'Biological sex is vital in healthcare' - BMJ rapid response

[ArabellaScott]

www.bmj.com/content/373/bmj.n1261/rr-2?fbclid=IwAR3NciluHjxL7bN5GBNdKU1RIFzxcUQF09uVTW8XN4eLPduHk7OWbFjZTw8

'The truth of the sex binary is anchored in the mechanism that brings every human into existence.[1] Humans have two different types of gametes, two types of reproductive systems, two discrete reproductive roles: two sexes. As a result, we have given these two sexes different names: female and male. These will exist whether or not the clinician writes them down, or asks a transgender patient “what is your sex?” The fact that 0.02% of babies[2] have differences in sex development that cause the usually easy identification of sex to become a more complex affair, does not invalidate sex as one of the most clinically useful categorisations in medicine. To suggest that it does, and therefore sex should not be recorded, is absurd'

• written in response to this article:

www.bmj.com/content/373/bmj.n1261

'Rethinking sex-assigned-at-birth questions' - Unhelpful, potentially harmful, and should be abandoned

I recently completed a form to begin a foundation degree via my workplace (assistant practitioner in healthcare) and on the form was written "does your gender identity align with the gender you were assigned at birth".

I wish I had had the stones to cross it out and write, "my biological sex was observed at my birth, and I am female".

But was too scared of the repercussions. I really need this degree 🥴

Meanwhile in the USA....

www.plebity.org/conversations/gender-ideology-is-wreaking-carnage-in-our-medical-schools-an-eye-witness-report/

We have a long way to go still and must be watchful of American standards being adopted here. Much NHS IT software is from USA and generally uses gender interchangeably or as an alternative to sex in basic data capture.

Also with creeping privatisation of the NHS most/many of the companies will be American.

@Gassylady

Whilst I am rather incredulous at this letter the fact it has been published doesn’t mean all doctors hold such views.

Believe me, we don't. I'm not the only doctor who lurks here.

Gender identity information can be valuable to help guide the clinical encounter, respect the transgender patient’s sense of self and gain a fuller picture as to healthcare needs. But gender identity should be recorded in addition to, not act as a replacement for, biological sex. If an unknown patient comes in to A&E, unaccompanied and unconscious, their gender identity would not be ascertainable. However, their sex would remain observable, and would make a difference to that patient’s care.

This is the point really. Sex and Gender ARE different. One is a choice, the other is a biological fact.

Sorry, what is a rapid response?

@MrsWooster I also found that response very funny! The flat earth comparison seems very apt.

I am a bit conmcerned about this answer to a question asked by Maya Forstater.

"In regard to pregnancy, many cisgender and transgender people have the ability to become pregnant, and some do not have that ability due to surgery or other reasons. Thus, pregnancy risk cannot be determined by knowing sex assigned at birth."

How is it possible to perform this sort of mixed up thinking, instead of just saying - "Sex is observed at birth and only the female of the species has the ability to become pregnant".

@screamingmeme

'All rapid responses

Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles'.

Some female people are infertile / no longer fertile, have had a hysterectomy, etc. So knowing whether someone is female or male doesn't help us determine pregnancy risk. Okay.

The insinuation that because I’ve had a hysterectomy the fact that I’m female is now completely irrelevant gives me the fucking rage

When are they going to do age? Assigned at birth age or the age you identify with? Risks of certain age related (old fashioned, non progressive assigned age) ailments are moot when you identify as a different age.

Yet... .

I see the letter is from a postgraduate student called Sara Dahlen. I haven't come across her before - I wonder if she's on Mumsnet? If so, hi Sara - great letter!

Thus, pregnancy risk cannot be determined by knowing sex assigned at birth."

How ridiculous. It's just a stupid gotcha. "Not every woman can get pregnant so knowing sex is irrelevant". Indicative of the mentality here.

@MissyB1

The insinuation that because I’ve had a hysterectomy the fact that I’m female is now completely irrelevant gives me the fucking rage

Me too. I had a hysterectomy because I am female.

I continue to have particular health needs due to my female biology, not least hormone fucking REPLACEMENT therapy because I had to have my ovaries removed as well.

I also continue to need breast screening.

#Don't HijackMyHysterectomy

Are we going to see, 'Babies don't get geriatric diseases, so knowing age is irrelevant '?

I don't understand how these people managed to get a qualification in anything, let alone medicine. In fact, I have trouble seeing how they make it to the end of their own streets without help.

Or, if people who are assigned as older people, start identifying as babies, then more babies could present with geriatric issues. Age would become irrelevant then too. Not really, but with great effort you could keep a straight face.

Could you identify as a healthy, slim non drinker for insurance purposes? Somehow reality would intrude.

[quote Waitwhat23]@screamingmeme

'All rapid responses

Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles'.[/quote]
Thanks!

When are they going to do age? Assigned at birth age or the age you identify with? Risks of certain age related (old fashioned, non progressive assigned age) ailments are moot when you identify as a different age.

Well a lot of old people are at risk of falls. And babies tend to fall over if you stand them up unsupported.

And don't let's start on nappies....

“Thus, pregnancy risk cannot be determined by knowing sex assigned at birth.

This is the height or ridiculous!
Course not all women can/do give birth. No men have given birth though so surely that in itself says a lot about risk.

I wonder what % of people who give birth have xx chromosome and I wonder what % have some other combination?

I wonder what % of people who give birth ha W uteruses and what % of people who have given birth don’t.

Well we can all guess the statistics can’t we.....but still.../

I find the argument that they don't like to be asked about biological sex so unconvincing as a reason not to ask about it - wtaf do they think everyone else's medical records are like, instagram?

"So Mrs Daws, I see you have lost 3 babies previously..."
"Have you considered that your weight might be having an impact..."
"So you have a family history of breast cancer and lost your mum and sister to it..."
"How long have you been trying to get pregnant...."
"When did you first notice that your child wasn't meeting their milestones?"
On and on for every single appointment, bringing up some of the worst things that ever happened to you....

How is being asked about their sex any more upsetting than anything else people are asked in medical appointments, how can we be acting like society is to blame for their distress and not the complete lack of proportion?

I’m loving the idea of identifying as a different age “No Dr I’m not 52 anymore, I’m now 25 and I would ask you to document that and respect it. And all medical treatment to be now based on my new age”.
Wonder how that would pan out 🤔

This recent thread on a bmj editorial might be of interest (rapid responses also feature Maya F)
www.mumsnet.com/Talk/womens_rights/4196699-Excellent-BMJ-editorial-on-sex-and-gender