BBC Article about why Transgender People are Ignored in Medicine

[gardenbird48]

www.bbc.com/future/article/20200814-why-our-medical-systems-are-ignoring-transgender-people

I’m a bit mystified by this - the patient in question is a trans man who passes really well. He has updated his medical records to show male and has essentially obliterated any history of being female.
He became ill with a kidney problem but because doctors were using the higher male thresholds for various tests, they didn’t start treatment in time and he nearly died.
I’m wondering how said patient expected the doctors to do anything different given the information that was provided to them. On one hand the transgender people actively want to obscure any reference to their biological sex and even transgender status but on the other hand doctors find that information essential in order to treat them safely. I feel very sorry for doctors.

Did the patient not state that they were on Testosterone for 20 years and why? Did they feel that that particular fact may also not have relevance? And yes, surely you have to answer to questions about major surgery like mastectomies...

Yes this seem very strange.

Plenty of people have to disclose intimate information to get the correct medical treatment e.g. about drug use and previous pregnancies - why is this different?

Later, he listened in amazement as a doctor gravely informed him that he had a uterus – a fact that Whitley was, naturally, already aware of.

But apparently hadn't disclosed to the doctors.

It's also unclear how it would be possible to answer questions about taking medication without revealing trans status.

I don’t understand. Did that person not think to mention that they were actually in possession of a surgically altered female body? Did the medical people not notice? I have been asked so many times if I’ve had any major surgery, blood products, am on any medication etc... at the Drs, dentists, gym etc. Surely to God any hospital admission for their kidney problems would have resulted in questions about what medication they were on - wouldn’t the fact they were on Testosterone have been a huge bloody clue?

Honestly it's completely baffling. Why don't they just add a section to the medical history questionnaire that people fill in before they have surgeries asking what is your biological sex? It's incredible that trans people don't understand how important it is to disclose this fact to Drs but also that this isn't a standard question on all medical history questionnaires.

I'm sure that many women have to disclose things at their pregnancy check in appointment that they would rather not reveal, but the choice is be honest or compromise your care.

This is why we can’t chant TMAM/TWAW. Biology matters for everyone & we need to be able to record biological sex as well as whether someone has had cosmetic or hormonal treatment to augment this.

I don’t see how introducing gender id in healthcare helps. The fact that this female was taking testosterone and had undergone whatever other procedures is relevant and the fact this wasn’t declared to a medic taking a history is surely down to the patient.

But declaring you’re trans on record doesn’t necessarily mean you’ve undergone any medical or surgical procedures, it’s simply what you say you are. That day.

And ultimately the point is they don’t want sex markers anywhere, they don’t want to be recognised as trans but as the opposite sex. TWAW, TMAM.

So, they want to be recognised as the opposite sex. They don’t want it shown on official records what sex they actually are. But they won’t tell medics if they have been taking hormones as part of an effort to look like the opposite sex to that which they were born.

Honestly, healthcare has got itself in this mess. NHS becomes part of a political project because it can’t stand up and say, there is absolutely no evidence that a) people can be born in the wrong body b) people can change sex.

Interesting... It's almost as if there's 4 biologically distinct (2 natural, and 2 man-made) categories of people: men, women, transmen, transwomen... Who would have thought?

It certainly reads more like a reluctance to be straightforward and honest, causing the medical staff to make dangerous decisions. Or maybe they honestly thought that a small amount of testosterone completely negates a female biology.... And they are supposedly educators....

Instead doctors must rely on their patient to tell them.

”Sometimes this can be okay,” says Dina Greene, a clinical chemist and expert in transgender health at the University of Washington, Seattle. In many cases, if someone is going to see a medical expert where gender seems irrelevant, patients might not want their doctor to know they are transgender, she says. "It’s stigmatised.”

Well make up your bloody mind! Either you want the medical professionals to know you’re transgender or you don’t! Your ‘Gender’ may appear to be unimportant during an appointment, but your sex may make the difference between life and death.

Women often present differently with heart conditions than men, so for a clinical chemist to suggest that someone identifying themselves as not being of their born sex, may not be important, is extremely irresponsible.

The crisis in trans health care appears to be about people suddenly realising that all this cosmetic surgery and hormones is not good for you, nor is lying about your sex.

This is a problem entirely of their own making Yup.

It's the trans version of cutted up pear.

@Antibles

This is a problem entirely of their own making Yup.

It's the trans version of cutted up pear.

I have a strong urge to go read that thread again now.

Yes, the sex of a patient's body matters, but so does gender identity - if that gender identity means that they have had surgery / hormones. If your sex is female but gender is man and you are taking testosterone then a doctor needs to know that. Just as a doctor needs to know about other medically relevant details. So I think it's not quite right when people say it's sex, not gender that counts. As so often, it's more complicated than that.

