At the start of March, the Collaboratory hosted historian and trans studies scholar Jules Gill-Peterson for a private seminar and public talk titled “Gender Dysphoria and the Class Divide of Transgender Healthcare.” Gill-Peterson’s talk explored how the gender dysphoria diagnosis (beginning in the 1970s at Stanford University) reshaped access to medical transition. While often understood as a liberalizing development, this model shifted the financial burden of transition onto patients themselves, producing a class divide and displacing the poor transsexual folks whom early gender clinics had originally sought to support.
Gill-Peterson argues for a sharp class divide between the working-class transsexual (those actively on hormones and pursuing or completing sex change surgeries) and the wealthier transgender subject — a blurrier category that, in her argument, tends to emphasize self-styling and internal identity over medical transition. She then applies familiar class dynamics to these categories, arguing that the two are interlinked and ultimately structured in conflict with one another.
On the day of the seminar and the talk, I happened to have a routine HRT check-up scheduled right in the middle of everything. I had friends travelling to the city for the talk and, in what was perhaps a slightly desperate attempt to spend more time with them, I invited them to come along to my appointment.
All of us are pretty visibly queer/trans twenty-somethings (yes, the funky hair, piercings, eccentric fashion, all of it), each dabbling in trans theory in different contexts and under varying levels of financial precarity, and each having spent at least the past few years navigating the bureaucratic hoops of medically transitioning in Ontario. Between the three of us, we’ve covered a fair bit of ground on that front.
As we sat in the back of the clinic waiting room, I handed over my notes and a printed chapter draft from Gill-Peterson’s upcoming book, which she had circulated for the seminar, joking that the stack of reading could function as our “children’s entertainment section.”
My friends immediately grabbed the pages and started skimming them intently. As they read, they kept interrupting themselves with little exclamations at the sharper turns of phrase or the more pointed moments in the argument. Watching them, I caught myself thinking about the strangeness of the scene. Here we were, three nonbinaries in a clinic waiting room, hunched over a draft chapter of trans studies scholarship and talking about sky-high theoretical arguments and methodological turns while we waited for my name to be called and my latest exact hormone levels to be read out. It felt straight out of some surreal performance piece.
The chapter itself (without spoiling it!) centers on what Gill-Peterson calls “transgender liberalism” — a way of understanding trans healthcare that celebrates visually expanded access while quietly reproducing deep class divisions in who can actually obtain care, how easily, and under what conditions.
She takes a particular issue with the long history of “no-ho no-op” transmascs claiming a kind of gender-transcendent superiority over the working-class transsexual man. As we sat there in the clinic awaiting our turn in a system that we had all spent years learning how to navigate, it was hard not to feel the salience of the argument folding back onto our own situation. The text was describing the exact infrastructures we were inhabiting, the ones that had made our own transitions possible while simultaneously foreclosing them for many others.
And yet the scene also made something else visible to me — something harder to account for in the kinds of histories Gill-Peterson traces. Her analysis ends in the year 2000, and I’m not sure how large the 1990s-era no-ho no-op “performative transmasc” looms in the present.
The nonbinary transmasc today — or at least the ones I keep encountering in Toronto trans meetups, mutual aid organizations, academia, and on my shifts working at the province’s LGBTQ+ youth helpline — is also miserably dysphoric and sitting in the waiting room, picking up side gigs to make ends meet like everyone else.
Beyond that, none of us arrived at that clinic alone. The knowledge required to navigate Ontario’s transition-related healthcare system had been assembled slowly, together: through group chats and local meetups, through heavy conversations with older trans friends, and through the accumulated trial-and-error of other people who’ve figured out which doctors are sympathetic, what to say to get what you need (and how to get it at a price you could afford), and which bureaucratic obstacles could be quietly sidestepped.
And yet still, we are all nonbinary transsexuals. So much of my presence in that waiting room that afternoon had been shaped by those networks, and I felt that so strongly and strangely in that moment. I find myself at a loss tying to account for the “what happened” (evidently, quite a lot) between the period Gill-Peterson describes and trans life today. I don’t think the trajectory of transgender liberalism is as clear or unchanging as it might first appear, particularly when viewed from the vantage point of the present.
The history of trans medicine is relatively easy to document, but the histories of how trans people actually learn to access that medicine are far more difficult and muddied to trace. Much of that knowledge circulates informally, moving through friendships, hotlines, community organizations, and diffuse digital infrastructures. They appear in fleeting moments like the one in that waiting room: a cluster of friends passing around a draft chapter, pausing mid-sentence to remark on a particularly sharp turn of phrase while waiting to have another testosterone level read out and another prescription renewal issued.
This is part of why I find myself hesitating slightly at the edges of Gill-Peterson’s distinction between the working-class transsexual and the middle-class transgender subject.
The divide she identifies is real, and the classed structure of transgender healthcare remains unmistakable. There’s a real urge to nod along with this critique of the wealthy academic transmasc. However, the lived experience of navigating that system today unfolds through collective infrastructures that cut across these analytic categories.
The nonbinary twenty-somethings in that waiting room were certainly not outside the circuits of privilege that made our own transitions possible, and at the same time, the knowledge that had allowed us to get there was the product of countless other trans people from a wide range of class backgrounds sharing information, experimenting with strategies, and leaving behind fragments of guidance for others to follow.
And what does it mean to read this and discuss it in academic transsexual circles today? How are we reckoning with the real-world consequences that transsexual people can be rich now too?
Seen from that angle, what had looked like an almost comically academic scene in that waiting room also looked like something else. It was a tiny node in a much larger and mostly invisible infrastructure of shifting forms of trans care: one built not only through clinics and diagnoses, but through the ongoing, collective labour of figuring out how to survive within them.
Ally Krueger-Kischak (any/all) is a Research Assistant on the Drag Kings Oral History Project. As an MA candidate in History and Sexual Diversity Studies, their research explores trans and queer rural histories, futurities, and working-class environmentalism in Southern Ontario.