A doctor who refused to use transgender pronouns as people's chosen sex as it went against his Christian faith has lost his tribunal.
Disability assessor Dr David Mackereth, from Dudley, West Midlands, claimed the Department for Work and Pensions (DWP) breached his right to freedom of thought, conscience and religion.
But a panel ruled his biblical view of what it is to be male and female was "incompatible with human dignity."
Dr Mackereth said he intends to appeal.
The hearing was told he would refuse to refer to "any 6ft-tall bearded man" as "madam" following a conversation with a manager at an assessment centre and later left his role.
The tribunal panel - sitting in Birmingham - found the DWP had not breached the Equality Act. It stated there was no contravention and dismissed the complaints.
"A lack of belief in transgenderism and conscientious objection to transgenderism in our judgment are incompatible with human dignity and conflict with the fundamental rights of others," the judgement said.
Dr Mackereth, 56, said he was "deeply concerned" by the ruling.
"Without intellectual and moral integrity, medicine cannot function and my 30 years as a doctor are now considered irrelevant compared to the risk that someone else might be offended," he said.
"I believe that I have to appeal in order to fight for the freedom of Christians to speak the truth. If they cannot, then freedom of speech has died in this country, with serious ramifications for the practise of medicine in the UK."
Andrea Williams, the chief executive of the Christian Legal Centre, said if the decision is upheld it will have "seismic consequences" for anyone in the workplace "who is prepared to believe and say that we are created male and female".
"It is deeply disturbing that this is the first time in the history of English law that a judge has ruled that free citizens must engage in compelled speech," she added.
A DWP spokeswoman said: "We acted to protect claimants from behaviour that would have failed to treat them with dignity, so we welcome this ruling. We expect all assessors to approach their work sensitively."
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