Decolonizing Two-Spirit Care With Western Medicine: A WPATH Paradox No One Addressed

Contemporary transgender medicine is a field rife with contradictions. At least traditionally, its central medical practices—providing cross-sex hormones and gender-transition surgeries—are meant to liberate patients from the patriarchal rigidity of assigned sex roles by rigidly re-assigning their sex presentation. (That said, the more recent nonbinary-related interventions seek to “queer” such a rigid approach to transgender medicine.) The field also lends unprecedented medical autonomy to patients who are among the least able to consent to drastic medical interventions for a nonfatal psychiatric condition: children who harbor a litany of psychiatric diagnoses.

After spending the better part of two months this past winter watching conference videos from the World Professional Association for Transgender Health, or WPATH, I concluded that the most mind-scrambling paradox in transgender medicine emerged from sessions concerning the care of Native Americans who identify as two-spirit.

First off, as I learned from one particular conference session, the full recording of which I’ve published above, the term “two-spirit” wasn’t even coined until the 1990s. One presenter in this session said that the term was cooked up to differentiate from traditional Western approaches to the sex binary the means by which Indigenous populations experienced identities that fall outside of the sex binary. So one can’t help but wonder if the very idea of being two-spirit was shoehorned into what became the contemporary Western LGBTQIA+ identity politics.

But more striking was this conference session’s baffling suggestion that, above all else, healthcare for two-spirit Native Americans needed to be decolonized, and yet in the process these patients ought to receive Western medicine’s approach to transgender identity: cross-sex hormones and gender-transition surgeries.

This glaring contradiction remained under the surface and unacknowledged throughout this session; the speakers never made any direct effort to square the circle.

Nevertheless, as they uttered streams of what I call publichealthspeak (word salad that says little of actual substance but accomplishes the central goal of signaling the virtue of the speaker) and made lots of references to the vital importance of honoring intersectionality, they left me pondering the following two questions: