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Correspondence to: A B Alpert [email protected]
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 to facilitate identification.7 Medicine also has a longstanding history of dividing the population by sex assignment for the purposes of identification, inpatient care, and policy enforcement.8
Questions about sex assigned at birth were putatively added to questions about gender to identify more transgender people for research purposes, and to increase clinicians’ knowledge about their patients. In one US survey, two-step questions outperformed a single question with four identity options: “male,” “female,” “transgender,” and “other.”3 However, the single question option may have been difficult for many respondents as some transgender people are male or female and creating separate categories for “female,” “male,” and “transgender” suggests that this is not the case.
Questions about sex assigned at birth have been argued to be necessary for preventive...