In the worst case scenario, treating transmen as male could lead to their death
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It was 2016 and Cameron Whitley was gravely ill. He was urgently in need of a kidney transplant, which should have been no problem. He was young and otherwise healthy. He had medical insurance. He even had several gallant friends willing to undergo major surgery for him.
There was a catch, however. His doctors were missing a crucial piece of information – one which, until then, no one had thought to look into. Without it, they weren’t able to put him on the list.
And so, more than a year after he first turned up at a hospital in the US Midwest with mysterious ear pain – eventually leading to a diagnosis of chronic kidney disease – he was forced to go on dialysis. By this point, his organs were functioning at less than 8% of their normal capacity.
But here again, Whitley hit a snag: his doctors were in need of another vital piece of information – and without it, they couldn’t work out how often he would need this treatment. They had to guess; they got it wrong; he became yet more unwell. All this time, his friends were practically throwing their kidneys at him.
Finally, just as Whitley, who is an assistant professor of sociology at Western Washington University, was approved for a transplant, his dialysis treatment led to massive blood loss and the operation had to be delayed. “It was really hard. I was horribly sick,” he says.
What was going on?
Whitley is a transgender man – he identifies as male but his biological sex is female. He has been living as a man for around 20 years. In his words, he fully “passes” as one, for want of a better term – and he is registered as a man on all his legal documents, from his passport to his medical records.
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In Whitley’s case, the problem was how the severity of kidney disease is assessed. The usual protocol is to calculate a patient’s “estimated glomerular filtration rate” (eGFR), which measures the amount of a certain waste product in their blood and therefore shows how efficient their kidneys are at filtering it out. If the eGFR is below a certain level, it’s an indication that their kidneys are failing and they are eligible for a transplant.
There are several different lower limits for an eGFR, depending on things like a person’s weight, age, sex and race, which are intended to reflect the natural variation in the human body. Based on the female cut-off, he would have been allowed a transplant immediately. But he’s registered as a man on his medical records, and this meant his doctors used the male eGFR level. He wasn’t put on the list until he reached it – a decision that ultimately delayed the surgery by over a year, and very nearly cost him his life.