Medical uncertainty and reproduction of the “normal”: Decision-making around testosterone therapy in transgender pregnancy

Medical expertise and authority often serve as foundations upon which patients’ uptake of medical advice is built, and possibilities for health-focused behavioral changes in the patient’s life are motivated and compelled (Pescosolido, Tuch, & Martin, 2001). This expertise is operationalized through processes of medical social control, surveillance, and bureaucratic technologies, particularly in the context of ambiguity and uncertainty (Almeling, 2020, Almeling, 2022, Conrad, 1992, Freeman, 2015, Poteat et al., 2013, shuster, 2019, shuster, 2021, Timmermans and Almeling, 2009). In the case of pregnancy, health care providers dispense advice and protocols around nutrition, exercise, pharmaceutical and substance use, mental health, and the need for regular medical monitoring to protect the health and wellbeing of, essentially, two patients—the pregnant person and the fetus (Rothman, 2014) .

But what happens when medical science doesn’t yet have all the answers about how patient behaviors may relate to health outcomes for both the pregnant person and the fetus—particularly when they may create potentially-divergent health outcomes for the pregnant person and fetus?