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Sydney Morning Herald
17-06-2025
- Health
- Sydney Morning Herald
Choosing the sex of an IVF baby is banned. Should it be?
'I'm here to promote awareness for the availability of gender selection and to hopefully ignite some conversation so that perhaps in the future, people won't have to travel to the United States to have this done,' Potter says. What are the rules and the concerns behind them? The National Health and Medical Research Council reviewed their guidelines on assisted reproductive technology in 2017 and upheld its view that sex selection should not be used unless to reduce the risk of a genetic disease. (Duchenne muscular dystrophy, for example, mostly affects males.) One of the concerns cited by the NHMRC's ethics committee was that nonmedical sex selection could lead to people favouring one sex over the other based on cultural or personal biases. What the NHMRC considered in its ban on sex selection Whether sex selection is a justifiable use of medical resources. Whether there's an ethical difference between people wanting sex-balanced families and people choosing a particular sex due to personal or cultural bias. The possibility that sex selection my validate or reinforce gender stereotyping and discriminatory attitudes, and create pressure on the person born to conform to their parents' gender expectations. The possibility that sex selection may open the way for selecting other characteristics such as eye or hair colour. Concerns that people may be terminating pregnancies as an alternative sex-selection technique. Concerns Australians seeking sex selection could be travelling to international clinics with a lower standard of care. Values inherent in Australian society that relate to freedom and autonomy, particularly in relation to reproductive choices. Read the full reasoning behind the guidelines. The imbalance of the sex ratio in China is often cited as an example of cultural bias favouring male babies; in 2004 there were 121 males to every 100 females, at least partly because sons were preferred, so female fetuses were more likely to be aborted. China's sex ratio has since evened out, but there's still a male skew. Choosing the sex of an embryo to 'balance' a family's split between male and female children is one of the most common reasons people seek out sex selection, and it's viewed as more ethically acceptable. Alex Polyakov, an associate professor at the University of Melbourne and medical director of Melbourne's Genea IVF clinic, believes couples should be able to choose the sex of their third child, as long as their first two children are of the same sex. 'I think the argument that it will skew the sex ratio is really quite nonsensical,' he added, arguing the proportion of people taking part in sex selection would have to be huge to have such an effect. 'I don't really see an ethical or moral issue if safeguards are put in place.' By the same token, Polyakov has also warned embryo testing and selection strategies can decrease chance of pregnancy or lead to the discarding of healthy embryos, which in some cases has risked parents missing out on biological parenthood altogether. 'I think we often forget that the overriding aim is to increase the pregnancy rate, to get someone pregnant as soon as possible,' he says. Do people choose more males over females? Data is mixed on whether people are more likely to choose male or female embryos. An analysis of about 2300 embryo transfers at a US IVF clinic between 2012 and 2021 found 56.5 per cent of people who opted for sex selection chose male embryos. A study on a different hospital found roughly equal rates of sex selection when it was someone's first child, but a 59 per cent preference for females on the second child. Potter said about 70 per cent of his clients request female embryos, often driven by women who wanted a mother-daughter relationship. 'This process is driven by the female partner in most cases. For a lot of women, they've been imagining having a daughter ever since they were playing with dolls and modelling parenting behaviour as a child,' he says. Sex v gender Bioethicist Dr Tamara Browne, a senior lecturer in health ethics at Deakin University, says she's sad this debate has rekindled. 'We really haven't gotten very far when it comes to counteracting gender stereotypes and achieving gender equality,' she says. 'The two are interlinked, and I've become even more convinced that if we're to achieve gender equality, we have to stop parenting children differently according to their sex.' Assuming daughters will be closer to their mothers, or that boys offer different, more 'macho' experiences such as being into sport, plays into outdated gender beliefs, Browne says. Loading 'We don't have any good scientific evidence that you can only get these sorts of parenting experiences with a child of a certain sex,' she says. She makes the point that sex selection allows people to choose the sex chromosomes and genitalia of their child. It can't decide a child's gender – the way they express that sex. How, Browne argues, do we expect more men to take up nursing or childcare roles, and women to take up STEM subjects like maths and engineering, if we reinforce the idea they're born with different traits and abilities and therefore should be parented differently? I also ask Potter if he ever discusses with his clients the chance that a child born from a sex-selected embryo could eventually embrace a different gender identity – for example, a baby born from a female embryo who grows up as a trans man. (About 5 per cent of Americans under 30 say their gender is different to the sex they were assigned at birth, according to Pew Research Centre.) 'There would be no reason to discuss that, any more than it would be to discuss with an expecting mum,' Potter says. 'It's a pretty unlikely thing and kind of a grim topic.' How much should it cost? Dr Hilary Bowman-Smart, a research fellow at the University of South Australia who has studied prenatal testing, thinks sex selection in embryos isn't a particularly valuable use of medical resources, but the current reasons to keep it illegal were not compelling. Loading Bowman-Smart is concerned, though, about companies making money from sex selection services. 'I would be concerned about this becoming an expensive service that is advertised to people during a vulnerable time in their lives who otherwise might not have cared too much either way,' she says. While Polyakov backs sex selection in some circumstances, he doesn't believe it should be covered by Medicare. If it were legalised in Australia he estimates the practice would cost about $500 to $700 per embryo. 'So if you have 10 embryos, that adds about $5000 to $7000,' on top of the existing costs, he says.
