Speaking Through Silence: An Ethnographic Inquiry into the Communicative Experiences of Transgender and Gender Diverse People in Healthcare

This article explores the communicative experiences of transgender and gender diverse (TGD) people within contemporary healthcare systems, with a particular focus on remote and digitally mediated clinical encounters. Drawing from remote ethnographic fieldwork conducted in Italy, the study examines how voice—both as a literal and metaphorical construct—emerges as a central site of recognition, negotiation, and vulnerability. Participants reported structural misrecognition through bureaucratic disembodiment, misgendering, and symbolic erasure, particularly in administrative and telemedical contexts. The analysis foregrounds the affective labor and strategic communicative practices deployed by TGD individuals to navigate institutional asymmetries, including code-switching, silence, and micro-activism. The study contributes to existing scholarship on structural transphobia by emphasizing the discursive and relational dimensions of clinical encounters. It draws upon post-structuralist, sociolinguistic, and medical anthropological frameworks to conceptualize healthcare as a culturally mediated arena where gender identity is performed, contested, and at times, strategically withheld. Voice is theorized as both an epistemic resource and a site of contested legitimacy, particularly in telehealth settings where the absence of embodied presence intensifies communicative fragility. Findings underscore the necessity of institutional transformation through communicative justice, inclusive protocols, and a shift toward dialogic practices that affirm plural identities. Until such transformation is achieved, TGD individuals will continue to navigate care through silence, resilience, and linguistic improvisation. This article advocates for a reconceptualization of clinical listening—not as passive reception, but as an ethical and relational act essential to equitable healthcare.