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Purpose: We respond to a call for studies of “embodied experiences of stigma in context” by investigating how transgender embodiment shapes perceived needs for access to and experiences of “sex-specific” cancer screenings (SSCS) (e.g., breast and prostate exams, Pap smears) in the North American healthcare system.

Design/Methodology/Approach: We analyze data from semistructured interviews with a diverse sample of 35 transgender-identified adults. Based on thematic narrative analysis, we explore four themes in relation to embodiment: discrimination; discomfort and hyperawareness of genitalia; strategic reframing and active management; and SSCS health care encounters as positive and gender affirming.

Findings: In relation to SSCS, transgender individuals experience discrimination, do emotion work, and actively manage situations to obtain needed health care, and sometimes forego care because barriers are insurmountable. Health care providers' responses to transgender embodiment can disrupt health care encounters, but they can also facilitate access and create opportunities for affirmation, agency, advocacy, and new forms of interaction. Embodiment- and gender-affirming interactions with health care providers, which varied by gender, emerged as key influences on participants' experiences of SSCS.

Research Limitations/Implications: Our sample primarily includes binary gender-identified individuals, and while our interview guide covered many topics, the SSCS question did not explicitly reference testicular exams.

Practical Implications: Cancer prevention and detection Cancer prevention and detection require health care professionals who are prepared for differently embodied persons. Preventive cancer screenings are not “sex-specific”; they are relevant to individuals with medically necessary needs regardless of gender identity or embodiment.

Social Implications

Originality/Value: Few medical sociologists have focused on transgender embodiment. Findings enhance our understanding of how transgender embodiment and minority stress processes influence access to needed SSCS.

Recent research finds that youth who identify as transgender or gender-expansive are disproportionately incarcerated in juvenile justice systems and are treated differently from their non-trans peers (Himmelstein and Brückner, 2011; Hunt and Moodie-Mills, 2012; Irvine, 2010; Mitchum and Moodie-Mills, 2014). Juvenile justice systems have paid little attention to this group of young people in terms of their unique service needs and risk factors. Using qualitative methods, the researchers analyze in-depth interviews and focus group findings from formerly incarcerated trans youth in juvenile justice settings to better understand their experiences. This paper aims to examine the challenges for young people, and, as well as considered recommendations for juvenile justice professionals to study toward making changes in policies, practices and programs that are needed to support young people who are transgender or gender expansive.

Using qualitative, case examples and descriptive analysis, this paper describes the experiences of trans youth in juvenile justice settings and studies toward developing models of promoting trans-affirming approaches to enhance juvenile justice institutions for trans and gender-expansive youth placed in them. The paper describes the evolution of an approach used by the authors, in New York state juvenile justice settings to increase a trans-affirming perspective as a central role in the organization’s strategy and design, and the methods it is using to institutionalize this critical change. Findings culled from the focus groups and in-depth interviews with 15 former residents of juvenile justice settings and several (3) key staff members from the juvenile justice system, focusing on policies, practices and training models are useful tools for assessing progress and recommending actions to increase the affirming nature of such systems. At its conclusion, this chapter will provide clear outcomes and implications for the development of policies, practices and programs with trans and gender expansive youth in juvenile justice systems.

Finding are conceptualized in six thematic categories, namely, privacy, access to health and mental health care, the difference between sexual orientation and gender identity, name and pronoun use, clothing, appearance and mannerism, and housing issues.

This study is limited as it focuses on formerly incarcerated youth in the New York City area.

The following implications for practice stemming from this study are as follows: juvenile justice professionals (including judges, defense attorneys, prosecutors, probation officers and detention staff) must treat – and ensure others treat – all trans and gender-expansive youth with fairness, dignity and respect, including prohibiting any attempts to ridicule or change a youth’s gender identity or expression. Having written nondiscrimination and anti-harassment policy is also essential. These policies can address issues such as prohibiting harassment of youth or staff who are trans or gender expansive, requiring the use of respectful and inclusive language and determining how gender rules (e.g. usage of “male or “female” bathrooms, gender-based room assignments) will be addressed for transgender and gender-nonconforming youth. Programs should also provide clients and staff with training and helpful written materials. Juvenile justice professionals must promote the well-being of transgender youth by allowing them to express their gender identity through choice of clothing, name, hair-style and other means of expression and by ensuring that they have access to appropriate medical care if necessary. Juvenile justice professionals must receive training and resources regarding the unique societal, familial and developmental challenges confronting trans youth and the relevance of these issues to court proceedings. Training must be designed to address the specific professional responsibilities of the audience (i.e. judges, defense attorneys, prosecutors, probation officers and detention staff). Juvenile justice professionals must develop individualized, developmentally appropriate responses to the behavior of each trans youth, tailored to address the specific circumstances of his or her or their life.

