Today marks IDAHOTB — the International Day Against Homophobia, Transphobia, and Biphobia. It’s a day to stand in solidarity with LGBTQ+ communities, to confront stigma, and to advocate for more inclusive societies.

In light of this, we’re examining a recent UK Supreme Court ruling that has sparked widespread debate: a decision which reaffirms that, under the Equality Act 2010, the legal definition of a “woman” refers exclusively to someone who is biologically female – in other words, female at birth.

This ruling comes off the back of a series of challenges brought forward by campaign group For Women Scotland (FWS), including to the UK’s Supreme Court (the highest Court), over the definition of “woman” in certain Scottish legislation.

Where sex and gender identity once coexisted more fluidly in law and policy, they are now being separated in ways that are sure to ripple through society.

But beyond the courtroom, this ruling has far reaching complications. As the UK’s largest public body, the NHS delivers services that are both biologically and socially gendered – from cancer screening and maternity care, to mental health support and sexual health clinics.

But if “woman” is to be interpreted as “biological female” in law, how does this affect people whose identify differs from that which they were assigned at birth? How does it influence the NHS’s ability to provide inclusive, person-centred care?

How Did This Come Around?

FWS challenged the Scottish Government on the Gender Representation on Public Boards (Scotland) Act 2018, an act which sets a target for 50% of non-executive* public board members to be women. Under this act, a “woman” was initially defined as including:

“a person who has the protected characteristic of gender reassignment (within the meaning of section 7 of the Equality Act 2010) if, and only if, the person is living as a woman and is proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of becoming
female.”

FWS challenged this definition, arguing that being a transgender woman is not a protected characteristic under the Equality Act 2010, and that the definition used by the Scottish Government as above “impinges on the nature of protected characteristics which is a reserved matter“.

The Scottish Government then removed their definition of a “woman” from this act, and instead turned to using the definition under the Equality Act 2010, arguing that women that held a full Gender Recognition Certificate (GRCs) are also included. The Equality Act referred to a “woman” as a “female of any age”, and under the Gender Recognition Act of 2004, if a transgender woman has a full GRC, then their new gender is female, and legally their sex becomes female (and vice versa for transgender men).

This was further challenged in the most recent appeal by FWS, where the Supreme Court sided with them, unanimously ruling that, for the purposes of the Equality Act 2010, “woman” and “sex” pertain to biological sex, not gender identity, even for individuals holding a full Gender Recognition Certificate (GRC).

*Non-executive member =  a member on a public board, but not an employee of the public authority.

Impact On NHS Services

Single-Sex Wards and Facilities

One of the clearest and most immediate effects this ruling is likely to have is on the configuration of hospital wards. Current NHS England policy from 2019 states that “trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns they currently use”. With a legal definition based solely on biological sex, hospitals are likely to be obliged to group patients according to biological sex, not gender identity, meaning trans women may have to use male wards and trans men to female wards unless alternative options were available.

This would undoubtedly have an impact on access to other single-sex spaces, such as toilets and staff changing rooms, as NHS facilities will now need to adjust signage, policy, and enforcement accordingly.

Health Secretary Wes Streeting told LBC radio the following, when asked if trans women will now have to use male changing rooms and toilets within the NHS:

“No, what we want to do is make sure we have single-sex provision on wards in the NHS, and that’s based on biology, and to make sure that trans people have access to safe and dignified and respectful care.”

“The NHS is updating its guidance and what we would like to see is appropriate kinds of rooms and private spaces for trans people to be cared for in NHS hospitals.”

With various different patients requiring private rooms during their admission, from those who are immunosuppressed to patients with contagious infections, and often a lack of private rooms to begin with, the idea of trans people being treated in private rooms is perhaps a seemingly idyllic concept.

Gender-neutral options might be expanded to accommodate those who do not wish to use spaces designated by biological sex, but NHS infrastructure – already under strain – may struggle to fund such adaptations and these are likely to take some time.

