Bioethics Forum Essay

Australia’s Passport to Gender Confusion

Kudos to Australia for recognizing that some people might not be well served by a passport system that marks you only as either “M” or “F” and does so on the basis of your birth certificate. But, oh, what have they stepped in, as they’ve tried to step forward?

At first, I thought maybe the news reports I was reading just had it all wrong. I thought that Australia’s revision couldn’t be as messed up as it seemed from what I was reading, say, on But then I went to the Australian government’s own Web site, and found confirmation.

So what are the problems? In a nutshell: (1) confusion over sex and gender; (2) pretending intersex is a simple natural category; (3) imagining that transgender people never have anything but one of two simple genders; (4) letting doctors be the arbiters of social identity; and (5) uh, did they really have to pick “X”?

Let’s take these one at a time.

In its passport system, Australia, like many governments, appears to be using the terms “sex” and “gender” as if they were virtually synonymous. They’re not. “Sex” refers to one’s biology, whereas “gender” refers to one’s sense of self. It’s kind of funny that Australia is simultaneously changing its passport system specifically to recognize transgender people (many of whom feel their genders are at odds with their congenital sex) while also failing to get the difference between sex and gender.

The biggest tip-off of Australia’s confusion over sex and gender comes from the fact that “gender X” (the designated third gender) is limited to people who are intersex, which Australia defines as “being of indeterminate sex.” According to the new rules, transgender people, in contrast to intersex people, must be labeled either “M” or “F.” This approach indicates the Australians want to limit the gender X category to people who have some kind of alleged biological basis for a third gender.

But this is just nutty. The vast majority of people born with atypical sex types, or intersex conditions, see themselves as men or women, and the vast majority are not transgender. That is to say, they accept and live in the genders that they were assigned at birth, like most of us. Meanwhile, most people who are transgender have no discernable congenital sex atypicality. So why keep transgender people out of “gender X” and require intersex of someone to be let in to “X”?

To use a passport analogy, Australia’s approach to sex and gender is like confusing where you’re born with your citizenship. Clearly where you are born is a kind of biological fact that turns out, in the long run, only to match citizenshipmost of the time. Seems like it’s citizenship (and gender) that should matter to passports.

One weird effect of the new Australian system is to require people who are intersex to decide what matters to them more – their sex (“X” in this scheme) or their gender (“M” or “F” in this scheme, for most people born sex atypical). The new Australian system doesn’t actually recognize the reality of the vast majority of intersex people, who are either X/M (men with intersex) or X/F (women with intersex).

I’ve written more than I ever thought I would need to about how intersex is not a discrete natural category, so I’m not going to say much more about that here, except to note that the Australian revision seems to believe it is a discrete natural category, and one that is diagnosable by doctors. I’d love to hear how small a penis has to be or how big a clitoris has to be before you’re entitled to the “X” option. And I’d love to know whether that differs by nation, region, town, or doctor. I’m guessing the last.

The truth is that there aren’t three sex categories in nature – male, female, and intersex. In nature, sex blends in complicated ways from one sex trait to another. So the idea that there is a natural third category also legitimizes the other two categories as if they are natural, when in fact nature doesn’t draw these lines. We draw these lines on nature.

Okay, we’ve covered problems #1 (confusion over sex and gender) and #2 (pretending intersex is a simple natural category). The rest are pretty simple:

As to #3 (imagining that transgender people never have anything but one of two simple genders), do I need to say much about this other than that it is a hangover from the old conservative system that insists on two genders? The reality is that there are people who do not have any discernable intersex condition but also do not see themselves as simply men or women. Why are they restricted to M or F? Because this system still longs for a firm biological anchor to gender, I think.

Regarding #4 (letting doctors be the arbiters of social identity), the new Australian rules require a doctor’s note to certify a person as either transgender (or more like re-gendered) or as intersex. But why are we asking doctors to do this? (Why not just let people tell us who they are?) And could I ask, if we must have this doctors’-note system, could we please make everyone who thinks they are male-men and female-women get a doctor’s note proving it, too?

Finally, #5: Did they really have to pick “X”?

“X” has tended to signify unwanted or naughty things in American history, and I’m guessing Australia’s relationship with the letter “X” is not that different. I really don’t think we’re helping anybody by marking people born with sex anomalies as “X” men, grand as we might be imagining their superpowers to be.

Alice Dreger is a professor of Clinical Medical Humanities and Bioethics at Northwestern University Feinberg School of Medicine. This essay originally appeared on her blog for Psychology Today.

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