Providing trans-affirming services to youth in juvenile justice settings is a matter of equity and should be the goal strived for by all systems that care for these young people. Helping trans and gender-expansive youth reenter and reintegrate into society should be a primary goal. There are many organizations and systems that stand ready to assist juvenile justice systems and facilities in supporting trans and gender expansive youth in their custody and helping them to rehabilitate, heal and reenter a society that welcomes their participation and where they can thrive and not just survive.

The paper is original in that it examines the lived experiences of trans and gender-expansive youth in juvenile justice systems. An area, which has not been fully explored in the professional literature.

The treatment and placement of transgender individuals within the UK prison system has garnered considerable political and media attention. The purpose of this paper is to present an analysis of the experiences of three transgender women located within a male, category C prison in England.

Participants were interviewed and their accounts analysed using interpretative phenomenological analysis.

Three overarching themes emerged from the data set: participants’ experiences of transition; their identity within custody and the challenges associated with presenting as female within a male establishment; and what they perceived as their fight against the prison system which encompassed a fight for their rights alongside a daily struggle against harassment, victimisation and discrimination.

Three participants were interviewed which impacts the generalisability of the findings. Implications link to the care and management of transgender prisoners.

The care and management of transgender prisoners is a complex issue. This paper contributes to the discussion on how best to support and care for this group of service users who are arguably amongst the most vulnerable within the prison system.

Findings are discussed in relation to policy, management and safeguarding of transgender prisoners within the UK prison system. Recommendations are made regarding their placement and management in prison.

There are limited accounts from transgender prisoners regarding their experiences in prison. This paper aims to address that gap.

Over the past decade, there has been an increase in the number of transgender adolescents that receive gender-affirming hormones. While the long-term repercussions of taking hormones are understudied, it is possible that one of the impacts is infertility. Although infertility is not definite, healthcare professionals are still responsible for discussing fertility preservation with transgender adolescent patients, which encourages a population of young people to determine whether or not they want to biologically have children in the future. Drawing on in-depth interviews with healthcare professionals, parents, and transgender adolescents, this study explores the thoughts and perceptions pertaining to fertility and how these three groups work with one another throughout transition. My findings show that (1) adult participants (parents and healthcare professionals) have mental barriers, which include fear of regret and grief over the loss of anticipated biological motherhood, (2) there is a delay in the conversation happening between the healthcare professionals, parents, and trans adolescents, and (3) trans adolescents reject fertility, but are open to building a family. I argue that cisnormative and transnormative ideologies overshadow these conversations, which could result in limiting the potential for queer biological parenthood. The chapter ends with suggestions for how to make conversations pertaining to fertility preservation more expansive to dismantle transnormativity.

Purpose – To examine debates within the transgender rights movement over the GID diagnosis in order to demonstrate how diagnosis can be resisted as a source of stigma and social control at the same time that it is embraced as a means of legitimating experience and gaining access to resources, including medical services.

Methodology/approach – This chapter draws on qualitative data from: in-depth interviews with transgender rights activists and advocates, participant observation in transgender health care and activism settings, and content analysis of print and web-based materials on transgender health.

Findings – Transgender rights activists and advocates overwhelmingly reject the pathologization of gender variance. However, some actors advocate complete demedicalization, while others advocate diagnostic reform. Actors' advocacy for each position is influenced by the perceived costs versus benefits of diagnosis.

Social implications – The findings of this research shed light on the multiple and often contradictory effects of diagnosis. Diagnoses can both normalize and stigmatize. They can function to allow or deny access to medical services and they can support or act as barriers to legal rights and protections. Understanding these contradictory effects is essential to understanding contests over diagnosis, including the contemporary debate over GID.

