‘We just want the best for this child’: contestations of intersex/DSD and transgender healthcare interventions

Abstract

Intersex/DSD and transgender healthcare for children and adolescents has increasingly become a topic for public and academic debate. Key contestations concern early healthcare interventions in intersex/DSD care and 'cautious gatekeeping' in transgender care. With this article, which is based on an integrative literature review and expert interviews, we offer more insight into these debates, by mapping and comparing the arguments used by different stakeholders in both fields. Our analytical comparison of the debates reveals that contradictory perceptions of gender, the malleability of bodies and the autonomy of children/adolescents guide the arguments. While medical and psychological research may provide valuable input to further the debates, they remain inherently ethical and interwoven with gendered norms and expectations. This necessitates critical inter-and multidisciplinary conversations both in healthcare and in academic research.

The psychology of people with variable sex characteristics/intersex

“…Research on intersex shaped contemporary transgender medicine [4,5], but the norm towards surgery on VSC contrast with norms delaying surgery for trans youth rests on multiple contradictions [45]. The interdisciplinary field of "intersex studies" is expanding (see recent special issues of Sex Education, Culture, Health, & Sexuality; Psychology of Sexualities Review, and Transgender Studies Quarterly).…”

Wiedza i postawy studentów – przyszłych nauczycieli – w zakresie interpłciowości i transpłciowości

“…Ma to szczególne uzasadnienie, gdy weźmie się pod uwagę twierdzenie Marijke Naezer et al (2021), którzy wskazują, że interpłciowa i transpłciowa opieka zdrowotna dla dzieci i młodzieży coraz częściej staje się tematem debaty publicznej i akademickiej. Ich analizy porównawcze pokazują, że sprzeczne postrzeganie płci, plastyczności ciał i autonomii kieruje normami i oczekiwaniami dotyczącymi płci.…”

“…Dodatkowo psychologowie i psychiatrzy twierdzą, że pewien poziom "stabilności psychicznej" powinien poprzedzać interwencje zdrowotne osób transpłciowych. Adwokaci, aktywiści i eksperci uważają, że może to działać odwrotnie (Marijke Naezer et al, 2021).…”

Doing and undoing transgender health care: The ordering of ‘gender dysphoria’ in clinical practice

“…Body and identity, in this way, are both understood as stable and distinguishable categories that can, or could not be aligned with one another in terms of gender (van Eijk, 2014; see Sadjadi, 2019). Distinguishing who is ‘truly’ trans and who is not then becomes the task of the ‘gender specialist’ (Pearce, 2018), a kind of practice often referred to as the ‘gatekeeping’ of transgender health care (Naezer et al., 2021; Shuster, 2016, 2021; Speer & Parsons, 2006; Whitehead et al., 2012). Arguably, a cultural discourse calling for greater pushbacks against trans rights could further intensify these kinds of medical practices (see for instance MacKinnon et al., 2021).…”