For the Health of All: Global Transformations in Trans Knowledge

Abstract

Transgender health, and the scientific and medical knowledge underpinning it, has been transformed over the past two decades. Since the 2000s, coalitions of activists, doctors, and scientists have made important if fragile gains in an effort to depathologize trans people's encounters with medicine. However, both research and activism in the field has tended to center knowledge and controversies that take place in Euro-American societies. Three new books on transgender life in different locations—in Brazil, Argentina, the United States of America, and India—reveal how alternative ways of knowing and enacting trans health are emerging on a world-wide scale. Each book's engagement with the world-wide politics of trans knowledge from situated local and national contexts aligns with historical interest in science and technology studies in what Susan Leigh Star called the “high tension zone” produced by binary sex classification. Looking to experiments in trans knowledge beyond the locations where it is usually thought to be produced provides new opportunities to consider both how and why cisgender normativity is naturalized as a biological condition with powerful political effects.

In 2019, the World Health Organization removed “transsexuality” and “gender identity disorder of children” from the “mental and behavioural disorders” chapter of the International Classification for Diseases (ICD-11), the schema used to report health and health-related conditions globally. Readers are directed to a new ICD-11 section on “gender incongruence” in a chapter called “conditions related to sexual health.” In 2022, the World Professional Association for Transgender Health, the global body situated in the United States of America (US) that is responsible for setting standards for the field, Standards of Care Guidelines 8, removed any requirement for a psychiatric diagnosis of gender dysphoria for accessing gender-affirming procedures (Coleman et al. 2022). While these standards are not binding, and how they are taken up and defined by medical bodies differs according to regulations in relevant countries, the process of translating them into different languages highlights the global scope of sex/gender classification in the twenty-first century. This is particularly important in light of the emergence of what Australian sociologist Raewyn Connell (2021, 88) has called “trans health on a world scale.”

These outcomes, part of a transformation in knowledge about trans people's health needs, were the result of strategic efforts by coalitions of transgender activists, researchers, and doctors underway since the 1990s. One aim was “depathologization,” a political stance that sought to remove requirements for psychiatric diagnoses linked to “gender dysphoria” or “gender identity disorder,” and related restrictions on access to gender-affirming healthcare to facilitate a person's transformation and subsequent legal recognition. In many jurisdictions, a psychiatric assessment, hormone replacement therapy provided by an endocrinologist, and in some cases surgery, are necessary for the legal recognition of a person's gender, including their sex marker and name as written and recorded in state databases. These medico-legal processes have significant consequences for the social recognition of trans people, given that sex/gender is critical to the recognition of stable individual personhood on which citizenship rests. Nevertheless, for the majority of trans people globally, such interventions are either inaccessible or difficult to access, given that they are not funded through public health insurance. Moreover, the vast majority of research seen as central to defining trans health and medicine has been conducted in or about Euro-American contexts.

Science and technology studies (STS) scholars have long engaged with the position of trans people within binary sex as an everyday form of classification with far-reaching effects. In 1990, Star (1990, 45) drew attention to the demands placed on those whose relationship to binary sex classification places them in a difficult but productive “high tension zone.” Engaging extensively with Sandy Stone’s (1992) The Empire Strikes Back: A Posttranssexual Manifesto, a foundational essay in trans scholarship, Star (1990, 46) observed that demands to resolve this tension reflected the workings of sex categorization as a “socio-technical network, an exercise of power—and a certain kind of loss.” In the face of the cisgender gaze of science and medicine, as articulated by trans studies scholars such as Jules Gill-Peterson and C. Riley Snorton, the cost of a certain kind of recognition as an “ideal type” of male or female was the ability to authentically articulate other possibilities. As Star (1990, 47) asked, drawing on conversations she had with a trans student: “What would it have taken to preserve the ‘high tension’ of Jan's non-membership, the impurity of being neither male nor female?” While Stone's essay—pivotal to Star's argument—is rarely seen as a canonical text in STS, one strand of research has investigated the “axiomatic” classifications that medicine uses to authorize certain kinds of trans selfhood but not others (shuster 2021; Latham 2019). These critical accounts of the role of biomedicine in buttressing transgender normativity, based on cisgender and heteronormative science, helps to understand how a focus on liberal recognition may conceal more expansive ways of knowing and living as a trans person.

