Graduation Year
2023
Document Type
Dissertation
Degree
Ph.D.
Degree Name
Doctor of Philosophy (Ph.D.)
Degree Granting Department
Communication
Major Professor
Patrice M. Buzzanell, Ph.D.
Co-Major Professor
Sonia R. Ivancic, Ph.D.
Committee Member
Lori A. Roscoe, Ph.D.
Committee Member
Catherine Wilkins, Ph.D.
Keywords
Feminist new materialism, Health communication, Risk, Transgender
Abstract
This dissertation analyzed the risk narratives of transgender people engaged in do-it- yourself hormone replacement therapy. Transgender (trans) people, those whose gender identities and/or expressions defy normative constructions of gender, experience a variety of health inequities as a consequence of systemic oppression within U.S. society. Many of the health inequities observed in trans people can be traced to structural determinants, such as discrimination at home, work, and school that results in housing, food, and social instability. Yet, medical and public health researchers have often attributed trans health inequities to “high risk” behaviors in which trans people engage.
One such behavior that is frequently deemed “high risk” is do-it-yourself hormone replacement therapy (DIY HRT), which is the practice of ingesting sex hormones for gender affirmation without a healthcare professional’s prescription or oversight. Some trans people engage in DIY HRT because they lack access to prescribed HRT, while others choose DIY HRT because they distrust dominant medical systems. In this dissertation, I explored the narratives shared by trans people with lived experiences of DIY HRT (DIYers) to understand how trans people make sense of risk and how their articulations of risk may challenge dominant perspectives on health risks. Specifically, my dissertation asked: (1) How do DIYers narrate and navigate risk?; (2) What material-discursive entanglements animate DIYers narratives of risk?; and (3) How do DIYers’ risk narratives extend, challenge, and/or blur dominant articulations of risk within communication and public health research? To address these research questions, I analyzed data from two studies involving semi- structured interviews with 36 trans people who have engaged in DIY HRT. Guided by the theoretical framework of feminist new materialism, I applied the phronetic iterative approach to analyze interview data. To facilitate my analysis, I developed a new technique for visually coding and interpreting qualitative data, which I term risk narrative diagramming.
With regard to my first research question, I found that DIYers storied risk as a potential harm to health and wellbeing. DIYers described four primary risks within their narratives: unwanted HRT effects, gender dysphoria, transphobia, and legal risks. DIYers adopted a variety of prevention and mitigation strategies to manage these risks in light of the resources available to them, typically by relying on support from other members of trans communities. Regarding my second research question, I found that hormones, human bodies, viruses, media representations, professional organizations, and more entangle to (re)materialize risks in DIYers’ lives. For my third research question, I found that DIYers’ narratives challenge predominant risk frameworks that position risk either as an objective hazard best understood by experts or as a social construction disconnected from material reality. Instead, DIYers’ narratives illustrate that risks are material-discursive phenomena that emerge through complex, dynamic intra-actions among human and other-than-human agents. Because risk is relational and ever-shifting, individual risks cannot be objectively evaluated by experts. Instead, DIYers themselves are best positioned to assess risks within their own lives based on their embodied experiences, available prevention and mitigation strategies, challenges, resources, and life contexts.
I conclude this dissertation with a discussion of the theoretical, methodological, and practical implications of my findings. I advocate for conceptualizing health risks as Baradian phenomena that are not set or predetermined, but which are relational and dynamic and which, therefore, must be assessed within each individual’s unique life context. Ultimately, I recommend Liberatory Harm Reduction as a framework for building future health communication programs to support the health and wellbeing of trans DIYers.
Scholar Commons Citation
Cusanno, Brianna Rae, "Exploring the Risk Narratives of Transgender People Engaged in Do-It-Yourself Hormone Replacement Therapy" (2023). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/10751
