Trans Care Webs: A Review of Hil Malatino’s Trans Care

Hil Malatino’s Trans Care asks a seemingly simple question: What does care look like in trans lives? To be clear, Malatino isn’t asking how trans people are cared for. This is not a book about institutionalized forms of care or about how to make clinics, schools, social services, or public programs more trans-inclusive. Rather, this is a book about how trans people care for one another – via formal mutual aid projects, as part of informal collectives, and through what Malatino calls a “t4t [trans4trans] praxis of love.”^[1] Trans Care tries to find new ways of talking about care work and care ethics that can do justice to the communal care practices that sustain trans people on a day-to-day basis.

Trans Care begins and ends with the US medical-industrial complex. As Malatino writes, medicine is the “nexus of care most commonly associated with transness,” even as gender-confirming care remains “economically inaccessible, geographically dispersed, and rigorously gatekept.”^[2] What interests Malatino in this project, however, are the networks of care that trans people have created in response to medical refusals and institutionalized transphobia more broadly. Trans folks create “arts of living that make [their lives] possible” in a world that, at its best, is only “thinly accommodating” and that, more often, is just “devastatingly hostile.”^[3] Malatino is, of course, referring to the ubiquity of explicitly transphobic policies and the ever-present threat of anti-trans violence, but their focus in this book lies on less overt forms of oppression. Malatino takes great pains to show just how brutal everyday life can be for trans people in the United States as they make their way through a relentlessly cis-centric society. In the process, Trans Care brings into focus the creative and collaborative care practices that enable folks to endure these routine and, often, dehumanizing injustices.

The opening chapter, “Surviving Trans Antagonism,” offers an excellent introduction to the theme of “trans care” and to the pace and style of the book. Malatino covers a lot of ground in a mere eighteen pages: starting with reflections on the aftercare they expected to receive from friends following their upcoming top surgery; then shifting into an engagement with queer disability justice approaches to care labor; eventually moving into a critique of the callously alarmist tone of the 2018 New York Times article “‘Transgender’ Could Be Defined Out of Existence under Trump Administration”; and, finally, wrapping up with a discussion of why Fall Out Boy’s misogynistically emo music might appeal to transmasculine youth. In each chapter, Malatino deftly weaves together cultural analyses, personal experiences, and theoretical ruminations. Published as part of the University of Minnesota Press’s “Forerunners: Ideas First” series, Trans Care is barely eighty pages. Malatino embraced the spirit of the series and wrote a short book “where intense analysis, questioning, and speculation take the lead.”^[4] The result: a quick read that leaves you wanting more from Malatino.

This first chapter borrows Leah Lakshmi Piepzna-Samarasinha’s crip-femme-anarchist concept of a “care web” to describe the expansive networks of love, friendship, and solidarity on which trans lives depend.^[5] Care webs are a strategy for sharing the physical and emotional labor required to care for one another in the face of a shrinking welfare state and dwindling community resources. To avoid becoming alienating or exploitative, these webs must be cultivated intentionally. This is not easy. People must learn to communicate clearly about what they need and what they can offer while simultaneously unlearning the shame that they’ve been socialized to feel when asking for help. Malatino dedicates the rest of the book to exploring how trans care webs are woven, how they tear or shred, and how they are repaired and rewoven. Notably, Malatino leaves questions of disability behind in this chapter, not considering the particular experiences of sick or disabled trans folks, nor exploring the connections between trans and disability justice.

The next two chapters of Trans Care focus on the limits of existing frameworks for theorizing care labor. The second chapter, “Beyond Burnout,” looks at the way we talk about the toll this work takes on the people performing it. Malatino begins with the “voluntary gender work” that most (if not all) trans people habitually do – the largely unpaid labor of sharing referrals and resources, counseling partners and families (and other trans people’s partners and families), and educating the lawyers, social workers, and medical professionals who are supposed to be supporting them. This form of care work is exhausting in ways that Malatino feels cannot be captured by the concept of “burnout.” This concept comes from organizational psychology (a field primarily concerned with employee productivity) and assumes a hierarchical, nonreciprocal relationship between helpers and recipients. In this scenario, care only travels in one direction: from the professional helper to the dependent recipient. Helpers experience “burnout” when they become fatigued from the work of providing care to recipients. Such a framework cannot make sense of the horizontal exchanges and interdependent relationships that make up care webs – especially “when marginalized subjects engage in the work of making each other’s lives more possible.”^[6] What we need, Malatino insists, is a way of talking about the collective exhaustion experienced when the care work one performs isn’t just for others but is crucial to their own and their community’s survival.

