One of the aspects I find most troubling about the colonization of gender by the west is the way that the contained medicalization and/or pathologization has become the standard by which peoples around the world move to inhabit their genders.
What I mean by this, is the way the heavy focus on medical transition legitimizes the medical model and creates a situation that can be dangerous for non-western trans* people.This post describes the means by which many bakla in the Philippines access hormones:
Male-to-female transgendered people have access to hormones but their intake is mostly not medically supervised for it is very easy to obtain hormones in the Philippines. Hormones can be bought in most drugstores without any doctor’s prescription. Mostly, M2F’s buy birth control pills. I have no idea if hormones that FTM’s use can be easily bought.The ease of access and the lack of supervision can be dangerous. While one might be inclined to think that the lack of medical gatekeepers to the hormones represents an improvement of the situation in the west, where one must often go through a medical professional to access them, it is essentially meaningless to have this access without the requisite social, legal, and economic support to go beyond this stage (or to do this safely).
What is problematic about this situation is the way that it is clearly influenced by not only western medical technologies but the colonial structures that support the medical industrial complex.
Bakla people, cis or not, have existed in the Philippines since before colonization. We have been there. And without needed modern, western medical intervention. (Let me be clear, I'm not judging or otherwise condemning the choices of trans women and/or bakla in the Philippines to pursue medical transition, but I wonder about the colonial impact on how we conceive of both gender and medicine such that they are willing to pursue potentially dangerous paths to medical transition.)
I question the colonial processes by which the social and spiritual category previously occupied by trans women and/or bakla in the Philippines became so eroded that modern Filipin@ society has begun making a clear distinction between bakla as sexuality (i.e., effeminate man) and bakla as gender identity (i.e., trans women) and how this distinction is impacting the health of bakla trans women.
Because it is not accidental that this process has ended up centering and making supreme the western colonial conceptions of gender. It is not accidental that what was once a relatively free and painless procedure (moving to embody a different social than one might have been born to) has become an expensive, painful, and potentially dangerous one guarded carefully by medical gatekeepers and that only serves to reinforce the medical industrial complex.