Sex vs Gender in medicine and health care

This is already a problem where I work. Our patient record system still says "sex" but the case of trans patients, this field contains their gender identity, not their sex. The first line of any record opened is then supposed to say "phenotypically male/female" as appropriate...but often it gets omitted.

Many of our tests require accurate input regarding sex. The normal ranges for kidney function, stomach function and bone density are different for males and females. Entering the wrong sex will give a wrong result. Doses for some of our drugs are different for males and females. And for any test using radiation, female patients must be asked if they might be pregnant. I have seen transwomen asked if they could be pregnant, and I recently learned of a case where a transman wasn't asked, even though he was pre-op and was having a pelvic CT scan. That could have been disastrous, and would be totally preventable just by using the "sex" field correctly. Add a "gender identity" field by all means, but from a medical perspective the two are absolutely not interchangeable.

This is pretty much exactly the case where I work, down to transmen not being asked the vital “is there any chance you could be pregnant?” before certain investigations.

Bowl Its as if all of the guidance, policies etc have been drawn up in complete isolation.

I only mention the gyny cancer situation because its within my experience and also many women I know.

Its also the case of course for any woman who, for what ever reason, may know with surity that she cannot be pregnant.

The radiographers often (have to) ask suplementary questions eg when was your last period, have you had unprotected sex since then/ Regardless of the circumstances they will pursue this and if there is even the remotest of possiblity / or they cannot rule it out, they will not scan.

They can't not ask it even for women whose notes indicate total hystectomy due to gyny cancer (& I know some women have tried to have this changed due to the distress)

- this shows very well the double standard.

*scans, not sans, apologies.

I recently learned of a case where a transman wasn't asked, even though he was pre-op and was having a pelvic CT scan. That could have been disastrous, and would be totally preventable just by using the "sex" field correctly

This is ridiculous! Having had a total hysterectomy due to medical neccessity (& being childless as a consequence) shortly after the diagnosis and operation, I found the question 'could you be pregnant?' upsetting. I've had quite a few sans so understand the radiographers' responsibility.
They can't not ask it even for women whose notes indicate total hystectomy due to gyny cancer (& I know some women have tried to have this changed due to the distress) and yet uniquely in this situation, the rules, responsibilities, risk assessments etc are different.

Probably. Then lessons will be learned, etc.

Meanwhile someone’s health will have been irreparably damaged, or worse.

patient safety is the absolute number one priority and it’s being put at risk.

Will it take a significant mistake to happen before the forms are put back to how they were?

Christ that’s worrying - have you raised this as a concern?

This is already a problem where I work. Our patient record system still says "sex" but the case of trans patients, this field contains their gender identity, not their sex. The first line of any record opened is then supposed to say "phenotypically male/female" as appropriate...but often it gets omitted.

Many of our tests require accurate input regarding sex. The normal ranges for kidney function, stomach function and bone density are different for males and females. Entering the wrong sex will give a wrong result. Doses for some of our drugs are different for males and females. And for any test using radiation, female patients must be asked if they might be pregnant. I have seen transwomen asked if they could be pregnant, and I recently learned of a case where a transman wasn't asked, even though he was pre-op and was having a pelvic CT scan. That could have been disastrous, and would be totally preventable just by using the "sex" field correctly. Add a "gender identity" field by all means, but from a medical perspective the two are absolutely not interchangeable.

When I request blood tests, x rays etc it is done electronically through the patient records on the computer. There is automatic pre-filling of patient data- name, dob etc. AFAIK it uses sex rather than gender and would continue to use Male sex even if one identified as something else. Where other factors are important the lab also puts a reminder comment, for example it will comment that race is an important consideration in some blood tests. However, I have recently found that a patient who is registered as Male has actually been buying oestrogen and testosterone online and we had no idea. His/her medical records and therefore his test results are all Male regardless of his gender identity. This is why, just as with anything else, we need to have the full information to be able to look after people properly and without that may make clinically inappropriate decisions.

Stark I didn’t spot that ‘assigned’ . Such anti- medical bullshit.

