Currently, no word exists in our vocabulary for the broad category which includes being trans and being cis. To address this gap, I propose the adoption of a new term: gender modality. Gender modality refers to how a person’s gender identity stands in relation to their gender assigned at birth. It is an open-ended category which includes being trans and being cis and welcomes the elaboration of further terms which speak to the diverse experiences people may have of the relationship between their gender identity and gender assigned at birth.
Keywords: transgender; terminology; aspects of gender
In recent years, the suggestion that over 80% of trans and gender creative children will grow up cisgen-der has been strongly criticized in the academic literature. Although concerns over the methodology of these studies, known as desistance research, has shed considerable doubt regarding the validity of the reported number, less attention has been paid to the relevance of desistance research to the choice of clinical model of care. This article analyzes desistance research and concludes that the body of research is not relevant when deciding between models of care. Three arguments undermining the relevance of desistance research are presented. Drawing on a variety of concerns, the article highlights that “desistance” does not provide reasons against prepubertal social transition or peripubertal medical transition, that transition for “desisters” is not comparably harmful to delays for trans youth, and that the wait-and-see and corrective models of care are harmful to youth who will grow up cis. The assumed relevance of desistance research to trans youth care is therefore misconceived. Thinking critically about the relation-ship between research observations and clinical models of care is essential to progress in trans health care.
Keywords: transgender youth; gender dysphoria; desistance; medical transition; social transition
There are over 1 million transgender people living in the United States, and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.
Simpson’s paradox refers to cases when trends found in the data disappear or inverse when groups are aggregated. Because reported data are used to guide policymaking, understanding and being able to identify instances of Simpson’s paradox are crucial to LGBTQ+ policy. This article offers a theoretical introduction to Simpson’s paradox before looking to a recent LGBT poverty study as an example of the paradox and of its dangers in the context of LGBTQ+ policy. The study found that the aggregate of cisgender bisexual women was much poorer than other cisgender LGB groups and comparable in poverty levels to trans respondents, but the pattern was largely absent from age-disaggregated data—the aggregate pattern emerged from the comparatively young age of cisgender bisexual women in the study. Some thoughts are offered on how researchers can best mitigate the impact of Simpson’s paradox on policymaking as well as on how data users should engage with statistics to avoid distortions in the decision-making process.
Keywords: LGBTQ+ policymaking; Simpson’s paradox; statistics; age; sexual orientation; gender
A recent paper by Teresa Baron and Geoffrey Dierckxsens (2021) argues that puberty blockers and hormone therapy should be disallowed before adulthood on prudential and consent-related grounds. This response contends that their argument fails because it is predicated on unsupported premises and misinterpretations of the available evidence. There is no evidence that a large proportion of pubertal and postpubertal youths later discontinue medical transition. Meaningful assent is a viable and commonly accepted alternative to meaningful consent in paediatric bioethics. And finally, the primary purpose of transition-related interventions is to actualise youths’ gendered self-image, not treat an underlying mental illness.
Keywords: transgender youth; informed consent; bioethics; medical transition; gender-affirmative care
Jurisdictions increasingly recognize ‘X’ as a legal gender marker alongside ‘M’ and ‘F’, offering an alternative to those whose gender identity falls outside or in excess of the man/woman dichotomy. This chapter explores the justifications and limitations of ‘X’ as a gender marker, arguing that it does not place non-binary people on an equal footing to men and women since it serves as a single, catch-all option for a wide range of non-binary identities. The chapter the explores the possibility of expanding the availability of gender markers to reflect the full diversity of non-binary people but suggests that it would be rejected as absurd due to the ongoing role of gender markers in preserving cisnormativity. It concludes that abandoning gender markers may be the only fully inclusive option. For gender liberation to come within reach, we must imagine a future without gender markers.
Using the ‘Informed Consent Model’ (ICM), clinicians prescribing hormone therapy to trans patients do not require a letter from mental health professionals attesting to their gender identity and/or gender dysphoria. Despite their prevalence and history in North America, ICMs remain poorly understood by medical professionals and are often treated as a monolithic concept. This article surveys the differences between ICMs along a continuum ranging from Strong ICMs to Weak ICMs to No-Letter Models.
Keywords: transgender; medical transition; informed consent; hormone replacement therapy
Dans cet article, j’applique le droit de la responsabilité et de la déontologie professionnelle aux approches thérapeutiques vis-à-vis des jeunes trans et créatif·ve·s dans le genre. J’explique que sous ces régimes légaux, l’approche correctrice (qui vise à prévenir les identités trans) sont fort à penser illégales alors que l’approche de l’attente vigilante (qui vise à délayer la transition sociale et/ou médicale) se rapproche de plus en plus de l’illégalité puisqu’elle est fondée sur des raisonnements cissexistes. Seule l’approche trans-affirmative respecte tant l’esprit que la lettre du droit de la santé.
