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.

transgender have unique needs and the health care system needs to recognise this.

Yup, they need to honest about their born sex, past history of operations and any medication they’re on, to the health professionals. Just like the rest of us have to. That way they’ll get the correct treatment.

there are two sexes and two surgically and hormonal altered variations that may have different medical needs than what they would have had if they'd stick to their natal configuration.

There are two sexes. Period.

All our medical needs are based on a complex combination of sex, presenting medical complaints, past medical history, past medical interventions/operations and current medications. Some have no past medical history - others have complex ones.

Transgender past medical history/interventions etc is but one example of many healthcare needs medics come across daily e.g cardiac/ lung disease/ cancer etc.

Doesn’t change the fact that there is still two sexes.

The NHS should only be asking for Sex: Male or Female.

Gender ideology should not be given any further credence.

Staff are busy enough without being confused and gaslit.

Hormones and surgery come under medications and procedures, previous medical history. If somebody wants to lie about that, on their own head be it.

@ThinEndoftheWedge

there are two sexes and two surgically and hormonal altered variations that may have different medical needs than what they would have had if they'd stick to their natal configuration.

There are two sexes. Period.

All our medical needs are based on a complex combination of sex, presenting medical complaints, past medical history, past medical interventions/operations and current medications. Some have no past medical history - others have complex ones.

Transgender past medical history/interventions etc is but one example of many healthcare needs medics come across daily e.g cardiac/ lung disease/ cancer etc.

Doesn’t change the fact that there is still two sexes.

This.

It takes a lot of self absorbed naïveté to think that altering sex data on medical records or keeping quiet about hormone treatments etc is justified because of your profound specialness and it’s the doctors job to second guess this. If myself or one of my children had a weird blood group or a severe allergy or a back to front heart or whatever, I’d be telling every doctor in every conversation to make sure no mistakes happened.

@GoldenBlue

NHS systems should record sex and administrative gender.

Sex being biology and used for pathology, pharmacology, screening etc.
Gender can be used for letters etc for politeness/kindness

The risks associated with the loss of medical history is high and even allowing patients to knowingly make this decision is a real concern

That won't happen because the geniuses who drafted the GRA made it a criminal offence for a HCP to disclose the bio sex of someone who has a GRC without consent. (people always disbelieve me about this so here is a lawyer, explaining it)

So no one in the NHS is going to record trans people's sex - and so risk getting a criminal record and the sack.

Exactly, MissLucy!

It’s a bonkers bit of legislation that is so busy ‘affirming’ an untruth that it puts the actual health and well-being of transpeople at risk.

This is what happens when you let niche activists (ie Press For Change, Whittle and Burns) write laws: blind spots. They were so busy shitting on the sex based rights of women and girls that they didn’t notice the shit on their own doorstep.

Before I retired I looked after a couple of M tF transgender patients. This fact was recorded on their medical records. There was no problem, but this was about 5 years ago, before it all got so silly.

@endofthelinefinally

Before I retired I looked after a couple of M tF transgender patients. This fact was recorded on their medical records. There was no problem, but this was about 5 years ago, before it all got so silly.

I hadn’t really registered that point before if, as demonstrated in Lanarkshire (?), it is expressly forbidden to ‘out’ a transgender person without their permission, there could have been a medic in the room that knew the truth (or possibly all) but because of the permission problem couldn’t say anything. Taking it to it’s logical conclusion even asking for permission would be ‘outing’ so they can’t even do that. Could that have been the reason for the out of room conflabs? Doctors having to choose between patient safety and their jobs? They might have known full well the patient was trans but giving sex appropriate treatment would have been ‘outing’ them. there are situations where certain religious groups refuse medical treatment and the doctors have to respect that but at least they can have the conversation!

@LillianBland
Good question. I didn’t deal with payment protection, but as it’s just another form of insurance then yes, I would say that any failure to declare long-term prescribed medication, of any sort, would potentially invalidate the policy even if what you were claiming for was unrelated. The underwriters have to rely on you telling the truth so they can calculate your premium, therefore they take a dim view of withholding, lying, or even ‘Oh, whoopsie I forgot’.
I suspect that the insurance angle is one that has yet to really cause issues, but it’s time will shortly come, mark my words.

@endofthelinefinally

Before I retired I looked after a couple of M tF transgender patients. This fact was recorded on their medical records. There was no problem, but this was about 5 years ago, before it all got so silly.

It is fine to record it - in theory. The problem is that you cannot disclose it, arguably even to someone else in your own GP practice. So it is very dangerous to record it because, as you know, GPs send summaries of medical information with referrals to hospital etc.

Actually, all GPs are probably at risk of inadvertent disclosure anyway, because every trans patient is likely to have something in their medical record that gives away their bio sex. But we would be foolish to compound the risk by explicitly documenting the sex.

[quote Vermeil]@LillianBland
Good question. I didn’t deal with payment protection, but as it’s just another form of insurance then yes, I would say that any failure to declare long-term prescribed medication, of any sort, would potentially invalidate the policy even if what you were claiming for was unrelated. The underwriters have to rely on you telling the truth so they can calculate your premium, therefore they take a dim view of withholding, lying, or even ‘Oh, whoopsie I forgot’.
I suspect that the insurance angle is one that has yet to really cause issues, but it’s time will shortly come, mark my words.[/quote]
Thanks for answering, Vermeil. I dare say the next complaint will be that an insurance company hasn’t paid out because transphobia.

