Confronting gender and sex binaries in transgender healthcare for adolescents: A parent’s autoethnographic account

•Transgender individuals are constrained by medical constructs of gender and sex.•Binary sex and gender categories embed problematic notions of patient agency.•The history of transgender medicine is linked to surgeries on intersex infants.•Transgender teenagers and their families are able to resist medical discourses.•Complicating sex/gender distinctions can facilitate diverse embodiments of gender. This article critically analyses binary constructs of gender and sex within transgender healthcare, examining aspects of their history and effects in the context of adolescents seeking gender-affirming medical care. To do so, it unpacks both medical and feminist theories that separate gender from sex, inclusive of theories involved in the highly problematic history of surgical interventions into intersex infants’ bodies (interventions which continue today). In addition, the article identifies variable and sometimes incompatible concepts of gender at play in the clinic. Power differentials surrounding age and patient agency are also analyzed. Utilizing the methodology of analytic autoethnography, the author draws on her own experiences in a New Zealand clinic as the mother of a transgender teenager, presenting vignettes from healthcare consultations to illustrate operations of medical power as well as resistance against problematic formulations of clinical expertise. Focusing on both the oppressive and unstable legacies of sex/gender distinctions that are operative in gender-affirming care, the article highlights the importance of ethnographic and relational accounts for exposing them and for understanding the simultaneously vulnerable and potent positioning of transgender teenagers who seek care. The concluding discussion outlines alternative understandings of the relationship between sex and gender that could support a more diverse range of sex/gender embodiments.