The Age
17-06-2025
- Health
- The Age
Choosing the sex of an IVF baby is banned. Should it be?
'I'm here to promote awareness for the availability of gender selection and to hopefully ignite some conversation so that perhaps in the future, people won't have to travel to the United States to have this done,' Potter says. What are the rules and the concerns behind them? The National Health and Medical Research Council reviewed their guidelines on assisted reproductive technology in 2017 and upheld its view that sex selection should not be used unless to reduce the risk of a genetic disease. (Duchenne muscular dystrophy, for example, mostly affects males.) One of the concerns cited by the NHMRC's ethics committee was that nonmedical sex selection could lead to people favouring one sex over the other based on cultural or personal biases. What the NHMRC considered in its ban on sex selection Whether sex selection is a justifiable use of medical resources. Whether there's an ethical difference between people wanting sex-balanced families and people choosing a particular sex due to personal or cultural bias. The possibility that sex selection my validate or reinforce gender stereotyping and discriminatory attitudes, and create pressure on the person born to conform to their parents' gender expectations. The possibility that sex selection may open the way for selecting other characteristics such as eye or hair colour. Concerns that people may be terminating pregnancies as an alternative sex-selection technique. Concerns Australians seeking sex selection could be travelling to international clinics with a lower standard of care. Values inherent in Australian society that relate to freedom and autonomy, particularly in relation to reproductive choices. Read the full reasoning behind the guidelines. The imbalance of the sex ratio in China is often cited as an example of cultural bias favouring male babies; in 2004 there were 121 males to every 100 females, at least partly because sons were preferred, so female fetuses were more likely to be aborted. China's sex ratio has since evened out, but there's still a male skew. Choosing the sex of an embryo to 'balance' a family's split between male and female children is one of the most common reasons people seek out sex selection, and it's viewed as more ethically acceptable. Alex Polyakov, an associate professor at the University of Melbourne and medical director of Melbourne's Genea IVF clinic, believes couples should be able to choose the sex of their third child, as long as their first two children are of the same sex. 'I think the argument that it will skew the sex ratio is really quite nonsensical,' he added, arguing the proportion of people taking part in sex selection would have to be huge to have such an effect. 'I don't really see an ethical or moral issue if safeguards are put in place.' By the same token, Polyakov has also warned embryo testing and selection strategies can decrease chance of pregnancy or lead to the discarding of healthy embryos, which in some cases has risked parents missing out on biological parenthood altogether. 'I think we often forget that the overriding aim is to increase the pregnancy rate, to get someone pregnant as soon as possible,' he says. Do people choose more males over females? Data is mixed on whether people are more likely to choose male or female embryos. An analysis of about 2300 embryo transfers at a US IVF clinic between 2012 and 2021 found 56.5 per cent of people who opted for sex selection chose male embryos. A study on a different hospital found roughly equal rates of sex selection when it was someone's first child, but a 59 per cent preference for females on the second child. Potter said about 70 per cent of his clients request female embryos, often driven by women who wanted a mother-daughter relationship. 'This process is driven by the female partner in most cases. For a lot of women, they've been imagining having a daughter ever since they were playing with dolls and modelling parenting behaviour as a child,' he says. Sex v gender Bioethicist Dr Tamara Browne, a senior lecturer in health ethics at Deakin University, says she's sad this debate has rekindled. 'We really haven't gotten very far when it comes to counteracting gender stereotypes and achieving gender equality,' she says. 'The two are interlinked, and I've become even more convinced that if we're to achieve gender equality, we have to stop parenting children differently according to their sex.' Assuming daughters will be closer to their mothers, or that boys offer different, more 'macho' experiences such as being into sport, plays into outdated gender beliefs, Browne says. Loading 'We don't have any good scientific evidence that you can only get these sorts of parenting experiences with a child of a certain sex,' she says. She makes the point that sex selection allows people to choose the sex chromosomes and genitalia of their child. It can't decide a child's gender – the way they express that sex. How, Browne argues, do we expect more men to take up nursing or childcare roles, and women to take up STEM subjects like maths and engineering, if we reinforce the idea they're born with different traits and abilities and therefore should be parented differently? I also ask Potter if he ever discusses with his clients the chance that a child born from a sex-selected embryo could eventually embrace a different gender identity – for example, a baby born from a female embryo who grows up as a trans man. (About 5 per cent of Americans under 30 say their gender is different to the sex they were assigned at birth, according to Pew Research Centre.) 