The NHS has recently updated its guidance on how to update your gender on your patient record. This was done to give trans and non-binary people who are eighteen and older more choices about what happens to their medical record when they re-register their gender. In this blog we will explore the current options, some of the pros and cons of the different choices, and provide you with more information to help you make an informed choice.
Information about re-registering your gender with your GP is found in the guidance produced by Primary Care Support England. This organisation provides guidance to GPs on a range of different topics. You can read their full guidance on changing your gender on your NHS record here.
Changing your gender marker impacts the invitations you automatically receive for screening appointments. We won’t discuss this in depth in this blog, but you can read more about how screening invitations work, which screenings you are eligible for, and how to attend the appointments here. We will be updating these pages soon to reflect recent changes such as the opt-in update for cervical screening, so keep an eye out for that too!
Remember, you can always speak to someone at your GP practice if you have any questions or would like to discuss these topics further.
Why was there an update?
Your NHS record contains information about your health and care like your medical history, test results, doctor’s notes, and other important information. On your medical record, there is only one category to record your sex or gender identity. As we know that transgender and non-binary people can have a difference between these two things. This means that your gender replaces your sex registered at birth on your NHS record.
When someone did update their gender on their NHS record, Primary Care Support England (PCSE) used to say that an entirely new NHS record should be created under their new gender marker. Patients and GP practices were encouraged to choose between either a “male” or “female” gender marker.
When the new NHS record was created, the patient should have been given a few options:
- To copy their entire medical history onto the new record;
- To copy across some of their medical history, but remove things that could make them identifiable as trans; or
- To not copy across any of their medical history.
The second and third options in this list should also involve a conversation with the GP Practice about the information that will not be moved over to the new file, and what responsibility the patient has to remember this information and share it when relevant. However, we know that this system did not always work and sometimes this meant that important information could be lost in the process.
Why is your medical history important?
Your medical history provides important information about your health over your lifetime.If this is lost, healthcare professionals have to work with limited information and it can make it harder to give you the right medical care that you need.
What has changed?
In mid-2025, PCSE updated its guidance on changing your gender marker on your NHS record. The new guidance means that you now have more options when you re-register your gender. We will take a look at each of these options below, and explore the pros and cons of each.
1. You can now choose to keep your old NHS record
PCSE now allows the gender marker on your existing NHS record to be changed. This means that you do not need to have an entirely new NHS record if you don’t want to. Here are some things to consider:
All of your medical history will still be on your NHS record. As we discussed above, having a complete medical history can be very important to ensuring that you get the best care possible. There will also be less responsibility on you to remember and tell healthcare professionals about important health information, as this will usually be included in your medical history.
You may be identifiable as trans based on your medical history. If you keep the same NHS record, healthcare professionals will be able to see information about your past medical care that could make you identifiable as trans.
2. You can choose to have a new NHS record
You can still choose to have an entirely new NHS record when you change your gender marker if you would prefer. This would follow the same process as in the past. Here are some things to consider:
You can choose how much of your medical history is carried across. As we talked about earlier, you should be given the choice to copy or remove different parts of your medical history when your new NHS record is created. This can give you more control over what information is on your new record.
Your medical history may be lost if the process does not go smoothly. As well as all of the things we have already discussed, losing your medical history may also mean that healthcare professionals will not know that you are trans. Some people may prefer this, but it can also create challenges. For example, if you are a trans woman it is important that your GP and other healthcare professionals know that you have a prostate if you are having prostate-related symptoms. In cases like this, it will be your responsibility to disclose your identity and any other relevant medical history to make sure that you are given the right tests and referred down the correct pathways.
3. You may choose to change your gender marker to “I”
In the past, PCSE encouraged all new gender updates on a patient’s record to be “male” or “female”. However, PCSE’s new guidance states that you can now choose to change your gender marker to “i” for “indeterminate”, if you would prefer.
What we know:
Your gender identity will be visible to people working in the NHS. Having an “i” marker on your record is likely to out you in healthcare settings, especially as not many people currently have “i” markers on their medical record. You may see that as positive, as it can make it easier for healthcare professionals to know your gender identity and factor this into your care. However, some people may feel that they do not want to be easily identifiable as trans or non-binary in this way.
You will be automatically invited for breast screening. People with an “i” record are automatically invited for breast screening appointments between the ages of 50 and 71 in the same way people with a “female” record are. Unfortunately, there is currently no way for people to “opt-in” to receive breast screening invitations if they have a “male” NHS record. If you have an “i” record but are not eligible for breast screening, you can opt-out of the breast screening programme so that you will not receive invitations. Your GP can discuss this with you.
You will not be automatically invited for cervical screening. People with an “i” or “male” record are not automatically invited for cervical screening. If you have a cervix you can ask your GP to opt you in to receive cervical screening invitations automatically.
What we don’t know:
Access to referral pathways. As the NHS’ computer systems are still mostly based on a two-gender system of male and female, it is important to discuss with your GP about how an ‘i’ gender marker will affect your access to cancer screenings and other appointments or referrals.
Blood tests and medicines. To get the right results from your blood tests, the people looking at your blood sometimes need to know your sex registered at birth and if you’ve received any gender affirming care. The same is true when prescribing some medicines. Having an ‘i’ marker will help you to start this conversation, but it might also involve working with the staff to make sure everyone who needs to know, gets the right information.
What should you do?
It’s your choice! Overall, the changes made by PCSE are to give you more options when updating your gender at the GP. We think it is good that there is greater choice, but as with everything, there are pros and cons to each of these different options. We encourage you to think about what is most important to you. If you’re not sure what this is right now, that’s okay! There is no pressure to update your gender on your record – some people never do it! But if you want to, it’s important to be informed and do it when you feel ready. Some people may also update their gender more than once. Remember, you can always talk to someone from your GP practice if you have any questions about what this would mean for you and your healthcare.