Thanks bimble . I had thought it might only be a matter of time but I didn't think it would be this soon. Aargh! It's hard for me though not to see this as a case of bad faith. I may need to be disabused here but **in my day to day** when I say "man" I don't really include transmen and when I say "woman" I don't really include transwomen. Has common parlance changed already? If it has, fair enough, I'm more behind the times than I thought. If it hasn't, it sounds rather like the service has taken for granted that patients will follow its politics and has not even bothered to issue guidelines to the effect of "asking patients themselves". I dread to think yet another burden to be shouldered by women like my friend will be that of making sure the wording on these kind of requests prevents a conflation of sex with gender (as reflected in the nurse's response) but I don't think transgender women should bear that burden either. I don't think it's that difficult for whoever receives this sort of request to ask the patient if they would mind being attended to by a transgender woman/man.