By The Associated Press
When the man arrived at the hospital with severe abdominal pains, a nurse didn't consider it an emergency, noting that he was obese and had stopped taking blood pressure medicines. In reality, he was pregnant ̵
The tragic case, described in Wednesday's New England Journal of Medicine, points to larger issues about assigning labels or making assumptions in a society increasingly confronting gender variations in sports, entertainment and government. In medicine, there is a similar danger of missing diseases, such as sickle cell and cystic fibrosis that largely affects specific racial groups, the authors write.
"The point is not what happened to this particular individual but this is an example of what happens to transgender people interacting with the health care system, ”said the lead author, Dr. Daphna Stroumsa of the University of Michigan, Ann Arbor.
"He was rightly classified as a man" in the medical records and appears masculine, Stroumsa said. "But that classification threw us off from his current medical needs." 19659004] The current case was not the case where the case occurred, and the patient was not identified.
Transgender men, who are considered female at birth but who identify as male, or may not be using masculinizing hormones or have had surgical alterations, such as womb removal.
The 32-year-old patient was the nurse who was transgender when he arrived at the emergency room and his electronic medical record listed as male. He had had testosterone for a period of several years and had a hormone that has masculinizing effects and can reduce ovulation and menstruation. But he quit taking the hormone and blood pressure medication after he lost insurance.
A home pregnancy test was positive and he said he had "peed himself" – a possible sign of ruptured membranes and labor. A nurse ordered a pregnancy test but considered him stable and his problems non-urgently.
Several hours later, a doctor assessed him and the hospital test confirmed pregnancy. An ultrasound showed unclear signs of fetal heart activity, and an examination revealed that part of the umbilical cord had slipped into the birth canal. Doctors prepared to do an emergency delivery, but in the operating room no fetal heartbeat had been heard. Moments later, the man delivered to a stillborn baby.
A woman showing up with similar symptoms "would have been surely triaged and had been more urgently for pregnancy-related problems," the authors wrote.
"It's a very upsetting incident, it's a tragic outcome, ”said Dr. Tamara Wexler, a hormone specialist at NYU Langone Medical Center.
"Medical training should include exposure to transgender patients. Wexler said," health workers are better able to meet their needs.
Nic Rider, a transgender health specialist and psychologist at the University of Minnesota, said training is not enough.
"There are implicit biases that need said, "Rider said," Rider said.
Health records may use male / female templates for gender but "it doesn't mean we just throw out critical thinking or think about how humans are diverse," Rider said. The case is horrifying but "not terribly surprising," said Gillian Branstetter, a spokeswoman for the advocacy group, the National Center for Transgender Equality in Washington.
Transgender people often run into problems getting gender-specific health care such as cervical cancer screening, birth control and prostate cancer screenings.
More needs to be done to improve medical awareness and recognition of diversity because "the consequences can be so dear, as this case shows," Branstetter said. 19659021] FOLLOW NBC OUT ON TWITTER FACEBOOK & INSTAGRAM