Beyond the curriculum: negotiating power and knowledge in informal trans health educational initiatives.

The transgender community faces significant barriers in healthcare due to inadequate medical education and systemic discrimination, resulting in persistent health disparities and limited access to competent care. This study examines how informal educational initiatives, defined here as grassroots activities that operate outside formal medical curricula, serve as alternative strategies for addressing trans health knowledge gaps in medical education. Drawing on semi-structured interviews with 39 healthcare professionals, transgender individuals, and activists, as well as analysis of relevant documents and observations at lectures on transgender health, we apply boundary object theory to explore how these initiatives facilitate knowledge exchange across institutional boundaries. Our findings indicate that informal initiatives provide flexible platforms for engagement and learning, fostering direct dialogue and knowledge sharing between medical students, healthcare professionals and the transgender community. However, their broader impact is constrained by entrenched power dynamics and the lack of formal curricular integration, which limits their capacity for systemic change. This research offers novel insights by demonstrating that even well-intentioned educational practices can inadvertently reinforce exclusion through institutional gatekeeping. Our study demonstrates that while informal efforts can bridge some knowledge gaps, advancing health equity ultimately depends on institutional and policy reforms that embed community perspectives and expertise into medical education.