Trans and health: reality bites

I bet adding an extra field to a humongous database is not a simple, or cheap, option. That American geezer who's sueing to have nonbinary on his passport, I read that if he succeeds it's going to cost millions.

There are estimated to be between 200,000 and 500,000 trans people in the UK.

I know this is the Guardian, but 'Really?'

Did they miss the memo that went out this week downgrading the 262,000 figure from the census as being unreliable and massively over inflated due to the terrible wording of the questions?

Why are they trying to over inflate the numbers to up to double what has been discredited as an overestimate?

"Gender identity" isn't sex, and even transactivists often say this. Even those who insist you can actually change sex, will use the concept of "sex assigned at birth" in their definition of trans. So surely they could have it clearly stated prominently at the top of their notes that they have a "gender identity" of M and a "sex assigned at birth" of F or vice versa/whatever, and a clear note of what screening is required based on what they still have, what they've had removed, and so on. That would be brief and easy to understand.

The whole deletion of true sex thing is mindblowingly stupid and directly contravenes "do no harm".

I saw a trans man write on Twitter that he’d had a hysterectomy in order that he’d no longer have to worry about missing cancer screenings.

I don’t understand this. Surely sex should be recorded correctly, plus any cross-sex hormone treatment or surgery? The patient’s gender identity could also be recorded and flagged, so that medical staff are reminded at each contact.

The answer is to continue to record birth sex and add a gender field to the database. Medical records are supposed to be confidential and used only on a need to know basis.

This would provide the right information for screening invitations. Invitations could be worded carefully and appropriately for anyone whose gender and birth sex don’t match.

Is this not exactly what they wanted? No record of their "assigned sex at birth"?

This is so not OK, from the article:
NHS England stipulates that when a patient changes their registered gender, they are given a new NHS number and must be registered as a new patient at their GP practice. All their previous medical history is transferred into their new medical record and their previous name, sex at birth, any other gender-specific terms and old NHS number are removed.

Is this NHS England treating people like they have a GRC (which is dangerous enough for withholding and concealing vital medical information) but even people who don’t have a GRC? Thereby putting them at completely unnecessary risk of harm?

There should be no changing of sex markers at all for anyone in a healthcare system that relies on shared funding from a central pot. Because you can’t change sex. Just have a box that says ‘would like to be known as (new name and title)’

I work in the NHS and it is also worrying that patients can change their NHS number along with their gender so whole episodes of previous healthcare are difficult to find. If people find it offensive to have a sex marker alongside their gender marker then maybe they could agree not to change their NHS number and screening could be arranged by the sex registered to that NHS number, almost set up at birth!

I've been thinking it through and I literally can't come up with an appropriate conversation.

It's absurd but I wonder if the only logical way through this is AI triage for screening both for population health and run of the mill healthcare (including acute). The AI then pops out recommendations for follow-up and interpretation of any tests.

Even this would only work with accurate sex recording. For the number of trans-led gender identity services, surely there must have been focus groups and papers about how to handle this.

I can't help remembering the Darwin Awards when I read things like that. I would have been more sympathetic in the past but at this point I'm honestly exhausted by the bottomless stupidity of this cult and its hapless members.

In the fullness of time when some poor sod is eventually diagnosed with a terminal cancer that should have been picked up on regular screening except they weren't invited because of the sex fudge, it'll be the NHS that will be sued. Another foreseeable and expensive consequence of allowing gender ideology to dictate.

"Experts say the problem is the way GP electronic records in England are updated when patients change their gender."
No, 'the problem' is that it is permitted to change the records at all, from the truth to a lie.

I would expect that core NHS computer systems are old. And they're undoubtedly difficult to redesign (there were a lot of articles on NHS systems in Computer Weekly in the 1980s/90s). There is no way that record layouts set out in the ?1970s? would accommodate changing such a defining field as sex. It would have been unimaginable.

So, when did some arsehole start imagining it? And, faced with a legacy system that couldn't be made to do their bidding, fudged it with 'let's create a new person, then load the history of another into it'. But the new person is a fiction and the sex field carrying the wrong value fucks up everything sex-related.

I really hope that whichever arsehole who did this was proud enough of themselves to claim the credit and leave documentary evidence of what decisions they steamrollered through. And I hope they are made to pay for the damage they have done to the health of so many people.

You can't have your gender cake and eat it.

The article still manages to have a hand-wringy vibe of "won't someone think of the poor oppressed trans people being failed by health services!!!" while literally making obvious that this is a result of demanding to have sex markers changed. Either your sex is important for healthcare providers to know and that info needs to be there and you accept that... or not in which case you do need to take responsibility for it yourself, because how can HCPs if they don't have the info?

Obviously the whole idea of going along with this demand was ludicrous in the first place but FFS.

There was a recent interesting discussion about screening tests on FWR and, iirc, an information leaflet that was targeted at Travellers.

Somebody who works with Travellers explained that although the leaflet seemed short on specifics and might not even have used the word cancer, it had been workshopped to be appropriate and was culturally competent.

I don't know how, but I wonder if the population health part of the healthcare system will need to adopt a, "Are you having your regular screening tests? Talk to your health provider."

That doesn't solve acute or emergency issues. Nor does it address dissonance that is so strong, the person at the heart of it can't contemplate even discussing appropriate screening (e.g., breast, cervical, prostate, reporting birth sex to help interpret kidney clearance results etc.) but there has to be a better method.

Next up - constructing fake genitals out of unrelated body parts and taking opposite sex hormones causes complications and deaths shocker. I expect a study to "reveal" this in about 5 years...

Pretending sex doesn't matter and prioritising gender instead has serious consequences when it comes to health? No way! Who could have seen this coming?

Stonewall (or maybe just Nancy Kelley, I can't remember) was complaining about transmen not being invited for smear tests a year or so ago. Well duh. If trans people don't want their biological sex on their records and the NHS are happy to play along with this dangerous nonsense, what the hell did you expect was going to happen?

I imagine it will be painted as “transphobic NHS systems” rather than accepting reality needs to be reflected in the records.

It’s not just cancer screening either. It concerns me from an acute perspective too. What if a woman who is registered as male presents to the emergency department with abdo pain? Do people recognise she needs a pregnancy test to rule out an ectopic?

What if a 60 man registered as female presents with back pain? Does a junior doctor who’s all in on gender ideology check his prostate for signs of cancer?

oh look-another thing not to give a flying fuck about. There really is no end to this fucking bollocks, is there?

Ooh I know this one...is it literal violence? 😀

Well colour me shocked!

Nailed it @Datun

No way! Are they really saying that ... Sex Matters??

You dont say. Amazing. Who knew that biology was relevant to health