This paper examines the transnational political economy underpinning the constitution of healthcare regimes aiming to address gender variance and targeting transgender people. In the history of ‘transsexual healthcare’ the relationship between medical knowledge and financial profit was never linear. Since medical technologies, such as feminizing and masculinizing hormonal therapies and surgeries, became available and medical protocols were established (in some countries already in the 1950s), accessing gender transition has been facilitated, namely to those fitting the diagnostic criteria of “transsexualism” and “gender identity disorder” (substituted by “gender dysphoria” in DSM V). Simultaneous, however, treatments were made costlier. Two fundamental reasons have been found to underpin the inequalities in the access to trans healthcare. Firstly, the rigid psychiatric categories for understanding gender variance contributed to exclude some individuals. Depathotologization and the right to gender self-determination have therefore been central for LGBTQ+ and trans activism as a trans politics for the affirmation of gender identities gained momentum. Secondly, the historical decline of the welfare state made medical procedures increasingly inaccessible for lack of coverage by national health systems or insurances. Consequently, and along class lines, opportunities for expanding a global market of privatized trans medical-care filled the gap, reproducing inequality at the expenses of a political economy for social and gender justice. Drawing on qualitative fieldwork with trans people and healthcare professionals in Portugal and the United Kingdom, we argue that the commodification of health at the global level impacted protocols and standards of care leading to the commodification of trans bodies.

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trans-related healthcare,health-care regimes,gender politics,capitalism and welfare-state,biopolitics