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A pregnant man's tragedy tests gender concept



When the man came to the hospital with severe abdominal pain, a nurse did not think it was an emergency and noted that he was overweight and had stopped taking blood pressure medication. In reality, he was pregnant – a transgender man in labor that would end in a birth.

The tragic case, described in Wednesday's New England Journal of Medicine, points to major issues of assigning labels or making assumptions in a society constantly confronting gender change in sports, entertainment, and government. In medicine, there is a similar danger of missing diseases such as sickle cell and cystic fibrosis, which to a large extent affect specific race groups, the authors write.

"The point is not what happened to this person but this is an example of what happens to transgenic people who interact with the health care system," says the lead author, Dr. Daphna Stroumsa at the University of Michigan, Ann Arbor.

"He was rightly classified as a man" in the records and appears masculine, Stroumsa said. "But that classification threw us away from taking into account his actual medical needs."

Stroumsa would not tell where or when the case occurred and the patient was not identified.

Transgender men, who are considered female at birth but who identify as male, may or may not use masculinizing hormones or have had surgical changes such as uterine removal.

The 32-year-old patient told the nurse that he was a transgender when he arrived at the emergency room and his electronic medical record listed him as male. He had not had a period of years and had taken testosterone, a hormone that has masculinizing effects and can reduce ovulation and menstruation. But he stopped taking hormone and blood pressure medication after he lost insurance.

A home pregnancy test was positive and he said he had "peed himself" ̵

1; a possible sign of lack of membranes and labor. A nurse ordered a pregnancy test but considered him stable and his problem was not urgent.

Several hours later, a doctor evaluated him and the hospital sample confirmed the pregnancy. An ultrasound showed unclear signs of fetal heart activity, and a study showed that part of the umbilical cord had entered the birth canal. Doctors prepared to make an emergency cesarean delivery, but in the operating room, no fetal heartbeat was heard. Right now, the man delivered a stillborn baby.

A woman who appeared with similar symptoms "had almost certainly been triaged and evaluated more urgently for pregnancy-related problems," the authors wrote.

"It's a very outrageous incident, it's a tragic result," says Dr. Tamara Wexler, a hormone specialist at NYU Langone Medical Center.

"Medical education should include exposure to transgender patients" so that health workers can better meet their needs, Wexler says. "Many doctors who practice do not have it in their training" but can still learn from such patients now.

Nic Rider, a transgenic health specialist and psychologist at the University of Minnesota, said that the exercise is not enough

"There are implicit phenomena that need to be addressed," Rider says.

Health costs can use male / female gender templates but "that doesn't mean we just throw critical thinking or think about how people are different," says Rider.

The thing is frightening but "not terribly surprising," Gillian Branstetter says. , a spokesman for a advocacy group, the National Center for Transgender Equality in Washington.

Transgender people often go into trouble getting sexually-based health care, such as cervical cancer screening, birth control and prostate cancer control.

More Needed is made to improve medical awareness and recognition of diversity because "the consequences can be b I am so tremendous, as this case shows," says Branstetter.

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Marilynn Marchione can be followed on http://twitter.com/MMarchioneAP

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Associated Press The Health and Science Department receives support from Howard Hughes Medical Institute & # 39; s Department of Science Education. AP is solely responsible for all content.


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