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.

@OldCrone

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 the fault if the GC feminists of course! It’s probably a ploy to hurt trans people, under the guise of heath care. 😉 I’m waiting for it to be added to the list of GC crimes against trans people. 😁

There is a long, long list of examinations, investigations & assessments and evidence of transition is not hard to identify
But if the HCP risks their job by even mentioning that the person might need sex specific treatment that is different to their identified sex and therefore ‘outing‘ them without express permission this is indeed a real risk. A minefield that busy doctors should not have to deal with.

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
Thanks Eo - as a point of interest, if you had chosen to hide all record of your trans status, would you be able to access any prescriptions for continuing hormone treatment/monitoring for example or do they explain that erasing your history would prevent the doctors from continuing any transition relevant treatment?
As I understand it transitioning is a medically ongoing process. Obviously doctors wouldn’t prescribe any treatment if it wasn’t relevant to the patient and therefore wouldn’t be keen to prescribe testosterone injections to a man with no apparent medical need? I would be interested to know how many trans people opt to erase all previous records or whether most decide not to.

This article is unhelpfully written, as it's not explicit about what doctors knew and didn't know. My interpretation is not that the medics didn't know the patient was trans, but rather that the treatment protocols they apply are either 'male' or 'female', and the guesswork was actually about how to treat people who are trans, and they plumped for 'treat as male'. I looked at another couple of pieces about this case published in journals, but they are co-authored by the patient themselves, so can't exactly be considered reliable. But I'm pretty certain that the patient being trans was not concealed.

@gardenbird48

There is a long, long list of examinations, investigations & assessments and evidence of transition is not hard to identify But if the HCP risks their job by even mentioning that the person might need sex specific treatment that is different to their identified sex and therefore ‘outing‘ them without express permission this is indeed a real risk. A minefield that busy doctors should not have to deal with.

It seems that the whole question of 'outing' a trans person when accessing medical treatment wasn't thought through at the time the GRA was passed. The ability of a trans person to hide their biological sex from people such as their employer was one of the main reasons for the GRA, along with allowing them to marry someone of the same biological sex. But I don't think anyone thought about the implications of someone being open to prosecution for disclosing the biological sex of a trans person, when to deny it puts the trans person themself at risk.

The threat of prosecution for 'outing' someone as transgender puts the doctors treating such a person in an impossible position.

For arguments sake how would a patient with a sex hormone endocrine disorder and unusual hormone levels be treated? I would have thought their endocrinology consultant would communicate with their renal consultant and work out the best way to implement the treatment protocols if it wasn't obvious. Shouldn't the teams who provide the sex reassignment hormones have the same duty here?

Shouldn't the teams who provide the sex reassignment hormones have the same duty here?

You would think so, but trans patients only stay under the care of the GIC while they are completing the trans pathway - once they’ve gotten to a certain point they are discharged and their GP just issues repeat prescriptions. Many GPs don’t even feel qualified to alter a dose strength, so they certainly aren’t going to take on responsibility for decision making in complex cases.

Add in the confusion of the GICs being funded by NHS England/Wales/Scotland and you end up with weird situations such as a person in Devon attending the Sheffield GIC (because the waiting list was shorter) and the GIC endocrinologist has no relationship with Devon renal consultant and no one knows who is funding what.

Whereas in normal NHS situations the endocrinologist and renal specialist work for the same trust, often in the same hospital, and likely have numerous common patients and are used to consulting each other.