"We have knowledge that is unique": Patient activism and the promotion of trans-inclusive primary care

Despite growing visibility of the trans population in Israel, there has been limited research on trans healthcare in a local context, particularly in the field of primary care medicine. Primary care encompasses services provided in locally distributed clinics and has a crucial role in providing both preventive and specialized healthcare. The aim of this study is to outline barriers to trans-inclusive primary care and measures employed by the trans community to overcome them. Biopower and counter-conduct are used as analytical frameworks to examine the trans-exclusionary features of the Israeli healthcare system and steps taken to resist it. To examine these issues, 19 medical care professionals and 20 trans people and activists were interviewed, and a variety of relevant texts were analyzed. Our results indicate trans-exclusionary features in primary healthcare, such as ambiguity regarding trans-inclusive services offered, sex-specific treatments, and lack of medical training programs dedicated to the trans population. To overcome these difficulties, the Israeli trans community has accumulated communal experiential knowledge and transferred it to physicians and policymakers in a localized and informal manner. We argue that by using informal practices, the trans community can provide support and information to its own members as well as operate alongside power systems, albeit in a slow and lengthy manner. More generally, the findings of this study highlight howf patient activism is employed by marginalized populations, who face not only health disparities, but institutional discrimination as well.