I find the whole page (link again: www.nhs.uk/conditions/gender-dysphoria/treatment/) so shockingly presenting unfiltered TRA politics:

Eg GnRH analogues suppress the hormones produced by your child’s body. They also suppress puberty and can help delay potentially distressing physical changes caused by their body becoming even more like that of their biological sex, until they're old enough for the treatment options discussed below.

WTF? Do TRAs (or apparently now, the NHS ) believe that children’s pre-pubescent bodies are without biological sex, or that they somehow exist with ‘less’ inherent biological sex, than an adult post-pubertal body does?
That’s a mad idea and obviously not how any human body has worked, ever.

It just shows how utterly ‘surface’, in all senses, the TRA concern is. All about external perceptions of outward appearance viewed through a sexualised lens- that bullshit I mentioned above on the same page about ‘acceptable appearance’ ie confirming to conventional gender stereotypes of fuckability.

Completely denying the important sex-based and distinctive physical systems that are in biological life forms, that give rise to any of these sexual characteristics (which are being presented here as somehow entirely optional to continue to possess). As if human physical sex can somehow be deleted and replaced with something else, the same as the opposite sex naturally possesses. It’s selling vulnerable people a lie and it’s really wrong.

‘For some people, support and advice from a clinic are all they need to feel comfortable in their gender identity. Others will need more extensive treatment, such as a full transition to the opposite sex. The amount of treatment you have is completely up to you.‘

It is total overselling in any medical context (like in an NHS website ) to be talking about treatment for ‘full transition to the opposite sex’ complete with ‘functioning’ genitalia. It’s not true or achievable and it’s wrong to present this as fact, however well intentioned the NHS is in doing so.

Chatty Lion you are right to pick up on those NHS pages. It refers to "sex assigned at birth" not "sex observed at birth" . Then it starts rambling on about rare hormonal and intersex conditions which the vast majority of trans people do not have. It makes no mention of factors such as autism.

It also divides possible sufferers into 2 groups - people who from a very young age feel they are in the wrong body; and adults. It makes no reference to the growing numbers of teenagers and very young adults who are presenting (self-diagnosed) as trans.

Fantastic posts, ChattyLion.

Just seen this thread which is also relevant: www.mumsnet.com/Talk/womens_rights/3313760-Up-to-150-youngsters-treated-with-puberty-blocking-jabs-might-not-even-be-transgender

Compare it with the body dysmorphia section of NHS choices for a stark contrast:
www.nhs.uk/conditions/body-dysmorphia/

Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others.
People of any age can have BDD, but it is most common in teenagers and young adults. It affects both men and women.
Having BDD does not mean you are vain or self-obsessed. It can be very upsetting and have a big impact on your life.

Note: there is not then any similar narrative about the types of surgeries you can have to get an ‘acceptable’ or ‘functioning’ new face or whatever body part your dysmorphic perception sees as problematic. It’s all about talking therapy.
Why is it such a different approach to NHS treatment here, and in describing the possible treatment outcomes?

(Sorry I am essentially recycling my post from the Biology is not Bigotry thread but here goes):

I am worried that people considering a surgical approach to dysphoria and the general public may not be being given really accurate health information because the TRA dogma must always be appeased.

So if you consider what is a vagina and what is a penis. What these organs are and what they can normally do. The physical systems that they are part of, which contribute to why they do what they can do. Keep that reasonable expectation and understanding in your mind.

Then if you look at the NHS Choices pages on gender dysphoria:
www.nhs.uk/conditions/gender-dysphoria/treatment/

Then scroll right down to the section about biologically male adults having surgery, it says: eg

The vagina is usually created and lined with skin from the penis, with tissue from the scrotum (the sack that holds the testes) used to create the labia. The urethra (urine tube) is shortened and repositioned. In some cases, a piece of bowel may be used during a vaginoplasty if hormone therapy has caused the penis and scrotum to shrink a significant amount.

It continues that:

The aim of this type of surgery is to create a functioning vagina with an acceptable appearance and retained sexual sensation.

It also says a ‘functioning penis’ can be made out of surgically altering a biologically female person’s body.

