Unsurprisingly Sullivan bases her review on the immutable binary nature of sex. Just to remind readers, this is a statement of belief rather than evidenced fact. Indeed organisations representing over 3,500 scientists said precisely this in response to President Trump’s executive order stating that sex is both binary and immutable.

But Sullivan then states boldly that all research should ask about “biological sex” – another term which has no clear definition in science or in law – regardless of whether how you were born is relevant to the topic being investigated. She takes issue with what seems like a perfectly reasonable set of questions in an NHS staff survey, matching a trans-inclusive way of capturing relevant data.

Some of her recommendations touch on NHS protocols and use of data. When someone transitions into a different gender, they get given a new NHS number, because the NHS has viewed ‘sex’ as immutable for IT purposes. The individual’s old NHS record is then added as a note to the new record, but that means it cannot be searched other than visually. The ‘sex’ marker is used to automatically call you into various screening programmes. F means you get called for cervical and breast cancer screening, while M leads to prostrate checks. These may or may not be relevant for a whole bunch of people, not just trans people.

This has been an issue for as long as I can remember. As a computing professional with experience in managing data, I was involved in conversations with NHS people 15 years ago about the need for more granular data (for example whether someone has ovaries or not) and why couldn’t the ‘sex’ marker be amended, and it wasn’t a new conversation then. Each time NHS people said that changes were being considered, but the cost of implementing them would be high.