Stop mixing up sex and gender GPs told

[flyingbuttress43]

www.telegraph.co.uk/news/2021/04/02/doctors-must-stop-mixing-sex-gender-patients-undergoing-wrong/

Doctors have been told to stop mixing up sex and gender because it can end up with people getting the wrong treatment.

Senior medical researchers led by the University of St Andrews said there was clear evidence that biological sex and gender were both powerful risk factors for "virtually every disease and affect every organ."

The article is behind a pay wall, so here are some salient points...

Sex differences in drug metabolism were well recognised;
Gender significantly affected how a person engaged with treatment;
One GP, commenting on the article on the BMJ website said she spent hours a week ensuring the right people were called for cervical smears;
NHS systems do not allow for sex and gender to be recorded separately;
Sex and gender are not synonymous.

"Dr Margaret McCartney of the School of Medicine at St Andrews, said: "There are many instances of sex and gender being confused by the research community and society more broadly. Unless we identify and count categories correctly, we will end up with errors which serves all populations poorly."

All so obvious to us on Feminism Chat, but good to see push back
on this sex/gender mixup from the research community.

Hamster
Keep biological (sex observed at birth) marker.
Reference patient's transsexuality as an ongoing condition (just as one would reference kidney disease or IBS)
Place gender marker for dignity reasons.

YES. THIS

• Keep biological (sex observed at birth) marker. Reference patient's transsexuality as an ongoing condition (just as one would reference kidney disease or IBS) Place gender marker for dignity reasons.*

As simple as possible, but no simpler.

@R0wantrees

Perhaps a pre-op or post-op marker might be helpful. (Thinking aloud as I haven't fully thought it through)

Details of specific operations should be on a patient's records regardless eg a lot of women will have had mastectomies and hysterectomies.

Oh I know. I think my brain was going more along the lines of

Pre-operative transsexual
Post-operative transsexual

As a categorisation, even before delving deep into medical records for details of surgery.

Is that specifically male transsexuals and by pre/post op you mean genital surgery?

@R0wantrees

Perhaps a pre-op or post-op marker might be helpful. (Thinking aloud as I haven't fully thought it through)

Details of specific operations should be on a patient's records regardless eg a lot of women will have had mastectomies and hysterectomies.

Yes @R0wantrees that makes sense. I am sure NHS records would show, Being intersex my NHS record states female, as I do need a great deal of call ups up for typical female related issues. Smears et cetera. I live as male. But the primary record should clearly show the biological sex. A "post op" trans woman, remains a biological male, who has undergone castration, and has had penile skin inverted to create a cavity.

There is no vagina, there is no XX chromosomes, such an individual would still have a prostate. They would not have a cervix, nor ovaries. Medically the NHS would require biological reality of the person they are treating.

Being intersex is clearly shown on my NHS record, it is medical fact.. How the person "IDs" is secondary.

The "post op v. pre op" does not change the biological sex of the individual. It just states if the biological male has testes and penis intact.

In lay man terminology a castrated male is a eunuch, may offend people, in lay mans terms an intersex person may be called a "hermaphrodite" - old medical term.

Castration does not magically turn a biological male into a biological female.

These people are free to identify as female, and dress as they wish. The law protects that right. But biological reality does not change. NHS and medical profession MUST stick to biological facts.

A "post op" trans woman, remains a biological male, who has undergone castration, and has had penile skin inverted to create a cavity.

There are though a range of specific genital surgeries now rather than just one 'op' and of course there are women as well as men.

Hence why I said medical and surgical history
as that covers all options

These people are free to identify as female, and dress as they wish. The law protects that right.

The law does not (as far as I'm aware) protect the 'right' of a man to 'identify as female'. The GRA enables those who acquire a GRC to be treated as if they were the opposite sex in most (but not all) cases.

@R0wantrees

A "post op" trans woman, remains a biological male, who has undergone castration, and has had penile skin inverted to create a cavity.

There are though a range of specific genital surgeries now rather than just one 'op' and of course there are women as well as men.

Yes a range of options, but for a "female to male" transexual, the surgery does not create a vagina, it is a cavity, main ones are penile inversion, or colon tissue is used to create a cavity.

The surgery for a "male to female" transexual does not create an actual penis and testes that produce sperm,

The operations for both doe not change biological sex of a human, the procedures are they to emulate the genitalia of the opposite sex, for cosmetic reasons.

Equally intersex surgery does not change my biological status, and sadly can be as serious, but not by choice, often life saving. Even at my age...

@R0wantrees

Is that specifically male transsexuals and by pre/post op you mean genital surgery?

Yes, as hormone levels will be different (even as a biological male) with the removal of the testes - which could potentially skew blood results/provide false positives or negatives as the sex would still say M. Hence why I think a post-op vs pre-op category would be useful.

Endocrine levels constantly change and fluctuate whilst pre-operative (between male and female levels) as doses or oestrogen/anti-androgens are regularly altered.

CORRECTION **

The surgery for a "female to male" transexual does not create an actual penis and testes that produce sperm,

There are other circumstances when men have their testes removed or have disrupted hormone levels eg testicular cancer.

@R0wantrees

There are other circumstances when men have their testes removed or have disrupted hormone levels eg testicular cancer.

But they would be on the medical notes too.

Referring back to my earlier post - I haven't entirely worked out the "pre vs post" thing in my head yet, but all other points I stand by.

@EmbarrassingAdmissions

we do need sex/gender/organs recorded more accurately on everyones medical records.

I must admit that I was irritated it took >6 weeks for the vaccination programme to start asking people which ethnicity category they would pick (no data collected previously).

Yes to this as it does matter for data

Alex2112 - The operations for both doe not change biological sex of a human, the procedures are they to emulate the genitalia of the opposite sex, for cosmetic reasons.

