Care in transition: Global norms, transnational adaptation, and family-centered gender-affirming care in China

In recent years, trans medicine has increasingly shifted towards gender-affirming care, focusing on assisting transgender people in finding safe and effective ways to support their gender identity. Through standards of care, clinical guidelines, and classification systems, international experts have established global norms with profound downstream implications. However, how local providers respond to these new norms remains underexplored. Drawing on ethnographic work in clinical settings, conferences, and 30 in-depth interviews with healthcare providers, I argue that family-centered gender-affirming care has emerged in China as providers strive to balance global ideals of “good” trans medicine with the constraints of the local healthcare system. While international standards assist providers in adopting a less pathologizing and binary view of care, they provide limited practical guidance for navigating local social and institutional challenges. Faced with a lack of legal and institutional support, providers increasingly rely on family members' involvement to mitigate medical dispute risks. This reliance manifests in two forms: restrictive gatekeeping, where care is delayed or denied based on family members' attitudes and providers' assessment of transgender adults’ ability to lead a “normal life,” and affective gatekeeping, where providers use psychological support and gender diversity education to involve family members as caregivers. These findings enrich sociological studies in global health by illustrating how the interactions between global norms and local healthcare systems can both alleviate and reproduce barriers to care. •Global norms around gender-affirming care are adapted to align with China's local healthcare infrastructure.•Healthcare providers embrace a more inclusive, non-binary approach to trans medicine.•Social and institutional challenges undercut the practical implementation of global norms around gender-affirming care.•Family involvement in gender-affirming care reproduces medical gatekeeping and barriers to access.