Rebecca Sanaeikia

Current approaches to transgender data collection in U.S. biobanks center self-identification questions, typically one-step or two-step items that classify participants as transgender or cisgender based on gender identity and sex assigned at birth, give comparatively little attention to the systematic capture of granular biological and treatment-related information. As a result, crucial details such as hormone regimens, surgical history, organ inventories, and other component-level variables are often treated as secondary or optional, referenced briefly if at all rather than embedded as core elements of study design and data infrastructure for transgender data. This paper argues that such an imbalance limits both scientific validity and ethical adequacy; without consistently collected granular data, which I term Atomic Approach, researchers cannot distinguish between biological and structural pathways of risk, design targeted interventions, or avoid epistemic harms that arise when broad identity categories are used as imprecise proxies for complex constellations of traits and experiences.

In this paper, we investigate the ethical and epistemic implications of the medico-legal process of gender-affirming care (GAC) in Iran by focusing on Ayatollah Khomeini’s fatwa on gender-affirming surgery (GAS), as well as legal and medical policies and practices. Hence, we show how despite the legal provisions for gender transition in Iran, trans*Footnote1 individuals face systemic violence and dire living conditions – challenges that are intensified by the entanglement of the medical requirements with the processes of legal gender recognition. Employing Beauchamp and Childress’ (2013) principles of biomedical ethics and Kristie Dotson’s (2011) concept of epistemic violence, we show how the Iranian medico-legal process of gender transition fails to respect the ethical principles of autonomy, nonmaleficence, beneficence, and justice for trans* individuals. Analyzing the legal and medical regulations and processes, we also highlight the ethical breaches that, through testimonial quieting and silencing, contribute to pervasive violence against trans* individuals. Hence, we argue that the process of GAC not only infringes trans* individuals’ rights but also subjects them to multiple forms of violence. To overcome the unethical medico-legal process of gender transition and to remedy epistemic violence against trans* individuals, we propose separating the medical process of GAC from the legal process of gender recognition.