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The sky is trans, why wouldn’t I be

The sky is trans, why wouldn’t I be

By Florence Ashley

This podcast is an audio repository of Florence Ashley‘s scholarly writing on trans law, bioethics, and more!
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Nuancing feminist perspectives on the voluntary intoxication defence

The sky is trans, why wouldn’t I beOct 23, 2020

Do gender assessments prevent regret in transgender healthcare? A narrative review

Do gender assessments prevent regret in transgender healthcare? A narrative review

Florence Ashley, Neeki Parsa, til kus, & Kinnon R MacKinnon, “Do gender assessments prevent regret in transgender healthcare? A narrative review” (2023) Psychology of Sexual Orientation and Gender Diversity

Abstract: 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.


Oct 17, 202338:52
The Saint of Christopher Street
Jul 11, 202340:14
What is it like to have a gender identity?
Jul 02, 202342:43
Randomized-controlled trials are methodologically inappropriate in adolescent transgender healthcare

Randomized-controlled trials are methodologically inappropriate in adolescent transgender healthcare

Florence Ashley, Diana M. Tordoff, Johanna Olson-Kennedy, & Arjee J. Restar, “Randomized-controlled trials are methodologically inappropriate in adolescent transgender healthcare” (2023) International Journal of Transgender Health

Abstract: Despite multiple rigorous observational studies documenting the association between positive mental health outcomes and access to puberty blockers, hormone therapy, and transition-related surgeries among adolescents, some jurisdictions have banned or are attempting to ban gender-affirming medical interventions for minors due to an absence of randomized-controlled trials (RCTs) proving their mental health benefits. This article critically reviews whether RCTs are methodologically appropriate for studying the association between adolescent gender-affirming care and mental health outcomes. The scientific value of RCTs is severely impeded when studying the impact of gender-affirming care on the mental health of trans adolescent. Gender-affirming interventions have physiologically evident effects and are highly desired by participants, giving rise to concerns over adherence, drop-out, response bias, and generalizability. Complementary and well-designed observational studies can instead be used to ground reliable recommendations for clinical practice and policymaking in adolescent trans healthcare, without the need for RCTs. The lack of RCTs on the mental health impacts of gender-affirming care for trans adolescents does not entail that gender-affirming interventions are based on insufficient evidence. Given the methodological limitations of RCTs, complementary and well-designed observational studies offer more reliable scientific evidence than RCTs and should be considered of sufficient quality to guide clinical practice and policymaking.

(Link to article)

Jun 25, 202326:59
Transporting the burden of justification: The unethicality of transgender conversion practices
Nov 19, 202201:01:04
Interrogating gender-exploratory therapy
Sep 06, 202235:48
Adolescent medical transition is ethical: an analogy with reproductive health
Jul 07, 202201:02:05
‘Trans’ is my gender modality
Apr 14, 202203:33
Youth should decide: the principle of subsidiarity in paediatric transgender healthcare
Feb 08, 202227:51
The constitutive in/visibility of the trans legal subject
Dec 24, 202101:05:22
The clinical irrelevance of ‘desistance’ research for transgender and gender creative youth

The clinical irrelevance of ‘desistance’ research for transgender and gender creative youth

Florence Ashley. “The Clinical Irrelevance of Desistance Research for Transgender and Gender Creative Youth” (2021) Psychology of Sexual Orientation and Gender Diversity

Abstract: In recent years, the suggestion that over 80% of trans and gender creative children will grow up cisgender has been strongly criticized in the academic literature. Although concerns over the methodology of these studies, known as desistance research, has shed considerable doubt regarding the validity of the reported number, less attention has been paid to the relevance of desistance research to the choice of clinical model of care. This article analyzes desistance research and concludes that the body of research is not relevant when deciding between models of care. Three arguments undermining the relevance of desistance research are presented. Drawing on a variety of concerns, the article highlights that “desistance” does not provide reasons against prepubertal social transition or peripubertal medical transition, that transition for “desisters” is not comparably harmful to delays for trans youth, and that the wait-and-see and corrective models of care are harmful to youth who will grow up cis. The assumed relevance of desistance research to trans youth care is therefore misconceived. Thinking critically about the relationship between research observations and clinical models of care is essential to progress in trans health care.