Keywords: enfants trans; approches cliniques; droit de la santé; déontologie professionnelle
Trans reparative therapy is an umbrella term for sustained efforts that seek to discourage behaviors associated with a gender other than the one assigned at birth and/or promote gender identities that are aligned with the person’s gender assigned at birth. It is predicated on the view that being transgender or markedly gender nonconforming is pathological and that transitioning should be avoided if at all possible. Reparative therapies are known by many names: conversion therapy, reparative practices, the corrective approach, the psychotherapeutic approach, and the pathology response approach. Different terms highlight different aspects and subtypes of reparative therapy. This entry addresses the practices’ current social context, the differences and similarities between reparative therapy targeting sexual orientation versus gender identity, the defining features of contemporary approaches, the practices’ harmfulness and unethicality, and the legal regulation of reparative therapy.
Gender information management is becoming an area of increased concern and tension in recent years due to the parallel rise of trans visibility and the increase of government surveillance. With this Article, I aim to provide a structured and principled analytical framework for managing gender information in a manner that is responsive to different institutional contexts. Part I sketches the ethical considerations and principles which guide my recommendations. Whereas ethical considerations are the values which underlie my recommendations—the why—the proposed principles provide us with conceptual tools to bridge the why, when, and how of gender information management. Part II explores four different contexts in which gender information should be gathered and recorded and makes recommendations specific to each of those contexts. These four contexts are: administrative records, special programs, aggregate assessment, and research. Part III sketches how and what—when justified under the recommendations—gender information should be requested, recorded, and recounted.
The names of cases in in rem actions—an action directly over a thing rather than against a person—are frequently humorous. Just look at South Dakota v. Fifteen Impounded Cats! However, there are distinct differences in the volume of humorous styles of cause between the United States and Canada. After confirming that the Unites States indeed has funnier in rem styles of cause than Canada, this paper seeks to understand the reason behind this discrepancy. Unexpectedly, the answer revealed itself to be neither the United States’ greater police powers nor remnants of British haughtiness in Canada…
Keywords: funny case names; in rem actions; humorous law; civil forfeiture
How to account for participants’ psychological and emotional exhaustion with research has been under‐explored in the research ethics literature. Research fatigue, as it is known, has significant impacts on patients’ well‐being and their ongoing and future participation in studies. From the perspective of researchers and researched communities, research fatigue also creates selection bias and opportunity costs, negatively impacting the collective scientific enterprise. Institutional Review Boards should systematically consider research fatigue during the research approval process and strive to mitigate it.
Keywords: research fatigue; over-researched communities; research ethics; ethics approval; IRB; REB
Trans health is an irreducibly political area of medicine. Clinicians must become aware of that politicization and actively engage with trans communities in humble, attentive and supportive ways, using their power to better trans lives across the board. Such an approach has fourfold benefits: 1) it positions trans communities as knowers and subjects in their own healthcare; 2) it fosters a strong therapeutic relationship; 3) it grants access to otherwise inaccessible information; and 4) it responds to social and political determinants of health. After reviewing these benefits, we discuss what fruitful engagement with trans communities would look like.
Keywords: transgender, gender dysphoria, community medicine, primary care, family medicine, politics
Quelle fonction ont les pratiques citationnelles dans l’académie ? Quand citons-nous ? Qui citons-nous ? Cet article tente de reconcevoir nos réponses à ces questions en critiquant l’esprit hiérarchique qui infuse les pratiques citationnelles dominantes dans l’espace universitaire et en offrant une approche aux citations centrée dans l’érotisme et la créativité artistique.
What are the functions of citational practices in academia? When do we cite? Who do we cite? This article seeks to rethink our answers to those questions by criticising the hierarchical spirit that infuses mainstream citational practices in university, and by offering a novel approach to citations grounded in eroticism and artistic creativity.
Le langage du droit crée le sujet transgenre en tissant une conception légale du sexe ou genre, une conception qui a longtemps exclut les personnes trans. L’autaire propose d’analyser le langage du genre en droit québécois pour en faire ressortir deux phases conceptuelles. À travers ces deux modèles – l’un médical et l’un minoritaire – le droit québécois relate l’existence des personnes trans en premier lieu comme un moment essentiellement transitoire et liminal entre deux états d’être binaires, alors que le modèle minoritaire y voit plutôt une réalité d’exception, se définissant par son opposition au cadre social majoritaire. Ces deux visions s’enchaînent historiquement et révèlent l’évolution récente de la conception négative des personnes trans comme minorité qui ressort des avancées législatives récentes en droit québécois. L’autaire conclut que, malgré les avancées, il reste plus à faire pour réellement inclure les personnes trans comme sujets habituels de droit.