'There would be no reason to discuss that, any more than it would be to discuss with an expecting mum,' Potter says. 'It's a pretty unlikely thing and kind of a grim topic.' How much should it cost? Dr Hilary Bowman-Smart, a research fellow at the University of South Australia who has studied prenatal testing, thinks sex selection in embryos isn't a particularly valuable use of medical resources, but the current reasons to keep it illegal were not compelling. Loading Bowman-Smart is concerned, though, about companies making money from sex selection services. 'I would be concerned about this becoming an expensive service that is advertised to people during a vulnerable time in their lives who otherwise might not have cared too much either way,' she says. While Polyakov backs sex selection in some circumstances, he doesn't believe it should be covered by Medicare. If it were legalised in Australia he estimates the practice would cost about $500 to $700 per embryo. 'So if you have 10 embryos, that adds about $5000 to $7000,' on top of the existing costs, he says.
ABC News
21-05-2025
- Health
- ABC News
Does the gender-affirming model provide trans youth the healthcare they need? There are good reasons to think it doesn't - ABC Religion & Ethics
Over the last 10 to 15 years, the number of children and adolescents seeking medical help for gender dysphoria has rapidly increased in Australia. In the context of uncertainty over how to respond to this phenomenon, the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents (ASOCTG) was developed by an interdisciplinary team of physicians and researchers at the Royal Children's Hospital Melbourne, and published in 2018. The development of these guidelines contributed to the widespread adoption of what is called 'gender-affirming care' across state medical bodies — as well as by the Australian Professional Association for Trans Health (AusPATH), which defines it as follows: Gender affirming healthcare emphasises affirming language, psychological and peer support, support for social affirmation, and/or medical affirmation (e.g. puberty blockers for young adolescents, or feminising or masculinising hormones and/or surgery for older clients), as medically necessary and clinically relevant. It is important to note, however, ASOCTG was not endorsed by the National Health and Medical Research Council (NHMRC), which has been asked by the federal government 'to develop new national guidelines for the care of trans and gender diverse people under 18 with gender dysphoria'. These proposed national guidelines will not be finalised until March 2028. In the interim, medical bodies in Australia have an opportunity to reconsider the evidentiary basis for the gender-affirming model of care. This comes at the same time that, due to growing evidence of harms, several European countries — including Finland, Sweden, Norway, Denmark and the UK — recommended that aspects of the practice of gender-affirming care be restricted. As recently as 1 May 2025, the United States Department of Health and Human Services released its 'umbrella review' evaluating 'the direct evidence regarding the benefits and harms of treatment for children and adolescents with gender dysphoria', which concluded that: many U.S. medical professionals and associations have fallen short of their duty to prioritize the health interests of young patients. First, there was a rapid expansion and implementation of a clinical protocol that lacked sufficient scientific and ethical justification. Second, when confronted with compelling evidence that this protocol did not deliver the health benefits it promised, and that other countries were changing their policies appropriately, U.S. medical professionals and associations failed to reconsider the 'gender-affirming' approach. Third, conflicting evidence — evidence that challenged the foundational assumptions of the protocol and the professional standing of its advocates — was mischaracterized or insufficiently acknowledged. Finally, dissenting perspectives were marginalized, and those who voiced them were disparaged. Gender ideology and the risks of gender-affirming care The ideological premises of gender-affirming care are that, irrespective of age: children know their gender and healthcare needs; their gender identity will remain stable; affirmation (social, medical and surgical) is necessary to assist mental well-being; incongruence between gender identity and biological sexed reality is normal; and any distress experienced by youth is the result of intersectional vulnerabilities and prejudice. Australian governmental