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This response to an article raises some concerns related to how the attribute "sex" is used within the NHS:

Healthcare providers and the NHS should hold accurate, reliable information about patient's sex as a basic minimum.

At the moment they do not. There is no single data attribute that records that I am female (and not in fact a male person who identifies as female and has asked to have their record changed).

This is very important because it might lead to malpraxis:

The patient is given the wrong treatment as a result of a failure to match the patient correctly with their artefacts (samples, letters, specimens, X-rays, and so on).

This Psychology & Neuroscience answer provides a quick way to understand the difference between sex and gender:

Sex is a biological construct, what is real:. Attributes that characterize biological maleness and femaleness include:

  • Chromosomes
  • Hormones
  • Anatomy

Gender is a social construct, or 'man-made':. Attitudes and feelings that a given culture associates with a person's biological sex such as:

  • Gender expression
  • Gender roles and behaviors
  • Gender identity

If I understand correctly, a medical system should be concerned about storing both values and especially the first one which is an input for what is "normal" medical results values, treatment decisions, etc.

Considering the importance of both concepts, is there any public health system that registers both biological sex and gender in the medical records?

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    The AAP slide is just wrong. Gender roles and expression are socially determined, but there is strong evidence that gender identity is often innate (though not necessarily genetic), and that a transgender person cannot be usually be made cisgender through socialization or viceversa. Also... man-made?
    – Obie 2.0
    Commented Dec 22, 2021 at 20:48
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    @Obie2.0 A better way to phrase it is that gender is subjective. It is possible to determine biological sex objectively because of its observable physical characteristics. The only way to determine gender identity is to ask someone what their gender is, because it is something that only exists in a person's mind.
    – Joe
    Commented Dec 22, 2021 at 21:03
  • The definition of sex and gender are not very relevant to this question. What is important is that they can be different and it makes sense to store them both in a medical system. Thus my question.
    – Alexei
    Commented Dec 23, 2021 at 5:44
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    @Jontia Yes, it would be important to minimize ambiguity. I am seeking for any health system that has separate fields, regardless of their definition.
    – Alexei
    Commented Dec 23, 2021 at 9:28
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    @StuartF I mean the public health system (the one that is run by some state structure as opposed to privately owned hospitals). I have edited the question to reflect that.
    – Alexei
    Commented Dec 23, 2021 at 10:52

1 Answer 1

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The US VA is rolling out separate fields:

In 2016, the US Department of Veterans Affairs (VA) began implementing a SIGI demographic field across all EHRs, requiring administrative staff to ask enrolled and new veterans their gender identity (full implementation of SIGI has not yet occurred and will occur when a later EHR upgrade displays SIGI in the EHR).

This gender identity field is in addition to the "birth sex field". It is still possible to update both fields.

It is important to note that a strict separation of gender and sex at birth - and a treatment based solely on the latter - is not as useful as made out by Maya Forstater (an anti-trans activist who is not an expert in any medical field).

A trans person who has transitioned (hormone therapy, surgeries, etc) will have different needs and will be at risk if treated according to his or her gender assigned at birth:

Furthermore, depending on hormone and surgical interventions, some health screenings may be irrelevant for TGNC patients. To determine appropriate health screens and assess potential risks associated with hormone therapy, providers must have access to current information regarding a patient’s physiologic anatomy.6 Health screenings and laboratory results in sophisticated EHRs (ie, EHRs that might autodetermine normative values) may populate incorrect treatment recommendations, such as sex-based medication dosages. Furthermore, laboratory test results could be incorrectly paired with a different assumed hormonal history, potentially putting the patient at risk.

As individual (birth) sex & gender markers would still not contain any information about the current hormonal & physical status of a trans person, they would not be useful in determining proper medical care.

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    As I mentioned in a comment above, it's not clear what a "national health system" means. The VA seems to count as a "national health system" by some definitions, as it's certainly national and a health system, even if it's not universal. Most countries (even the UK) do not have a single centralised body controlling healthcare, and numerous independent organisations are involved in funding, regulating, and providing.
    – Stuart F
    Commented Dec 23, 2021 at 10:51
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    I have replaced national with public (run by state more or less) and this answer is a good example of what I am looking for. +1. Thanks.
    – Alexei
    Commented Dec 23, 2021 at 10:54
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    Ref. "current hormonal & physical status of a trans person" - So, it makes sense to store both fields and there is a difference to take it into account for diagnosis/treatment.
    – Alexei
    Commented Dec 23, 2021 at 10:55
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    @Alexei At most, that might serve as a marker which essentially says "we don't know" (because some - but not all - trans people decide to transition via hormone therapy and a number of possible surgeries). You could probably have a less divisive and more helpful "needs individual (not necessarily sex at birth based) care" checkbox (which might also serve cis people with unusual hormone levels or relevant surgeries).
    – tim
    Commented Dec 23, 2021 at 11:12
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    A third complicating factor, though I imagine is has even less treatment impact: cancer patients receiving an allogeneic stem cell transplant may have a bone marrow from somebody with different sex chromosomes. A cis male's blood would have a 46XX karyotype after receiving a PBSCT from a woman, but their other cells would be 46XY Commented Dec 24, 2021 at 18:36

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