A transgender man went to hospital with abdominal pain and found out he was pregnant.
The New England Journal of Medicine published details surrounding the incident in a case study yesterday (15 May).
Listed only as Sam, a 32-year-old transgender man, his boyfriend brought him into the hospital after he complained of ‘severe’ stomach pains.
Sam told doctors his level of pain was around an eight out of 10. So they tested his blood pressure and heart rate.
While in the hospital, he told doctors he was transgender and hadn’t menstruated in ‘several years’, due to previously taking testosterone.
‘The triage nurse assessed him to be a man with abdominal pain who had not taken his prescribed blood-pressure medications,’ according to the report. The nurse gave him a ‘non-urgent assessment’ and ordered more tests.
Then what happened?
Several hours later, a physician came to evaluate Sam with some test results. She noted more previous medical history and considered he could have possible early pregnancy complications.
She also reexamined his abdomen and found: ‘The patient had severe abdominal pain, possible ruptured membranes, and hypertension in advanced pregnancy, which suggested possible labor.’
Medical professionals then confirmed the pregnancy but could not determine if there was a heartbeat.
Sam consented to an emergency caesarean delivery and nurses prepared him for surgery.
‘In the operating room, no fetal heartbeat could be detected on ultrasound,’ the report concluded. ‘Given the fetal death, Sam was transferred to a delivery suite where, moments later, he delivered a stillborn baby.’
A flawed classification system
Daphna Stroumsa is a fellow in the National Clinician Scholars Program and a clinical lecturer in obstetrics and gynecology at the University of Michigan.
She said Sam was ‘rightly’ classified as a man.
‘But,’ she said. ‘Sometimes classifications, including those of race and sex, fail to capture the complexity of our patients and prevent us from taking the best course of action.’
Stroumsa then added: ‘So in our case… the binary sex system — for our patient or for other transgender or intersex people — fail to capture the rich information about their sex.
‘So what we think of as “biological sex” is actually multiple characteristics, many are non-binary,’ she said.
Stroumsa said putting him in the ‘male box’ meant that he didn’t receive urgent care.
She wants to see medical professionals ‘keep in mind’ classificatory cracks, like in this example.