The elusive promise of liberal recognition has become particularly apparent at the present moment, where state-sanctioned efforts to define sex on biological terms are placing trans people outside of, and even posing a threat to, the liberal order. In early 2025, the Trump administration deployed spurious science in an executive order that purports to “restore biological sex,” where the origins of biological sex are defined with reference to gametes, where sperm is male and egg is female (for a view of the longer history of the science of sex in these terms, see Martin 1991). ¹

Three recent books by Christoph Hanssmann, Vaibhav Saria, and Moisés Lino e Silva offer important examples of the global stakes of trans health and knowledge. Through sensitive ethnographic engagement, each book shows how trans people in Argentina, New York, Brazil, and India, engage with knowledge practices associated with liberal forms of rights and recognition. Each author pays careful attention to the individual lives, biographies, and processes related to trans life in diverse locations today. They center those who belong to prominent social categories used to refer to trans feminine people in different parts of the world; hijras for Saria, and travestis for Lino e Silva and Hanssmann. Consonant with broader shifts in STS attentive to marginality and difference, each book attends to knowledge practices that grapple with the limits of liberal forms of recognition. Resonating with decolonial and feminist concerns in STS, these accounts reveal the critical insights to be gained by engaging with the sexed and gendered foundations of knowledge at a global scale, and the vitality of a “high tension zone” (Star 1990, 45) as a way to alternative, collective visions of freedom and justice.

Diagnosing Pathology

Christoph Hanssmann's book Care Without Pathology provides an ethnographic account of the political and medical debates linking “depathologization” to the rise of the field of trans- health (Hanssmann uses a hyphen, which I follow in my discussion of his book in this section) in the first decades of the 21st century. He asks a series of crucial questions related to the global politics of trans health and knowledge. If being recognized as “transgender” does not require a diagnosis, how will it be possible to facilitate forms of medical treatment and care for those who need it? Who and what are gender-affirming medical care and hormone treatments for? How is being or not being trans defined? How is it possible to account for and apportion responsibility for the violence that trans people face?

Based on extended fieldwork in Buenos Aires and New York City, the book considers the “emergence of trans- health in its public form and through its transnational institutionalization within the thicket of global trans politics” (Hanssmann 2023, 12). Tracking detailed shifts in the global classification of trans- health and its effects, Hanssmann provides rich materials based on extensive fieldwork with scientists, medical doctors, academics, trans activists, travestis and trans community organizations, in these two cities. The result is a book relevant beyond trans studies, and useful for STS scholars interested in identifying forms of feminist and decolonial “care without pathology” as “new modes of orienting biomedical treatment” (Hanssmann 2023, 6). Care Without Pathology moves beyond narrow visions of trans- healthcare linked to identity as private right, and into more unexpected political interventions.

In 2012, Argentina passed a Gender Identity Law (Republic of Argentina 2012), which sought to protect the rights of transgender people by overturning decades of pathologization. No longer did trans people have to obtain a psychiatric diagnosis to access gender-affirming medical procedures, like hormones and surgery. The law promised to protect trans people's rights to health through publicly funded insurance, yet its effectiveness was challenged by the economic austerity measures introduced by a newly elected conservative president in 2015. New York, the other location where Hanssmann conducted fieldwork, saw the mobilization of transgender rights over the same period. In the US, a global center for pathologizing knowledge about trans people and the science of sex more broadly, healthcare is largely privatized, with publicly subsidized care only available to low-income people under certain conditions. In 2015, New York became one of a small number of states in the US to allow publicly funded trans therapeutic care, including gender affirmation. In both Argentina and the US citizenship is entangled with histories of settler colonialism, closely tied to binary sex as a means of naturalizing hierarchies of the human, partly by defining a boundary that excludes those outside of it.

To understand the global emergence of trans health as differing phenomena in these sites, Hanssmann brings theories from STS to bear on a rich range of sociological data. He skillfully draws on a range of data sources, including classification schemes, diagnostic criteria, participant observation, and interviews. Here, the use of Star's “theory methods packages” (cited in Hanssmann 2023, 16)—a recursive relation between theory and methods—is deftly used to make good a decolonial feminist proposition to challenge hegemonic paradigms of identity-based trans- health. We see care without pathology in practice when we meet New York nurse practitioner Talia, who worked around the regulatory exclusion of hormone prescription to poor patients with public insurance by using a diagnosis of “Endocrine Disorder Not Otherwise Specified.” Talia worked around a system that pathologized trans- people and structurally excluded poor people and people of color by tinkering with the classification scheme available to them. Yet even then, Talia and other healthcare practitioners wondered why they were “required to diagnose wellness,” grappling with the “illness-care conundrum” as “the difficulty of providing or accessing care in the absence of a specific and diagnosable illness” (Hanssmann 2023, 52–53). The difficulty of this provision of care was addressed by practitioners, who sought to facilitate wellness, framing their work as warding off pathological forms of structural harm experienced by trans- people.

