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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.

While transgender people have had some success in gaining recognition and human rights in the collection of nations known colloquially as ‘the West’, a well-financed reactionary movement is attempting to roll back these gains. A constellation of white supremacist, conservative, and heteropatriarchal organizations and movements are in collusion with so-called ‘gender critical feminists’ to resist feminist and gender-inclusive challenges to traditional gender and sexual hierarchies by targeting trans girls and women – more so than trans boys, trans men and non-binary people – for surveillance and exclusion (Sharrow, 2021a, 2021b). In the past several years, bills designed to delegitimize and exclude trans people in various ways have been introduced in many US state legislatures. Within this larger anti-trans campaign, bills designed specifically to block trans girls and women from participating in ‘female’ sport have been signed into law in 11 US states to date and proposed in many others. It is no accident that organized sport is a site for contesting the inclusion of transgender people and that transgender girls and women are the primary targets of these campaigns. Debates about criteria for female eligibility and a succession of pseudo-scientific forms of ‘sex testing’ in elite levels of sport highlight both the ideological nature of the two-sex system and the intense material and cultural investment in maintaining its façade. In this chapter, I mobilize moral panic theory to focus specifically on anti-trans campaigns in the United States aimed at preventing trans girls and women from participating in ‘female’ sport as evidence of a testosterone panic.

This chapter critically examines the unprecedented 2020 decision by World Rugby's (WR) primarily male leadership (92% of board members) to ban transgender (trans) women from playing women's rugby union. We examined the process that was followed and found a lack of consultation with those directly impacted: women. To address this critical gap in the policy development process we conducted interviews and focus groups with cisgender female rugby players (junior to elite) of mixed ethnic backgrounds living in England, Canada and Australia. This was done with the support of rugby governing bodies and professional rugby teams. We found no support for WR's blanket ban. Rugby players felt the policy was a contradiction of rugby's claims it is a ‘game for all’. The minority of players with safety concerns supported exclusion on a case-by-case basis, with exclusion justified in a small number of narrowly defined circumstances (e.g. elite male players who transitioned recently). Importantly, the women and girls questioned why rugby's leaders had chosen to focus their energy on ‘protecting’ them from trans athletes but had ignored serious problems which cause them direct harm, such as a lack of funding, pervasive sexist and homophobic behaviour, sexual harassment, and substandard coaching and training facilities (relative to men). Our findings are consistent with and they support the position of women's sports organizations which have called on WR's male leaders to discard their blanket ban and undertake a rigorous, science-driven, collaborative policy development process.

The chapter studies the phenomenon of trans-conflict region. The task of operationalization of the concept of trans-border region is solved. Specific potential of trans-border region is studied through the prism of regionalization and globalization. Similarities and differences of two regions according to spatial, historical, functional, and political characteristics are determined. The chapter analyzes one of the most important characteristics of border – barrier and contact. Peculiarities of functioning of trans-border region (with active conflict) are analyzed as a specific territory and presence of irredentist potential in the trans-border area. Implementation of the concept of trans-border region into the managerial discourse confirms the presence of regional entity with high conflict level.

The aim of this chapter is to examine and challenge the fairness rhetoric used by many US lawmakers to prevent trans girls and women from participating in school sports. Legislators embrace faulty scientific claims to assert unfairness based on physiology and many sport philosophers work from the premise that the first priority of sport is to be competitively fair. We argue that this is a misguided notion and that sport must be just before it can be fair. Using Iris Marion Young's framework of justice, we contend that excluding trans athletes from school sport is an injustice. We propose that focusing on the eradication of injustice is the ethical path forward for the inclusion and full participation of trans people in sport.

Sport co-produces our notions of sex, gender and sexuality. Sport policies based on inclusion demand trans athletes become visible. This creates a problem within sport's hierarchical gender order, and trans athletes' bodies become comprehensible only through mobility from one sex/gender to the other – literally the embodiment of movement through a static gendered space.

In this chapter, we examine the contradictory expectations placed on trans athletes to be visible within heterosexist, white supremacist ‘regimes of looking’ (Fleetwood, 2011). Our purpose is twofold: (1) to critically examine the construction of transness through white racial frames and (2) to grapple with the inherent harmfulness of sport. We ask why trans people would want to participate in an institution that actively limits opportunities for expansive subjectivity, ultimately concluding that the potential for queer futures lies in the very construction of limits themselves. We forward a belief in what sport could be when intentionally created through queer world building. We highlight teams, leagues and spaces that have developed processes that work against dominant forms of medicolegal recognition and visibility politics.

This study builds on existing research to explore how transgender and non-binary people navigate complex terrain when it comes to strained and ambiguous relationships with families of origin. This chapter draws on 23 in-depth interviews with trans and non-binary adults (ages 19–41) to examine the ways that respondents navigated ambiguous and complex family relationships marked by mixed messages and contradictory behaviors from parents regarding their sexual and gender identities. I find that respondents engage in a range of strategies – correcting, conforming, and concealing – to bargain for belonging within families of origin through their work to preserve family ties. Beyond experiencing the emotional costs of ambiguous parental support, I find that some respondents also experience financial strain and inadequate housing, stemming from unstable, distressing relationships with their parents. This chapter demonstrates that ambiguous support from family and complex familial relationships may contribute to a cycle of precarity for trans and non-binary adults. Finally, I show that for respondents, connections to local queer and trans communities and supportive partnerships buffered the negative impacts of familial ambiguity. However, not all respondents had access to community support, intensifying their experiences of marginalization. This chapter contributes to the literature working to destabilize the support versus rejection binary used to characterize LGBTQ experiences and has implications for better understanding the pathways into poverty that trans and non-binary people experience.

This chapter examines the creation and development of trans inclusion policies in community sport in Australia. More specifically, it explores the impact of such policy, or lack thereof, on trans and gender diverse people who are currently engaged or wish to engage with community sport in the state of Victoria, Australia. This chapter evaluates the impact of Federal legislation and guidelines for the inclusion of trans and gender diverse people in Australian sport, and how sport organizations have responded in creating trans athlete policies for community sport participation. Next, we discuss the experiences and challenges for trans and gender diverse athletes playing and competing in community sport. We examine how these athletes work against institutional norms which typically reinforce a rigid gender binary. This chapter draws on a range of research projects in Australia by the first author and concludes with some recommendations for future research and both policy and practice.

This study explores the health-seeking process for queer and/or trans people, and factors involved in their healthcare negotiations and decisions to seek care. The data included 20 semi-structured interviews of people who identify as queer and/or trans in the southeastern United States. Qualitative analysis was conducted using constructivist grounded theory to inductively analyze accounts of healthcare events, behaviors, and experiences of queer and/or trans people. Participants’ ages ranged from 18 to 57, with a majority identifying as trans/gender nonconforming (65%) and those remaining identifying as queer, cisgender individuals (35%). Both queer and trans identities can overlap, therefore, I use the term “queer and/or trans.” Categories generated through the coding process were as follows: (1) mental health concerns, (2) negotiating gendered and heteronormative assumptions, and (3) significance of participants creating a bed of knowledge. My analysis asserts that these data indicate that queer and/or trans participants manage not just healthcare decisions, but the hopelessness attached to seeking this type of help.