Well, for instance, a former count's sister decided she wasn't happy with her cousin inheriting after her brother died, and Barrayar still hasn't gotten around to overturning the rules that prevent women from inheriting countships. So she ended up taking an Armsman and a sample of her brother's Y-chromosome to the doctors in Beta Colony.

It was a bit of a fight, but he is now count. Embarrassed the hell out of my cousin Ivan, who ended up having to submit an affidavit as to the, ah, physical changes Dono had made.

Most worlds don't have as good of cloning and surgical procedures as Beta Colony -- there's a reason Dono had to leave the planet, besides that he wanted to make sure his cousin wouldn't interfere -- but if your world has cloning, then you've probably got some medical options. It's just a matter of figuring out what they are, and coming up a plan to go after them.