A patient’s right to reality
“Their records said they were male but they were in labour. They had a prolapsed umbilical cord, but there was a delay while doctors worked out what was going on, and by the time they found it, the baby had died,”
It is a violation of a patient’s rights to deny them relevant information about their health.
That might seem too obvious mention, but many Australian are unaware that vital data on health and welfare is being corrupted or lost.
Data sets of national importance are no longer properly segmented by biological sex, including reports from the Australian Institute of Health and Welfare (AIHW).
In its Data by sex and gender summary, the AIHW acknowledges that in many of its collections, the words male or female may now refer to either [biological] sex and/or [self-identified] gender, depending on the source of the data.
This is because, the Institute explains, “Most current data sources do not record sex and gender as separate concepts so it can be unclear which is the focus."
"For example, a person born male but living as a woman for many years may select ‘female’ as their response to a question asking if their sex is ‘male’ or ‘female’."
Data from institutions like the AIHW, Medicare, PBS or Centrelink inform all manner of decisions about our health and wellbeing.
The corruption of sex-based records doesn’t just affect policy - it’s also hurting individual patients.
In 2023, a submission from 120 researchers addressed to the National Health and Medical Research Council described an incident involving a transgender person who arrived at an emergency department with abdominal pain:
“Their records said they were male but they were in labour. They had a prolapsed umbilical cord, but there was a delay while doctors worked out what was going on, and by the time they found it, the baby had died,”.
In 2022, there were reports that over 1,400 women and girls used the PBS indicator for 'androgen deficiency' to access testosterone.
Androgen deficiency is a male hormonal disorder. This misuse of the PBS indicator system to obtain harmful levels of exogenous testosterone through the public health system raises serious questions about oversight, regulation and safety.
While measures are being taken to 'reduce ambiguity', it’s no longer possible to guarantee the accuracy of a large body of reporting on biological sex.
A combination of factors have gotten us to this point:
Confusion created by so called ‘inclusive-language’ in research and surveys.
The conflation of sex and gender in overlapping records.
Legislation that doesn't mandate sex-disaggregated data.
Current government guidelines on sex and gender data that are poorly conceived and insufficiently enforced.
The risk of death and injury is likely to accumulate over time
Australian Government Guidelines on the Recognition of Sex and Gender say that the 'preferred approach' is for departments and agencies to collect data on gender - a social construct.
The guidelines recommend that information regarding a person’s biological sex should only be collected where there is a ‘legitimate need’ for that information.
This advice is deeply flawed. Outcomes related to biological sex are influenced by evolving cultural and environmental trends. It’s impossible to predict in advance when sex-based data may or may not be relevant to any area of inquiry.
A failure to keep baseline sex-based date as par for the course has proved to be deadly many times before.
The classic cautionary tale is this: despite the fact that women involved in car crashes are far more likely to be seriously injured than men, it wasn’t until 2011 that it occurred to regulators to include crash-test dummies based on the size of the average female in their safety tests.
Previously, all dummies had been based on the size of the average biological male.
Biological sex is relevant to all aspects of our health, including: medication dosages, our susceptibility to common diseases (like cardiovascular disease, cancers or COVID-19), blood donations, the interpretation of diagnostic tests, mental health outcomes, contraception and fertility including (miscarriages, fibroids, endometriosis, PCOS, abortion, contraception, menstrual health, pelvic pain or birth trauma).
It’s necessary to collect comprehensive and continuous sex-based data in order to determine when, where and why biological sex is relevant.
Everybody who interacts with the health system needs governments to maintain accurate, sex-based data.
People who undergo Gender Affirming Care have a biological sex, just like every other Australian.
On top of this, many of them will have unique hormone profiles that require individualised treatment and monitoring.
The Trans Health Research Group has highlighted the many reasons why accurately recording sex and gender data is critical for the health of TGD people:
“Trans people often have physical characteristics that are different to cisgender people. Gender-affirming hormone therapy may impact the prevalence and characteristics of diseases or health conditions in trans individuals that are sex-based or influenced by sex-hormones, and gender-affirming surgeries may remove or significantly alter body parts, including the genitals and internal reproductive organs.”
The corruption of sex-based data is a violation of the right of to enjoy high standards of health.
People are now able to change their sex and or gender markers on all manner of records, with very little difficulty or oversight.
From there, gender data can merge with all other indicators that have previously provided valuable sex-based statistics on car-accidents, insurance claims, drink-driving, and any number of other records related to health or welfare.
It’s unclear why the ability to change identity records on the the spot has been deemed more important than public health.
It’s a certainty that no one benefits from this arrangement.
References and More Resources - Erasing Sex From Medicine
Referenced On this page
Australian Institute of Health and Welfare. AIHW data by sex and gender. https://www.aihw.gov.au/about-our-data/aihw-data-by-sex-and-gender. Published 2023.
Don’t desex the language: Doctors warn of danger over gender-inclusive terms https://archive.md/8VHoq.
Gender Clinic News. Gender on steroids. https://www.genderclinicnews.com/p/gender-on-steroids. Published 2023.
Attorney-General's Department. Australian Government Guidelines on the Recognition of Sex and Gender. https://www.ag.gov.au/sites/default/files/2020-03/AustralianGovernmentGuidelinesontheRecognitionofSexandGender.pdf. Published 2013.
Criado Perez C. The deadly truth about a world built for men – from stab vests to car crashes. The Guardian. https://www.theguardian.com/lifeandstyle/2019/feb/23/truth-world-built-for-men-car-crashes. Published February 23, 2019.
Cheung AS, Wynne K, Erasmus J, Murray S, Zajac JD. Position statement on the hormonal management of adult transgender and gender diverse individuals. Med J Aust. 2019;211(3):127-133. https://www.transresearch.org.au/_files/ugd/53102e_df8d5243d6044b939addf57b4be5c19b.pdf.