Submitted by ViejoOrtiva t3_ztevi3 in askscience
In a post about a woman complaining in the Scottish Parliment about trans people beeing able to change their birth certificate many comments pointed out that this would bring a lot of problems becouse many emergencies are treated different when the pacient is a woman or a man, but there where no examples given (that I could find). So what better place to settle this doubt!
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Heart attacks, for instance, show different symptoms in people with XX genotype compared to XY genotype. In principle, if a transman presented with nausea and lightheadedness, the symptoms could be misinterpreted and they may not get the emergency measures required. However, this smells an awful lot like a terfy smoke screen to me.
The only thing that springs to mind is the category of problems to do with gonads ie ovaries and testicles. In this case, the person needs to inform the treating doctor what anatomy they have so something like abdominal pain can be treated properly. If anything, this is a disadvantage for a trans person- if they had terrible abdominal pain and couldn’t explain their situation fully, then the medical team looking after them might go looking for the wrong diagnosis because they’ve got the anatomy muddled up. This is a potential issue regardless of birth, gender or other certificates.
This sounds like an excuse to scare monger and bash the trans community rather than anything else.
Urinary catheterization.
Abdominal pain origin can be misinterpreted.
Teratogenic medications could be accidentally used.
Eclamptic seizure could be misdiagnosed as a normal seizure and treated with a benzodiazipines instead of magnesium sulfate.
Checking for recent history of use of phosphodiesterase inhibitors before administration of nitrates could be missed.
Radiological imaging particularly with larger radiation doses are not ordered on potentially pregnant individuals, a pregnancy test may not be offered to a male before imaging putting the offspring at risk. This is also true of some medications like accutane. Though there are reports a new medical recommendation will be including a question for the patients potential to be pregnant to all patients regardless of their sex reported on their file.
Then there are some anatomical differences in the location of certain blood vessels, glands, organs, that aren’t exactly visually apparent, but I can’t say this would be problematic in a surgical setting, maybe problematic in a diagnostic setting.
There can be differences in reported symptoms between sexes, and some medications maybe more effective for a particular sex than another.
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The ridiculous part of this argument is that your medical records will already take this into consideration. If your clinician doesn't consider your anatomy, while still respecting your gender, they are bad clinicians. This is just an argument someone makes if they are either not a healthcare professional or they are just being disingenuous.
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I was going to say this, as this one is a biggie for on-scene triage. I do wonder if there has been any study to see if hormonal therapy to accompany transition has any impact on reported symptoms of heart related issues.
** Since we are on the subject **
PSA: Women do not generally experience the same symptoms when in the early stages of a heart attack as men do. This is directly from the Mayo Clinic:
Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:
Neck, jaw, shoulder, upper back or upper belly (abdomen) discomfort
Shortness of breath
Pain in one or both arms
Nausea or vomiting
Sweating
Lightheadedness or dizziness
Unusual fatigue
Heartburn (indigestion)
These symptoms may be vague and not as noticeable as the crushing chest pain often associated with heart attacks. This might be because women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart — a condition called small vessel heart disease or coronary microvascular disease.
Compared with men, women tend to have symptoms more often when resting, or even when asleep Emotional stress can play a role in triggering heart attack symptoms in women.
Please take these symptoms seriously. Women are more likely to die from a heart attack than men.
You are incorrect about mammograms. While men can get breast cancer, mammograms are generally not recommended for them because of the relatively low occurrence rate and that fact that they are designed for larger breast tissue mass. However, that may not apply to the transitioned population (both directions). It depends on a number of factors and should be discussed with a medical professional.
Some sauce for those that are curious:
In an emergency situation your records may not be readily available, though that's not a particularly strong argument.
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Yeah it sounds like something a quick perusal of their medical history, or even just a quick question of "are you AMAB / AFAB? This is relevant for diagnosis" would clear up.
Aside from the first line and chest pain are those heart attack symptoms not also the standard heart attack symptoms for men?
So, two of these only are a problem if a transguy is pregnant. That's extremely rare since they usually take hormones that make that impossible.
For the urinary catheter: they might prepare the wrong one, but they'd realise they'll need the other after one second of looking, so I doubt that would actually be much of a problem.
