Sex vs Gender in medicine and health care

[elephantfan]

I had some blood tests recently. I am able to look up my results in my GP records.
I noticed that on the results forms, where it used to say sex, it now says gender.
Is this wise in the context of medicine and medication monitoring?
Why has this happened and who decided?
Genuinely wondering if there could be any risks to health here?

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

Especially for kidneys.

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.

www.gov.uk/government/people/sally-davies

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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But the lab does the report based on what the form says. They wouldn't check the patient's medical records.
They just print the normal range next to everything and print anything out of range in bold.
The GP receptionist used to give me my results( and make a hash of it, hence my arrangement to access my records myself).

X post. I will read that now. Thanks.

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.

Maybe there isn't a problem. That is why I was asking.
I have read on here that there is a potential problem if an individual is biologically one sex but identifies and records as the gender usually linked to the opposite sex, it might become problematical if there is a difference in lab value normal ranges.
But happy to be educated.
I was acquainted with someone who was a carer for a friend. She died suddenly and unexpectedly.
Only when I saw the death certificate did I realise her biological sex was male.
It made me wonder how important that would be for health care.

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.

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.

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.

Ok. Thank you.
And thank you for the patience.
Sorry if it is annoying.

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!

DoH advice

I just noticed that the forms had changed.

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

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

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.

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

I'm actually talented at stopping threads

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).

(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?

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?

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

Fantastic posts, ChattyLion.