In the Argentinian case, following the introduction of the Gender Identity Law, trans- activists harnessed various statistics to an affective politics, which Hanssmann (2023, 111) evocatively calls “epidemiological rage.” An affect of “epidemiological rage” emerged within the postauthoritarian history of Argentina, where an intersectional vision of popular health (salud popular) framed institutional violence as a core issue impacting collective health. A significant focus in the field of trans health has been the disproportionately poor health outcomes of trans women of color (Scheim et al. 2022). Sitting behind this epidemiological evidence are diverse knowledge practices (and indeed questions as to who comes to stand for “trans”), including those attached to HIV. These measures often link poor health outcomes to an individualized calculus of risk, tied either to risky sexual practices or to transphobia. Technocratic models of risk and rational public health calculation might be seen as paradigmatic of state control. However, Hanssmann shows that his interlocutors drew on epidemiology—a science with many detractors in the critical social sciences—and infused it with an affectively charged advocacy attentive to material concerns, rather than individual rights. In the Argentinian case, a biopolitical concept of population was transformed into a collective form of advocacy, which presents a useful example of the experimentation taking place under the rubric of trans- health.

The kinds of processes trans- activists engaged with in Argentina in the early twenty-first century highlight another insight in the “high tension zone” (Star 1990, 45) of trans knowledge, linked to the assumption of what gender itself is and how it maps onto liberal politics of recognition. While a concept of “gender identity” linked to the self now circulates as a commonsense and universal assumption, including in definitions of trans- health, Hanssmann's book illustrates the potentially limiting assumptions that underpin such a project. Rather than embrace a vision of gender identity, minoritarian subjects—like travestis—expressed skepticism about their easy integration into this way of being and knowing trans. Perhaps paradoxically, attending to the specific ways that trans activists tinkered with knowledge practices helps to show that such concerns are not about an individual, universal trans subject at all—but rather one embedded within a specific context, where experiences of injustice are tied to coloniality, capitalist exploitation, and the very project of liberal recognition.

Freedoms Elsewhere

A view of knowledge practices and a politics of trans- therapeutics raises crucial questions relevant to other accounts of trans social life, specifically as they interact with global scientific and medical practices. They also take place in the shadow of much anthropological research and ethnographic practices long implicated in a prurient gaze case toward trans people beyond Euro-American contexts. What does this style of scholarship hold for rethinking trans knowledge practices on the terms laid out by Hanssmann and earlier STS scholars including Susan Leigh Star and Sandy Stone?

Moisés Lino e Silva's book presents further insights into the processes by which knowledge brings together some practices, bodies, and concepts in relation to trans. What is most notable here is the author's reticence to address specific knowledge practices labelled trans: it is notable that Lino e Silva generally does not use “trans” as a driving analytic in his account, but rather “queer.” Whether this decision is Lino e Silva's or due to his interlocutor's lack of engagement with knowledge related to “trans” is not clear. Indeed, this is not a book that aims to explicate the political life of trans globally, though it is important to ask why it does not; notably, the only reference to trans politics in the index is to the 1966 Gene Compton's Cafeteria Riots in San Francisco. The central character in Minoritarian Liberalism book, set in Brazil, is Natasha, a self-identified travesti (the same term is used in Brazil, with similar racialized, classed, gendered, and sexual meanings as in Argentina) in her late twenties at the time the fieldwork took place. At its core, the book is an elegiac analysis—at once moving and troubling—which examines Natasha's life and death under conditions of racial capitalism.

