Intended for healthcare professionals

Rapid response to:


Rethinking sex-assigned-at-birth questions

BMJ 2021; 373 doi: (Published 24 May 2021) Cite this as: BMJ 2021;373:n1261

Rapid Response:

Re: Rethinking sex-assigned-at-birth questions

Dear editor,

We are writing on behalf of the Gender Dysphoria Alliance leadership board and membership. We are an education and advocacy organization for those with gender dysphoria – those who have medically transitioned and those who haven’t.

We acknowledge that there is disagreement among transpeople about political and clinical matters. We disagree with the erasure of accurate biological language and realities, for several reasons.

Firstly, “assigned at birth” comes from the history of treating children with DSDs. The practice of assignment is now rare in the western world and surgeries on infants to reassign their sex is now discouraged. We object to the conflation of DSDs and gender dysphoria (GD). To date, there is no evidence that GD is a type of DSD, certainly not in all cases, if at all. We assert that GD is an experience with many possible pathways to it. Though there may well be a neurological basis for some types of GD, we are still our sexed bodies observed at birth, who may choose to masculinize or feminize the appearance of our bodies because of GD.

We believe it’s highly important for people with GD such as ourselves, whether we medicalize or not, to retain awareness of our biological sex. Because it’s not truly possible to change sex, accepting our full reality as trans people is important for both our psychological and physical well-being.

Psychological integration requires that we accept our full, unique reality as it is. We cannot address the dissociation we experience otherwise.

There are healthcare implications and safety concerns if our biological sex isn’t clearly recorded on our medical records to orient care providers to our medical needs.

Finally, we believe that the alteration of language and the falsified understanding of biological sex, applied to all people, is the result of extreme activism which is increasing societal hostility towards trans people. We do not wish to participate in that, and we don’t think it’s necessary in order for us to have rights and be integrated into society.

Thank-you for your consideration.

Aaron Kimberly
Aaron Terrell
Gender Dysphoria Alliance

Competing interests: No competing interests

07 October 2021
Aaron G Kimberly
Aaron Terrell
Gender Dysphoria Alliance