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Electronic health records are enabling a new generation of health care researchers to study thousands and millions of patients at a time. But scientists can’t easily tap into that promise for transgender and gender diverse populations — because in many cases, the records simply don’t reflect their identities.

Up until 2015, most digital health records only allowed physicians to enter a patient’s sex, and the field offered just three options: male, female, or other. By ignoring the complex relationship between sex and gender, those limited choices can harm trans and gender diverse patients both psychologically — as they are repeatedly misgendered or deadnamed by providers — and physically, if a record fails to recommend screenings for cervical or prostate cancer, for example.

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