Perspectives on sex and gender inclusion in clinical practice guidelines: a qualitative study.

INTRODUCTION: Clinical practice guidelines (CPGs) provide standardised direction for the diagnosis, management and treatment of medical conditions. However, sex and gender, critical determinants of health, are often inconsistently incorporated within guideline development. This study explored expert opinions on how sex and gender are currently considered in CPGs, the barriers to meaningful integration and practical strategies to strengthen equity-focused guideline development. METHODS: Semi-structured interviews were conducted with 28 participants representing clinical practice, sex and gender research, public health and health and advocacy organisations. A framework analysis approach was used for data analysis. FINDINGS: Two overarching challenges were identified as limiting the integration of sex and gender in CPGs: (1) persistent evidence gaps, including limited clinical data disaggregated by sex and gender and (2) politicisation of terminology, which undermines clarity and consistency in guideline processes. Participants highlighted the need for stronger evidence stratified by sex and gender, clear reporting standards, inclusive and appropriate language and greater representation of women and gender-diverse people on guideline committees. An intersectional approach was viewed as essential to ensure guidelines recognise structural, cultural and social contexts that shape differing health needs. CONCLUSION: This study outlines practical, internationally relevant actions to improve the integration of sex and gender into CPGs. Strengthening evidence, reporting standards and inclusivity within guideline processes provides a clear pathway to enhance clinical quality, improve equity and better support diverse populations.