At issue for Lino e Silva is Natasha's inability to live as a free person, within the confines of freedom set out as normative liberalism, a “standard and universalizing mode of liberalism derived from European and North American history, philosophy, and political theory since the Enlightenment—a dominant set of modes of freedom based on the prescription of individualism, autonomy, private property, and, at the same time, dependence on state protection, as its trademark” (Lino e Silva 2022, 12). Natasha's life and those of the favela-dwellers more generally are the prism through which to interpret minoritarian liberalism. Life in Rio de Janeiro's vast hillside favelas is violent, and subject to specific kinds of state controls like checkpoints and drug raids. Yet this context also provides opportunities for non-normative freedoms unavailable to those who live outside the favela, specifically those who live on the “asphalt”—the term used by favela dwellers to refer to the formal settlements in the city. These “favela categories of difference” (Lino e Silva 2022, 20), which are at their core linked to spatial understandings of urban life, are used by Lino e Silva in concert with a method of assemblage. Sharing some concerns with STS, assemblage for Lino e Silva is a way to trace socio-material relations, albeit mostly limited to those linked to urban form and spatial politics.

This use of a theory of assemblage, an overused concept in STS and adjacent fields, does not overwhelm Lino e Silva's analysis. Rather, his focus remains on the biographies and goings-on in one group of favela-dwellers. Touching and unexpected insights emerge through ethnographic research conducted over a year of extended participant observation of the life of a hillside favela. The reason for selecting travestis seems to be in part due to Lino e Silva's positionality as a queer person—albeit one whose experiences are admittedly far from the life of trans people in the favela. But perhaps the bigger reason for the selection of travestis is the theoretical insights they offer. Ethnographic analysis facilitates a cross-cultural analysis of the Euro-American concept of “liberalism.” As Silva (2022, 17) writes: “The dangerous travesti living in a lawless land epitomizes the fears of normative liberals toward those unwilling to submit to dominant norms of gender, sexuality, and, I would add, capitalist projects of individualism and privatization.” Travestis are Lino e Silva's way into considering how liberal freedom fails the poor, for reasons that they cannot access or live up to a dominant set of modes of freedom based on the prescription of individualism, autonomy, private property, and, at the same time, dependence on state protection.

More specifically, Lino e Silva argues that what travestis have to teach readers are “minoritarian liberalisms,” and the overlapping concept of “minoritarian freedoms.” The kinds of freedoms available in the favela are both gender and sexual freedoms, which rest on a capacity to seek freedom bound to a collective vision beyond that of the state. Lino e Silva picks up adroitly on concepts of freedom in Indigenous societies within anthropology, and the philosophy of Rousseau and Locke. This engagement helps to highlight that liberalism is not a solely Western practice situated within capitalist modes of production. Rather than an either/or critique—liberalism/outside of liberalism—Lino e Silva argues that ethnographic accounts reveal how alternative forms of liberalism (in Lino e Silva's terms, “minoritarian,” following Deleuze and Guattari's book on Kafka) take place in the shadow of capitalist projects. These are not the same everywhere, but can be found in the gaps of capitalist projects, like those in the favela. This makes the humanistic liberalism of academic scholarship suspicious to Lino e Silva. For Silva (2022, 21), a reflexive critique of the liberal and humanistic analytic underpinning academic scholarship, with its Euro-American gaze, can help to create “ever more radically mutant modes of freedom.”

These mutations generate a high-tension zone indeed. Travestis are at the intersection of these conditions of possibility, moving far beyond a question of gender or sexuality tied to the individual self. Their position at the limits of gender as a mode for claiming recognition puts them in a challenging and vulnerable position. Lino e Silva's reluctance to engage with the trans politics of knowledge perhaps stems from his concern to avoid identifying an individualized gendered or sexual self at all. This tension emerges primarily in the absence of a discussion of how trans politics shaped Natasha's relationship to herself and others. Nevertheless, for Natasha, gender was not understood in terms of the self, whether in terms of expression (irrelevant, given that Natasha is free to dress as she wishes and have sex with whom she wishes in the favela), or state recognition (also irrelevant, given that it has no bearing on her desired forms of freedom). Where this lack of a stable individual self becomes particularly challenging is in the face of biological vulnerability to HIV, an epidemic which disproportionately impacts trans women (Scheim et al. 2022).

