Thy O’Donell was early into his gender affirmation, dealing with an ovarian cyst that had just burst, when he was admitted to a Canberra hospital. Someone asked him to rate his pain. “A nine,” he said. “Okay, miss,” came the reply. “No,” Thy said. “Mister.”
That exchange is the whole problem in miniature. Thy is a PhD researcher at the Australian National University studying end of life and palliative care for trans and gender diverse people, and when I asked him what had stayed with him most from his own experience of the healthcare system, this was the moment he went to: not because it was the most dramatic thing that ever happened to him, but because it was so small, so easily fixed, and so completely unfixed. He was there for what he called “a very female issue, and still is,” advocating for himself through the pain, in an institution that, at the time, was run by a Catholic health provider not especially interested in getting his pronoun right. It has since become part of Canberra Health Services and is no longer religiously affiliated. But Thy’s point wasn’t really about that one hospital. It was about how often the moment someone is at their most vulnerable is the exact moment they’re asked to do the most explaining.
That idea doesn’t stay contained to one interview, either. Once you hear it from Thy, you start noticing it everywhere else in this podcast’s back catalogue too: in Bronte Price’s stories about funerals, in Dr Annetta Mallon’s stories about mourning, in philosopher Katrina Jaworski’s work on how gender shapes the way a death gets read, in the small print of who gets asked what, and when. None of these guests were talking to each other. But put their conversations side by side and they’re describing the same gap from four different rooms.
You can be on HRT until you die
A lot of what Thy hears from the trans people he interviews for his research comes down to information nobody has ever told them. “They don’t know that you can be on HRT until you die,” he told me. Estrogen might need to switch from oral to a patch or an injection if someone loses the ability to swallow, but it doesn’t need to stop. That single fact sits inside a much bigger one: palliative care, Thy argues, is already one of the more holistic corners of medicine, built around treating the whole person rather than the diagnosis. The trouble is that clinicians he interviews for his research will often tell him gender “doesn’t actually really come up” in their work, in the same breath as describing how they ask a dying person how they’d like their hair done or what they want to wear. “I argue that gender affirming care is all forms of care,” Thy said. Somebody has already asked the gender affirming question. They just haven’t clocked that that’s what it was.
That’s not a small distinction, because it changes what the fix looks like. It isn’t a new specialty, a new set of credentials, or a training day nobody has budget for. When Thy was recently rushed into surgery, his mother filled out the patient board at the end of his hospital bed, the one for things that were important to him, with his dog, his mum, and his pronouns, written large. Nobody had to be an expert in trans health to make room for that. Somebody just had to ask, and somebody had to write it down where the next person on shift could see it.
Two names on a coffin
Where the gap stops being an oversight and starts costing something is at the end. Thy has read the same accounts most people in death literacy circles have: trans women dressed as men for their own funerals, chosen family arriving to find a stranger’s version of the person they loved laid out for viewing.
Bronte Price, Australia’s first marriage celebrant certified in LGBTQIA+ weddings who now also works in funerals, has stood inside that exact split more than once. In one case, where a trans person’s biological family still thought of them by the name they used before they transitioned, the funeral ran two nameplates on the one coffin, one at each end, and part of Bronte’s job on the day was managing, with as much care as he could manage, who saw which one. In another, a family and a person’s own chosen people couldn’t be reconciled into a single service at all, so Bronte ran two separate ceremonies: one that used the person’s name and pronouns and told the stories their friends knew, and one that talked about who they’d been before.
Dr Annetta Mallon, a grief therapist and end of life educator, told me about a trans woman known to one of her closest friends. When the woman died, her family by DNA buried her as a man: the order of service ran her deadname, with, as Annetta put it, no mention of who this particular woman was or the richness of her life. “Essentially two thirds to three quarters of herself and her people were cut off,” Annetta said. Annetta’s friend ended up travelling to help run a second, truer memorial, because the first one hadn’t been for the woman anyone there had actually known.
Both Bronte and Annetta land on the same word for what’s supposed to catch this before it happens: family. Not biological family specifically, but found family, or as Annetta put it, the people who understand you, show up for you, and have a kindred mindset, who might have zero DNA in common with you and still be the ones who know exactly how you wanted your hair done. Thy hears the found family instinct constantly in his interviews too, in a slightly different key: “My partner will fight anyone,” his participants tell him. Which is wonderful, until you ask the next question, the one Thy always asks back: what happens if they’re not available? Or, as Bronte’s stories make clear, what happens if a biological family simply doesn’t let them in the door?
