The right to health care has been a central catalyst of transgender social movements. The social meanings of “transgender health care” have come under acute pressure in the recent period of increased institutional recognition, research funding, political backlash, and social inequality. This dissertation is comprised of three papers that examine how “transgender health care” is negotiated and mobilized for institutional and social change through an in-depth study that focused on transmasculine health in Los Angeles County, California. The research was conducted alongside a community-based participatory action research initiative led by a grassroots organization working to advance gender, racial, and economic justice.

This multiple-methods dissertation includes two papers that are guided by a constructivist grounded theory analysis and based in interviews with 26 transmasculine participants and a third paper that uses cross-sectional data from a community-designed survey of 300 transmasculine adults. The first paper builds on popular trans critiques of clinical healthcare to theorize compelling care as a social process through which decentralized acts of self-defense reflect and marshal collective action for building power in clinical medicine. The second paper situates the relational and community-building processes of transmasculine people as health care work outside clinical medicine, surfacing a distinctly racialized gendered care burden and elucidating community-generated frameworks for health and healing interventions. The third paper builds on community-organized mobilizations for transgender healthcare services as institution-building and healthcare resource redistribution using community survey data to model the strategy as structural health equity intervention with demonstrative health benefits. Taken together, the three papers intervene in the medical and political relegation of “transgender health care” to discreet forms of clinical medicine or specialization, recasting transgender health care as a social change phenomenon that is influencing healthcare institutions and reshaping the terms of health caring.

LGBTQ+ (lesbian, gay, bisexual, transgender, queer, et al.) people are an increasingly organized portion of the United States and Canadian workforce. In 2013, members of the United Food and Commercial Workers (UFCW) formed OUTreach, a constituency group that works to secure rights and protections for LGBTQ+ workers against discrimination and mistreatment on the job. Their advocacy efforts have centered on ensuring access to workplace benefits through collective bargaining agreements, providing educational programming, and collaborating on political advocacy campaigns.

After several decades of patchwork civil rights legislation, LGBTQ+ workers are now legally protected from discrimination in employment under national law in both the United States and Canada. Yet awareness and implementation of nondiscrimination protections are uneven, and LGBTQ+ workers are still susceptible to differential treatment. There has been limited research about working conditions for LGBTQ+ people in terms of health and safety, unequal treatment on the job, and access to benefits. Likewise, there is very limited information about the leadership of LGBTQ+ workers in contemporary union organizing or the scope and effects of union support for LGBTQ+ workers’ rights.

This report explores LGBTQ+ workers’ contributions to union organizing and how they and their allies have benefited from union advocacy. Three significant findings and recommendations are outlined below. We used a participatory and research justice approach, working closely with UFCW OUTreach to collect and analyze the data. Using mixed-sampling methodology, we surveyed 1,004 union members and conducted 15 interviews with LGBTQ+ workers in diverse industries and regions across the United States and Canada. In addition, we conducted a review of relevant policy and academic literature.