Sep 07, 202150:24
‘X’ Why? Gender markers and non-binary transgender people
Jun 29, 202134:18
The continuum of informed consent models in transgender health
Jun 17, 202110:52
Corriger nos pratiques : les approches thérapeutiques pour intervenir auprès des enfants trans examinées dans une perspective juridique
May 02, 202124:04
Recommendations for institutional and governmental management of gender information
Apr 03, 202101:24:21
Trans reparative 'therapy'
Apr 03, 202114:43
Gender (de)transitioning before puberty? A response to Steensma and Cohen-Kettenis
Feb 10, 202106:60
Puberty blockers are necessary, but they don’t prevent homelessness: Caring for transgender youth by supporting unsupportive parents
Feb 10, 202109:54
Shifts in assigned sex ratios at gender identity clinics likely reflect changes in referral patterns
Feb 10, 202103:43
Surgical informed consent and recognizing a perioperative duty to disclose in transgender healthcare

Surgical informed consent and recognizing a perioperative duty to disclose in transgender healthcare

Florence Ashley, “Surgical Informed Consent and Recognizing a Perioperative Duty to Disclose in Transgender Healthcare” (2020) 13:1 McGill Journal of Law and Health 73–116

​In this article, the author argues that our current medical practices with regard to obtaining informed consent are inadequate. They do not require the systematic disclosure of information which is necessary to prepare for the surgery and what it comes with, but which would not impact the decision to undergo surgery. The article analyzes the two primary processes for obtaining informed consent, namely with and without a referral from a mental health professional, and sketches how both processes fall short of disclosing all relevant information. The author draws on personal experience and community knowledge to argue for an expansion of the notion of informed consent which is better adapted to the needs of patients who are preparing for the surgical process. They highlight how surgeons and mental health professionals are poorly situated to learn and transmit all actionable information and take note of the various barriers patients face in attempting to independently access this information. They then foreground the importance of community knowledge and interdisciplinary collaboration as central devices to meet the legal burden born by professionals tasked with obtaining informed consent and facilitating the informed consent process, as well as to improve the well-being of trans individuals who seek transition-related surgeries.

(Link to article)

Dec 29, 202001:24:21
Humorous styles of Cause in In Rem actions: A comparison of Canada and the United States
Dec 15, 202028:07
Qui est-ille ? Le respect langagier des élèves non-binaires, aux limites du droit
Dec 09, 202029:46
L’In/visibilité constitutive du sujet trans : l’exemple du droit québécois
Dec 09, 202055:49
Simpson’s paradox in LGBTQ+ policy: A case study
Dec 07, 202021:29
Accounting for research fatigue in research ethics
Nov 18, 202031:37
Homophobia, conversion therapy, and care models for trans youth: defending the gender-affirmative approach
Oct 25, 202049:32
Transgender healthcare does not stop at the doorstep of the clinic
Oct 25, 202012:22
In favor of covering ethically important cosmetic surgeries: Facial feminization surgery for transgender people
Oct 24, 202013:27
Science has always been ideological, you just don’t see it
Oct 24, 202011:07
The misuse of gender dysphoria: Toward greater conceptual clarity in transgender health
Oct 24, 202022:12
Nuancing feminist perspectives on the voluntary intoxication defence
Oct 23, 202001:13:33
Don’t be so hateful: The insufficiency of anti-discrimination and hate crime laws in improving trans wellbeing
Oct 09, 202001:32:48
Genderfucking non-disclosure: Sexual fraud, transgender bodies, and messy identities
Sep 30, 202001:32:30
Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth
Sep 26, 202041:51
A critical commentary on ‘rapid-onset gender dysphoria’​​
Sep 26, 202049:09
Gatekeeping hormone replacement therapy for transgender patients is dehumanising
Sep 26, 202013:49