Sex vs Gender in medicine and health care

Sorry. Haemaglobin values are different for men and women. Not red cells. Anyway, sex is clinically relevant.

I’m not surprised by that. I’m not sure about the NHS anymore, or forms for taking blood. I know in the private sector all forms are designed on house so it would be down to whoever is designing the form.

I had to review one at work and we changed ‘gender’ to ‘sex’ as sex was clinically relevant. Some biochemical parameters are sex based. Eg red cell count / GFR

DoH advice

What’s important is that the lab has accurate sex information. References ranges differ for many tests and so they need that.

I’m not sure how it works in an NHS context, but when we send lab kits to central labs for private trials a form is filled out with the patient’s sex on and their unique blinded identifier. If that differs from what we have in the database it triggers a query automatically.

I’m assuming there’s some way of making sure the correct sex gets to the lab?

I’m sure someone who send off NHS tests/works in clinical biochem will know this!

But your patient records are based on your NHS number which has your birth sex on. So if you self-identity then you will need to get this specifically changed on your medical records.

Presumably the patient, who might be physically male but identify as female (or vice versa) will have the gender they want to be in their patient records, and that gender will be put on the form.

The normal range for female (or male) will then be listed on the results, along with the patient's results. Which could look off the chart peculiar for some blood tests, and (more dangerously) look normal for others, even though the results might be abnormal for the person's actual, biological sex.

This is an issue with self ID if it happens.

Right now when you legally transition it is gatekept through doctors and psychiatrists assessing. Your medical records indicate status.

If you have had medical treatment this has to be monitored - with blood tests on all sorts of levels regularly done. The lab need to know these are for a trans person or they can jump to wrong conclusions (such as that a transwoman might be pregnant or decline to do the requested PSA test as the form is marked as of a woman if trans not specified).

The medical trail within your GP files ensures this is all done properly even if you do not want to. It is out of your hands effectively.

With self ID though there will likely be none of this and also a lot of legally transitioned people who have no medical treatment to show up in the files.

But if they present at a GP and register by self IDing then they could get misrecorded. And if the person choses not to tell anyone if they are in medical need that might create issues too until it gets revealed by any examination.

Self ID will also endanger the transitioner because it transfers the responsibility of revealing biological sex to the person from the doctor's treating them.

The transsexuals who understand biology would tell and do but also have medical records revealing truth.

Given the transwomen are women insistence out there from the wider trans umbrella and the defensiveness with which identity seems fragile and protected I fear that self ID cases who do not medically transition - or - worse still self medicate off the internet without creating an NHS trail - will be the least likely to reveal their biology even if it puts their life at risk.

So it is another good reason not to remove gatekeeping.

Electronically generated forms usually have sex or gender prefilled using the information already on file. Paper forms have sex or gender completed by the person taking the blood. If they genuinely can't tell what sex/gender someone is then that could be an issue but it would still be an issue if the form said sex.

Sorry if I sound obtuse but I genuinely can't understand what the problem is.

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Chief Medical Officer

Professor Dame Sally Davies

Dame Sally was appointed Chief Medical Officer (CMO) for England and Chief Medical Advisor to the UK government in March 2011, having held the post on an interim basis since June 2010. She is an independent adviser to the government on medical matters, with particular responsibilities regarding public health.

Dame Sally advocates globally on AMR. She has spoken on AMR at numerous events including the World Health Assembly side events, the G8 science ministers’ meeting in 2015, the Global Health Security Initiative in 2015, and the UN General Assembly side event in 2016. She was chair of the 2013 AMR forum at the World Innovation Summit for Health (WISH) and was for three years the chair of the WHO Strategic and Technical Advisory Group on AMR. Most recently, Dame Sally has been appointed a co-convener of the UN Inter-Agency Co-ordination Group on AMR, set up in response to the AMR declaration made at UNGA 2016.

Dame Sally was a member of the World Health Organization (WHO) Executive Board 2014-2016 and has led delegations to a range of WHO summits and forums since 2004.

She is currently a non-executive director on the boards of: The Institute for Health Metrics and Evaluation; Genomics England Ltd; The Blavatnik School of Government, University of Oxford; The Clinton Health Access Initiative; and UK Research & Innovation. She was formerly on the boards of Cumberland Lodge and Ashridge Business School.

From 2004-2016, Dame Sally was the Chief Scientific Adviser (CSA) for the Department of Health (DH), where she was actively involved in NHS R&D from its establishment and founded the National Institute for Health Research (NIHR).

Dame Sally received her DBE in 2009. She was elected Fellow of the Royal Society in 2014 and a member of the National Academy of Medicine, USA in 2015.

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I think for the vast majority of people sex and gender are used interchangeably. Sex or gender will come from the individual'a medical records. A blood form that has changed the word sex changed to gender will not affect this.

Especially for kidneys.

There is a risk that people will be harmed when treated based on how they identify rather than material reality, yes.