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?

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.

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.

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.

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.

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

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

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.

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.

*scans, not sans, apologies.

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.

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.

My personal opinion is that sex and gender are not interchangeable terms and that sex should be used on diagnostic test paperwork for clinical accuracy. I have been having regular tests via hospital and GP for a couple of years and only on this most recent set of lab reports has the field heading been changed from sex to gender.

It caught my eye and made me wonder.
Presumably this must be a national decision.

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.