When the man with severe abdominal pain arrived at the hospital, a nurse did not consider this an emergency because he was obese and had stopped taking blood pressure medication. In fact, he was pregnant – a transgender who was about to stillbirth.
The tragic case described in the New England Journal of Medicine on Wednesday suggests major problems in labeling or adopting assumptions in a society of increasing confrontation with gender differences in sports, entertainment and administration. In medicine, there is a similar risk that diseases such as sickle cells and cystic fibrosis are missing, which mainly affect certain racial groups, write the authors.
"It's not what happens to this person, but what happens to Daphna Stroumsa of the University of Michigan, Ann Arbor.
"He was rightly classified as a man" in medical records and appears as a male, Stroumsa said. "But this classification has kept us from considering its actual medical needs."
Stroumsa did not state where or when the case occurred, and the patient was not identified.
Transgender men who are considered female at birth, but who are identified as male, may use masculinizing hormones or have surgical changes, such as: B. uterine removal had.
The 32-year-old patient told the nurse that he was transgender when he arrived at the emergency room, and his electronic medical record listed him as male. He had not had time for several years and taken testosterone, a hormone that is masculine and can reduce ovulation and menstruation. But he gave up taking hormone and blood pressure medication after losing the insurance.
A home pregnancy test was positive and he said he "peed on himself" ̵
A few hours later, a doctor assessed him and the hospital test confirmed a pregnancy. An ultrasound showed unclear signs of fetal heart activity, and an examination revealed that part of the umbilical had slipped into the birth canal. The doctors were preparing for a cesarean delivery birth, but there was no fetal heartbeat in the operating room. Moments later, the man gave birth to a stillborn baby.
A woman with similar symptoms "would almost certainly have been more urgently examined and investigated for pregnancy-related problems," the authors wrote.
"It's a very disturbing incident, it's a tragic result," said Dr. Tamara Wexler, a hormone specialist at the NYU Langone Medical Center.
"Medical education should include exposure to transgender patients," making health workers better able to meet their needs, said Wexler, "Many practicing physicians did not have this in their education," but can still learn from such patients.
Nic Rider, a transgender health specialist and psychologist at the University of Minnesota said training was not enough.
"There are implicit prejudices that need to be addressed," Rider said.
Health records may use male / female gender templates, but "that does not mean we only Reject critical thinking or think about how people are diverse, "said Rider.
The case is frightful But "not terribly surprising," said Gillian Branstetter, spokeswoman for an advocacy group of the National Center for Transgender Equal Opportunity in Washington, for problems in obtaining gender-based health care, such as: For example, cervical cancer screening, contraception and prostate cancer.
More needs to be done to improve medical awareness and recognition of diversity because "the consequences are as bad as this case shows," said Branstetter.
Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP
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