Part of the problem is a failure of the medical system to treat us as individuals. This happens all the time. Sometimes, the practitioner/system is at fault, other times it's just that we have to go on averages because we can't have everything expressly calculated for every individual. But, for example, an asthmatic might know that their own peak flow doesn't drop in a classic way. It's important that they work with the doctor and communicate that so that appropriate treatment can be given or not. And that's a responsibility on both sides.

With the kidney case, there probably aren't reference cases for trans men and women, because research has been done on the big, obvious groups of men and women. But that's an argument to collect more data on a diverse group of people and do more research. You can't do that research if you don't collect accurate data.

You only have to read "Invisible Women" to know that vast swathes of medicine ignore women and evidence suggests that black women are even more unheard, especially in relation to pregnancy and birth. I would like to see the BBC reporting more about these issues, which affect far more people than healthcare for transgender people.

But deciding you are trans presumably doesn’t change your glomerular filtration rate or protein:creatinine ratio or whatever, these are tangible, measurable values... unless the trans lobby is now advocating that as well as calculating reference ranges for biological parameters based on age and sex, we now need to study the individual effects of every combination of male/female hormone treatments on every organ system in the body, to come up with some trans reference range?

@PumbaasCucumbas Would it definitely not have an effect on these things? Sex hormones do a lot of stuff. And they talked in the article about how knowing what ranges should be used for various stats was difficult. I'm guessing that part of the problem is that being trans and making bodily changes makes things more complicated. That doesn't mean doctors and patients shouldn't work together to do the best they can. While at the same time accepting that things might not be as easy as for other patients.

So there are two issues here:

• medical staff not knowing that a trans person was born, and is biologically, a different sex as this is not recorded. And not all trans people are willing to be open and upfront about this - despite medical confidentiality. I have little sympathy with this argument, medical staff are not psychic - there is a reason they ask about medical history (o/w gender reassignment surgery or medication is relevant).

• a lack of research into the impact that taking sex hormones can affect presentation and progression of medical conditions. This I have huge sympathy with - but as a small population with great diversity in how medical transition has been effected, and an unwillingness to allow accurate data to be collected - i struggle to see how this can be easily resolved.

But the point is, we don’t have those studies, those standardised ranges made by clinical trials of thousands of patients. Reference ranges can even vary between labs or the type of machine used etc.

So for example, you start with a geriatric female patient... parameter reference range a-z, you know she’s on ACE inhibitors and warfarin, so that might explain a slightly higher/lower reading for value v and r for example, a medic can put all that into the clinical picture and make sense of it.

Not if someone actually ticked male or adolescent on the submission form... then the results are meaningless for that patient. This is effectively what happened here.

So, when the doctor asked - and they always do ask - whether Cameron was taking any drugs or other medication, did he not think to mention 20 years' worth of testosterone? And explain why?

Problem sorted.

Did the patient not state that they were on Testosterone for 20 years and why? Did they feel that that particular fact may also not have relevance? And yes, surely you have to answer to questions about major surgery like mastectomies...

Just reiterating this. You get bombarded with questions when you are first booked in for any procedure - including are you taking any medication?

I find it very hard to believe the medical staff was so remiss they omitted to ask a question which is 100% routine.

@merrymouse

I'm sure that many women have to disclose things at their pregnancy check in appointment that they would rather not reveal, but the choice is be honest or compromise your care.

A woman who has herpes for example. The patient might be too embarrassed to mention it but risks potentially fatal consequences for her baby if there is a vaginal birth during a flare up. The midwives of course have heard it all before and, in the nicest possible way, could not care less.

This person has no-one to blame but themselves.

I suppose if someone passes well and their privacy is maintained at all times (as in guidelines on one of the Scottish nhs threads). Is it possible, on change of shift or a different nurse coming to do an observation, that “male” is assumed and a blood sample submitted accordingly, even if trans history is buried somewhere in their notes?

I'm still not clear how, while it was cute and awesome for the HCPs to assume Cameron was male, the fact that a scan revealed a uterus didn't lead to some fairly blunt questioning.

If anyone is responsible for Cameron nearly dying (and I'm so glad they got a kidney), then it's Cameron and a system which TRAs have created which doesn't allow anyone to ask questions.

@Clymene

I'm still not clear how, while it was cute and awesome for the HCPs to assume Cameron was male, the fact that a scan revealed a uterus didn't lead to some fairly blunt questioning.

If anyone is responsible for Cameron nearly dying (and I'm so glad they got a kidney), then it's Cameron and a system which TRAs have created which doesn't allow anyone to ask questions.

The scan did indeed lead to "blunt questioning". The real question is why the hell didn't Cameron tell the medical staff from the outset about their status?

From the article One solution to these issues is to introduce an option to register as transgender or non-binary

Clearly it makes sense for a patient to tell medical staff that they are transgender but non- binary?

What difference does that make if there are no surgical or pharmacological interventions.

Patient lies to doctors; blames them. I'm all out of sympathy. This is what false records and forcing everyone else to lie gets you.