About transgendered patients

[YEGRN]

Hello all,

In addition to "working the floor" I also teach nursing, and two of my students this past week posed an excellent question. I had my (second year) students working on taking patient health histories, and the following question came up: If a nurse has a patient whom s/he suspects is transitioning from one gender to another (and the patient hasn't disclosed this information), how does one respectfully ask if a) this is indeed the case, and b) how far along is the patient in their process of transition. Additionally, when is a transgendered individual considered to be anatomically male/female? (I'm assuming that hormone therapy and surgery have been done). Finally, one more question: for transgendered individuals who have not yet made the physical transition, and even though they're using, say in this case a female name, when all of their ID is still in their birth/male names, I'm assuming that this patient would be identified for medical purposes as "male," even though he wishes to be addressed and treated like a woman (or vice-versa in the case of a woman transitioning from female to male).

Curious to know what others think!

Many thanks.

[Fribblet]

Gender is cultural; sex is biological.

If a person has had sexual reassignment surgery, then they are now a transexual, and, for all intents and purposes, male or female (depending on which surgery they had).

If they are using hormones and living as the opposite gender, then they are transgendered but biologically the opposite sex and should be identified as such in the medical record. However, it is perfectly acceptable to refer to this patient as the gender they prefer.

In fact, no matter where a person is in their transition, I refer to and identify them in the manner they prefer. Some who are transitioning to a female, wish to be referred to by their chosen female name and with female pronouns. Others, when receiving medical care prefer their biological sex and given name. It depends on where they are in the transition and their own personal preference. But, when it comes to demographics, if they have not had reassignment surgery, then their biological sex is listed.

This is just my understanding and perception. Hope it was somewhat helpful!

[flashpoint]

Touchy situation!

I ran into a tochy sort of situation a few years ago. We had a male who was taking female hormones while awaiting surgery come to the ER with chest pain. The lab tech wasn't sure whether to put male or female when she was putting info into the EKG machine. The PA that was on told her to use male because the patent's chromosomes were male. The patient got a copy of the EKG and was VERY offended upon reading the line that said male.

You just can't win sometimes. I would think that people undergoing a gender reassignment / transition procedure would be understanding when things like that happen...people just aren't sure what the right thing to do it...and the right thing could easily vary from person to person.

[phoenixrn]

There are two important issues: obtaining necessary and accurate information, and respecting the patient's self-identification.

From what I know of the transgendered community, there are several different ways that they refer to themselves that can be charted with relevance to medical care. Some examples of what I would write:

Transgendered male to female (MTF for short): has had the surgery, living completely as their new gender

Transistioning female to male (FTM for short): has not yet had the surgery, could be taking hormones or in any of the many stages of transistioning to a new gender.

Another point of relevance is if they are taking hormones or not. Where I work, there is community of transgendered MTFs who have kept their male genitals and are taking female hormones, living as female.

It never hurts when you introduce yourself to ask "How do you like to be called? Do you identify with a particular gender?" and this can be a leading question to more relevant questions that a nurse would need for his/her assessment.

I think it would be a GREAT assignment for nursing students to contact a local LGTB center and study the experiences that the LGBT community have had with the medical system. Let me know if any of my recommendations should be modified!!!

[Flying ICU RN]

I'm assuming that this patient would be identified for medical purposes as "male,"

A fascinating topic from a social standpoint, you have some thinkers there.

I have never researched the issue, but I wonder about how far the re-definition can go from a medical perspective, as unidentified skeletal remains would always be primarily identified by gender.

[VivaRN]

I usually start out by saying, "these are questions we ask everyone" (and we do)

What was your sex at birth?

How do you identify today?

Have you, or do you wish to have reassignment surgery?

Are you on hormones? What are your goals for therapy?

Our clinic policy is not to list sex differently unless the patient has undergone surgery and is anatomically that sex. The labels read Suzie Brown, 44M, but I've never had anyone complain if I call her Suzie and she accesses women's services (for example, sees providers who see women and social workers who work with women).

