Gender is a commonly required field in medical records. However, it is important to note that just because it may say male or female on the patient’s paperwork, it does not necessarily follow that that gender is accurate or useful for GPs when they are carrying out a medical evaluation.
Doctors need to know what body parts people have so that they can determine the root cause of any biologically related ailments, as well as what screening tests people might need to be offered.
A person’s gender can be different to the sex they were assigned at birth, and people of different genders may have different anatomy and physiology. Some women may have a prostate gland and testes and some men may have a womb, ovaries and breast tissue, while other people may have a mixture of both. So how does a healthcare professional navigate their need to understand the biological requirements of an individual from a medical perspective, while being respectful of their gender identity?
Doctors must begin to think differently about gender. They must understand that if they ask a direct question of whether someone is male or female, they may not receive the answer they are looking for, or the information they may need to know. The question that really needs to be asked is ‘do you have a cervix, and should you have a smear test?’ ‘Do you have a prostate, and should we think about a test for prostate cancer?’ etc
When it comes to young trans people, further challenges arise in terms of understanding projected growth and development. Which height charts should doctors use to monitor growth of adolescent teenagers on gender-affirming care pathways for example? There is no point plotting a child’s height on a female chart if they are going through a male puberty, as the results will not be accurate.
There are some medical circumstances when traditional male and female ranges are different. Blood tests are a good example. The range for your haemoglobin (red blood cells, checking for anaemia) is classified differently for men and women. But what if you realigned your gender when you were young, and even though you were assigned male at birth, you had gender-affirming care in good time, and went though a female puberty in your adolescence? Should doctors use male or female blood test ranges? You are a woman, with the height and stature of a woman, but your chromosomes are XY, so which range should you use?
What about an adult, receiving care later in life? At which stage do we measure their blood tests on male ranges, female ranges, non-binary ranges? Before treatment, during treatment, two years after treatment has started? These are all questions to which we do not yet know the answers in enough detail.
We have a long way to go in rethinking the gender narrative. Let’s get used to asking the questions to make this process easier for our trans brothers and sisters:
‘Can I just check your name, address, date of birth and gender please?’
‘Is your gender different to the one recorded here?’
‘Can I ask when you started medical treatment to affirm your gender identity?’
‘Can I ask what gender-affirming surgery, if any, you may have had?’
‘Can I just check what kind of screening from this list might apply to you?’
‘It states that your gender is male on this report, is that a true reflection of your gender identity?’
Asking these questions may well provide that missing piece of the puzzle that will enable faster more accurate diagnosis and better patient outcomes, which should always be the main aim for our patients.