Abdominal pain can have multiple causes, so their origin are often only found after imaging and a full work-up anyway.
So, imo, giving EMTs a one or two hour "awareness lesson" during training would be enough to avoid all of this. That's not enough of a reason to not allow people to correct their gender on their birth certificate.
Yeah. Neither is the birth certificate or ID card always available (like when you get into an accident while jogging). So for emergencies, the gender on those documents rarely plays a role. And in cases the patient is still able to talk (or has someone with them who knows them) and they answer honestly to "Are there any prior medical issues or infos we should know about?", it can be taken into consideration anyway.
Those aren't emergencies and it would come up in any prior appointment or while making the appointment. It may be a bureaucratic issue if insurance doesn't want to pay for a (diagnostic) procedure that's not in accordance with the gender on record. But that's something fixable with insurance policies becoming more inclusive and not something that would lead to worse health outcomes for the patient.
I’m disabled and I get picked up in ambulances a handful of times every year. Sometimes I’m unconscious, sometimes I don’t have my ID. My health is bad enough that minutes literally matter in those situations (my heart “pauses”). I’d imagine there’s thousands of people in the same boat.
Before anyone asks, this was more at the beginning of my illness 16 years ago, I am better about keeping my ID and medical info on me now. But people make mistakes and forget, especially when they’re ill.
It’s a really strange argument to make in general. These are concerns about the health of a trans person being used to deny rights to them.
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From the top of my pharmacist brain:
The Cockcroft-Gault equation used for determining renal function has a different multiplier for women. This determines what drugs can/can’t be used or adjustment of drug dose depending on level of renal impairment.
Classification of UTIs is automatically more complicated for men which dictates the type of treatment. Men are typically more resistant to getting UTIs due to the added length of the penis.
Testosterone does not make pregnancy impossible, that’s a very dangerous myth. Trans men typically don’t get pregnant because they either have/use some form of birth control, or dislike or arrive sex due to dysphoria, or only have AFAB partners. Many trans men are still very fertile. We would have to stop hormones in order to have a safe pregnancy, but getting pregnant on hormones is COMPLETELY possible and does happen.
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As a pharmacy student I asked my teacher about the Cockcroft-Gault equation in regards to transpeople. Since it isn't quite certain where the difference comes from, it isn't known which equation should be used for trans patients. The equation is only able to give an estimate based on averages and if you really need to know the renal function, doing the full work up that needs the urine collected over 24 hours is the only accurate method anyway. Since sex hormones change a lot and could alter renal function by themselves, I'd imagine a trans woman could be close to the male average at the beginning, but closer to the female average after a decade or so of taking hormones. But we just don't have scientific data to actually tell when which modifier should be used.
As for UTIs, that would also depend on whether the transgender person is operated or not. So pre-OP transmen could do with the "easier" treatment, post-OP they would probably fall into the complicated category. And that's not considering that it might be an OP-related infection if the OP wasn't too long ago.
It's definitely certain that medical professionals need to know the medical history to choose the best treatment. But whether the birth certificate contains the AGAB or the right gender, it may lead to the wrong treatment for trans people anyway. So using that as a reason to not be allowed to change it just seems like an excuse to me.
Hm, yeah, sorry. I'm more familiar with the medical issues of transwomen then transmen. But you're right, the transman I know used an IUD for protection until he had a hysterectomy.
So for the possible pregnancy complications, transmen being well educated and EMTs considering it as a possibility is important.
Many things, none of which are particularly important as the feelings of the patient don't override the science of the sex. I haven't met a surgeon yet who planned a hysterectomy only to find out in the middle of the operation that the patient identified as a woman but was randomly assigned male at birth.
The history and an initial planned workup can be jumbled if it is not obvious which sex the patient is, but that is easily addressed once a physical exam or a more detailed history is taken, when they are important. For example, if you have a sprained ankle, neither your sex or gender identity alter the treatment for the injury. If you have abdominal pain, your sex and the presence or absence of various genitalia do become important in the workup regardless of your gender identity.
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[deleted] t1_j1e1n02 wrote
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