Sex, Gender and Medicine: Ethical and Legal Contradictions for Intersex and Gender Diverse Children and Adolescents

  • Edmund Horowicz

Student thesis: Phd


The relationship between medicine and both intersex or gender diverse children and adolescents is contentious, particularly in respect of the provision or non-provision of clinical interventions to affirm or support a binary sex or gender identity. Whilst intersex and gender diverse children and adolescents experience very different medical and social responses, there is a commonality in that where a child’s sex or gender identity does not conform to normative expectations, they are both subject to being medicalised. This thesis seeks to explore the ethical and legal contradictions in the way in which clinical, particularly surgical, interventions are provided or not for intersex and gender diverse children and adolescents. Specifically, the thesis considers the proactive approach to ‘fixing’ the bodies of intersex infants and children and the prohibitive approach to the provision of gender-affirming interventions for transgender adolescents through the first two publication chapters. A key ethical and legal issue analysed within these chapters is that the provision of medical interventions for intersex and gender diverse children and adolescents is also complicated by these populations having varying degrees of lesser autonomy, in comparison to a person over the age of eighteen (the age of legal majority). Furthermore, as this thesis will demonstrate, answering clinical questions as to whether we should or should not provide clinical interventions ultimately require us to better understand more profound and fundamental issues. In part, these issues will be argued as stemming from why and how clinically these identities are placed within diagnostic classification manuals, explored in the last two publication chapters. This thesis ultimately argues that decision-making should be afforded only to competent intersex or gender diverse adolescents but moreover and to better resolve these clinical dilemmas, the rationale for inclusion and the nomenclature within clinical classification manuals must be reconsidered.
Date of Award31 Dec 2022
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorSimona Giordano (Supervisor) & Caroline Hoyle (Supervisor)


  • Decision-Making
  • Gender Diverse Children
  • Capacity in Minors
  • Intersex children
  • Transgender adolescents

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