Gender in the Hospital Kaitlin Hollander 3/11/15 CCRMC Behavioral Medicine

Let’s start with a case! Cause, medicine.

Report: “ER Bed 16 is a 54 year old male to female transgender presenting with SOB and pleuritic chest pain with bilateral opacities seen on CT admitted to medicine for pneumonia.”

What stands out in this pt presentation?

*Is transgender a noun or an adjective? *What sex did you hear first (male or female)? *What did you picture in your mind when you heard this presentation?

Other examples: “There’s a woman, well she’s transgender, well I don’t know what body parts she has, so maybe she’s a man. Okay, there is this man…” “This man came into gyn clinic today; he was trans. It was so cool.”

Genderbread Person

Gender is not equal to sex is not equal to sexual orientation  Gender is a social construct  Sex is biological (and not absolute!)  Sexual orientation has to do with attraction and is totally different  (Don’t listen to Kaplan!)

Some Facts  2009 study showed that 41% of transgender respondents had attempted suicide in their lifetimes. National average of all genders is 1.6%.  No federal law exists to protect those who are transgender from discrimination.  Only about 70% of trans patients who think they need emergency care seek it.

Let’s rewrite the pt presentation

 Bed 16 is a male to female transgender woman presenting with SOB….  Bed 16 is a transgender woman, male to female, presenting with SOB….  Bed 16 is a woman who is transgender, male-to-female, presenting with SOB….  Bed 16 is a transwoman presenting with SOB….  Bed 16 is a woman presenting with SOB…

Recommendations  Ask pt’s their preferred name and pronoun.  Give privacy as much as possible, especially during genital exams.  Do not out the pt without their permission.  Ask about hormones and where they are acquired.  Surgical history if appropriate.

 “Treat the body as if it belongs to them, rather than defines them.” – UCSF Center of Excellence for Transgender Health

A note about hormones  In transmen, the most common adverse effects include weight gain, changes to lipid profiles, hepatic dysfunction, elevated hematocrit, and cardiac issues.  Transwomen face the same risks associated with estrogen supplementation as genetic women: blood clots, weight gain, gallstones, and emotional lability.” – Ryan Polly Ad EM Nursing Journal  Interpret labs based on the hormonal state of the pt.

Resources  UCSF Center for Excellence for Transgender Health UCSF Center for Excellence for Transgender Health   Transgender Law Center Transgender Law Center   WPATH – World Professional Organization for Transgender Health 

UCSF Center for Excellence for Transgender Health  Protocols for primary care  Information about mental health  Local resources  Yearly symposium  HIV prevention  Cultural competency trainings

WPATH  International guidelines  References for mental health evaluations before transition (note: not required)  Great resources for children who are gender non conforming  Reproductive recommendations  International conferences  Research

WHAT IS WRONG WITH THIS?

Thank you!