Research

Current best practices recommend a "two-step" method for collecting gender and sex data, asking separately about gender identity and sex assigned at birth. While an improvement over single-item measures, two-step approaches still impose binary or otherwise limiting categorical structures on biobank participants. This paper proposes an "atomic approach" that disaggregates the construct of gender/sex into its constituent clinical attributes — hormone profiles, surgical history, chromosomal variation, and so on — collecting only what is medically relevant for the specific research context. The atomic approach reduces epistemic injustice by centering what participants actually need from healthcare rather than fitting them into pre-existing taxonomic schemes.

This paper analyzes the epistemic and political harms of content moderation practices that disproportionately silence marginalized users. I introduce the concept of "content bubbles" — conditions in which LGBTQ+ voices are algorithmically suppressed or arbitrarily removed, while anti-LGBTQ+ content proliferates. The result is a double bind: trust in digital platforms erodes because moderation is perceived as hostile, but non-participation further excludes marginalized groups from the public sphere. Drawing on feminist epistemology and theories of epistemic injustice, I argue that justice-centered content moderation requires co-governance with affected communities and transparent, auditable enforcement standards.

Gender-affirming care is routinely treated as exceptional — a special category of medicine applicable only to transgender and gender diverse (TGD) people. Yet cisgender patients routinely receive functionally equivalent care (breast reconstruction, hormone therapy, gonadal surgery) without the same gatekeeping, scrutiny, or moral controversy. This paper argues that this asymmetry constitutes an arbitrary and ethically unjustifiable distinction rooted in "trans exceptionalism" — the treatment of trans medicine as categorically different from the rest of medicine. I propose a justice-first framework for gender-affirming care that applies consistent ethical standards across cis and trans patients, centering patient autonomy and contextual clinical need.

We investigate the ethical and epistemic implications of the medico-legal process of gender-affirming care (GAC) in Iran, focusing on Ayatollah Khomeini's fatwa on gender-affirming surgery and subsequent legal and medical policies. Despite legal provisions for gender transition in Iran, trans* individuals face systemic violence and dire living conditions — challenges intensified by the entanglement of medical requirements with legal gender recognition. Employing Beauchamp and Childress's principles of biomedical ethics and Kristie Dotson's concept of epistemic violence, we show how the Iranian medico-legal process fails to respect autonomy, nonmaleficence, beneficence, and justice for trans* individuals. We highlight how testimonial quieting and silencing contribute to pervasive violence, and argue that the process of GAC not only infringes trans* individuals' rights but subjects them to multiple forms of violence. We propose separating the medical process of GAC from the legal process of gender recognition as a necessary remedy.

Data on the health of transgender and gender diverse (TGD) people are scarce. Researchers are increasingly turning to insurance claims data to investigate disease burden among TGD people. Since claims do not include gender self-identification or modality, researchers have developed algorithms to identify TGD individuals using diagnosis, procedure, and prescription codes. Claims-based algorithms introduce epistemological and ethical complexities that have yet to be addressed in data informatics, epidemiology, or health services research. We discuss the implications of these algorithms, including perpetuating cisnormative biases and dismissing TGD individuals' self-identification. Using the framework of epistemic injustice, we outline ethical considerations when undertaking claims-based TGD health research and provide suggestions to minimize harms and maximize benefits to TGD individuals and communities.

Platform content moderation failures — from Meta allowing anti-trans language to Bluesky suspending trans users for criticizing J.K. Rowling — are not mere policy disagreements. They are public health crises. Online hate campaigns targeting trans people translate directly into real-world harm: bomb threats against gender-affirming care clinics, clinic closures, and documented mental health damage to queer youth. Drawing on bioethical principles of respect for persons, beneficence, and justice, I argue that tech platforms must be held to the same accountability standards as public health agencies: transparent decision-making, co-governance with victimized communities, and independent audits of harm.

The dominant bioethics literature on trans people reacts to anti-trans legislation without centering trans experience or testimony. I argue for a "true trans bioethics" that starts with transgender people's testimony — even when the research is about policy or bias. Reacting to anti-trans rhetoric objectifies trans people and prioritizes a cisgender audience over the people most affected. Drawing on Talia Betcher's trans philosophy, I advocate for holistic trans bioethics that addresses the sense-making questions trans people actually ask: not "is HRT legitimate?" but "how should I decide about gender-affirming surgery?" and "why does my doctor dismiss my expertise about my own body?" Naming trans-specific harms — like "trans broken arm syndrome" — is itself a form of epistemic justice.