institutions have embraced gender ideology, as is evidenced by the changing definitions of commonly used terms on governmental websites, the replacement of 'sex' with 'gender' as a protected characteristic in anti-discrimination legislation, the implementation of anti-conversion therapy legislation, and the threat of discrimination claims from the human rights commissions if doctors fail to use preferred pronouns during consultations. This legal restriction that Australian doctors now face compels them to affirm a child's gender identity and disregard the importance of neutral exploration of a child's symptoms, the changing capacity for abstract concepts with maturity, and the time-frame of identity development which extends into adulthood. Recommendations to support distressed children with a psychotherapy first-line — what is sometimes called 'watchful waiting' — are, in turn, criticised by some activists as 'medical gatekeeping', despite there being evidence that a normally timed puberty leads to resolution of symptoms in 85 per cent of children with gender dysphoria. (Though it should be noted that the authors of the study in question 'recognized that the boys … were seen during a period of time when treatment recommendations, if such were made, often aimed to reduce the gender dysphoria between the child's felt gender identity and biological sex'.) AusPATH rejects stand-alone psychotherapy, even though such a stance is antithetical to usual child psychiatric practice and psychiatrists reject claims that equate psychotherapy with conversion therapy. ASOCTG also encourages the social transition of children — which includes changing names and pronouns of children — in home or school environments, according to the wishes of the child. In the case of older adolescents, this might include breast binding and genital tucking, or the use of padding and prostheses. According to the guidelines, medical transition is, in turn, facilitated by the prescription of puberty blockers and cross-sex hormones. Despite arguments that puberty blockers simply 'pause' puberty, they are most often a step towards cross-sex hormone treatment that will irreversibly change a child's physical features. Although children are promised an opportunity to 'change sex', the reality is potentially life-long medicalisation. Moreover, medical transition can cause potentially serious physical complications — including bone density loss (osteoporosis), sexual dysfunction (anorgasmia), metabolic and cardiovascular complications, thromboembolic (stroke) risk, mood changes, pelvic floor dysfunction and surgical complications. There is also evidence that puberty blockers can interfere with pubertal hormonal changes necessary for brain development. The risks of infertility and permanent sterility require children to decide upon ethically challenging fertility preservation at a time in their lives when many have not experienced their first romantic relationship. Is gender-affirming care truly 'life-saving' care? The assertion that medical transition is 'life-saving' and urgently required is a frequently made claim that can have the effect of coercing parents, policy makers and institutions to suppress some of their questions and deeper concerns. And yet an independent review of data on rates of suicide among young gender dysphoria patients of the Tavistock and Portman NHS Foundation Trust, following the 2020 restriction of puberty blocking drugs, suggests that medical transition is unlikely to mitigate suicide risk among trans-identified youth. On the contrary, a large Finnish study concluded that it is other co-occurring mental health conditions that are associated with suicide — as a result, the authors stressed the need for professionals to treat other conditions, such as trauma or autism, rather than rush to provide medical transition or surgery. Despite the clear need for holistic care, scientific reviews, an independent service review and a recent Family Court finding have all demonstrated that some Australian specialist gender clinics do not, in fact, offer the comprehensive treatment — including for that of co-occurring conditions — they promise. Doctors are unable to confidently predict which child will, and will not, persist in their gender identity. Detransitioners, or those experiencing regret, often present several years after interventions are commenced and fail to notify their original treatment provider. Their experience is not taken into account by ASOCTG, and hence guidelines are not provided regarding how best to support a young person wishing to cease their medications — an omission mirrored by lack of governmental funding for organisations, such as Genspect, that support detransitioners. Notwithstanding mounting evidence of harms and international practice changes, the Australian Society of Plastic Surgery recently lobbied the federal government to provide Medicare rebates for 28 gender-affirming surgeries. AusPATH has encouraged those advocating for this change to refer explicitly to the 'life-saving' properties of such medical interventions. The suppression of dissent With the release