Abstract：
BACKGROUND: Transgender individuals seeking gender-affirming surgeries (GAS) are often denied or delayed by mental health professionals (MHPs). Studies on the gatekeeping of GAS have been mainly conducted in the Global North and primarily focus on the perspectives of health professionals. This case study from India incorporates health professional, community, advocate, and activist perspectives to contribute new evidence about MHP gatekeeping in GAS. The study aims to examine the role of power and gender in MHP gatekeeping of GAS in India.
METHODS: A qualitative multi-method case study including thematic analyses of key informant interviews (n = 9) and policy analysis using the policy triangle framework.
RESULTS: Health professionals and transgender persons participate in the construction, performance, and reproduction of gender indicating the persistence of gender normativity in India which enables gatekeeping by MHPs. However, evidence suggests some signs of a change from binormativity to a culturally intelligible and historically familiar \"trinormativity\".
CONCLUSIONS: To understand MHP gatekeeping, there is a need to contextualise this example of biopower within the larger social construction of gender within which MHPs operate. A transition from binormativity to \"trinormativity\" enables MHP gatekeeping of transgender persons seeking GAS. This risks creating new forms of gender-related oppression, such as new hierarchies and class differences between the gender binary and the \"third gender\".
METHODS: A qualitative multi-method case study including thematic analyses of key informant interviews (n = 9) and policy analysis using the policy triangle framework.
RESULTS: Health professionals and transgender persons participate in the construction, performance, and reproduction of gender indicating the persistence of gender normativity in India which enables gatekeeping by MHPs. However, evidence suggests some signs of a change from binormativity to a culturally intelligible and historically familiar \"trinormativity\".
CONCLUSIONS: To understand MHP gatekeeping, there is a need to contextualise this example of biopower within the larger social construction of gender within which MHPs operate. A transition from binormativity to \"trinormativity\" enables MHP gatekeeping of transgender persons seeking GAS. This risks creating new forms of gender-related oppression, such as new hierarchies and class differences between the gender binary and the \"third gender\".
摘要：
背景：寻求性别确认手术（GAS）的变性人通常被精神卫生专业人员（MHP）拒绝或推迟。关于GAS看门的研究主要在全球北部进行，主要侧重于卫生专业人员的观点。这个来自印度的案例研究包括卫生专业人员，社区,倡导者,和激进主义者的观点，为GAS中的MHP把关提供新的证据。该研究旨在研究权力和性别在印度GAS的MHP把关中的作用。
方法：定性的多方法案例研究，包括对关键线人访谈的主题分析（n=9）和使用政策三角框架的政策分析。
结果：卫生专业人员和变性人参与建设，性能，和性别的复制表明印度性别规范性的持续存在，这使MHP能够把关。然而,有证据表明，有一些迹象表明，从双元性转变为文化上可理解且历史上熟悉的“三元性”。
结论：要了解MHP看门，有必要在MHP运作的更大的性别社会建构中，将这个生物力量的例子背景化。从双生物到“三生物”的过渡使寻求GAS的变性人的MHP成为可能。这有可能造成新形式的与性别有关的压迫，例如性别二元和“第三性别”之间的新层次结构和阶级差异。
方法：定性的多方法案例研究，包括对关键线人访谈的主题分析（n=9）和使用政策三角框架的政策分析。
结果：卫生专业人员和变性人参与建设，性能，和性别的复制表明印度性别规范性的持续存在，这使MHP能够把关。然而,有证据表明，有一些迹象表明，从双元性转变为文化上可理解且历史上熟悉的“三元性”。
结论：要了解MHP看门，有必要在MHP运作的更大的性别社会建构中，将这个生物力量的例子背景化。从双生物到“三生物”的过渡使寻求GAS的变性人的MHP成为可能。这有可能造成新形式的与性别有关的压迫，例如性别二元和“第三性别”之间的新层次结构和阶级差异。