In the most emotionally challenging sections of the book, Lino e Silva documents Natasha's sickness and death as the result of complications stemming from an untreated HIV infection. On hegemonic forms of knowledge about sexuality and gender, Silva (2022, 43) is scathing, “Minoritarian subjects have their freedoms, theory, and experiences persistently erased by more powerful modes of truth and knowledge production—such as the medical sciences.” Medical knowledge, a form of knowledge linked to liberal recognition, could not interpret Natasha's life, what Lino e Silva describes as her desire to retain a form of freedom. Lino e Silva recounts his own absence and a return to the favela, where he sought out and found Natasha in a state of advanced illness. This section relies on mostly second-hand narratives, and much of what occurred before her death remains unclear. We do not hear, for instance, an account of whether Natasha engaged with healthcare workers, and her own insights into her experiences. In its place, Lino e Silva accounts for the significant ethical conundrum he faced upon meeting her. She appeared to refuse any kind of medical intervention or treatment at this point, to Lino e Silva's sadness and even rage, who observed this not as Natasha's failing but as the lack of imagination of such liberal modes that see only one form of life as worthy. Under such conditions Silva (2022, 180) fretted, worried that in suggesting he was imposing “a legitimate ethics of care, imposing a normative liberal logic of self-care.” One wonders what might have happened if this affect had been transformed into an alternative, collective form of recognition of the need for trans health, like the epidemiological rage described by Hanssmann.

There are many accounts of premature trans deaths, as well as important epidemiological studies, which highlight that such deaths and poor health may be linked to inadequate legal or medical gender affirmation. Lino e Silva may well critique these insights as part of a project of normative liberalism (though my sense is that this is not the audience for this book). Ultimately one might be left with a fatalistic sense that there is nothing to be done, given that there is little mention of other collective visions of justice. And perhaps, regrettably, there was nothing to be done in Natasha's case; the structural forms of violence, indeed the project of liberalism, generated an “outside” where she was deemed less than human, her life less worthy. Lino e Silva's diagnosis of the limits of individual projects of freedom are shared by Hanssmann. But Hanssmann presents a more hopeful account, equally empirically grounded, that shows how minoritarian liberalism can flourish in unlikely places. One such form of minoritarian liberalism—one closely tied to political mobilization for racial justice—may indeed be the space opened by collective visions of trans health itself. Within such a form of minoritarian liberalism, a collective vision of “trans- therapeutics” (Hanssmann 2023, 147–148), Natasha may have been given space to flourish.

The Violence of Classification

Both Hanssmann and Lino e Silva pay close attention to local and national contexts to better understand how a world-wide system of knowledge produces various kinds of trans marginality. One unifying force is that of HIV, an epidemic that has served as an avatar of globalization since the 1980s, but which has largely fallen out of the consciousness of everyday queer and trans life in many Euro-American contexts. While the overall number of new HIV infections globally declined following the introduction of testing and anti-retroviral therapy alongside an expanding number of prevention strategies in many parts of the world, these gains have been unequal. In several parts of the world, including the USA, the HIV epidemic has increased among some populations, including poor trans women of color (Scheim et al. 2022). Within global public health, HIV is an enormous field of knowledge, replete with diverse scientific, technological, and commercial actors. This global politics of HIV can be characterized by what Adia Benton (2015) calls “exceptionalism,” referring to the conditions of knowledge under which the disease came to be addressed as entirely unique, laying the conditions for fragmentation and an inability to address broader forms of inequality. HIV exceptionalism is a powerful and troubling form of biopolitics, one that shapes how transgender is known, even as the conditions of living with and dying from HIV for trans people are different everywhere.

Vaibhav Saria's masterful book is a moving study of hijra sexuality in the eastern Indian state of Orissa, a classical object of anthropological attention and interest. Hijras are sometimes classified, like travestis, as a global variant of “trans,” growing out of interest in “non-binary,” “fluid,” or “third gender” identities. Saria refutes this integration of hijra (like travesti, Indonesian waria, and others often placed into a Euro-American cartography of trans identities) into an imaginary that sees them as evidence of trans elsewhere. In explicitly naming hijras “transgenders” rather than “trans women,” Saria (2021, 3) more directly foregrounds “complexities that haunt queer studies and anthropology.” Hijras are often classified into an array of categories, often in relation to the HIV epidemic, but none so important as “high-risk sexual practices” within the field of “global health… [which] continues to implement and fund strategies based on impoverished psychologized understandings of behavioral change and modification” (Saria 2021, 13). The result is a widespread failure to understand why hijras have sex with men and why they do not use condoms. It is also a failure to reckon with the conditions of poverty that generate extreme precarity. To address this concern is no small task; global public health and the HIV/AIDS industry has a proliferating number of terms, concepts, toolkits, and technologies to try to address hijras and others. These and the related language of rights related to sexual orientation, gender identity and expression, often derive from knowledge that is distant from the ordinary lives of the poor.

