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I have been tasked with creating a new front-end for an insurance company, the idea being to provide rough quotes based on filling out a questionnaire, the back-end quote generation etc. is all already working and has been used internally for years, we plan to provide a significantly wider range than the quote provided by this system to the end user.

The questions are quite straightforward: age, location, ethnicity, smoker non/smoker, years driving etc. However, one particular question has given me food for thought for a while now.

The back-end system requires the person's biological sex as an input factor, because testicular cancer and breast cancer among other things are taken into account for the quote. I am worried that only having two options for sex may be seen as trans-phobic or exclusionary, an 'other' box however is not adequate, as we do need to know their biological sex.

The current WIP is to have a 'Sex' selection and an (optional) 'Gender' selection separately. Although this may be confusing for some, the ethical issue is that we discard the 'Gender' selection, basically making it a padding to avoid offending trans people. Which in my opinion is offensive, and the UX equivalent of giving a child your keys to make them happy.

I'd like to have a solution to this issue that fulfills these points:

  • The user is prompted to provide their biological (birth) sex
  • The user is not made to feel excluded if they are trans or otherwise
  • The questionnaire is presented as ethically as possible

I believe this issue is unrelated to other "duplicates" purely because an 'Other' box etc. is not applicable, and the question cannot be removed entirely.

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  • Male or Female doesn't consider intersex. Why not have those 3 options, and a "biological sex" label?
    – Escher
    Commented Jan 16, 2018 at 20:21
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    Wouldn't any transform surgery done make the birth sex irrelevant to the cancer statistics (as the individual may no longer have the parts that are relevant to the specific cancer type)? Maybe you need to ask which relevant parts the user has instead. Commented Jan 16, 2018 at 20:24
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    @DannyVarod I might feel a bit uneasy if a website asked me to select which genitals I have from a list of all possible parts... The company should be okay without having that level of granularity. Commented Jan 16, 2018 at 21:11
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    Being transgender does not change risk factors in any way. It's determined by many factors and most of those are tied to your genetic makeup rather than how you look. Even with surgery that aspect does not change... this will unfortunately mean trans people will always be affected and confronted with this even if they look and feel like a different gender. Asking for which parts someone has is therefore not possible (not to mention how creepy it is haha). Commented Jan 17, 2018 at 9:20
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    @Wanda I suppose that to be a transgender (m->f or vice-versa) has some statistical impact (because of hormones, at least) in some disases but AFAIK unfortunately (or fortunately? the risk of discrimination might be even bigger) we do not have any study with a significative population (excluding, obviously, psychiatric studies). Well, I honestly I never saw ANY study at all (but I'm just a programmer then I'm absolutely not an informed one) Commented Jan 17, 2018 at 11:09

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A very similar question can be found here: Handling gender in statistical test data.

Unfortunately, by asking for someone's biological sex and not the gender, you cannot avoid causing discomfort for some people. However, if you explain your reasoning on why you need to know what was assigned, rather than what a person feels their gender is, you can get the answers you need and keep the discomfort to a minimum. Accuracy in medical matters is considered by most to be important enough to warrant such a question.

Having both a gender and biological sex question will not help with reducing discomfort. In fact, I'd say it makes it worse; you actually point out the disparity of the situation even more, because the answers don't align. And for the majority of people who would answer the same for both questions, you just add confusion because it's not clear for everyone what the difference is.

I'd recommend not to refer to gender if it's not necessary. Insurances are transactional in nature and most people will understand that risk calculating (for which you need to know biological sex) is part of the process.

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Can we have a section grouping biological details like age, height, weight, etc and then use the field "Biological Sex". Just below the section we can have a comment stating "Information required to calculate risk based on biological factors".

This will give the user of the system a clear message specifying that in the field of medicine, the diagnosis is done based on biology and that exclusion of options other than Male/Female is not meant to be offensive.

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  • Birth gender is rather confusing though; gender is chosen, sex is assigned. If you go this route, use biological sex instead of anything with gender in it. Commented Jan 17, 2018 at 9:03

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