@LillianBland
A court case would be very interesting. It was discussed above how even without any disclosure of biological sex, any related treatment in medical notes would still give it away. I don’t see how it could be argued in any sensible way that cross sex hormones or anything like that could be ruled exempt from disclosure for the purposes of insurance without it unleashing a torrent of knock-on effects. Underwriters employ doctors, who will assess the risk posed by medications and medical history when calculating a premium. As the health risks posed by things like puberty blockers have recently shifted from ‘Its all totally FINE’ to ‘Well, actually we don’t know, this could be iffy’, then insurers will seriously resist such an imposition that might cost them money. The dropping of sex as part of a premium calculation would have been fine with them, as it would mean they could just bump up women’s premiums, but this... this would be different. There could be various end results- 1. Trans people get some special dispensation that means they don’t have to declare any medical info regarding their transition, so everybody else’s premiums get bumped up a bit to cover it as a result, which could potentially lead to more legal wrangling due to its inherent unfairness, or 2. Trans people who have had any treatment become virtually uninsurable, or 3. Reality bites, courtesy of a slick legal team from someone like Axa or Lloyds. You have to be truthful, no ifs or buts, crying or whining.
Ideally the latter, as something has got to give and anything else certainly isn’t equality, it’s unjustified special rights for a tiny minority.

I agree that the GRA's provisions on this unworkable for healthcare and were clearly not drafted by anyone with a brain an understanding of operational realities.

I would actually like to see how a court case would work out. Regarding a trans person taking hormones/testosterone and not declaring it, I’ve had similar treatment, which has left me with osteoarthritis, due to endometriosis and my insurance would definitely be invalid, if I didn’t declare it. I’d be bloody furious if there was special exemptions if you identified as trans. Actually, what would stop any woman declaring herself trans, in order to take advantage of the exemptions, if they have their tubes tied, a hysterectomy, breast implants removed, hormone treatment, etc? Now that would be interesting.

This case may have occurred in the USA, but it's a perfect example of why the GRA is bad law.

It’s not the first time a female bodied person who identifies as trans, has suffered because they have tried to hide the sex they were born as.

thefederalist.com/2019/05/23/baby-died-doctors-told-mother-man/

every trans patient is likely to have something in their medical record that gives away their bio sex.

I don't understand the word "likely" here, how can a person transition medically without this being on their medical record?

@testing987654321

every trans patient is likely to have something in their medical record that gives away their bio sex.

I don't understand the word "likely" here, how can a person transition medically without this being on their medical record?

Medical notes can be jam packed with information and that particular nugget could be buried between flu, broken arm and numerous other things. Or they may have insisted on new medical records as the original ones refer to their sex. It’s similar to people wanting no mention of the name they were given at birth, because that’s ‘dead naming’.

@testing987654321

every trans patient is likely to have something in their medical record that gives away their bio sex.

I don't understand the word "likely" here, how can a person transition medically without this being on their medical record?

I recently changed GPs, got a call from the old practice's secretary asking me if I wanted references to my sex censored from the notes so they wouldn't be outing me to my new practise. I'm still in the process of medically transitioning so I still need to disclose that info but for someone who has completed transitioning it would be easy enough to hide :/

In the UK following transition a patient can choose to have a new nhs identity with no previous history and their new sex. It is there own decision and they take the risk themselves.

However it is very dangerous for the patient. There is no data carries across, so no previous medical history.

Other patients choose to keep to keep history and have their sex changed on the same record. At least this preserves historic details but it's still very unsafe

asking me if I wanted references to my sex censored from the notes so they wouldn't be outing me to my new practise.

Wow, that really is crazy. A recipe for disaster really.

Sorry I'm going to repeat my earlier point. Even if someone foolishly chose not to disclose that they were trans and had undergone treatment, I absolutely do not believe it is possible, at least in the UK for someone to be on the brink of receiving a transplanted kidney without a Dr spotting evidence of their medical history. It is just inconceivable.

There is a long, long list of examinations, investigations & assessments and evidence of transition is not hard to identify.

There are many reasons to reform or repeal the GRA but this issue is a sideline, if not a complete derailment. Let us not be distracted by fictional bollocks.

I absolutely do not believe it is possible, at least in the UK for someone to be on the brink of receiving a transplanted kidney without a Dr spotting evidence of their medical history.

Of course a doctor will eventually - on close examination of the patient - find out the sex of their patient. However, it seems to be a common occurrence for these patients to change doctors if their sex is flagged up as important. And as you can see from the BBC article, the first ultrasound did indeed allow the HCPs to establish the actual sex of their patient. Who then immediately changed doctors.

It is true however, that there will be no record of a patient's complete medical history available to an NHS doctor in the UK if said patient re-registered as the opposite sex. Records do not carry over. That was a key demand of trans rights organisations.

This has nothing to do with the GRA by the way. It is not part of the law. It was just a demand made at the time of the GRA process and the NHS then implemented it.

Even though, given how we register patient details on NHS databanks, adding a field showing that the patient identifies as trans would de dead easy. Problem solved.

That was a key demand of trans rights organisations.

So trans rights organisations campaigned for the right of trans people to hide their sex from doctors who are treating them, and trans people are now complaining of inadequate healthcare which is a direct result of doctors not being aware of their sex.

And whose fault do they think this is?

It’s Schrödinger’s transperson all over again: simultaneously insisting they identify as male (or female) not trans thank you very much AND demanding special treatment on account of the trans status they otherwise refuse to identify as.