If only there was some way to know what treatment trans patients should get

[GrabbyGabby]

https://www.theguardian.com/society/2023/may/05/nhs-treatment-algorithms-not-taking-transgender-patients-into-account

Entire article waffling on about how doctors dont know how to treat trans patients when treatments are adjusted according to 'gender'.

It is so idiotic i don't know where to start.

The question should be how damaging is replacing sex with gender for trans patients.

I couldn't make it past the first line without needing to comment
"A host of algorithms used by medics to assess disease risk" I believe the first one is "are you a girl or boy? Algorithms are transphobic.

I read it earlier and thought exactly the same as you OP. Never read such fucking nonsense in my life. Absolute shame on any healthcare professional who comes out with incoherent drivel like this. Two words will solve all your problems, you idiots - BIOLOGICAL SEX!

What a load of cobblers. Gender assigned at birth - what does that even mean - you are a girl so must wear pink! It’s sex that matters in medical care. As medical records are confidential who apart from the doctor and patient will know what is written on them? I am sure there are ways of respecting a person’s life choices when interacting with them which doesn’t put their health at risk.

It's just too hard!

Actually it probably is a bit. If you take hormones at high levels that are meant for the opposite sex, you do increase your risk of all kinds of nasty diseases. That could probably just be an add in. Are you a woman on huge doses of testosterone? Cardiac risk through the roof - tick.

It uses gender throughout when it means sex. All of these protocols etc are based on sex and for very good reasons. Like following the wrong protocol might kill the patient.

So we have a group of people who come along and choose to muddy the waters, appear to be reluctant (from what I've previously read) to get involved in any trans-specific medical research - often decrying it as intrinsically 'transphobic' - and then complain when their needs aren't met.

By all means, conduct trans-specific medical research. But I suspect some of the results won't be welcomed by the trans 'community' when they fail to affirm. Or when they highlight negative consequences of pumping the human body full of exogenous opposite sex hormones.

I read that and came to post. It’s almost as if your entire biology doesn’t change when you change your pronouns. I’m glad this group has pointed this out to those silly doctors who haven’t thought about it.*

I had to fill out a registration form for my local sexual health clinic a while ago. There was only a tick box for gender. No place to fill out sex at birth or if you are trans. When you are attending a sexual health clinic this is important! How many people would tick their preferred gender and be treated incorrectly.

And the article doesn’t seem to understand the difference between sex and gender.

*(I’m sure most doctors have thought about it.)

I got fed up too, a doctor waffling on about gender, when 'sex' would pretty much solve the issue. Additional research into the impact of cross sex hormones is what is needed.

This has been entirely the community's own making though since any mention of research into this is rounded on as being transphobic. For years posters on here have been pointing out this major flaw, so I am pleased that eventually it is being looked at, but it should never have come to this.

My friend is a nurse and despite her private views she has to deal with some very ill people. If “gender”makes people more likely to engage with medical services than “sex” on a form, she doesn’t have a problem with it. Most doctors/ nurses know how to behave once they are faced with a physical patient.
This is a practical issue, not just a political one.

the ramifications of inappropriate gender-based medical scores can be serious, and the issue is a concern for all trans patients, not just those on hormone replacement therapy.

There’s a big difference between these two things.

One is important - does taking cross sex hormones affect other parameters and thus make a difference to the normal levels used? Thus is a significant problem as finding out new normals for a tiny population of people is a huge task. Realistically, where money is limited, it would have to be assessed whether this was good use of funding for what is inevitably going to be a tiny group of patients, albeit patients who already have a considerable risk of iatrogenic problems.

The other is not medical, it’s paperwork. Medical documentation should have sex as the fundamental, recorded information as it is sex that defines which set of normal parameters you choose. Gender identity can be recorded in addition, if it is considered important to psychological patient welfare, but it is medically irrelevant and to prioritize its recording over sex is the triumph of political stupidity over science.

How would it be more likely to get people to engage, it is a nebulous concept that doesn't exist?

What value is it adding that 'sex' wouldn't cover?

Most doctors/ nurses know how to behave once they are faced with a physical patient.

That isn't always the case, and it seems 4 years on the pieces still haven't fallen into place. The way to resolve this is to take the focus off 'gender' but it is all about the affirmation rather than receiving appropriate healthcare.

www.google.com/amp/s/metro.co.uk/2019/05/20/pregnant-transgender-mans-baby-died-because-nurse-didnt-realize-he-was-in-labor-9613972/amp/

A whole load of waffle that never managed to make clear what it meant: trans patients need to be assessed according to their sex rather than their gender.

Well it would be interesting to know if changing your name and clothing has any affect on how drugs work in your body. I mean, obviously no one can in any way predict that!

On the other hand, the fact “gender” is used by these Drs means I don’t take any of what they say, seriously.

Im so conflicted. <Not>

PortiasBiscuit, sex needs to be recorded on medical record to cover times when examination is done without the patient eg for blood tests. You can’t just ignore it!
Gender could be added as an overlay to cover additional needs, but honestly, so many medical procedures & treatments have not been adequately tested on much larger populations where there might be a difference, eg different skin tones makes a difference in some cases and er, obviously being a woman. I think any additional spend on understanding medical impacts for these ‘minorities’ is more important than catering for 0.2% of the population. Which other tiny minority gets this amount of focus?

The thing is people just use people's names rather than pronouns or whatever else, when HCPs are interacting with patients there is little need to be saying she/her/he/his- they just use their names anyway.