THIS ^^ At the end of the day, ALL trans surgeries are cosmetic.

@R0wantrees

These people are free to identify as female, and dress as they wish. The law protects that right.

The law does not (as far as I'm aware) protect the 'right' of a man to 'identify as female'. The GRA enables those who acquire a GRC to be treated as if they were the opposite sex in most (but not all) cases.

Yes, a messy set up. I took my driving Licence at age 17, when I lived a female, ... used to be easy to change driving licence etc, NOW i need a GRC to change to male, as it keeps switching back to sex when I took test, even if just change of address.

Can be a pain, and my NI Number was set age 16, when I was living as female. Obviously no difference now, but used to be ...

NHS number states FEMALE, as NHS are aware easier as i need call ups etc,

GRA made it worse for intersex. I fear not best method for trans, and can be abused, "self ID" is crazy.

THIS ^^ At the end of the day, ALL trans surgeries are cosmetic.

My point is that patients who have had oophrectomies or removal of testes for other reasons but with the same implications for hormone production disruption would present similar outcomes in terms of possible blood markers.

@R0wantrees

THIS ^^ At the end of the day, ALL trans surgeries are cosmetic.

My point is that patients who have had oophrectomies or removal of testes for other reasons but with the same implications for hormone production disruption would present similar outcomes in terms of possible blood markers.

Which is where the huge gaping hole in my post/pre idea lies

In which case, I'm not entirely sure what the answer is. I'll sleep on it and see if I can come up with something less hole-y.

GRA made it worse for intersex. I fear not best method for trans, and can be abused, "self ID" is crazy.

Its horrific that people's intersex conditions were appropriated by the TRAs at the time to help drive through the GRA and yet the outcome of that legislation is to make it harder for those people.

@R0wantrees

GRA made it worse for intersex. I fear not best method for trans, and can be abused, "self ID" is crazy.

Its horrific that people's intersex conditions were appropriated by the TRAs at the time to help drive through the GRA and yet the outcome of that legislation is to make it harder for those people.

Indeed, it was bad enough before, and now people assume I am trans, as I have to apply for daft forms to get the most simple stuff to match my sex. Yes it was done to assist trans, but has blurred the meaning of intersex for majority of people. Most will ask, "so you lived female, and now transitioning to male".. or "so you are trans"? and sadly many trans people use the term intersex to suggest there is a 3rd biological sex, - which there is not.

I am fed up with explaining different, and yet i get accused of being "trans phobic" or a "TERF".

I just want society to be aware of the facts, the facts that trans activists prefer to deny or dodge. And as soon as I expose their errors, they scream transphobe ! .. it is getting crazy.. strange world...

and now we see it become a political issue? I just laugh it off...

@HamsterV2

Chersfrozenface

That's the infuriating and worrying thing. It's a SEX box. I have actually told one Dr that I can't actually change sex and was stared at as if I'd gone mad.

This must be a major worry and extra mental load for you to check they have your sex correct all the time.

I can only hope the ability to make these significant administrative changes to medical records is fixed with a better system. I can only think that these ambiguous records will lead to extra time needed for diagnosis and many errors.

to you, Alex, and all intersex people affected by this and

to the women impacted and worried by it and

to you, Hamster, and all the trans people let down by it.

This gender bullshit is helping nobody - why are we pandering to it?

My point is that patients who have had oophrectomies or removal of testes for other reasons but with the same implications for hormone production disruption would present similar outcomes in terms of possible blood markers.

A trans woman would have normal levels (ish) of oestrogen. Their blood chemistry is not the same as a castrated male.

Sex and gender aren't the same. Plus not everyone associates their gender with their sex. That's why GPs and other medical practitioners are informed of the differences.

Context:

2/4/21 The Scotsman, "Doctors must learn to distinguish between sex and gender, top Scottish medics warn
Doctors confusing sex and gender are putting patients’ treatment at risk, a group of senior medical researchers has warned.
(extract)
A team led by St Andrews University has said that doctors often fail to distinguish between the two, which can make treatment for some patients ineffective or inappropriate.

In an article published in the British Medical Journal on Friday, the authors argue that the distinction is “critical” for good healthcare, and failing to account for it can lead to “errors” which can negatively affect all patients.

A distinction between sex and gender is made by the World Health Organisation, with sex relating to biology and gender to societal roles, but the researchers say that current medical practice often uses the two terms interchangeably.

“There are many instances of sex and gender being confused by the research community and society more broadly,” said Dr Margaret McCartney, of the School of Medicine at St Andrews University.

“Unless we identify and count categories correctly, we will end up with errors which serves all populations poorly, including minority populations.”

Professor Susan Bewley, Emeritus Professor (honorary) in Obstetrics and Women’s Health at King’s College London, said the differentiation is important for all patients’ healthcare.

“Medical care requires an understanding of the difference between sex and gender categories; untangling them is crucial for safe, dignified, and effective healthcare of all groups,” she said.

“Avoidable harm may result when they are conflated – for example, if sex specific laboratory reference ranges are used for people whose gender is recorded but not their biological sex or hormone prescription.”

The World Health Organisation provides a distinct meaning for each term, stating: “Gender is used to describe the characteristics of women and men that are socially constructed, while sex refers to those that are biologically determined.”

The article adds: “Sex and gender are not synonymous. Sex, unless otherwise specified, relates to biology: the gametes, chromosomes, hormones, and reproductive organs.

"Gender relates to societal roles, behaviours, and expectations that vary with time and place, historically and geographically.

"These categories describe different attributes that must be considered depending on the purpose they are intended for."

www.scotsman.com/health/doctors-must-learn-to-distinguish-between-sex-and-gender-top-scottish-medics-warn-3187822