The third chapter, “Theorizing Trans Care,” extends the critique of existing frameworks to feminist theories of care labor. Malatino calls out feminists for presuming a binary gendered division of labor, focusing on women’s domestic work, and locating that work within the heteronormative home. If we want to fully understand trans care webs, then we need to start with a “different set of locations and relations.”^[7] Malatino stresses the importance of paying attention to the places where trans care actually happens (e.g., bars, streets, clinics, classrooms, community centers) and accounting for the labor involved in piecing together familial or domestic units (i.e., the units that feminist thinkers often assume already exist). Moreover, Trans Care encourages us to abandon the fantasy that it is somehow possible to equalize care work. Detailed record keeping of who did what for whom does not guarantee a “fairer” exchange of labor. Instead, Malatino calls for a framework that recognizes how different people have different kinds of needs at different points in times and how a person’s capacity for caregiving will fluctuate over the course of their daily lives and across their lifetime. Malatino’s critical interventions in these two chapters resonate beyond the realm of trans care and have implications for any racially or economically vulnerable community struggling for liberation. That said, I would’ve appreciated further commentary on the racialization of care labor and the dynamics of cross-class and multiracial trans care webs.

In the fourth chapter, “Something Other than Trancestors,” Malatino shifts gears to reflect on the care ethics guiding their archival research. How can justice be done to the everyday trans lives that flash up in the historical record – through the stories shared in community newsletters or the anonymized case studies written by doctors? Malatino acknowledges the “sense of connection” they’ve felt with the minor figures they’ve encountered through their research, but they caution against mistaking a feeling of familiarity for evidence of sameness; these pasts might “slant rhyme” with trans presents, but they shouldn’t be claimed as a trancestorial “lineage.”^[8] Still, Malatino knows these earlier instances of trans worldmaking matter. Trans lives today are, in many ways, possible precisely because of the paths forged by earlier generations. The traces of trans-ness that haunt the archives can serve as a source of hope, a “resource for resilience,” and even “a roadmap for another way of being.”^[9] Feeling an obligation to these “ghosts,” Malatino urges researchers to tell the story of these lives with the utmost of care. Tending to the archive can become a gesture of “transtemporal solidarity” and a form of intergenerational trans care.^[10]

Finally, the fifth chapter, “Trans Care within and against the Medical Industrial Complex,” circles back to medical care. Malatino considers the now common practice of trans people launching crowdfunding campaigns to cover the costs of gender-confirming surgeries. They begin by situating social media and crowdfunding efforts within a longer history of trans organizing and information sharing: from support groups to print newsletters to the early internet’s listservs and newsgroups. But Malatino also draws attention to recent studies showing that young white binary trans men with significant social media capital tend to benefit the most from crowdfunding. Hinging medical care on what amounts to a popularity contest risks reproducing dominant hierarchies of “deservingness” – where already privileged folks enjoy a disproportionate degree of access and support.^[11] This is not to suggest that an ethical trans care praxis must turn its back on crowdfunding. Rather, Malatino imagines a “dual movement” where crowdfunding is accompanied by critiques of these imperfect workarounds and demands for a radical redistribution of health and wellness resources.^[12]

Yet, even as Malatino recognizes the urgent need for concrete institutional reforms, Trans Care puts forth a vision for trans politics that has little interest in mainstream LGBT agendas or calls for expanded rights and recognition. Within the vacuums of care created by institutional abandonment, trans survival and flourishing have come to depend on the weaving of elaborate webs of care and connection. What Malatino wants readers to understand is that these trans care praxes are a kind of prefigurative politics – a way of “building the new world in the shell of the old.”^[13] With this political vision in mind, Trans Care lays the conceptual groundwork needed for devising strategies to render trans care webs even more resilient and perhaps a little easier to sustain.

Liz Montegary

Liz Montegary is Associate Professor of Women’s, Gender, and Sexuality Studies at Stony Brook University. She is the author of Familiar Perversions: The Racial, Sexual, and Economic Politics of LGBT Families (Rutgers, 2018) and co-editor, with Melissa Autumn White, of Mobile Desires: The Politics and Erotics of Mobility Justice (Palgrave, 2015).

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