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Does Biological Sex Matter? A True Story from the Emergency Department

Writer's picture: Dr ParkerDr Parker
NHS ambulance at Accident & Emergency

In my career in emergency medicine, I have treated all kinds of injuries and ailments minor and major, from broken bones to heart attacks. And of course, a number of those patients are transgender or gender non-conforming.


When a patient presents at the emergency department it is vital that the medical staff get a fast and accurate understanding of them and their history, so that they can provide the right treatment. When a patient witholds information, for whatever reason, they put themselves at risk. Emergency Department staff only want the best for you, and however uncomfortable or embarrassing it might be, it’s definitely one of the times when you need to be completely honest! And with the increasing number of trans patients, the question of biological sex naturally comes up more frequently.


For instance, a young man attended an emergency department I know with abdominal pain. He had blood tests, a urine dip and an ECG (tracing of the heart). His medical records showed that he had no past medical history. He had developed lower tummy pain a few hours ago which was getting worse. He had also vomited. He denied any pain on passing urine and any penile discharge. His examination was normal; his tummy was soft and not particularly tender. All his blood tests and other investigations were normal, so after a discussion, he was sent home with some painkillers and told to return if he got worse.


He did indeed return just a few hours later in a significantly worse state. He arrived via ambulance into resus (where the patients go when requiring immediate life critical care). It was then determined that he had an ectopic pregnancy and could have died. On his first visit he had never mentioned that he had female genitalia or that he was having penetrative ‘front sex’. Fortunately, once this was understood, the correct care could be administered and he made a full recovery. If he had disclosed right at the start that he was a transman with a womb and ovaries having front sex, the initial emergency care would have looked for things such as an ectopic pregnancy and would have prevented his near-death experience.


The lesson here is that when doctors ask questions, and particularly in an emergency department, it isn’t because they want to upset or embarrass you. Rather, they just need a full picture of you and your background because they are truly trying to help. Remember, a doctor can only help in an emergency if they have the full story. Your past gender may indeed be part of a life you left behind long ago, but sharing knowledge about it could be vital for you today. Regardless of how you feel about your biological sex, it very much matters in the emergency department.


Remember too that lifestyle changes mean that other serious conditions are affecting new generations in different ways, such as cancers in younger people. Sexually transmitted infections can be very serious and are still common. Screening is a very important part of everyone's well-being. Transmen may still need breast cancer scans. Transwomen may still need prostate checks. And to be able to give you the best advice medical staff need to understand you and your background fully. So, take them into your confidence and I guarantee you’ll be better off for it.


Questions? You can always contact me via help@edennew.life.

Dr Parker

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