Mots clés: genre, transgenre, approches critiques, droit à l’égalité, sexe, sujet de droit
The defence of voluntary intoxication, which has been back in the news as a result of the recent decision of the Ontario Court of Appeal in R v Sullivan, is frequently decried as antifeminist. Pursuant to the defence, defendants who acted while intoxicated to the point of automatism or severe psychosis may be acquitted. This article seeks to complicate feminist perspectives on the voluntary intoxication defence, showing that the issue of voluntary intoxication is far more nuanced than some suggest. After summarizing the state of the law of the voluntary intoxication defence and reviewing its prevalence in the jurisprudence, this article critically reflects on the voluntary intoxication defence and highlights how its removal contributes to the criminalization of mental illness and weakens crucial criminal law standards used to protect the most vulnerable — both problems from a feminist standpoint. The article concludes that a feminist analysis of the voluntary intoxication defence requires more nuanced policy discussions than those that have prevailed in the public sphere.
Keywords: voluntary intoxication defence; automatism; criminalization of mental illness; principles of fundamental justice; carceralism; feminism
In recent years, opponents of the gender-affirmative approach to trans youth have argued that it bears homophobic roots and may be tantamount to conversion therapy. This argument is mistaken. In this article, I first argue that there is no evidence that social and/or medical transition is motivated by homophobia. Contrary to the critique’s tacit premise, many if not most trans people are LGBQ following transition. Furthermore, despite social progress in the last decade, transphobia remains more common than homophobia. Second, the gender-affirmative approach is fundamentally dissimilar to conversion therapy, unlike clinical approaches that oppose affirmation and seek to prevent transition. The comparison to conversion therapy relies on a superficial understanding of sexual orientation, such that a change of label (e.g. straight, bisexual, gay, lesbian) is equivalent to a change of sexual orientation even without changes to the targets of sexual attraction. By contextualizing conversion therapy in relation to trans youth care, I show that, on the contrary, conversion therapy has long focused on preventing transgender youth from growing up trans.
The term ‘rapid-onset gender dysphoria’ (ROGD) was coined in 2016 to describe an alleged epidemic of youth coming out as trans ‘out of the blue’ due to social contagion and mental illness. The term reflects a deliberate attempt to weaponise scientific-sounding language to dismiss mounting empirical evidence of the benefits of transition. This article offers an introduction to the theory of ROGD and its history, presents a detailed critique of the empirical and theoretical claims associated with the theory, and highlights structural concerns with the ROGD discourse. The article argues that claims associated with ROGD, including assertions of declining mental health and degrading familial relationships following coming out, are best explained by the leading ROGD study’s recruitment of parents from transantagonistic websites against a background of growing visibility and social acceptance of trans people. ROGD theory is best understood as an attempt to circumvent existing research demonstrating the importance of gender affirmation, relying on scientific-sounding language to achieve respectability.
Keywords: rapid-onset gender dysphoria; social contagion; trans youth; gender affirmation
Trans reparative therapy refers to a range of practices seeking to discourage behaviours associated with a gender other than the person’s gender assigned at birth and or promote gender identities that are aligned with their gender assigned at birth. This thesis explores the legal regulation of trans reparative therapy. The first chapter situates debates surrounding trans reparative therapy in the contemporary Canadian context, explains the choice of ‘reparative therapy’ as a terminology, and defines trans reparative therapy. The second chapter explores the scope of trans reparative therapy bans by interpreting Ontario’s Bill 77, concluding that it prohibits any practice that discourage trans outcomes, and by offering a dual typology of trans reparative therapy bans. The third chapter provides a policy analysis of bans, responding to critiques levied against them, highlighting their limits and benefits, and drawing on sociological research to propose supplementary means of discouraging reparative practices.
In this article, the author argues that our current medical practices with regard to obtaining informed consent are inadequate. They do not require the systematic disclosure of information which is necessary to prepare for the surgery and what it comes with, but which would not impact the decision to undergo surgery. The article analyzes the two primary processes for obtaining informed consent, namely with and without a referral from a mental health professional, and sketches how both processes fall short of disclosing all relevant information. The author draws on personal experience and community knowledge to argue for an expansion of the notion of informed consent which is better adapted to the needs of patients who are preparing for the surgical process. They highlight how surgeons and mental health professionals are poorly situated to learn and transmit all actionable information and take note of the various barriers patients face in attempting to independently access this information. They then foreground the importance of community knowledge and interdisciplinary collaboration as central devices to meet the legal burden born by professionals tasked with obtaining informed consent and facilitating the informed consent process, as well as to improve the well-being of trans individuals who seek transition-related surgeries.
