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How Healthcare Providers Hold Trans Patients Accountable to Medical Authority

Sexual and Gender Minority Health

ISBN: 978-1-83867-147-1, eISBN: 978-1-83867-146-4

Publication date: 15 January 2021


Purpose: We analyze how medical providers use accountability processes or the regulatory means through which individuals hold themselves or others accountable to social norms, to uphold their medical authority. We use the case of trans medicine because in this medical domain, providers often have little to no expertise and few are trained specifically in delivering trans medicine or working with trans patients. As a result, providers experience uncertainty and are left without the typical tools and expertise on which they depend in most other areas of medical decision-making.

Design/methodology/approach: We conducted in-depth interviews with 23 medical providers and observations of transgender healthcare conferences in the United States between 2012 and 2015.

Findings: Our work offers insight into the provider side of patient-provider encounters and medical decision-making in gender minority health. The first accountability strategy providers employed was to invoke the language of evidence as a method to maintain their authority, in spite of the paucity of scientific evidence that undergirds this emergent medical domain. The second strategy was to mandate compliance by holding trans people accountable to the expectation of acquiescing to medical authority.

Originality/value: We contribute to the scholarship on gender minority health by examining how high power actors use accountability processes to restore order in interactions with trans and nonbinary patients. We demonstrate how enforcement to expectations through accountability processes is a plausible, though oft-overlooked, dimension of health inequalities.




We wish to warmly thank Clare Forstie, Ellen Lamont, the anonymous reviewers, and the editors – Brea Perry and Allen LeBlanc – for insightful comments on versions of this manuscript.


shuster, s.m. and Bodenheimer, G. (2021), "How Healthcare Providers Hold Trans Patients Accountable to Medical Authority", LeBlanc, A.J. and Perry, B.L. (Ed.) Sexual and Gender Minority Health (Advances in Medical Sociology, Vol. 21), Emerald Publishing Limited, Leeds, pp. 231-252.



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