this is along with name, race and other demographic information
They don’t have a gender field, and it really feels like they are just reducing sex and gender down to “you are what you were assigned at birth”, and then hiding behind amorphous medical “reasons” as justification …
It sounds like a medical records thing and you should use whatever gender is listed on your medical records, which should probably match your social security records.
Some people only change state records so they have to respond differently depending on who’s asking. I think in this case its related to federal records.