Intended for healthcare professionals


Rethinking sex-assigned-at-birth questions

BMJ 2021; 373 doi: (Published 24 May 2021) Cite this as: BMJ 2021;373:n1261
  1. Ash B Alpert, fellow1,
  2. Roman Ruddick, student2 3,
  3. Charlie Manzano, student2 3
  1. 1Division of Hematology and Medical Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
  2. 2San Francisco State University, San Francisco, CA, USA
  3. 3Transgender Cancer Patient Project, Martinez, CA, USA
  1. Correspondence to: A B Alpert ash_alpert{at}

Unhelpful, potentially harmful, and should be abandoned

Many scholars support the collection of data on sexual orientation and gender identity in clinical, research, and census records to improve collective knowledge of sexual and gender minority health.1 Organisations often recommend using two-step questions to record identity: typically an initial question about gender (“What is your gender identity?”) followed by one about sex assigned at birth (“What sex were you assigned at birth, on your original birth certificate?”). However, transgender people have concerns about sex-assigned-at-birth questions,2345 and these questions may not be the best way to obtain the information that clinicians need.

The United Nations recommends that all countries maintain a population registry in which sex is a required personal detail.6 The rationale has been to uphold sex specific rights, duties, and policies such as those related to military service, pregnancy, and segregation in prisons and other facilities. Sex data are also used in travel and other documents …

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