Keywords: transgender; informed consent; law; duty to disclose; surgery
The notion of gender dysphoria is central to transgender health care but is inconsistently used in the clinical literature. Clinicians who work in transgender health must understand the difference between the diagnosis of Gender Dysphoria as defined and described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the notion of this term as used to assess eligibility for transition-related interventions such as hormone-replacement therapy and surgery. Unnecessary diagnoses due to the belief that a diagnosis is clinically required to access transition-related care can contribute to stigma and discrimination toward trans individuals.
Keywords: transgender; access to health care; ethics of diagnosis; pathologization; gender dysphoria
Dans cet article, je commence en proposant un résumé des techniques existantes de français neutre. Ensuite, j'évalue les avantages et inconvénients de diverses approches. Enfin, je propose une nouvelle approche systématique au français neutre basée sur les travaux d'Alpheratz, auxquels j'ajoute mes propres modifications.
In this article, I begin by summarising the extant techniques of gender-neutral French. Then, I evaluate the advantages and disadvantages of various approaches. Finally, I propose a new systematic approach to gender-neutral French based on the work of Alpheratz, complemented by my own alterations.
Mots-clés: français neutre; language; grammaire; personnes non-binaires Keywords: gender-neutral French; language; grammar; non-binary people
In this letter to the editor, I comment on the controversy surrounding the disruption of Kevin Hsu's talk at the Society for the Scientific Study of Sexuality Conference. Responding to J. Michael Bailey and Bruce Rind who accuse critics of being ideologically-motivated, I highlight how the science/ideology dichotomy they present is a false one, and that science always retains a normative, value-infused element. Hsu and Bailey's support of the theory of autogynephilia is not pure science, but equally ideological. In light of science's ideological elements, I tentatively propose the notion of epistemic violence as a means of choosing between competing interpretations in scientific research involving marginalised populations.
In a previous article, I argued that assessment requirements for transgender hormone replacement therapy (HRT) are unethical and dehumanising. A recent response published by the Journal of Medical Ethics criticises this proposal. In this reply, I advance that their response misunderstood core parts of my argument and fails to provide independent support for assessment requirements. Though transition-related care may have similarities with cosmetic surgeries, this does not suffice to establish a need for assessments, and nor do the high rates of depression and anxiety justify assessments, especially given the protective role HRT plays towards mental well-being.
In a recent commentary published in The American Journal of Bioethics, Michael Laidlaw, Michelle Cretella, and G. Kevin Donovan argue that the watchful waiting is the leading clinical approach and that it disallows puberty blockers prior to 16 years old. In this response, I show that they misrepresent the literature. The leading approach is the gender-affirmative model, not watchful waiting, and the watchful waiting allows youth to take puberty blockers when they begin puberty.
Keywords: transgender youth; puberty blockers; watchful waiting; the Dutch approach
Gender identity clinics have reported unexplained shifts in assigned sex ratios in recent years. Recent attempts at explaining these shifts have often presumed that they reflect a shift in assigned sex ratios in the underlying transgender and gender diverse population. This letter to the editor challenges the assumption, highlighting that the disparity in size between gender identity clinic populations and trans and gender diverse communities makes it more likely that the shift in assigned sex ratios is attributable to a change in referral patterns due to sociocultural factors.
Keywords: gender identity clinics; sex ratios; demographics
Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the way in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences, as sustains an unjustified double standard in contrast to other forms of clinical care. Physicians should abandon this unethical requirement in favour of an informed consent approach to transgender care.
Youth explore their genders—both theirs and others’. Exploration is not only a vessel of discovery and understanding, but also of creation. Centring the notion of gender exploration, this article inquires into the ethical issues surrounding care for transgender youth. Arguing that exploration is best seen not as a precondition to transition-related care but as a process which can operate through transitioning, the article concludes that the gender-affirmative approach to trans youth care best fosters youth’s capacity for healthy exploration. Unbounded social transition and ready access to puberty blockers ought to be treated as the default option, and support should be offered to parents who may have difficulty accepting their youth.
