Transcare BC also provides information on the process
transgender patients must follow in order to do things like change their name, get perscriptions,
and access surgery. As these are key areas of care we can show what the current processes
look like and point out areas where accessibility is denied in the form highlighted in our other
sources. And perhaps most importantly by using this source in our paper we will hopefully put
readers and our audience in contact with one of the best sources for transgender information in
BC in case they need it or would like to learn more.

My favorites:
I’m sure it shows in my summary just how much I LOVE ​Bringing Transparency to the
Treatment of Transgender Persons. ​While yes… sarcasm. Really though this source provides a
great window into how discriminatory, marginalizing, uninformed and outright bad discussion of
trans healthcare is. I could not have asked for a better example of the problems we face in
seeking treatment through forms of misgendering, excuses to use slurs/outdated terms, and
irresponsible use of resources in an effort to hold back proper healthcare for transgender and
GNC patients. This source makes it easy to show clear examples of discrimination to support
the data collected in ​Health Care Experiences of Transgender Binary and Nonbinary University
Students. L
​ astly but perhaps most importantly it illustrates the lack of transgender perspective in
academia and health care. The fact that this got peer-reviewed and published is a sign at just
what a massive blindspot there is for transgender issues. Van Meter exemplifies exactly why our
other sources find transgender and GNC patients distrust the healthcare system and struggle to
find proper care.
My actual favorite article is ​Health Care Experiences of Transgender Binary and Nonbinary
University Students ​as it provides the most in-depth research into the issues of transgender
healthcare. The focus on qualitative data provides important stories of lived experiences while
the quantitative data provides us with important stats to use in our project to show how
widespread similar stories are. I also really like the focus on mental health that is very important
and often lacking from other studies on healthcare. Thankfully they have done a great job of
gathering data that shines a light on the barriers and effects of mental health care. The only
thing that I find lacking with this study is that it is based in the states which while comparable to
Canada likely has slightly different results. None the less this study shows widespread issues in
the healthcare system and points to areas where that could improve.

Syntheses:
The three academic sources and the Transcare BC website provide valuable information on
transgender issues in health care which will be a large focus of our project. They work really well
in tandem with The two good academic sources showing the data on discrimination which we
can then support with Meters transphobic paper to show why transgender people are more
likely to distrust the health care system and how the healthcare system creates social barriers to
patients. Connected to that Transcare BC provides a view of what the process is for patients to
get their healthcare allowing us to point out exactly where barriers are set up in the process. To
end on a more solutions focus note Transcare BC also provides excellent examples on how to
properly treat patients and create a more welcoming healthcare system. Thanks to its resources
for healthcare professionals we can point at exactly what can be changed to improve care.
Altogether this makes a succinct and impactful understanding of trans experiences that can be

shared with the class to improve understanding through personal stories while showing how
they’re political.
My other two resources bring into focus the experience of cis women from two very different
perspectives. The Bell Jar first tells us a tale from a western perspective and how mental health
institutes affect women in the United States. This beautiful story provides an understanding of
the dark history of mental health practices in Western culture. By providing us with an
understanding of the history we can explore how healthcare seeks to shed this past bust also
has lingering remnants such as the non-collaborative focus we see exemplified in Van Meters
paper when he claims to know best without consulting the people who’s lived experience is
affected. This topic of collaborative healthcare is further discussed in a fourth academic source
that did not make it into this bibliography. It provides key insights on how more collaborative
approaches to healthcare and in paticular transgender healthcare increases the wellbeing of
patients and allows practitioners to provide more effective healthcare (Grift, Mullender, &
Bouman, 2018). While ​The Bell Jar ​provides a view into the past of healthcare Grift et al
provides a look into the progress being made to avoid those same mistakes.
Through these sources so far we have been broadening our exploration of gender and health
care beginning at transgender healthcare and moving to cis womens healthcare in the west. No
woman, no cry brings another perspective into focus that deals with how colonialism and
globalism intersect with healthcare both from a macro and micro lense. While it recounts the
personal stories of mothers struggling to receive proper health care. It also combines with our
other sources to provide a macro view where we can see differences in the accessibility of
healthcare between the global North and South. By showing how healthcare serves as a node
of power we can explore how such an institution reinforces hegemonic power relations both at a
local and global level. By providing such a visible example of these forces we can become
aware of more subtle forms of power at our local level.

Bibliography:

Brown, T. M., & Fee, E. (2003, June). Alfred C. Kinsey: a pioneer of sex research. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447862/

Goldberg, A. E., Kuvalanka, K. A., Budge, S. L., Benz, M. B., & Smith, J. Z. (2019). Health
Care Experiences of Transgender Binary and Nonbinary University Students. ​The
Counseling Psychologist,​ ​47(​ 1), 59–97. doi: 10.1177/0011000019827568
Grift, T. C. V. D., Mullender, M. G., & Bouman, M.-B. (2018). Shared Decision Making in
Gender-Affirming Surgery. Implications for Research and Standards of Care. ​The Journal
of Sexual Medicine,​ ​15(​ 6), 813–815. doi: 10.1016/j.jsxm.2018.03.088
Home Page: EBSCO. (n.d.). Retrieved from https://www.ebsco.com/

Improving gender-affirming care across BC. (n.d.). Retrieved from
http://www.phsa.ca/transcarebc/

Medical Technology Directory. (2018, August 1). Retrieved from
https://www.hayesinc.com/hayes/publications/medical-technology-directory/dir-sex707/
No woman, No cry​. (2010).
Plath, S. (2006). ​The Bell Jar.​ New York, NY: HarperCollins.

Van Meter, Q. L. (2019). Bringing Transparency to the Treatment of Transgender Persons.
Issues in Law & Medicine,​ ​34(​ 2), 147–152.
Vermeir, E., Jackson, L. A., & Marshall, E. G. (2017). Barriers to primary and emergency
healthcare for trans adults. ​Culture, Health & Sexuality,​ ​20(​ 2), 232–246. doi:
10.1080/13691058.2017.1338757

Search log:
Database:

Search:

Hits:

Sources chosen:

Lang Lib

Gender and healthcare

141,604

Bringing transparency to the
treatment of transgender
persons

Lang Lib

Transgender Healthcare

8,690

Health Care Experiences
of Transgender Binary
and Nonbinary University
Students
Barriers to primary and
emergency healthcare for
trans adults

Lang Lib

Transgender and nonbinary
healthcare

186

Health Care Experiences of
Transgender Binary and
Nonbinary University
Students

Google

Trans healthcare BC

8,340,000

Trans Care BC

Google

Documentaries on women
and healthcare

2,320,000

No woman, no cry

My bookshelf

Fiction section

12

The Bell Jar