Florence Ashley’s research while affiliated with University of Alberta and other places

Background: Gender assessments are often required to access gender-affirming medical interventions. These assessments are typically defended as a way of preventing regret, offering a compromise between the interests of trans and detrans people. Whether they do is integral to ongoing debates about models of care in transgender health. Methods: Building on previous work demonstrating the inefficacy of gender assessments, this article explores the impact of gender assessments and argues that they are detrimental to detrans people. Results: Assessments appear to be detrimental to detrans people because they disincentivize honesty and authenticity, inhibit gender exploration, increase shame and anger associated with detransition, foster transnormativity, hinder the development of a strong therapeutic alliance, and diminish the quality of informational disclosure. Conclusion: Given the detrimental consequences of gender assessments, clinicians should reconsider gatekeeping practices in favor of supporting patient decision-making and offering better care to people who detransition.

Purpose of Review This study analyzes literature on sexual orientation and gender identity or expression change efforts (SOGIECE) settings, perpetrators, methods, and timing of exposure to inform and improve the effectiveness of SOGIECE prevention efforts. Recent Findings We identified 41 unique studies conducted in 14 countries during 2000–2024. Primary categories of SOGIECE perpetrators included (1) clinicians/healthcare settings (secular), (2) other public bodies, (3) religious, (4) social circles, and (5) “troubled teen industry.” The most common SOGIECE modalities were gender role enforcement (66%), prayer (59%), group-based practices (53% of studies), individual secular counseling (41%), removing demons (41%), religious/pastoral counseling (38%), sexual abstinence (38%), encouragement of heterosexual relationships (38%), and aversion therapies (34%). Among 6,164 participants, 60% were < 18 when they were first exposed to SOGIECE. On average, participants experienced SOGIECE for 2–5 years, with some attending SOGIECE for 10 + years. Summary Contemporary SOGIECE are diverse in their approaches and settings, necessitating multifaceted prevention strategies, including educational and regulatory interventions to address SOGIECE not immediately recognizable as such. More resources are required for SGM who may experience prolonged exposure to SOGIECE.

In this essay, I theorize genderfucking as a critical legal methodology. Genderfucking is defined by its focus on the needs and experiences of those who ‘fuck’ with gender, resisting attempts at gender governance through laws, policies, and practices. Adopting a politics of messiness, genderfucking is critical of recognition and calls into question the state’s legitimacy in defining and policing gender categories. Genderfucking offers a rich and fertile approach for analyzing a social, political, and legal world indelibly marked by regimes of gender and, in so doing, steps on the path towards gender liberation.

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these Standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender-diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH's worldwide mission and scope. Method: This paper employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound.

Gender assessments are traditionally required before accessing gender-affirming interventions such as hormone therapy and transition-related surgeries. Gender assessments are presented as a way of preventing regret experienced by some people who reidentify with the gender they were assigned at birth after medically transitioning. This article reviews the theoretical and empirical foundations of commonly used methods and predictors for assessing trans patients’ gender identity and/or dysphoria as a condition of eligibility for gender-affirming interventions. We find that the DSM-5 diagnosis, taking gender history, standardized questionnaires, and regret correlates rely on stereotyping, arbitrary, and unproven considerations and, as a result, do not offer reliable ways of predicting future regret over-and-above self-reported gender identity and embodiment goals. This finding is corroborated by empirical data suggesting that individuals who circumvent gender assessments or pursue care under an informed consent model do not present heightened rates of regret. The article concludes that there is no evidence that gender assessments can reliably predict or prevent regret better than self-reported gender identity and embodiment goals. This conclusion provides additional support for informed consent models of care, which deemphasize gender assessments in favor of supporting patient decision making.