Tests gender notions ?



Blurred lines: A pregnant man’s tragedy tests gender notions
By MARILYNN MARCHIONE
May 15, 2019

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 — a transgender man in labor that was about to end in a stillbirth.

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’s a similar danger of missing diseases such as sickle cell and cystic fibrosis that largely affect specific racial groups, the authors write.

“The point is not what’s 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 considering his actual medical needs.”

Stroumsa would not say 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 be using masculinizing hormones or have had surgical alterations, such as womb removal.

The 32-year-old patient told the nurse he was transgender when he arrived at the emergency room and his electronic medical record listed him as male. He hadn’t had a period in several years and had been taking testosterone, a hormone that has masculinizing effects and can decrease 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-urgent.

Several hours later, a doctor evaluated him and the hospital test confirmed pregnancy. An ultrasound showed unclear signs of fetal heart activity, and an exam revealed that part of the umbilical cord had slipped into the birth canal. Doctors prepared to do an emergency cesarean delivery, but in the operating room no fetal heartbeat was heard. Moments later, the man delivered a stillborn baby.

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