Originality/value of paper – Through examination of an intra-constituent contest over diagnosis, this research demonstrates the need to distinguish medicalization from pathologization and illustrates the importance of examining the multiple and contradictory effects of diagnosis, both in and outside of medical settings.

This chapter examines the surgical body modification experiences of transgender and cisgender people in the United States. It analyzes how surgery consumers with different gendered histories pursue “enhanced” embodiment. Both cisgender and transgender people obtain similar surgeries, but their procedures are differently regulated. Based on 40 in-depth interviews, this chapter compares the presurgical and postsurgical experiences of transgender and cisgender people. The findings show that cisgender and transgender people felt similarly about their bodies before surgery and reported corresponding cosmetic and psychological motivations for surgery. Both groups also had comparable postsurgical outcomes and used surgery to actualize a more desirable gendered embodiment. Ultimately, surgery resulted in changed gendered embodiment that enhanced the self for both groups. It could be psychologically transformative for cisgender people and provide more of a cosmetic effect for transgender people. These findings complicate disparate regulations of transgender and cisgender surgeries. They highlight surgeries as body technologies that enhance gendered embodiment allowing both cisgender and transgender consumers to articulate gendered concepts of the self.

Purpose/approach: This introduction provides an overview of the themes and chapters of this volume.

Research implications: The chapters in this volume present original research employing empirical and textual methods illustrating the complex responses and policy challenges posed by contemporary understandings and misunderstandings of the nature of gender. Various forms of gender panic and responses to it within individuals, institutions, national states, and the world society are explored.

Practical and social implications: Research demonstrates that gender panic can lead to potentially harmful reactions and fruitless policies that reinforce rather than dismantle the gender binary, thereby, impacting vulnerable members of societies.

Value of the chapter: The chapter and the volume are intended to illustrate the nature of current gender panics and related policies and to encourage further scholarship with the goal of promoting greater understanding as well as developing constructive solutions to issues raised.

In this chapter, we explore the lived experiences of transgender and gender non-conforming (TGNC) prisoners, arguably the most vulnerable minority in the prison estate, using the data from our correspondence study with transgender women and non-binary individuals incarcerated in male establishments in England and Wales. We provide a brief review of the extant literature, describe the English prison system and the regulations concerning transgender prisoners, and analyze two axes of vulnerability of TGNC prisoners: social (stemming from relationships between prisoners) and institutional (resulting from the prison regime). Along the social axes, we find, in contrast with prior research, that our respondents defied the stereotypes of trans prisoners as submissive to males in a hypermasculine prison society and as involved primarily in abusive relationships. Along the institutional axes, we find that, despite the progressive by international standards transgender prison regulations, prisoners were subject to vicissitudes in treatment that negatively affected their ability to express their gender and their health. Focusing on access to gender-affirming items (clothing, prosthetics, make-up) and gender-affirming medical treatment, we develop recommendations for the prison service that could improve the conditions of confinement for TGNC prisoners.

Purpose: To consider the extent to which the legal recognition of non-binary gender has the potential to disrupt the gender binary.

Methodology/Approach: This chapter will employ case study as method, focusing on recent changes to Australian law and policy, which introduce a third gender category. I rely on the work of queer theorists on normativity and recognition as a theoretical framework and on the work of social scientists on transgender people as evidence.

Findings: This chapter finds that while there is much to be celebrated about increasing alternatives to the dominant categories of male and female, the legal recognition of non-binary gender may in fact serve to conceptually purge the dominant gender categories of non-conforming elements while simultaneously masking the ways in which institutions of regulatory power continue to demand conformity with normative standards of gender.

Research Limitations: Since few non-binary individuals in Australia have adopted the X marker the implications laid out in this paper are speculative. The experiences of non-binary individuals present an important avenue for further research.

Practical Implications: I recommend, as an alternative to further gender classifications, that we should seek to minimize the degree to which membership of a particular gender category is used to distribute rights and privileges.

Originality/Value of Paper: This chapter advances the literature on non-binary gender, contributes to existing queer and feminist analyses of the gender binary and extends work on normativity to legal recognition of alternative genders.