When the man arrived in the hospital with severe abdominal pain, a nurse did not consider him an emergency, noting that he was obese and had stopped taking blood pressure medicines. Actually, she was pregnant – a transgender man in labor who was about to end up in a dead birth.
The tragic case, described in Wednesday's New England Journal of Medicine, refers to broader issues on labeling or assumption of assumptions in a society that is increasingly confronted with gender variations in sport , in the entertainment and in the government. In medicine, there is a similar danger of missing diseases such as sickle cell disease and cystic fibrosis that largely affect 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 who interact with the healthcare system," said the lead author, Dr. Daphna Stroumsa of the University of Michigan, Ann Arbor.
"He was rightly classified as a man" in medical records and looks masculine, Stroumsa said. "But that classification discouraged us from considering his real medical needs."
Stroumsa did not want to say where or when the case occurred and the patient was not identified.
Transgender men, who are considered females at birth but who identify themselves as males, may or may not use masculinizing hormones or have had surgical alterations, such as the removal of the uterus.
The 32-year-old patient told the transgender nurse when he arrived at the emergency room and his electronic medical record listed him as a male. He had not had a period in several years and was taking testosterone, a hormone that has masculinizing effects and can reduce ovulation and menstruation. But he stopped taking the hormone and blood pressure after losing the insurance.
A home pregnancy test was positive and said she "pee" – a possible sign of ruptured membranes and labor. A nurse ordered a pregnancy test but considered it stable and its problems not urgent.
Several hours later, a doctor evaluated it and the hospital test confirmed the pregnancy. An ultrasound showed unclear signs of fetal cardiac activity, and an examination revealed that a portion of the umbilical cord had slipped into the birth canal. The doctors were preparing for a caesarean section of urgency, but the fetal heartbeat was not heard in the operating room. Moments later, the man delivered a stillborn baby.
A woman showing similar symptoms "would almost certainly have been evaluated and evaluated with greater urgency for problems related to pregnancy", the authors wrote.
"It's a very upsetting incident, it's a tragic result," said hormone specialist Tamara Wexler at NYO Langone Medical Center.
"Medical training should include exposure to transgender patients," so health professionals are better able to meet their needs, Wexler said. "Many practicing physicians do not have this in their education," but they can still learn from these patients now.
Nic Rider, a transgender health specialist and psychologist at the University of Minnesota, said training is not enough.
"There are implicit biases that need to be addressed," Rider said.
Medical records can use male / female gender models, but "it does not mean that we simply throw away critical thinking or think about how human beings are different," Rider said.
The case is terrifying but "it's not terribly surprising," said Gillian Branstetter, spokeswoman for a defense group, the National Center for Transgender Equality in Washington.
Transgender people often encounter problems in obtaining gender-specific health care, such as womb neck cancer screening, birth control and prostate cancer screening.
More needs to be done to improve medical awareness and recognition of diversity because "the consequences can be so terrible, as this case demonstrates," Branstetter said.
Marilynn Marchione can be followed to http://twitter.com/MMarchioneAP
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