NHS England - blood donation if you are transgender

[Biscuitsanddoombar]

It seems their policy is to test haemoglobin under the gender people identify as rather than the sex they actually are

As has been pointed out - haemoglobins won’t change if someone just identifies as a different gender

Who are the people in charge of this stuff?

Thread

twitter.com/colwight/status/1383207465592913921?s=21

Policy

www.transfusionguidelines.org/dsg/wb/guidelines/transgender-individuals

Surely this has to be dangerous?

I don’t really understand the science but what risk factor is there for the person receiving the blood if they are wrong in their “assumption” that the person has had HRT.

Also what about the fact they are receiving blood from someone who may be on serious drugs with unknown side effects.

And as for the HIV risk being ignored...

I don’t get the deferral bit. You just have to say you have no gender and you can then donate if you have been having sex with men, but you can’t if you confirm that you are male bodied and have had sex with another man? Have I understood that correctly?

There is a risk to male blood recipients receiving blood from female blood donors that have ever been pregnant
www.bmj.com/content/359/bmj.j4795

So potentially a transman’s donation being categorised as male and given to a male recipient could be a risk.

The haemoglobin test has a higher cut off for male donors than female donors (if you fall below this you cannot donate as your Hb may be too low for it to be safe for you). The levels are set quite high though to have a large safety margin. A transman being tested on the male test would be more likely to fail, a transwoman on the female test more likely to pass (than if tested as their sex registered at birth), but I don’t think it would be likely to cause any real harm, as the levels have a big safety margin anyway.

The HIV risk is a whole other kettle of potatoes though. There is an argument that there has been a strong element of homophobia in the restrictions on men who have sex with men as they stand. I (a woman for avoidance of doubt!) was once deferred for disclosing that I had had protected sex with a bisexual man. Despite having a more recent negative HIV test myself and evidence of it. The regulations are such that a monogamous gay male couple are essentially currently barred from donating, although that is changing soon
www.blood.co.uk/who-can-give-blood/men-who-have-sex-with-men/

I believed that if you were taking drugs you would not be suitable as a donor... I was turned down for my run of the mill meds. Surely opposite sex hormones would be a problem? Who exactly will benefit from this dangerous nonsense?

[quote Cwenthryth]The HIV risk is a whole other kettle of potatoes though. There is an argument that there has been a strong element of homophobia in the restrictions on men who have sex with men as they stand. I (a woman for avoidance of doubt!) was once deferred for disclosing that I had had protected sex with a bisexual man. Despite having a more recent negative HIV test myself and evidence of it. The regulations are such that a monogamous gay male couple are essentially currently barred from donating, although that is changing soon
www.blood.co.uk/who-can-give-blood/men-who-have-sex-with-men/[/quote]
High risk groups absolutely should be barred. Men who have sex with men are high risk.

Men who have sex with men are high risk
Not inherently - a monogamous HIV-negative male/male couple has precisely zero risk (from their sex life). Hence why the current, arguably homophobic, policy has been reviewed and is changing this year so that once men have been in a stable relationship for 3 months the bar is lifted - see the link I posted.

I'm really hoping someone will turn up in a bit with the science and this isn't as mad as it sounds, because surely, it can't be? Leaving aside the alarming insanity that haemoglobin will hopefully obey choice and preference (and artificial hormones) as opposed to reality, so lets dance until the medical disasters and court cases start..... gosh that's a fashionable approach at the moment....

I'm not eligible to give blood for several medical reasons, one of which is the medication I have to take to manage a condition.

Should someone who is taking a lot of medication to fill their body with artificial hormones - the full lifelong effect of which isn't really that well known, and the painful, dangerous sort of downsides rarely admitted to, particularly for people born female - really be giving blood full of that medication anyway? Is this a responsible thing to do?

The higher haemoglobin concentration of men, compared to women, is related to testosterone levels. As part of the gender reassignment process the sex hormone levels are changed so that a woman who becomes a man will receive testosterone. This will result in the haemoglobin concentration rising to the higher range seen in men. The opposite will be true if a man becomes a female.

Apart from the really odd phrasing here (“if a man becomes a female” - clearly this is written by someone who has little medical knowledge or is so steeped in cognitive dissonance that they have lost sight of reality) the fact is that levels of testosterone in males are not reliably or even often reduced to female levels. So there’s a clear problem with this policy unless sex is irrelevant... and if that was the case it wouldn’t be mentioned as there wouldn’t be an issue.

www.medscape.com/viewarticle/893280

Where does this sit with the rules around donation frequency? Men are able to donate more regularly than women.

It's bonkers.

www.mumsnet.com/Talk/womens_rights/3584176-NHS-Blood-donating-form-saying-gender-not-sex

www.mumsnet.com/Talk/womens_rights/3747649-Blood-donation-record-states-my-gender-is-female

www.mumsnet.com/Talk/womens_rights/3065980-Males-at-risk-from-female-blood-transfusion

www.mumsnet.com/Talk/womens_rights/3372218-Identifying-as-female-to-sell-blood

www.mumsnet.com/Talk/womens_rights/3208436-Could-this-be-harmful-dangerous

The Scottish National Blood Transfusion Service has a survey to check whether people would be off by particular safety questions, when they change to a more individual risk assessment and end the "gay blood ban."

There is a "further comments" box at the end where I stated how concerned I was that they do not record sex and how this could be dangerous for male recipients of blood.