Whose death counts
Philosopher Katrina Jaworski’s work sits a little outside the others, on suicide rather than palliative care, but her central finding rhymes with Thy’s almost exactly. Jaworski doesn’t study why people take their own lives. She studies how the rest of us interpret it afterwards, and she has found that gender decides most of that interpretation before anyone gets near the facts. Women’s suicides, she says, tend to be read as “attention seeking, waste of time, maladjusted, manipulative,” while men’s are treated as more serious and more willful, simply because men die by suicide at higher rates. The reasons offered follow a similar pattern: a woman’s death gets attributed to a relationship ending, a man’s to something economic, a lost job, a failing body, when Jaworski’s research keeps finding the same relationship breakdowns sitting underneath the men’s deaths too, just narrated differently because a man is the one telling it. Her own summary of the pattern is blunt: “we have a very masculine way of understanding suicide,” where the method has to look strong and assertive, while a woman doing the exact same thing gets called passive and reactive.
Her conclusion runs directly against the instinct to treat gender as an optional extra. “We cannot presume that suicide is a gender neutral phenomenon,” she told me, and the same logic holds for every other part of death and dying this podcast has covered: whose funeral gets planned around whom, whose name goes on the coffin, whose grief gets taken seriously. Treating any of it as neutral is exactly how one person’s account of their own life gets quietly overwritten by an assumption nobody thought to check.
Reflecting on why peer-led groups matter, Jaworski didn’t reach for a clinical framework. “They just want a sense of recognition and respect that who they are counts,” she said. “That they matter, that what they’re going through is real, and that it’s not their fault.” The context was suicide, but it could just as easily have been Thy talking about dying.
It’s worth noting where both of them, independently, pointed to the same real work already underway. Asked what resources he’d point people toward, Thy named the Queer as Death Collective. In her own, separate conversation, Jaworski brought up the same organisation unprompted, calling it the Queer Death Cafe, after coming across the group at a death and dying festival. When I mentioned its two Melbourne organisers, whose names she gave me as Hini and Alex, she didn’t hesitate. “They should be getting a lot of funding, in my books,” she said. “They’re doing the grassroots stuff that needs to happen.” Two guests, two separate conversations, landing on the same small group of people doing work nobody’s funding properly.
Ask, don’t assume
The reason all four keep circling back to documentation isn’t bureaucratic box ticking. It’s that a will, an advance care directive, or even a note behind the front door is the only thing standing between “what this person wanted” and “whoever’s loudest at the bedside.” Bronte estimates somewhere between 12 and 18 percent of the LGBTQIA+ community has that kind of paperwork in place. Thy’s research points at a similar pattern for the general population, worse again for trans people, who until this year weren’t even reliably counted. That changed this month: the 2026 Australian census asked about gender identity and sexual orientation for the first time in the nation’s history. Thy is glad it’s happening and frustrated it took this long, and quietly furious that people with variations in sexual characteristics were left off the question entirely.
None of this requires a new profession. Bronte’s client intake form asks for pronouns and, optionally, sexuality and gender, before he’s ever met anyone in person, so he’s never guessing from how two people look together whether they need a specific safety plan for a venue’s bathrooms. It’s the same move as the patient board at the end of Thy’s hospital bed. Ask. Don’t assume. Write it down so the next person doesn’t have to guess either.
Trans care is just care
When I asked Thy what meaningful progress would look like, he didn’t reach for anything radical. He wants advance care directive numbers to go up. And he wants clinicians to stop treating “trans” as a specialty bolted onto care rather than a fact about the whole person in front of them, the same person whose hair, clothes, and chosen people were always going to come up in a good palliative conversation anyway. He’s 28, and by the time we spoke he’d drafted his own advance care directive as well as his will, partly to show his parents it wasn’t something to be afraid of. He’d used the same line on them before, about the will: “Look, we can do this. I can do it, and I’m in my late twenties. You can do it.”
By the end, that ask is coming from four directions at once. Thy wants hospitals to treat gender as part of the whole person, not a special case parked outside the room. Bronte wants funerals to stop assuming who counts as family before anyone’s asked. Annetta wants whoever is standing closest to a death to protect the version of a person that was actually true, not the version that happens to be easiest for someone else to grieve. And Katrina wants all of us to notice that gender was already shaping the story long before anyone thought to check it, in a hospital bed, at a funeral, or in how a death gets explained afterwards. None of them are asking for something complicated. Ask. Don’t assume. Say it before someone else has to guess it, and tell the people who matter to you what you want your last months, your funeral, your name on the paperwork, to look like, while you’re still the one who gets to correct the record. Because the alternative isn’t neutral. It’s a nurse who writes “miss” and moves on, an order of service with the wrong name on it, a nameplate someone else chose, a death read as something it never was. You may not be ready to die, but at least you can be prepared, and so can the people who’ll be standing at the end of your bed.
