  Most algorithms deployed in healthcare do not consider gender and sex despite
the effect they have on individuals' health differences. Missing these
dimensions in healthcare information systems is a point of concern, as
neglecting these aspects will inevitably perpetuate existing biases, produce
far from optimal results, and may generate diagnosis errors. An
often-overlooked community with distinct care values and needs are LGBT+ older
adults, which has traditionally been under-surveyed in healthcare and
technology design. This paper investigates the implications of missing gender
and sex considerations in distributed ledger technologies for LGBT+ older
adults. By using the value sensitive design methodology, our contribution shows
that many value meanings dear to marginalized communities are not considered in
the design of the blockchain, such as LGBT+ older adults' interpretations of
trust, privacy, and security. By highlighting the LGBT+ older population
values, our contribution alerts us to the potential discriminatory implications
of these technologies, which do not consider the gender and sex differences of
marginalized, silent populations. Focusing on one community throughout - LGBT+
older adults - we emphasize the need for a holistic, value sensitive design
approach for the development of ledger technologies for healthcare, including
the values of everyone within the healthcare ecosystem.