Note: this is my use of quotation marks, not that of the NHS. They don’t use quote marks to imply any ‘simulation of’ they say you will get a functioning penis or vagina via these surgeries. That is simply not medically possible to aspire to.

These shouldn’t be described as ‘functioning’ organs post-surgery because the results of surgeries aren’t these organs as they occur naturally in the opposite sex, nor do they ever function like naturally-occurring sex organs.

As an example, the only ‘functioning’ the described surgically-created ‘vagina’ is capable of, that might be similar to a real vagina, is a capability of being penetrated. But without any of the vaginal musculature, natural lubrication and protective flora or similar level of physical sensation involved.

Is a capacity for penetration the only necessary activity or definitive ‘function’ of vaginas? Apparently so.

It’s all so reductive about what female sex organs are for and can do. It is also misleading people about what sex organs they will get and end up with, after hugely invasive surgeries.

These surgeries can never achieve a ‘functioning penis’ or a ‘functioning vagina’ in the way it’s implied, yet this is how it is described. Why are people (of any age) contemplating future surgery not being told the truth?

Second point: in the section (same NHS link as above) about children and young people. they mention Gnrh analogues (commonly known as ‘puberty blockers’) but not the dangers and the unknowns of taking these for kids.

The effects of treatment with GnRH analogues are considered to be fully reversible, so treatment can usually be stopped at any time after a discussion between you, your child and your MDT

They also don’t warn against buying these online for ‘self-medication’ which we all know happens.

It’s not a small number of kids being prescribed these via the NHS. in 2017, 800, with 230 kids on puberty blockers under the age of 14. Some reportedly as young as 10.
www.dailymail.co.uk/news/article-4743036/800-children-young-10-puberty-blockers.html

Never reaching normal sexual (and hormonal and emotional) maturation and never growing normal adult-sized genitalia as a result of taking these drugs is simply not a permanent choice that a ten year old has the mental capacity to make.
The reversibility and safety of these drugs would appear to be highly overstated, and the risks highly understated by this NHS narrative. These drugs could eventually also reduce the possibility or effectiveness of having ‘sex reassignment surgery’ leaving an adult with pemanently immature sex organs. As has been documented (see Jazz Jennings’ situation)

And if you google it these drugs are easily available for purchase online. Usual NHS caveats about fake drugs, ineffectiveness or overdose on a genuine product apply here very clearly. Where are the factual warnings on this NHS choices page against this?

I think NHS health information must be given factually. What they describe on this page, isn’t factually correct and might mislead.

I can see the NHS are trying to be sensitive to people’s feelings which is important but this must never be done at the expense of informed consent. It is not ok for the NHS to be confusing or misleading the people who might be reading this NHS health information, because they are considering treatment. Nor the general public. Everyone needs to know the actual medical effects of treatments to be able to consent to having those treatments. Other body dysmorphias and their NHS treatments are not described in this way.

I also object to the reductive way that sex organs are presented by this account- what is presented is a purely political presentation not a factual or medical presentation.
A genuinely fully functioning vagina is not just a passive cavity in the body that is there to be penetrated. (Which is all that surgery can create)

Also what the hell is a vagina with an ‘acceptable appearance’ such as they say these surgeries are needed to create. Acceptable to whom? What is an ‘unacceptable’ vagina and what does that look like?

If anyone can say that whatever they have in their pants is a vagina anyway, because TW=W, (and including a naturally occurring and fully functioning penis) then why is surgery even at issue? Why does our NHS give out this kind of information? Why not say eg that ‘the safest form of action is always to keep what you naturally have or will achieve through natural puberty’?

What about being sensitive to the feelings of people who disagree with this account of human sex organs?

I'm actually talented at stopping threads

Perhaps not so fast there Floorplan! Late-comers swoop in and play catch-up!

Can the question really be: "How to save the deluded from themselves?"
There is a time for dress-ups (when you are 5), and a time for reality (12 onwards).

I'm actually talented at stopping threads

Personally I think it's a problem and I've done blood related tests in nhs accredited labs.

You can change your NHS records to state your preferred gender on the basis of a chat with your gp. That happens now, no change to legislation needed.