According to the NIH's "Sex as Biological Variable" policy, "NIH expects that sex as a biological variable will be factored into research." Researchers must use male/female to identify their participants’ sex variables. According to Sarah Richardson, this is not always reliable. For example, studies of female cell lines have furthered research on prostate cancer. We argue that using binary sex as a biological variable without further analysis of sex-related characteristics in detail, and the correlation of sex and gender, exclusively harms the transgender and intersex population regarding precision medicine. To practice inclusive precision medicine, we can become sex contextualists. According to Richardson, "Sex contextualism offers an alternative to binary approaches to studying sex as a biological variable." We extend Richardson’s view for the transgender population. For example, although a trans woman's sex assigned at birth is male, they might have a closer amount of "sex hormones" to people assigned female at birth. Assuming a binary of male/female will give us all the information about an individual's hormones would be a mistake that excludes intersex and transgender patients who are/were under any type of gender-affirming care. For instance, a trans woman who is on HRT, might be studied as a cisgender man. We should reevaluate how to differentiate between people who underwent gender-affirming surgery and their cisgender counterparts. Currently, EHR’s data lacks the precision necessary for sex contextualist research. We argue we need to reconsider our policy to include other variables besides binary data of sex assigned at birth.
Authors: Rebecca Sanaeikia , University of Rochester ; Laura Stamm , University of Rochester
