Abstract Transgender (trans) people experience high rates of mental health issues including depression and suicidality. Improving access to transition-related medicine such as hormones and surgeries is suggested as an important mechanism to address these mental health issues. Yet clinicians experience challenges assessing and referring trans people for transition-related medicine. Standardized assessment protocols have been therefore recommended to optimize care. Although standardized protocols are purported to expand access to hormones and surgeries for trans people, it is unclear whether these tools achieve this goal. We therefore conducted an institutional ethnography to explicate how standardized readiness assessments coordinate access to hormones and surgeries in Canada. We analyzed key texts, talked with trans people, clinicians, clinician-educators, and administrators (total n = 22), and observed clinician-education workshops. In the context of determining transition readiness, standardized protocols direct clinicians to explore alternative diagnoses and assess the degree to which any complex mental health condition is “managed” prior to initiating hormones or surgeries. In response, we found that trans patients downplay or withhold mental health concerns from clinicians, or otherwise do additional work (e.g., take up unwanted psychiatric interventions) to convince providers they are “mentally ready” to transition. This phenomenon is paradoxical in that transition-related medicine is recommended to mitigate trans people’s psychosocial distress, but when patients reveal symptoms of distress they encounter significant barriers to treatment. We conclude that the logic underpinning pre-transition “mental readiness” assessments discredits the claim that standardized protocols optimize access to hormones and surgeries.

中文翻译：

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“我不认为他们认为我已经准备好了”：过渡前评估如何在加拿大为患有复杂心理健康问题的跨性别者造成医疗不公

摘要跨性别者经历着很多心理健康问题，包括抑郁和自杀。建议增加获取与过渡有关的药物（如激素和手术）的途径，将其作为解决这些精神健康问题的重要机制。然而，临床医生在评估和推荐跨性别者获得与过渡有关的医学方面面临挑战。因此，建议采用标准化的评估方案以优化护理。尽管据称标准化协议旨在扩大跨性别者获得激素和手术的机会，但尚不清楚这些工具是否达到了这一目标。因此，我们进行了一项民族志研究，以阐明标准化的准备情况评估如何协调加拿大获取激素和手术的机会。我们分析了关键文本，与跨性别者，临床医生进行了交谈，临床医生，教育工作者和管理人员（总计n = 22），并观察了临床医生教育讲习班。在确定过渡准备情况的背景下，标准化的方案指导临床医生探索替代诊断并评估在开始激素或手术之前对任何复杂的精神健康状况进行“管理”的程度。作为回应，我们发现跨性别患者低估了临床医生的心理健康状况，或者拒绝了临床医生的心理健康问题，或者进行了其他工作（例如进行不必要的精神病干预），以说服提供者他们“心理上准备好了”过渡。这种现象是自相矛盾的，因为建议使用与过渡有关的药物来减轻跨性别者的社会心理困扰，但是当患者表现出痛苦症状时，他们会遇到严重的治疗障碍。