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Purpose: This chapter provides a contextualized understanding of the gendered anxieties expressed by elite sport regulators that motivated the formulation of sex testing policies in sport between 1937 and 1968. The focus is on complicating the claim that sex testing was first instituted to prevent explicit male bodies from fraudulently masquerading as women in sport. Rather, the chapter argues that sex testing policies were formulated in response to anxieties over sex binary pollution.

Methodology: The chapter is based on a genealogical study of the female category in elite sport, built on archival research conducted at the International Olympic Committee (IOC) historical archives and online newspaper archive collections.

Findings: Boundaries around female embodiment were navigated and written into sex testing policy in response to threats to presumed ideas around gendered and sexed normality in sport. These threats were embodied by athletes who polluted or crossed the border between female and male, to the extent that their bodies were rendered hermaphroditic, excessively masculinized, or hybrid. These bodies caused gendered anxieties for sport regulators, who reacted with policy responses that aimed to purify the sex binary from category pollution or sex abnormality.

Implications: As long as sex binary policing in elite sport continues, awareness of the contextual history of sex testing is essential for understanding the underlying ideas upon which sex binary policing in sport has been built.

Throughout the late 19th and early 20th centuries, one of the many techniques used by physicians and psychiatrists to diagnose patients involved external and highly public examination. Typically conducted as a lecture to other medical experts and students, the patient was placed in the center of a round room with onlookers arranged in tiered seating to guarantee an unobstructed view. As the lead physician detailed the list of symptoms, using the patient's body as an illustration, observers witnessed the behavioral signs for themselves and discussed the possible underlying conditions or pathologies. This process of consultation and naming worked to increase the relative reliability among experts and bolster the professional reputations of medicine and psychiatry alike (Conrad & Schneider, 1992; Gillis, 2006; Grob & Horwitz, 2010). As researchers have noted (Aronowitz, 2001; Foucault, 1973), this change from focusing on disparate, idiosyncratic symptoms as expressions of individual illness to a system that recognized disease states comprised of symptom clusters marks a historical turning point in the history of medicine. The shift toward a classification scheme that linked medicine with science and technology bolstered medical authority and the power of physicians. In addition to professional credentials, accumulated knowledge, and institutional legitimacy, the authority of modern medicine both rests on and is expressed by medicine's decisive power to name and categorize through diagnosis (Jutel, 2009). Even as medical prestige has eroded, ceding some of its power to other entities,¹ physicians remain the final arbiter of official medical categories (Pescosolido, 2006), judges of what is, and what is not, a “real” diagnosis. In the diagnostic process, one looks within to reveal the nature of disease from without – empirical observation becomes immutable fact. Of course, as critical perspectives on medicine have long pointed out (Conrad & Schneider, 1992; Zola, 1972), the scientific “fact” of one time and place is the mythology or ignorance of another. Diagnosis, as both category and process (Blaxter, 1978), is infused with all manner of things social, historical, and cultural. This volume explores some of these infusions. In so doing, it aims to clarify and contribute to the emerging sociology of diagnosis – an endeavor first called for by Brown (1990), but more recently revived by Jutel (2009).

In several Western legislations, trans individuals must frequently undergo some form of gender identity assessment, for example, to receive legal recognition of their gender or to access therapeutic interventions. Thus, a standardised and empirically supported assessment approach becomes necessary. The purpose of this paper is to critically reflect on the current international guidelines for assessments by the World Professional Association for Transgender Health, which will be compared to standards in secure forensic settings, illustrated by British prison policies.

Findings of a systematic literature review following preferred reporting items for systematic reviews and meta-analysis standards are presented, summarising the current state of research pertaining to gender identity assessment instruments. Studies were included, when they presented empirical details pertaining to assessment approaches and passed the quality appraisal, but were excluded when they did not use a trans sample or presented clinical assessments not linked to gender identity.

A total of 21 included English articles, which mostly have been published in the USA in the past 20 years, propose ten different assessment approaches. Most of the studies support the use of the Minnesota Multiphasic Personality Inventory-2, the Bem Sex-Role Inventory, Body Image Scale for Transsexuals and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. The instruments are briefly summarised.

It becomes apparent that this field is severely understudied and that there is no consensus regarding the best assessment approach. Hence, any recommendations are only preliminary and are contextualised with further ethical considerations and suggestions for future research.

To the best of the author’s knowledge, this is the first systematic literature review pertaining to the (semi-)structured assessment of gender identity.

The purpose of this paper is to explore the harms suffered by intersex children who are subjected to medically unnecessary genital-normalizing surgery (GNS) and the possible applicability of statutes prohibiting female genital mutilation (FGM) to certain cases of GNS to redress this harm in the USA.

Consulting publications by medical researchers and intersex activists alike, this comment reviews the procedures undertaken as part of GNS (most commonly including clitoral reduction) and the reasons behind these procedures. It also parses the language of federal and state statutes prohibiting FGM in the USA.

Surgical practices that include clitoral cutting when the procedure is not necessary to the health of the person on whom it is performed constitute FGM and are punishable under federal and certain state laws in the USA. GNS with clitoral reduction fits the definition of FGM because it is performed for cosmetic and social reasons, not medical necessity.

Acknowledging GNS with clitoral reduction as FGM is a crucial strategy to ensure that female-assigned intersex children’s rights to bodily autonomy are protected to the same extent as non-intersex children’s rights. Intersex legal activists in the USA should press for enforcement of FGM statutes as to female-assigned intersex children until the medical practitioners who continue to defend and perform GNS see the procedures as illegal genital mutilation.

While there has been a significant amount of research conducted on growth hormone (GH) in the field of medicine, very few studies have actually examined the experience from the vantage point of adults who were treated for short stature as children. On the basis of in-depth interviews with three women and two men, I explore the experiences of those who have firsthand knowledge of such treatment. What becomes clear in these narratives is that GH serves as both a normalizing and a stigmatizing force for the recipient. More broadly, this study seeks to contribute to the growing body of research on issues of physical appearance that plant the seeds for unequal treatment of individuals by society.

Purpose – The purpose of this chapter is to theorize the relationship between diagnosis and medicalization through an examination of the medicalization of childhood gender variance and the Gender Identity Disorder of Childhood diagnosis.

Methodology/approach – The chapter examines textual data (published clinical and research literatures, and critiques of the diagnosis appearing in a range of venues) to track how childhood gender variance is medicalized over time and the role of diagnosis in that medicalization.

Findings – While diagnosis certainly plays a role in shoring up medicalization, this case study reveals the many ways in which diagnoses may also become key tools in attempts to curtail medicalization.

Research limitations/implications – As a case study, the findings are not generalizable to all diagnoses. As a study of an instance of the medicalization of deviance, these findings may be particularly applicable to analogous cases.

Social implications – These findings show the sometimes tenuous nature of medicalization processes, and the social uses of diagnoses in those processes.

Originality/value of paper – This chapter sheds light on a relationship that is often assumed to be unidirectional (e.g., that the formation of diagnosis results in increased medicalization), and answers calls for a more nuanced sociology of diagnosis, including greater attention to the relationship between diagnosis and medicalization.