of the review by the US Department of Health and Human Services, the United States is simply the latest country to reject the premises of the gender-affirming model of care. The document highlights the way that major US medical and mental health associations (MMHAs) have become susceptible: to institutional biases, including groupthink and the disproportionate influence of vocal, specialized subcommittees. These specialized groups may receive broad deference from the larger organization, especially when their initiatives are framed in the language of civil or human rights. Consequently, MMHAs can inadvertently become echo chambers where dissent is suppressed, confirmation biases go unchecked, and professional deference is exploited. Australia is not immune to this same condition. When poorly evidenced treatments with what may turn out to be irreversible effects and serious side-effects are provided to children, usual medical practice is to provide treatment within clinical trials or with the support of hospital ethics committees. Despite serious child protection challenges inherent to experimental treatments, the involvement of hospital ethics committees or treatment provided within the clinical governance offered by clinical trials is not standard practice in any public gender clinic in Australia. Private practitioners have no established governance to routinely monitor decision making. Due to lack of infrastructure, there are still no means for authorities to identify the total number of affected children who have been treated in the public and private sector to date. Returning to a better form of care Vulnerable Australian youth deserve sensitive, good quality, evidence-based guidelines. I do not believe the ASOCTG has been written to a sufficient standard that should guide the profession in this complex area of healthcare. In future, 'Australian Standards' should be a protected title only to be used with reference to governmentally endorsed documents produced to the highest standard. Excellence in paediatric healthcare requires a general setting free from ideological coercion, where decisions are made on the basis of good quality evidence-based medicine. Doctors need a federal commitment to establish universal safeguards, monitor long-term outcomes, and return to a model of holistic care provided within general mental health settings that includes care for detransitioners. Meaningful change to support the improved health of trans youth requires an uncompromising return to the highest standard of evidence-based medicine. But when we do, we will also need to brace ourselves for the harm that may have already been caused. Dr Catherine Llewellyn is a fellow of the Royal Australian and New Zealand College of Psychiatrists (FRANZCP) and completed advanced training in both Child and Adolescent Psychiatry and Addiction Psychiatry. She is also a fellow of the Australasian Society of Lifestyle Medicine (FASLM).
Daily Mail
10-05-2025
- Health
- Daily Mail
The 'mummy wine culture' leading to a surge in alcoholism among middle-aged Aussie women
Melbourne woman Diane Denton has warned against 'wine mum' culture after her sister died following a battle with alcoholism. 'My father was a dependent drinker and I lost my sister to alcohol earlier this year,' she told 7News on Saturday. 'From what I understand, her drinking was quite risky in the end. She was drinking all day, every day.' Ms Denton's sister died at the age of 49 and the loss has prompted Diane to quit drinking alcohol herself after years of partying. 'My general anxiety, and you know, these bouts of depression have been alleviated.' Alcohol is the most widely used drug in Australia, according to the National Medical and Research Council (NHMRC). But the phenomenon of 'mummy wine culture' is on the rise due to a growing reliance of women on alcohol to manage anxiety after having a child, the University of Sydney reported. One of the common factors is that women have been made to feel as though drinking wine to 'cope' with stress is 'normal', with memes and slogans pushing the idea. CEO of Hello Sunday Morning Dr Nicole Lee said her organisation, which encourages Australians to cut back on and quit drinking alcohol, has seen a rise in the behaviour. 'We're seeing a concerning increase, particularly in women in middle age,' she said, specifically citing among women aged 45 to 65. 'There's a real kind of mummy wine culture that's promoted as you know, alcohol is a great release for all of the hard work that we do.' Another issue she raised is that alcohol shops see women as an 'untapped market' and advertise drinks with slimmer bottles and colours viewed as more feminine. It is a concern echoed by global alcohol prevention group Movendi International, which has warned that companies have invested in marketing campaigns targeting women. 'There are alcohol products strategically targeting women by incorporating specific design elements that appeal to their tastes and lifestyles,' its website said. 'These products often feature special packaging that is smaller, pink, and designed to serve as fashionable accessories.'