Keywords: bioethics; transgender youth; social transition; medical transition; gender-affirmative care
In her article, Maura Priest argues in favour of legislation which would enshrine trans youth’s right to access puberty blockers without parental approval. In so arguing, she acknowledges the unlikelihood that such laws would be passed without a requirement that parents be notified. In this peer commentary, I argue that the proposed legislation should include measures for publicly-funded education and counselling of parents of trans youth. Although access to puberty blockers is necessary, it can also precipitate conflict within families, especially if notification is required. Given the disastrous impact of parental rejection and youth homelessness, any measures seeking to promote access to puberty blockers must be accompanied by harm-reduction measures targeting parents of trans youth who have difficulty accepting their child’s gender identity and transition. These measures can take many forms. Both supervised parent support groups and narrative ethics-inspired counselling should be considered as primary means of addressing parental hostility and rejection of their trans child.
Keywords:bioethics;policy; transgender youth; medical transition; puberty blockers
If I don’t tell you that I was assigned male at birth, as a transgender person, can I go to jail for sexual assault by fraud? In some jurisdictions like England or Israel, the answer is: yes. Previous arguments against this criminalisation have focused on the realness of trans people’s genders: since trans men are men and trans women are women, it is not misleading for them to present as they do. Highlighting the limitations of this position, which doesn’t fully account for the messiness of gendered experiences, the author puts forward an argument against the criminalisation of (trans)gender history non-disclosure rooted in privacy. Gender identity is a private matter and people should not be forced to figure it out or communicate it to others to have an intimate life. Mobilised in this context, privacy can be understood as a refusal of the state’s authority to order our gendered lives. The author argues that this mobilisation is compatible with leftist critiques of privacy. Finally, the author considers whether (trans)gender history non-disclosure is a criminal offence in Canada and concludes that it is not.
Keywords:criminal law; sexual fraud; privacy; discrimination; non-disclosure; human rights
In a recent article, Dubov & Frankel argue that facial feminization surgery should be deemed medically necessary insofar as it helps transgender people “pass” as cisgender, which is required for their wellbeing and ability to function. This peer commentary problematises their argument by pointing out how it constrains our understanding of trans embodiment to narratives of gender dysphoria, to the exclusion of narratives about gender euphoria and creative transfiguration, as well as by calling into question the value of facial feminization surgery for those who will never be able to pass as cis. With consideration to the diversity of trans experiences of the body and the variety of reasons why trans people desire facial feminization surgery, we invite policymakers to move away from justifications of insurance coverage that rely on the putative mutual exclusivity of medically necessary care and cosmetic care, arguing that aesthetic experiences of the self can be sufficiently ethically important to justify insurance coverage on their own. Under this theoretical frame, we can create space for insurance coverage while also resisting the gatekeeping that comes with medicalization.
Keywords: bioethics; insurance coverage; medical transition; transgender embodiment; facial feminization surgery
In a Letter to the Editor, “Gender Transitioning before Puberty?”, Steensma and Cohen-Kettenis (2011) cautioned against prepubertal gender transition by referring to two children assigned female at birth who, they say, had “transitioned when they were in elementary school” and subsequently struggled with returning to “their original gender role.” This letter to the editor criticises their argument, highlighting that it fails to account for the fact that the two youth had not socially transitioned in the usual sense of the term, and arguing that preventing youth from being gender non-conforming would be ethically questionable.
Keywords: bioethics; transgender youth; social transition; the Dutch approach; gender-affirmative care
The question of judicial protection of trans people has come to the fore in recent years, culminating in Bill C-16 which added gender identity and gender expression to the federal anti-discrimination and hate crime laws. In this article, the author contests the notion that anti-discrimination and hate crime laws are effective in mitigating anti-trans harassment, discrimination, and violence. Suggesting that the model of anti-trans acts which underlies anti-discrimination and hate crime laws is erroneous, the author argues that the law’s impact on trans well-being will be modest and that a careful analysis of anti-trans attitudes enables us to identify a number of more effective governmental avenues toward trans emancipation.
Keywords: criminal law; human rights; anti-discrimination law; hate crime laws; critical trans politics
Dans cet article, l’autaire explore la question de savoir si une obligation légale de respecter les pronoms et accords neutres existe en contexte scolaire francophone au Québec. Ille débute par un survol du contexte vécu par les personnes non-binaires francophones ainsi que de leurs besoins par rapport au respect des pronoms et accords neutres. Ensuite, ille analyse l’état actuel du droit relativement au harcèlement et à la discrimination envers les personnes trans en contexte scolaire et évalue la plausibilité qu’une obligation de respecter les pronoms et accords neutres soit retenue par les tribunaux québécois. Enfin, à la lumière des limites du droit, ille propose une approche stratégique concernant le respect des pronoms et accords neutres qui met l’accent sur le développement de politiques institutionnelles s’appuyant sur le droit.
Mots-clés: droits de la personne; droit à l'égalité; personnes non-binaires; pronoms; français