Language saves lives: why sex vs gender matters in healthcare communication

43% of UK adults don’t understand health information*

In the UK, more than 7 million people are classed as having very poor literacy skills. Not only does this make everyday life much more difficult, but crucially, it affects the ability to read and comprehend important health information. Why is this important? Because it is our responsibility to take steps to protect our health, and to make decisions about any health or medical care that we receive. And we can only do this when we have the knowledge to make these informed decisions.

One of the areas that is particularly difficult to circumnavigate at the moment is the use of sex vs gendered language in healthcare communications. Over the last 5 years in particular, sex and gender have become conflated in language - and unsurprisingly, this has caused a lot of confusion. In many ways, the topic of gender has overtaken sex with some people believing that their gender identity is more important than the sex that they were born as. This may be true in every area of their life - and while it’s understandable that many trans people may not want reminders of the sex that they have chosen to leave behind, when it comes to healthcare, it should be their biological sex that’s most important.

Sex = biological sex, determined by your genetic make up

Gender = how you choose to identify, which may or may not be the same as your biological sex

Unsurprisingly and understandably, 2024 has seen a rise in the use of gender-neutral language by business and organisations of all shapes and sizes, as we try and move towards a kinder and more inclusive society. Any good organisation doesn't want to isolate or discriminate against anyone, irrespective of their gender identity. And I get it, I really do. But as far as I’m concerned, healthcare and medical communications is one area where it is absolutely essential to fully and unapologetically keep sex-based language.

There are many health conditions that exclusively affect people based on their biological sex. There are also many that can affect both sexes, but are more common in one or the other. Being aware of this and being able to take steps to protect yourself is only possible if the correct, sex-based language is used to communicate the risks and preventative actions you can take. And companies have a responsibility to ensure that their audience fully understands the message that they are trying to share. This means that sex-based language must be used for their communication to be effective.

Irrespective of how you choose to identify (and let me be clear, I have no issue with people choosing to identify as a gender that’s different to that which they are born as), your human biology doesn’t change. It goes far deeper than what genitalia you have, or even what hormones you have. It’s part of your DNA. You can’t change it. As Professor Sir Robert Winston said, “Your sex actually is there in every single cell in the body”.

What this means is that biological sex directly affects what health conditions you are at greater risk of developing. Denying your biological sex could have serious implications for your health.

How do sex and gender influence health?

Basically, sex can affect your risk of disease, how diseases progress, and what type of outcomes you may have. For example, the WHO states that people born male experience more severe COVID-19 outcomes in terms of hospitalizations and deaths than people born female.  This is, in part, explained by higher quantities of angiotensin-converting enzyme found in people born male, which binds to the SARS-COV2 virus. Sex may also affect which treatment pathways you can follow, and which treatments are likely to be more successful.

Meanwhile, gender tends to affect how illness is experienced and health behaviours (including health-seeking). The WHO states that male-identifying people’s increased risk of acquiring SARS-COV2, is also linked to their lower rates of handwashing, higher rates of smoking and alcohol misuse and, related to that – higher comorbidities for severe COVID-19 symptoms as compared to people identifying as women. Gender inequality also disproportionately affects people identifying as female. In many societies, females have less control over decision-making about their bodies, in their intimate relationships, families and communities, and this can expose them to violence, coercion and harmful behaviours and practices, including things like Female Genital Mutilation (FGM). Gender inequality make it harder to access health information and critical services, and they are more likely to face discriminatory behaviours from healthcare professionals.

Real-life examples

A trans man said confusion over his gender caused delay in cervical screening results: https://www.bbc.co.uk/news/uk-england-humber-58515769

A trans man with locally advanced cervical cancer: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336482/

Ovarian tumour in adolescent trans man https://www.nature.com/articles/s41416-020-01129-4

Transwomen less likely to get screened for prostate cancer https://www.healio.com/news/primary-care/20240215/transgender-women-less-likely-to-get-screened-for-prostate-cancer-physicians-play-a-role

Understanding your risks

I can’t include them all, but here’s a taster….

If you are born as a male but identify as a female, if you still have testicles, you are still at risk of testicular cancer and should check your balls on a regular basis.

If you are born female but identify as male, you almost certainly still have a cervix and still need regular cervical screening tests to ensure you don’t develop cervical cancer.

If you are born as a male but identify as a female, you can’t develop a cervix so please don’t waste an NHS appointment for a cervical smear test (which are hard to get as it is), you don’t need one. (Yes, this has happened on two separate occasions that I know of).

If you are born female but identify as male, you don’t need to worry about your risk of prostate cancer, but you still need to be aware you are at greater risk of developing breast cancer, osteoporosis and other health conditions that predominantly affect those born as women.

And if you don’t identify with any specific gender, or even multiple genders, you still need to take note of your biological sex, the health conditions that you are at risk of, so that you can take preventative steps to reduce your risk and access the services that could benefit your long-term health.

You can read the NHS advice on health screening if you are transgender here: https://www.gov.uk/government/publications/nhs-population-screening-information-for-transgender-people/nhs-population-screening-information-for-trans-people

There’s absolutely no place for vagueness and ambiguity in healthcare language

And it’s not just people who identify as a different gender that need clear, accurate use of sex-based language. There is a huge population of people who don’t speak English as their first language and who may struggle to fully understand the information that’s available online and in healthcare settings around the UK. Again, the use of transparent, sex-based language is critical for them to be able to access the right healthcare services, ask the correct questions, make informed choices and take preventative action.

For healthcare professionals too, correct language and a clear classification of someone’s biological sex is essential to ensure their patients get the care that’s required. Otherwise we could see more and more instances like this:

Trans man gives birth to stillborn baby after pregnancy signs ignored https://eu.usatoday.com/story/news/health/2019/05/16/pregnant-transgender-man-births-stillborn-baby-hospital-missed-labor-signs/3692201002/

Potentially offending someone won’t kill them, but not conveying health information clearly enough just might!

I work predominantly with organisations in the health, biotech and medical industries and am deeply concerned about the pressure many organisations are experiencing to produce gender-neutral comms, and the wider impact that it could have on the future health of our population. I implore these orgs to continue to use sex-based language in their communications so that they can ensure they are giving people the best chance at understanding and acting on their health. I also ask for greater leniency when it comes to “judging” these orgs on their use of gendered or sex-based language and to think about the bigger picture - the essential role it plays in enabling people of everywhere to benefit from better health. It’s not done to be offensive or discriminatory, it’s potentially life-saving.

Dee x

*https://www.hee.nhs.uk/our-work/knowledge-library-services/improving-health-literacy#:~:text=There%20is%20a%20crisis%20in,not%20understand%20written%20health%20information.