Future gender in pediatric transgender and DSD/intersex consultations: a conversation analysis

No child's future gender identity can be predicted with certainty. This uncertainty can become a clinical challenge in both pediatric transgender care and differences of sex development (DSD)/intersex care, in which current predictions of a child's future gender may guide treatment decisions. Using conversation analysis, we examined video-recorded consultations in Dutch pediatric transgender and DSD/intersex care to examine how participants manage children's future gender in the here-and-now of their interactions. This article focuses on healthcare providers' sequence-initiating actions, ranging from rather unilateral to more bilateral approaches, specifically focusing on the two ends of the spectrum. We show examples of treatment assertions, where healthcare providers unilaterally relate potential treatment to a child's future gender, and bilateral perspective-display invitations, where the child's perspective on their future gender is explicitly incited. We show how treatment assertions leave little room for children to be interactionally involved, while perspective-display invitations elicit children to contribute to the local construction of their prospective gender, despite children's displayed uncertainty. Perspective-display invitations grant children epistemic authority regarding their future gender, whereas treatment assertions claim epistemic authority regarding gender-related treatment, although they do grant children deontic authority in terms of future treatment decisions. Also, treatment assertions are grounded in normative gender assumptions, but do render alternative futures possible by presenting treatment as optional. Perspective-display invitations may enable more open and collaborative challenging of gender norms. We argue that for clinical practice, particularly perspective-display invitations merit professional consideration as they facilitate children's participation and collaborative uncertainty management.