No, we mean sex AND gender

The use of language when dealing with gender and sex is important: in the field of health inequalities, it is important to recognise these two factors and how they interact in patients’ health and outcomes.

While sex is important for considerations of disease and genetic or biological risk, gender carries importance in the aspect of behaviours, systemic barriers to health care, and social determinants of health inequality. To acknowledge one does not devalue the other. To ignore gender or see it as synonymous with sex is to arrive at biological determinism that does not accurately describe public health or patient experience. Worse yet, to attempt to politicise inclusive healthcare¹ serves no one.

In our paper,² we described our participants as transmasculine and transfeminine based on their gender-affirming therapy. This avoided assumptions about their gender identity as this information is not available in the medical record. To assume every transgender person taking testosterone identifies as male ignores the potential for non-binary people to be in our data. Other researchers’ methods, data, or language have differed from ours, and it is our duty to cite them correctly, leading to the use of both ‘trans man’ and ‘transmasculine’ in our paper.

Those who do conflate sex and gender in medical research are unfortunately reinforced by the clinical systems on which we rely. In the GP patient record, sex and gender exist under one marker. We need only look to the NHS’s process for re-registering gender as a testament to this limitation and how it can lead to multiple systemic errors in access to screening and diagnostics for transgender patients. Having two distinct ‘sex registered at birth’ and ‘gender’ markers would facilitate greater accuracy in systems, patient care, and future research.

To praise the aim of inclusive language but then disparage it by weaponising other minoritised communities against its application is unfortunate. An intersectional view recognises that those who have English as a second language and those with learning disabilities can also be LGBT+. To ignore this is an oversight.

While it is disappointing to see people overlook the finding that transgender people in the UK have a higher prevalence of cancer risk factors in favour of criticising the terms used by and for the community, we cannot say this is uncommon in this current climate.

Our hope is that our esteemed colleagues, with all of their experience in understanding complex theory, can appreciate the relationship between sex and gender, and how it is appropriate and necessary to explore their relationship to each other when investigating transgender community mortality.