This is a population that has experienced a lot of pain and judgment. A little awareness goes a long way in building trust.

It's great these students raised the issue!

[Flare, ASN, BSN]

Another thought I didn't notice anyone touching on is room assignments. I would imagine that would make for a hairy situation if you have a biological man that identifies as a women (or vice versa). Some people may not have an issue sharing a room with a person who is outwardly one gender but in reality is the opposite, but i would imagine it would make a lot of people uncomfortable (especially if they are from an older generation) if they found out that the patient in the next bed is in the process of a gender reassignment. In this sue happy world you can bet on a lawsuit.

[dudette10, MSN, RN]

I ran into a tochy sort of situation a few years ago. We had a male who was taking female hormones while awaiting surgery come to the ER with chest pain. The lab tech wasn't sure whether to put male or female when she was putting info into the EKG machine. The PA that was on told her to use male because the patent's chromosomes were male. The patient got a copy of the EKG and was VERY offended upon reading the line that said male.

I don't know the answer, but I'm wondering if it really does make a difference what the gender is identified as on EKGs, EEGs, and imaging studies. I mean, would a cardiologist, neurologist, or radiologist be looking for specific details based on what we know about anatomical differences of organs shared by both genders? Would taking hormones affect these organs in such a way that a doctor reading the studies would be assisted by knowing that the patient is a transsexual or in the process of of transgendering.

If there is a medical reason for knowing this, and it was noted on studies the patient receives, it might be a good idea to let him/her know ahead of time to avoid offense.

[YEGRN]

Hello everyone,

Thank you so much for your replies, all of which I thought were very respectful and well-thought out. Above all I always teach my students respect, respect, respect for your patients regardless of gender, sex, colour, ethnicity, race, age, culture, religion.

As for the question that was posed by one of the respondees re: what would make us think that an individual is transitioning from one gender to another if the individual hasn't disclosed this information, my students gave as an example a man who still possessed a number of biologically male physical characteristics, such as evidence that the individual is shaving facial hair, prominent upper body musculature, a deeper voice, a prominent Adam's apple, but who was identifying with the female gender as shown by use of cosmetics, hair style, choice of clothing, breast development. Bear in mind that I'm not saying that one should automatically assume that a male is transitioning to female just because the individual has well-defined upper body musculature ... of course not ... I'm just saying that if there were a cluster of "clues," such as the characteristics I mentioned above, I would be inclined to ask if the individual were undergoing gender and/or sex transition, and I would want to to ask in such a way that the individual would not be offended in any way.

Again, thanks to all for responding!

[YEGRN]

Firefighting RN, I also want to thank you for raising an interesting issue about room assignments, especially if the individual is placed in a four-bed all female room with the patients (just assuming, for the sake of stating an example) who differ in age and their personal beliefs about sex and gender. I live in Canada and like to think that no-one would sue over this issue, but you never know. As a charge nurse, I would place a patient in a room with a roommate or roommates based on whatever gender they identify with, and if there happened to be complaints from the other patients or family, out of respect to the trangendered/transsexual patient, I would ask if s/he would like a private room. Assuming, of course, that a private room is available ... a rare thing in our imperfect world.

[BluegrassRN]

I don't know the answer, but I'm wondering if it really does make a difference what the gender is identified as on EKGs, EEGs, and imaging studies. I mean, would a cardiologist, neurologist, or radiologist be looking for specific details based on what we know about anatomical differences of organs shared by both genders? Would taking hormones affect these organs in such a way that a doctor reading the studies would be assisted by knowing that the patient is a transsexual or in the process of of transgendering.

If there is a medical reason for knowing this, and it was noted on studies the patient receives, it might be a good idea to let him/her know ahead of time to avoid offense.

Our EKG machines simply require that all info fields be completed.

[orange juice]

This is interesting I actually had a conversation about this with a friend that has many transgendered friends. They told me the person is either pre-op or post-op simple as that. So if its a male transitioning to a female. She is pre-op female and everything is referred as female. From my understanding from my friend most transgendered people prefer this if is it a medically induced change.