I'm afraid you do have to claim that you were assigned a sex at birth in order to fill in the form, but I think it is worth it to register concern. (And you can give your views on the new questions, which will be useful for them.)

forms.office.com/Pages/ResponsePage.aspx?id=veDvEDCgykuAnLXmdF5JmlzH8qINKktKqrArlDYS4NdUNDNEVEZKWjhTN0MwWEtITzlOSURPWUIwSC4u

Whole thing beggar's belief!

Wow, they are quite blunt here:

Please keep donating, particularly if you are: male - men can donate more often than women

www.blood.co.uk/who-can-give-blood/

And even:

www.blood.co.uk/who-can-give-blood/why-men-should-donate-blood/

This is what they say about hormones:

'HRT : Hormone Replacement Therapy

If having investigations - please wait until these are finished.

If treatment due to malignancy - We are sorry but you are unable to donate.

If this is being used to treat symptoms of the menopause, for gender change or to prevent osteoporosis only - You may donate if taken by mouth, using patches or if using an implant all wounds must be healed with no infection and you feel well on the day.'

And also:

(from the guide my.blood.co.uk/knowledgebase/Index/T)

'Transgender Individuals

Sorry, but we need to have more information for us to answer your enquiry. To give you an answer we will need to speak to you. Please call our Donor Helpline on 0300 123 23 23, Monday to Friday, 9am to 7pm as we may need to transfer you to the Referral Team. '

A well known GC trans woman was tweeting the other day about donating blood with a haemoglobin level acceptable in the women’s reference range, but not the men’s. Says would never be able to donate if the male range applied due to low iron. This person does acknowledge they are biologically male.

... which seems a bit unwise to me, that this is allowed by the service, rather than this person’s generosity in donating. will NHSBT be on the hook if they turn up with adverse health outcomes due to repeatedly donating with too low iron for their sex?

@Cwenthryth

Men who have sex with men are high risk Not inherently - a monogamous HIV-negative male/male couple has precisely zero risk (from their sex life). Hence why the current, arguably homophobic, policy has been reviewed and is changing this year so that once men have been in a stable relationship for 3 months the bar is lifted - see the link I posted.

It was a useful blanket policy after the number of deaths from infected blood products in the 80s and 90s (including haemophiliac children). But men's feelings etc etc

The 80s and 90s were 30-40 years ago, screening of blood products and understanding of HIV has come a long long long way since then - the blanket ban on all men who have sex with men donating has been a homophobic hangover for many many years now. It is absolutely right that it is now changing but way overdue. As I said a monogamous HIV-neg couple are zero risk and we have known that for decades, there was no reason to prevent those men donating other than prejudice.

I believe a transwoman donating with a Hb too low to pass on the male test but passes the female test, is highly likely to be absolutely fine, even if they still donate at the male frequency - because the cutoffs are set very conservatively anyway.

I believe the major risks to be considered here are (1) blood from transmen that have ever been pregnant being given to male recipients; and (2) that HIV does not care about someone’s gender identity when it comes to transmission risk. Tbh I doubt that the research has even been done yet on HIV risk and prevalence in various trans demographics, given the speed at which these demographics have developed and grown.

At the end of the day almost everything about safe blood donation relies on honesty from donors; important things such as waiting after tattoos or acupuncture, travel to at-risk destinations etc relies on self declaration, there is no way to independently verify these factors; so, given that we can expect that people who believe in gender ideology are going to declare their self-identified gender/sexuality rather than sex registered at birth - the blood service needs to manage this accordingly. I do believe it is still very important that “sex registered at birth” still be requested due to the increased risk to recipients of cross-sex female-to-male transfusions. But when it comes to risks around sexual history using terms such as man and woman will, unfortunately, be interpreted in different ways by different people dependent on their beliefs as to what those words mean, so the blood service have to manage those responses accordingly.

As Mr Spock would say " this is all highly illogical"

Hb will be measured in each sample, so can be matched if and as needed, the donor will be asked for any medication they are taking at which the hrt would come up, so I really don't see where the problem is.

Whilst there has been a research paper it was inconclusive whether it was causation or correlation. Currently sex is not matched as part of the process when someone requires a transfusion. If this changes then obviously additional checks will need to be included. Does anyone know if it's even an issue? Does taking hormones preclude you from donating blood, many medications do.

it's quite well described here

www.transfusionguidelines.org/dsg/wb/guidelines/ho005-hormone-replacement-therapy

[quote CatherinaJTV]it's quite well described here

www.transfusionguidelines.org/dsg/wb/guidelines/ho005-hormone-replacement-therapy[/quote]
That entry does not mention cross-sex hormones.

It gives advice on HRT given for malignancy, menopause symptoms, erectile disfunction, and about growth hormones, but gives no mention of gender dysphoria.

I hope that anyone donating would declare all medication they are taking. There are many medications that don't stop you from donating- including hormonal contraceptives. But it is important the service knows what they are getting, so they can use the blood appropriately.

Donating blood is an altruistic act, not something you should do for your own validation.

(I'm using "you" in the general sense throughout this post; not directing it to any individual.)

Many trans men may be turned away from donor clinics as their lesser haemoglobin levels will not meet the male standard

Any trans man who has been pregnant in the past (may have miscarried or given birth), may have antibodies in his blood that will pose a risk to a male recipient.