[ad_1]
When the man arrived at the hospital with severe abdominal pain, a nurse did not consider it an emergency, noting that he was obese and had stopped taking medication for the tension. blood. In fact, he was pregnant – a transgender man giving birth on the verge of ending a stillbirth.
The tragic case, described in Wednesday's New England Journal of Medicine, highlights broader issues of label assignment or hypothesis-making in a society that is increasingly confronted with gender differences in sports, entertainment and government. In medicine, there is a similar risk of the disappearance of diseases such as sickle cell anemia and cystic fibrosis, which largely affect specific racial groups, write the authors.
"The important thing is not what happened to this particular person, it's an example of what happens to transgender people interacting with the health care system," said lead author Dr Daphna Stroumsa of the University of Michigan, Ann Arbor.
"He was rightly classified as a man" in medical records and appears masculine, Stroumsa said. "But this classification has deterred us from taking into account its actual medical needs."
Stroumsa does not say where and when the case occurred and the patient was not identified.
Transgender men, who are considered women at birth but who identify as such, may or may not use masculinizing hormones or have undergone surgical changes, such as uterine removal.
The 32-year-old patient told the nurse that he was transgender when he arrived at the emergency room and that his electronic medical record indicated him as being a man. He had not menstruated for several years and was taking testosterone, a hormone that has masculinizing effects and can decrease ovulation and menstruation. But he stopped taking the hormonal and hypotensive drugs after losing his insurance.
A home pregnancy test was positive and he claimed to be "peeing" – a possible sign of diaphragm rupture and delivery. A nurse ordered a pregnancy test but considered it stable and her problems non-urgent.
A few hours later, a doctor assessed her and the hospital test confirmed her pregnancy. An ultrasound revealed signs of fetal heart activity unclear and an examination revealed that part of the umbilical cord had slipped into the genital canal. The doctors prepared for an emergency cesarean delivery, but in the operating room, no fetal heartbeat was heard. Moments later, the man gave birth to a stillborn baby.
A woman presenting with similar symptoms "would almost certainly be the subject of a sort and more urgent assessment of pregnancy-related problems," the authors wrote.
"It's a very upsetting incident, it's a tragic issue," said Dr. Tamara Wexler, hormone specialist at NYU Langone Medical Center.
"Medical education should include exposure to transgender patients" so that health workers are better able to meet their needs, Wexler said. "Many practicing doctors did not have it in their training" but can still learn from such patients now.
Nic Rider, a transgender health specialist and psychologist at the University of Minnesota, said training was not enough.
"There are implicit biases that need to be solved," said Rider.
Health records can use gender models for gender, but "that does not mean that we simply reject critical thinking or think about the diversity of humans," Rider said.
The case is horrible but "not really surprising," said Gillian Branstetter, spokeswoman for a rights advocacy group, the National Center for Transgender Equality in Washington.
Transgender people often face difficulties in obtaining gender-specific health care, such as cervical cancer screening, birth control, and prostate cancer screening.
More needs to be done to improve medical awareness and recognition of diversity because "the consequences can be terrible, as this case shows," said Branstetter.
___
Marilynn Marchione can be followed on http://twitter.com/MMarchioneAP
___
The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.
Copyright 2019 The Associated Press. All rights reserved. This material may not be published, disseminated, rewritten or redistributed.
[ad_2]
Source link