Data Collection and IT Systems

The NHS relies heavily on digital records to organise care. At present, your sex on your records is the sex you are assigned at birth, unless you change it. If “sex” in these systems is locked to a legal or biological definition, it could:

• Have an impact on health screening programs, many of which are sex specific. For example:
  • On one hand, it may help trans men with cervixes or trans women with prostates being overlooked by screening programs if their legal sex on NHS records is that of their biological sex.
  • On the other hand, it may mean other groups of people are further excluded from gender-specific services, such as trans women who are on oestrogen hormone replacement therapy (HRT) and breast cancer screening (as they are still at increased risk due to HRT but may not automatically be invited for screening if it is based on their gender at birth).
• Make it harder to track outcomes for trans and non-binary data, which could skew health data.

Implications for NHS Staff and Service Planning

Thousands of NHS staff are trans or non-binary too – and there is a worry they may face increased scrutiny or exclusion under biologically frames policies.

How will this change access to gender-affirming facilities, like toilets and changing rooms? And what about discrimination protection, especially if workplace policies begin prioritising sex over lived experience?

There is also the potential added burden to frontline staff too, who must interpret complex legal rulings on the shop floor whilst awaiting policy changes, possibly without adequate interim training, support, and guidance.

Medical Accuracy and The Role of Biological Sex in Healthcare

While legal language may now enforce a strict biological definition, medicine often operates in more complex manner.

Biological sex certainly matters – it influences hormone levels, disease risk, medication metabolism, and anatomy. For example, heart disease symptoms often present differently in biological women than in men.

But gender identity also matters. Someone’s lived experience, the medications they take (like HRT or testosterone), and their mental wellbeing, all shape how their healthcare experience. A trans man on testosterone may still need cervical cancer screening; a trans woman taking oestrogen may need monitoring for blood clots or breast cancer.

Recognising biological sex doesn’t require erasing gender identity – the challenge for modern healthcare is to integrate both, not to choose between them.

Further Marginalising A Marginalised Group

Trans and non-binary patients already face significant barriers to care, including:

• Fear of discrimination or misgendering.
• Lack of awareness and knowledge amongst clinicians.
• Delays in accessing fender-affirming services.
• Reluctance to disclose gender identity due to historical stigma can have impacts on patient health outcomes.

By reinforcing a legal definition of “woman” that excludes them, the courts may inadvertently worsen health disparities. These risks don’t appear to be abstract, either, as there are some studies suggesting that trans people are:

1. Less likely to attend cancer screening.
2. More likely to avoid healthcare environments altogether.
3. At increased risk of mental health conditions, chronic pain, and substance misuse.

Legal decisions, even when narrowly focused, can send signals that shape public attitudes, healthcare policy, and patient trust. If people feel unseen by the system, they’re more likely to stop engaging with it.

Should We Be Politicising Gender?

Supporters argue that clearer legal definitions are essential to protect sex-based rights. But rights needn’t be mutually exclusive – and in healthcare, framing inclusion and safety as opposing forces risks leaving everyone worse off.

In truth, biology and identity intersect in complex ways. Forcing a binary may offer administrative clarity, but it often comes at the cost of nuance, humanity, and person-centred care.

Could There Be a Better Way?

There are likely ways to help navigate this more inclusively in our healthcare system. For example:

• Separating legal sex from clinical sex in patient records, but having them both recorded.
• Consider anatomy, hormonal use, and lived experience when considering service eligibility, not sex alone.
• Engage trans voices in designing services and policies.
• Train all healthcare professionals in gender-sensitive communication and inclusive care.

This could help ensure that “biological sex” is acknowledged where it matters medically, but not weaponised where it doesn’t.

A More Inclusive Future

It’s possible to honour the reality of biological sex in clinical care while still affirming the lived experiences of trans and non-binary patients. 

The Supreme Court has ruled on what a “woman” is in law. But in medicine, a more important question remains: what does it mean to treat someone with dignity?

This ruling is just one part of a much wider conversation about gender, rights, and healthcare. On IDAHOTB, let’s reaffirm our commitment to inclusive, compassionate healthcare – regardless of sex, gender identity, or background.

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