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It focuses on the conditions of possibility for the emergence of a phenomenon under investigation. In this case, the focus is on the emergence of debates about transgenderism in healthcare. These have been technological (about the prospect of biomedical solutions to personal problems) and ideological, with the enlarged salience of identity politics and our currently unresolved \u201cculture wars.\u201d Identity politics have brought a focus on epistemological privilege or \u201clived experience\u201d and on rights to healthcare being driven by consumer choice. The current contestation and its history are discussed in relation to our four planar social being (nature, relationality, socio-economic structures, and our particular personalities) and future scenarios are rehearsed.<\/jats:p>","DOI":"10.1177\/13634593211046840","type":"journal-article","created":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T20:19:26Z","timestamp":1633465166000},"page":"535-553","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Transgender debates and healthcare: A critical realist account"],"prefix":"10.1177","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8140-8734","authenticated-orcid":false,"given":"David","family":"Pilgrim","sequence":"first","affiliation":[{"name":"University of Southampton, 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