Additional values in the value set

Current birth sex representation values categorize everything other than ‘Male’ and ‘Female’ into ‘Unknown’. It is important to disaggregate “unknown” further to accurately represent birth sex categories other than the two mentioned above.    “Sex assigned at birth” is an assigned label and does not always reflect how a person identifies and does not necessarily reflect a person’s gender identity. Sex assigned at birth and gender identity are not interchangeable concepts. Normalizing the term “sex assigned at birth”, we recommend removing the parenthesis from the category “Sex (assigned at Birth)”.

The gender value set being proposed is as follows:

  • Male
  • Female
  • Intersex*
  • X*
  • Other, please describe
  • Not asked*
  • Asked, but unknown


*New values being proposed

NCPDP Comment

  1. NCPDP recommends the addition of Non-Binary as a valid value.

LOINC has a number of…

LOINC has a number of observation codes that could appy including sex assigned at birth as suggested by at least 2 commentators.

46098-0 Sex 
74698-2 Sex [AHRQ] 
72143-1 Sex [HL7.v3] 
21840-4 Sex NAACCR v.11 
54131-8 Sex [USSG-FHT] 
76689-9 Sex assigned at birth 

Best Practice Recommendation from American Clinical Lab Assoc.

The American Clinical Laboratory Association (ACLA) has developed a Best Practice Recommendation for administrative sex and clinical patient gender used for laboratory testing and reporting. Please add the hyperlink below to the "Limitations, Dependencies, and Preconditions for Consideration" section, referencing ACLA's guidance document.


Need Sex Assigned at Birth

Administrative sex is used to indicate the sex a person has listed with their insurance company. Administrative sex and sex assigned at birth are not always the same. If someone legally changes their sex or the sex listed with their insurance company is different, then their administrative sex and sex assigned at birth no longer align. Therefore, it is necessary to ask both administrative sex and sex assigned at birth to accurately identify all transgender/GenderQueer patients. When insurance companies accept both sex assigned at birth and gender identity, then administrative sex will no longer be necessary.


Chris Grasso, MPH

Associate Vice President for Informatics and Data Services

Fenway Health

Is "Sex at birth" different…

Is "Sex at birth" different from Administrative Gender collected during registration?  This needs clarification in the industry, as different approaches have been used in multiple places.  It appears that "Sex at birth" has a) been considered a clarification of the meaning of "Administrative Gender", and b) been considered to be a separate demographic.

Administrative sex is not…

Administrative sex is not perfectly aligned with "Sex at birth" because at birth an infant can be undifferentiated. In addition, if we want sex recorded on the birth certificate, then many sates allow this to be changed: And as of January 2017, NY has allowed a person to have "Non-binary" as her birth certificate gender identity, see