The word "woman" could be erased from specialist NHS clinics dealing with female health issues under proposed new transgender inclusivity rules.
A report proposing new NHS treatment guidelines in Scotland suggests “a general move away from gendered healthcare” and warns that trans people are put off attending services if they are targeted at a certain sex.
It states that trans men may feel “really uncomfortable” if they have to attend a “women’s health clinic” for services such as contraception or cancer screening programmes.
The proposed guidelines, which are set to be sent to Nicola Sturgeon’s minister for approval imminently, want the Scottish NHS to formally recognise “increasing gender identities for patients”, especially those who consider themselves neither male nor female.
It also calls for laboratories to “decouple” reference ranges in test results from “gender markers”. Men and women have different healthy ranges on a series of criteria, for example in blood tests.
The report claims ranges should instead be “relevant to the individual.” The suggestion was branded a denial of reality by doctors.
Experts have raised fears that moves towards what trans activists see as “inclusive language” in the health service are dehumanising and potentially dangerous, for example by confusing those who do not speak good English.
“It seems that the Scottish NHS is in the grip of a science-denying cult,” Susan Smith, a director at the For Women Scotland campaign group, said.
“Gender, including non binary identities, are an irrelevance in medicine, but sex matters. This move will, almost inevitably, rebound on women.
“Progress to improve standards in women's healthcare has been hard won - this will set the clock back on those gains by decades.”
Women described as 'those of us with ovaries'
The Scottish NHS has previously been criticised for omitting references to women from public health campaigns and instead using terms such as “people who menstruate”.
A Scottish Government-backed advice leaflet designed to teach young people about periods referred to "those of us that have both our ovaries and a womb".
However, the proposed new NHS guidelines call for “inclusive signage”, literature and leaflets to ensure services are “accessible” to transgender people.
The report states: “Systems within NHS Scotland need to allow for increasing gender identities for patients, specifically including non-binary identities. This should be done as part of a general move away from gendered healthcare.
“Transgender individuals may be uncomfortable seeking reproductive health care or contraception when the services’ ‘target audience’ is advertised in a way that is incongruent to their gender identity (eg a transman may be really uncomfortable attending “women health clinic” for a coil or for a cervical smear).”
'Unhelpful and potentially dangerous'
Louise Irvine, a retired GP who is co-chairman of the Clinical Advisory Network on Sex and Gender, raised concerns at repeated references to the World Professional Association for Transgender Health in the report.
She said the association's guidelines were “very poor” and potentially harmful for patients and questioned why the advice of respected Scottish experts had not been preferred.
"Proposals to change whole systems of IT, language and clinics is timorous, unhelpful and potentially dangerous,” Dr Irvine said.
"It's not clear what ‘gendered healthcare’ even means, so how can the NHS move away from it?”
"You can't move entirely away from sexed healthcare, because everyone has a biological sex, even if they take additional hormones to affirm or appear differently.
"To interpret test results safely you need to know a person’s sex, as well as their age, conditions and drugs. To suggest otherwise simply denies reality.”
Prof Alice Sullivan, head of research at University College London’s Social Research Institute, also criticised the guidelines.
She said: “We can acknowledge people's identities without pretending they don't have a sex. Identifying as non-binary does not affect whether you may need a cervical smear or a prostate exam, for example."
A spokesman for NHS National Services Scotland, which commissioned the report, said it would be “inappropriate” to comment until its new gender reassignment protocol was officially published.