Saria's book is based on several periods of fieldwork in poor rural districts of Orissa, in eastern India, undertaken over eleven years. It is also a book based on a personal relationship to hijra sexuality, as Saria recounts overhearing their mother telling an aunty an alarming story about hijras: “They are born this way and when they come to bless the newborn baby, they check the genitals; if the baby is born like them, then they take the baby away” (Saria 2021, 1). The result is a moving and analytically clear-eyed account that can help to see hijra not as a version of trans elsewhere, but as a “broader ethical posture” (Saria 2021, 22). To achieve this, Saria merges psychoanalytic and queer theory to remarkable effect, recasting hijras in relation to forms of asceticism drawn from Hindu mythology, as well as the modern morality of living with queer sexuality and poverty. Reading hijras “diagonally” in Saria's terms helps to show that hijras are not outside of or resistant to heteronormativity (as some forms of queer theory may hold) but rather make the Indian family and male/female dyad possible. Tracing an “economy of semen” (Saria 2021, 9), the sexual transactions between hijras, lovers, and customers during sex work, Saria reveals the centrality of relations of obligation, fantasy, and mythology as they are lodged in ordinary life.

Saria's account is crucial for both STS and medical anthropologists who wish to understand the globalization of categories related to transgender and associated concepts of HIV risk. Like Natasha in Lino e Silva's book, many hijras that Saria worked with had grown ill and died following an uncontrolled HIV infection. However, reducing this phenomenon to concepts of individualized risk fails to grasp how, “the biological is very rarely the universal; scientific-medical discourses about sex have taken different routes as well as different roots across the globe” (Saria 2021, 19). This account serves as a reminder of the value of STS scholarship that continues to engage with the experiences of those who are subject to but have very little influence over powerful forms of scientific knowledge, as is the case with hijra community experiences of the HIV epidemic presented by Saria.

The utility of the very terms of trans pathologization and concomitant relevance to HIV risk are challenged by Saria's analysis. For one, hijras are not necessarily viewed or classified as pathological or at-risk in the terms commonly presented in Euro-American analysis (also bringing into question the relevance of global movements premised on depathologization). Moreover, an account of a hijra with a cisgender girlfriend whom she wished to marry showed up the limits of a framework of individual sexuality. In turn, “Clear boundaries between the categories of women that hijras have relations with (regular/non-regular, wives/girlfriends) become untenable in the light of desire and force us to question the relevance of such categories to predict condom use” (Saria 2021, 185). One way that global public health has sought to address this has been to create more categories, with a scientific ring to them, and in doing so concealing the situatedness of the psychological theories that they rely upon. ² This is one reason why health and sexual desire are mostly incommensurable in global public health, due in part to an unwillingness to admit the deeper psychoanalytic unconscious that shapes sex and gender, making it unclassifiable in the terms that contemporary models of medical and scientific knowledge require.

Through the deeply personal account of hijra lives in Saria's book, we can see global health as a rationalist way of knowing that is incapable of addressing why hijras contract HIV and frequently die young. One reason is that many forms of classification used in national and regional contexts are created by experts who are far from the people being classified, introducing specific concepts of sexuality and gender as biologized constraint. There is a hubris to epidemiological projects, which increasingly rely on molecular data (Molldrem 2025), that should be subject to scrutiny. The very concept of gender identity too serves to reify a psychologized concept of the self which misses much of what is uncategorizable. Where sexuality or gender identity is contextualized within ordinary life, HIV and other experiences of health can be better understood as embedded within socio-material realities and relations with others in the context of poverty. A more difficult question is how to address the ways that colonial models of knowledge production remain lodged in scientific and medical domains, which shape so much of how we know what is sex/gender/sexuality. A more radical view could be to see these ultimately colonial concepts as clouding understandings of trans social life in ways that are not necessarily helpful.

