Florence Ashley, “Reflecting on the Rhetoric of Adoption in Trans Youth Care” (2023) 2 Bulletin of Applied Transgender Studies 249–75   Abstract: Adoption is increasingly being discussed as an alternative to procreation for trans youth given the impact of gender-affirming medical care on fertility. In this article, I caution against idyllic views of adoption and offer a critical perspective on the social, political, and ethical dimensions of adoption. After reviewing adoption’s relationship to sexism, racism, imperialism, and cisheteronormativity, I sketch an alternative view of adoption as a com­plex and multi-valenced form of care in an unjust world. (Link)

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. Link: https://psycnet.apa.org/fulltext/2024-16010-001.html

Florence Ashley & Sam Sanchinel, “The Saint of Christopher Street: Marsha P. Johnson and the Social Life of a Heroine” (2023) 134 Feminist Review 39–55 Abstract: This article analyses the legacy of Marsha P. Johnson as a heroine through the notion of labour, emphasising how heroine narratives are both a product of labour as well as a form of labour. After offering a short account of Marsha P. Johnson’s role in the Stonewall riots and STAR, we explore the development of trans communities’ ability to create, sustain and disseminate heroine narratives, emphasising Tourmaline’s pivotal archival role in establishing Johnson’s legacy. Then, we elucidate the role of heroine narratives in creating and sustaining a collective identity. We argue that community attachment to Marsha P. Johnson reclaims the place of trans communities in LGBTQ+ history but is often done in a manner that obscures the whiteness of mainstream trans advocacy. We suggest that the recent increase in interest towards the life-sustaining labour of STAR House reflects the evolution of trans collective identity in the post-visibility era. (⁠Link to article⁠)

Florence Ashley, “What Is It like to Have a Gender Identity?” (2023) MIND Abstract: By attending to how people speak about their gender, we can find diverse answers to the question of what it is like to have a gender identity. To some, it is little more than having a body whereas others may report it as more attitudinal or dispositional—seemingly contradictory views. In this paper, I seek to reconcile these disparate answers by developing a theory of how individual gender identity comes about. In the simplest possible terms, I propose that gender identity is how we make sense of our gender subjectivity, the totality of our gendered experiences of ourselves. Gender identity is constituted by gender subjectivity, but this constitutive relationship is underdetermined. While gender subjectivity may narrow the range of inhabitable gender identities, it is always compatible with more than one. To arrive at a gender identity, we arrange gender subjectivity like building materials. My theory helps us understand how different people offer seemingly incompatible accounts of their gender identity without questioning their authenticity or validity. They simply arrange similar building materials differently. (⁠⁠Link to paper⁠⁠)

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)

Florence Ashley, “Transporting the Burden of Justification: The Unethicality of Transgender Conversion Practices” (​2022) 50:3 Journal of Law, Medicine & Ethics 425–42 Abstract: Transgender conversion practices involve attempts to alter, discourage, or suppress a person’s gender identity and/or desired gender presentation, including by delaying or preventing gender transition. Proponents of the practices have argued that they should be allowed until proven to be harmful. Drawing on the notion of expressive equality, I argue that conversion practices are prima facie unethical because they do not fulfill a legitimate clinical purpose and conflict with the self-understanding of trans communities. (Link)

Florence Ashley, “Interrogating Gender-Exploratory Therapy” (2022) Perspectives on Psychological Science Abstract: Opposition to gender-affirmative approaches to care for transgender youths by some clinicians has recently begun to consolidate around “gender exploratory therapy” as a proposed alternative. Whereas gender-affirmative approaches follow the client’s lead when it comes to gender, gender-exploratory therapy discourages gender affirmation in favor of exploring through talk therapy the potential pathological roots of youths’ trans identities or gender dysphoria. Few detailed descriptions of the approach’s parameters have been offered. In this article, I invite clinicians to reflect on gender-exploratory therapy through a series of questions. The questions are followed by an exploration of the strong conceptual and narrative similarities between gender-exploratory therapy and conversion practices. Finally, the ethical dimensions of gender-exploratory therapy are discussed from the lenses of therapeutic neutrality, patient-centered care, loving attention, and therapeutic alliance, suggesting that the approach may be unethical. (Link)

Florence Ashley, “Adolescent Medical Transition is Ethical: An Analogy with Reproductive Health” (2022) 32:2 Kennedy Institute of Ethics Journal, 127–71 Abstract: In this article, I argue that adolescent medical transition is ethical by analogizing it to abortion and birth control. The interventions are similar insofar as they intervene on healthy physiological states by reason of the person's fundamental self-conception and desired life, and their effectiveness is defined by their ability to achieve patients' embodiment goals. Since the evidence of mental health benefits is comparable between adolescent medical transition, abortion, and birth control, disallowing transition-related interventions would betray an unacceptable double standard. While great enough risks can override autonomy over fundamental aspects of personal identity, I demonstrate that the available scientific evidence does not corroborate the view that adolescent medical transition is dangerous. Consequently, adolescent medical transition should be recognized as ethical and remain available. (Link)

Florence Ashley, “‘Trans’ Is My Gender Modality: A Modest Terminological Proposal” in Trans Bodies, Trans Selves, 2nd ed. (Oxford: Oxford University Press, 2022) at 22 Abstract: Currently, no word exists in our vocabulary for the broad category which includes being trans and being cis. ​To address this gap, I propose the adoption of a new term: gender modality. Gender modality refers to how a person’s gender identity stands in relation to their gender assigned at birth. It is an open-ended category which includes being trans and being cis and welcomes the elaboration of further terms which speak to the diverse experiences people may have of the relationship between their gender identity and gender assigned at birth. (Link to article)

Florence Ashley, “Youth should decide: the principle of subsidiarity in paediatric transgender healthcare” (2022) Journal of Medical Ethics (online first) Abstract: Drawing on the principle of subsidiarity, this article develops a framework for allocating medical decision-making authority in the absence of capacity to consent and argues that decisional authority in paediatric transgender healthcare should generally lie in the patient. Regardless of patients’ capacity, there is usually nobody better positioned to make medical decisions that go to the heart of a patient’s identity than the patients themselves. Under the principle of subsidiarity, decisional authority should only be held by a higher level decision-maker, such as parents or judges, if lower level decision-makers are incapable of satisfactorily addressing the issue even with support and the higher level decision-maker is better positioned to satisfactorily address the issue than all lower level decision-makers. Because gender uniquely pertains to personal identity and self-realisation, parents and judges are rarely better positioned to make complex medical decisions. Instead of taking away trans youth’s authority over their healthcare decisions, we should focus on supporting their ability to take the best possible decision for themselves. (Link to article)