The reality is that anyone working in healthcare who actually knows what they're doing should understand basic biology. If a trans woman comes into A&E for example with abdo pain they would not even entertain looking to see if the biological man is pregnant, if a transman came in with whatever symptoms at no point would they assume its potentially prostate cancer.

The issue is that instead of the message "whilst biological sex is vital to safe and effective treatment and will be used in your diagnosis and treatment we respect how you identify" (or something similar), there's all of these harmful, wasteful and ridiculous hoops. It's more dangerous to deny biological sex as a vital factor in healthcare. Healthy obs and sats vary between men and women, to deny this reality and go by gender will lead to more harm.

Saw this article earlier by the 'science correspondent'; absolutely nonsensical the whole way through. Ended up just yelling SEX! at my phone while reading it. Sent it to my brother as he is well on his way to the mountain summit now

I think this is one of the things that really worries me about the whole "TWAW" thing. I have a friend who has a trans child (FtM, with no medical intervention so far, so basically short hair, boys clothes, and uses he/him) who is firmly in that camp; the child was astounded when he got his period because "boys don't have periods". Then read somewhere that "boys can have periods too", so decided it was ok.

This child then downloaded some fitness app which gives you tailored workouts. Of course, selected "Male" for gender, and was given workouts suited to teenage boys and men. Then pushed and pushed to try to achieve the goals, and came very close to serious injury trying to lift weights that were far too heavy because "the Internet says boys should be able to do this".

If that child grows up genuinely believing that he is Male, what happens in medical scenarios? He needs to understand that he can dress as he wants, use the name and pronouns he wants, but he is still in a female body and needs to access the correct medical care for that body, otherwise serious harm could follow.

If we look past the wishy washy language used in the article, this is important work that needs doing.

There are two aspects:

1 - ensuring the NHS computer systems can cope with the idea of a sex and an optional different gender with regards to risking, dosages etc. If there is one agreed way of recording sex and trans status, it will be much easier for everyone. NHS systems are so fragmented this will be a big piece of work.

2 - research into if and how hormone and surgical trans related treatments may affect sex based risk. Clearly a female taking testosterone is going to have different risks to males and non-trans females. This will probably have implications for lots of different areas as we well know taking cross sex hormones can massively mess with your health.

If everyone could use the same language around sex and trans status, it would simplify a lot of the problems e.g. with transmen being missed off smear lists. There is a lot of vested interest in obscuring scientific language around sex though so I'm not hopeful this will be resolved in a sensible way. Ultimately its trans people who will suffer from clinicians not being clear about their needs from ignorance or fear of offence.

I came on here to post and also shouted “sex” at my phone several times. An appalling bit of writing. The Trans Gap project? There have been groups wanging on for years about the differences between men and women in medicine and trying to get protocols and procedures updated to acknowledge this to ensure people got the right treatment. The cynical part of me says maybe now that will happen if this is done in the name of trans patients. It could end up actually benefiting everyone, in a roundabout way.

Adding an extra “biological sex” field on people’s medical records alongside name, DoB, gender, would seem to be the blinking obvious and drama free first step to a solution though.

They're not allowing comment under the article, but here's the link to the tweet if anyone is on there and can be arsed

https://twitter.com/guardian/status/1654363054870605828?s=20

I knew there'd be a thread on here about this absolutely witless piece of 'journalism'. A quick Google of the 'Trans Gap Project' is informative, especially biogs of General Secretary Otto Russell and Social Media Lead Dorian Wolfe (quoted in the piece).

Michael Niman, the Chair, appears to be a serial entrepreneur when he isn’t being a doctor, and his LinkedIn includes a puff for his YouTube channel about how he started a new business every 2 weeks. Or tried to.

It's complete nonsense, but unfortunately (if predictably) the Grauniad is treating it as holy writ.

I came on here to see if there was a thread about this. What a load of hand-wringing pish.

What I think I'm picking out of it is "I'm a TW/TM (don't know which Dr Dorian is) and I have constantly badgered and bullied to be recorded/referred to/treated as the woman/man I identify as. Oh shit! I'm not getting suitable care/treatment. I haven't been called for a prostate exam/smear and now I have problems, the NHS is failing me, wah,wah."

No shit Sherlock. Who could have seen this coming? Not me, no way!

As far as I'm concerned this is yet another example of people not understanding the consequences of what they support.

The NHS computer system already throws up anomalies when you have the correct sex stated e.g.

In June last year I had blood tests done. My cholesterol levels were fine. A few months later I had some more blood tests done. This time my cholesterol levels meant I was told I would need to be on Statins for the rest of my life.

Made an apt to see the doctor to see why the sudden change. Turns out there was no change in my results. However in between the two tests I had turned 50. The computer algorithm as soon as I turned 50 also automatically assumed I had a history of cholesterol problems in my family as the system was set to assume that fact. The Dr hadn't spotted it. I had to point it out on the screen. Low and behold once that box was unchecked I suddenly was fine again and didn't need to go on life long medication.

If that can happen when you aren't even pretending to be a different sex I can only imagine that having the wrong sex marker next to your name would completely skew the results on just about every test you have.

At this point I find myself thinking meh you wanted it, you got it! If it fucks up their medical care they only have themselves to blame.

At this point I find myself thinking meh you wanted it, you got it! If it fucks up their medical care they only have themselves to blame.

//

This. I'm getting to the point now where, if it's adults we're discussing, an absolute refusal to accept biology and just be a bloody grown up about it on rare occasions like medical issues has led me to have very limited sympathy for the person concerned if things go tits up.

My eyes hurt from rollover these days