April 22-24, 2021
Promoting Equity in Health Communication Research
Promoting Equity in Health Communication Research
Abstract: Theorizing Counterpublic Health: Do-It-Yourself Hormone Replacement Therapy and The Construction of Community Space(s)
Study Rationale:
Transgender and gender non-conforming (TGNC) individuals are considered an “at-risk” population with special health needs (Rider et al., 2018). One common risk factor is the use of hormone replacement therapy (HRT) without healthcare provider (HCP) oversight (i.e., DIY HRT) (Rotondi et al., 2013). DIY HRT medications are often procured through friends, street vendors, online pharmacies, or foreign-based pharmacies (Sanchez et al., 2009). To mitigate the risks of DIY HRT, many TGNC individuals use online forums to communicate about DIY HRT and ask/answer safety-related questions (i.e., accessing/interpreting blood test results) (Edenfield et al., 2019). Further research is needed to theorize how and why these community spaces exist. Guided by subaltern counterpublics theorizing (Squires 2002), we sought to explicate how DIY HRT users communicatively construct these online spaces, in effect creating a DIY HRT counterpublic health.
Methods:
We interviewed 20 TGNC people who lived in the U.S. and had experience using transfeminine (i.e., feminizing) DIY HRT. Participants were diverse in terms of their gender identity, race, insurance status, and geographic location. Interviews were audio-recorded, transcribed, and analyzed using applied thematic analysis (Guest et al., 2012).
Results:
Three themes emerged. First, a DIY HRT counterpublic health was formed in response to transphobia in the dominant cisgender/heterosexual public. Participants explained that dominant publics construct TGNC individuals as deviants deserving social rejection, harassment, and discrimination. These discourses then create the narrative that TGNC identity is a medical condition which needs to be diagnosed and treated by HCPs. At the same time, however, experiences of rejection and discrimination drive many TGNC people to begin transitioning in secret, leading them to use DIY HRT. Thus, organizing online allows DIY HRT users to avoid scrutiny from dominant publics.
Second, DIY HRT communities organize across various online forums, support groups, and instant messaging platforms. These spaces help community members access information about DIY HRT and find places to purchase medications. Participants noted that recent scrutiny from dominant actors (i.e., HCPs, mass media), has pushed the community to make these spaces hidden and interior to conceal and preserve communal spaces (Squires, 2002). A DIY HRT counterpublic health emerges whereby community members aggregate knowledge about HRT safety (embodied/experiential and scientific). In turn, the community (re)constitutes its own definitions of risks and safety.
Finally, DIY HRT counterpublic organizing results in individual and collective survival. Participants noted that the knowledge, counternarratives about health/gender, and emotional support they have received and provided in these spaces have been integral to positive identity development—helping them overcome experiences of isolation and marginalization. Thus, DIY HRT counterpublic health spaces can be lifesaving for many TGNC people.
Discussion:
This study theorizes the concept, counterpublic health—a subaltern community that rejects the dominant discourses and authority of biomedical and public health actors, in favor of community-based definitions of risk and safety; further explicating counterpublics’ functions (Chavez, 2011). Practically, this study offers insights into how dominant health actors (i.e., HCPs) can better meaningfully communicate with TGNC individuals who have experience using DIY HRT about their health and well-being.
Transgender and gender non-conforming (TGNC) individuals are considered an “at-risk” population with special health needs (Rider et al., 2018). One common risk factor is the use of hormone replacement therapy (HRT) without healthcare provider (HCP) oversight (i.e., DIY HRT) (Rotondi et al., 2013). DIY HRT medications are often procured through friends, street vendors, online pharmacies, or foreign-based pharmacies (Sanchez et al., 2009). To mitigate the risks of DIY HRT, many TGNC individuals use online forums to communicate about DIY HRT and ask/answer safety-related questions (i.e., accessing/interpreting blood test results) (Edenfield et al., 2019). Further research is needed to theorize how and why these community spaces exist. Guided by subaltern counterpublics theorizing (Squires 2002), we sought to explicate how DIY HRT users communicatively construct these online spaces, in effect creating a DIY HRT counterpublic health.
Methods:
We interviewed 20 TGNC people who lived in the U.S. and had experience using transfeminine (i.e., feminizing) DIY HRT. Participants were diverse in terms of their gender identity, race, insurance status, and geographic location. Interviews were audio-recorded, transcribed, and analyzed using applied thematic analysis (Guest et al., 2012).
Results:
Three themes emerged. First, a DIY HRT counterpublic health was formed in response to transphobia in the dominant cisgender/heterosexual public. Participants explained that dominant publics construct TGNC individuals as deviants deserving social rejection, harassment, and discrimination. These discourses then create the narrative that TGNC identity is a medical condition which needs to be diagnosed and treated by HCPs. At the same time, however, experiences of rejection and discrimination drive many TGNC people to begin transitioning in secret, leading them to use DIY HRT. Thus, organizing online allows DIY HRT users to avoid scrutiny from dominant publics.
Second, DIY HRT communities organize across various online forums, support groups, and instant messaging platforms. These spaces help community members access information about DIY HRT and find places to purchase medications. Participants noted that recent scrutiny from dominant actors (i.e., HCPs, mass media), has pushed the community to make these spaces hidden and interior to conceal and preserve communal spaces (Squires, 2002). A DIY HRT counterpublic health emerges whereby community members aggregate knowledge about HRT safety (embodied/experiential and scientific). In turn, the community (re)constitutes its own definitions of risks and safety.
Finally, DIY HRT counterpublic organizing results in individual and collective survival. Participants noted that the knowledge, counternarratives about health/gender, and emotional support they have received and provided in these spaces have been integral to positive identity development—helping them overcome experiences of isolation and marginalization. Thus, DIY HRT counterpublic health spaces can be lifesaving for many TGNC people.
Discussion:
This study theorizes the concept, counterpublic health—a subaltern community that rejects the dominant discourses and authority of biomedical and public health actors, in favor of community-based definitions of risk and safety; further explicating counterpublics’ functions (Chavez, 2011). Practically, this study offers insights into how dominant health actors (i.e., HCPs) can better meaningfully communicate with TGNC individuals who have experience using DIY HRT about their health and well-being.