The Limits of Knowledge

The value of these books for STS, and beyond, is to sustain a focus on “transgender” as not simply something out there to be mapped and liberated. They show how trans knowledge is not only tied to a specific kind of individual self, linked to gender identity which—when liberated—will be able to claim individual freedom as their primary political mode of action. Each author's contributions are also valuable because they push back against the squeamishness of sticking with the tensions, the difficulty, and the violence, that is a reality for many trans people in the contemporary world. This is particularly so if trans people are Black, Indigenous, or are poor and living in or in the aftermath of a violent authoritarian state. On the other hand, each book shows that the violence of colonial knowledge to trans people is not uniform, and cannot be easily separated out from its broader effects. A focus on those positioned “at humanity's edges” (Tiktin 2020, 186) crystallizes how race, public sexuality, and gender presentation are key to buttressing the liberal order. Indeed, following Lino e Silva, we can usefully understand how liberal concepts of personhood that rely on distinguishing between unfree and free, and the carceral responses they give rise to, are situated within specific historical and ethnographic contexts. The effects of such a concept—and its insistence on a stable concept of biological sex or psychological gender—expands far beyond trans people, affecting all of those whose understanding of self and body does not align with the terms set by the liberal state.

This makes attending to the coalitional knowledge strategies used to overcome them—most clearly mapped out in Hanssmann's optimistic book—so vital. Each of these books were written against the backdrop of shifting conditions of “trans knowledge” at a moment of contestation and rupture. The terms of trans knowledge are and are likely to remain deeply contested, highlighting both the limitations of framing trans in relation to the liberal promise of evidence and science. Under such conditions and their likely intensification, a far-reaching re-arrangement of what it means to diagnose or classify or know gender is needed, beyond that of identity. Reading these three books together helps to understand the important ways that trans activists, many of whom are living under conditions of state violence and poverty, are articulating more expansive collective politics, in ways that reject the terms of biological vulnerability offered to them. Trans health can itself become a kind of minoritarian liberalism that draws on the evidentiary logics of biomedicine and science, and reworks them to new ends. Understanding how this might be so requires a considerate and detailed engagement with models of scientific, medical, and technological knowledge that shape the boundaries of what it is to be trans in the contemporary world. These take various forms, coalitions and possibilities, including doctors, scientists, and others. For STS, it will take the form of more deliberately making space for, or recognizing the presence of, trans scientists and researchers. It will also mean that as forms of knowledge related to trans lives proliferate, there should be more space for knowledge produced by and for trans people who live in conditions of poverty and illiteracy.

Over the past ten years, I have worked on a series of projects about trans health and inequality in Indonesia. Together with coalitions of researchers, trans community members, and concerned colleagues, we examined gender affirmation as a component of health (Hegarty et al. 2025) and the structural violence of cisgender norms (Wolter et al. 2025). These have been challenging times: Indonesia has seen the introduction of punitive laws and regulations related to sexual comportment and gender appearance, with a new Health Law of 2023 introducing restrictions on surgery or treatment intended to change a person's identity from their “actual or genuine sex” (Republic of Indonesia 2023). These are tied to world-wide, imperialist ambitions to establish cisnormativity, what Jules Gill-Peterson (2021) has called the “cis state.” Efforts to delegitimate trans people's lives, and the state's assertion of a monopoly on claims to recognition through a spurious regime of biological truth, can be challenged where STS remains in this “high-tension zone” (Star 1990, 45). STS and trans studies can provide a different kind of critical engagement than the paranoid stance of much of queer critique (Sedgwick 2003), instead pursuing a scholarship where the “critic is not the one who debunks, but the one who assembles” (Latour 2004, 246).

What is needed to complement the brave scholarship in these books is broader engagement by STS scholars with these accounts of trans health and knowledge, particularly relevant to the biology of sex. This is particularly important within the broader terrain of technologies of reproduction, in which new scientific technologies are informing what biological sex means. In other words: how and in what ways is cisnormativity naturalized as a biological condition? In what ways can trans knowledge engage with biology to contest the limits of cisnormativity? One example is in vitro gametogenesis, a technology that challenges even supposedly mutable biological characteristics, as “the first technology that would allow a transgender person to produce a gamete that reflects their gender rather than their sex at birth” (Goff et al. 2024, 937). The attention of these three books can stimulate interrogation of the relationship between cisnormativity, inequality, and health in this emerging work on the biology of sex. These books highlight how trans people have always created forms of living and knowing in ways that escape the confines of biological definitions of sex and liberal personhood. For this reason, the trans experiments with science and medicine described in these books make for essential reading in light of contestations over sex and its link to cisnormative liberalism, which are likely to intensify in the years to come.