I ran the first Tiny House building course in Australia - so I see a few good analogies for gender medicine. Stop. Hear me out. I picked up a few things about structures, codes and what happens when people misclassify serious work as minor work.
Most building codes let you do “cosmetic” or “like-for-like” repairs without a permit - repaint, replace a window, patch plaster. No inspection, no approval, because by definition you’re not changing anything structural. The rule exists so trivial work isn’t drowned in red tape. Now imagine someone uses that exemption to quietly remove a load-bearing wall. The paperwork still says “minor repairs.” The house looks the same from the street. Nobody inspects it, because the category tells them there’s nothing to inspect. The building stands - until it doesn’t.
That is the category error at the heart of gender medicine.
In all other fields of medicine the load-bearing wall is the standard medical model - it’s a process of diagnosis: listening, assessing, investigating, researching current evidence, considering all that, and then making a diagnosis or treatment recommendation. This process is the structure that holds ethical medicine up. It’s encoded in the Medical Board’s Good Medical Practice Code, which requires doctors to provide balanced, evidence-based information so patients, parents, guardians and minors can make voluntary decisions with adequate understanding of benefits, risks, and uncertainties.
But in gender medicine, the architects of “gender-affirming care” removed that load-bearing wall and replaced it with something that looks similar from the outside: affirmation. A partition wall, painted to match. It holds nothing up.
It may use medical language.
It may sit inside clinics.
It may appear in referral pathways.
It may be described as compassionate care.
But if the diagnostic process has been replaced by affirmation, then the structure has changed. And that matters.
We are now seeing the floor begin to collapse under the weight of irreversible harms, poor-quality evidence, worsening distress in some studies, permanent bodily consequences, broken families, and young people who were never properly assessed before being placed on life-altering pathways.
Attention goes to the visible cracks - court cases, regret, medical injury, family breakdown, suicide claims, political fights. That’s what makes the news. That’s the drama. But the cracks aren’t the problem. The wall that’s missing is.
A small category error can cause a huge structural shift. Regulators need to inspect the structure before more young people are harmed.
The question regulators should be asking is not merely: “Was this called gender-affirming care?”
The question should be: “Did this clinic actually follow the ordinary standards of medical assessment, informed consent, risk disclosure, diagnosis, evidence review, and professional care?”
A label is not a load-bearing wall.
Calling a treatment pathway “gender-affirming care” does not exempt it from ordinary medical, legal, consumer, and professional standards.
That is why regulators must inspect the structure, not accept the category.
Inspect. Assess. Apply the code.
AWW is auditing all 49 private gender clinics in Australia for compliance with Australian Consumer Law and National Law informed consent standards. Every clinic audited to date has failed to meet these standards.
See https://www.aww.org.au/informed-consent
Yes, excellent analogy. Thank you
Such a good analogy - thank you.