Medical Tuesday Blog
Transgender Anatomical Changes
Dr. Rosen: We’re hearing a lot about transgender issues but little about the real issues. And I don’t mean a civil rights issue.
Dr. Edwards: I’m sorry that so much of what we do now is civil rights. When we practice legal medicine, I believe that medicine will lose. We’re not legally sophisticated and I really don’t wish to be. But I guess it goes with the territory.
Dr. Milton: Unfortunately, I think you’re correct, Edward. I just attempt to practice the best medicine I know how. If someone trips me up legally, that’s why we spend so much on medical liability.
Dr. Rosen: And that’s really a dark path. If you’re sued for malpractice, you will lose a lot of time while helping your lawyer to defend you, it may affect your practice adversely, if only due to the stress you’re functioning under.
Dr. Ruth: I have one colleague who was involved in a nuisance lawsuit, and although it came out favorably, it continues to haunt her. Every time she fills out a medical staff privilege renewal, she has to explain the circumstances, document the result and relive the cruelty. There are colleagues she can’t face, even those that were not involved. And it seems a number of her patients found out and although she won, she lost a lot of them. Her income dropped significantly. She’s even considering closing her practice and doing something else.
Dr. Rosen: Getting back to transgender therapy, what are the issues. Many times the parents have to sign the permits since these issues come up before they come of age. There are a number of regrets on transgender hormonal reversals as well as what some feel is mutilating surgery. Since the statutes of limitation on persons on issues of controversy, the statutes of limitation appear to start running when they become of age. Then when these patients become of age, they may take legal action. We now see children as they mature, even sue their parents. I don’t think parents that sign for their daughter to have a bilateral mastectomy, bilateral oophorectomy, bilateral salpingectomy, total hysterectomy, and vaginectomy really understand what they are embarking on.
Dr. Michelle: I’ve never had a transgender patient so I feel uninformed.
Dr. Rosen: I’ve only had one and I thought he was male until he told me before I completed my exam. He of course had the usual top and bottom operations and with his hormone therapy sported a full beard and mustache. There is no bathroom issue on someone who has completed the surgical changes as well as the hormonal changes. He would never be mistaken as to being in the wrong bathroom.
Dr. Michelle: You really didn’t know he was a genetic female until he told you he was?
Dr. Rosen: Not at all.
Dr. Michelle: Then if he went into the bathroom ascribed for his birth gender, that would create quite a stir, wouldn’t it?
Dr. Rosen: It certainly would.
Dr. Michelle: Then to follow some of the laws concerning the gender issue wouldn’t really work, would they?
Dr. Rosen: They would create more problems than the legislature tried to solve. The typical problem when law usurps medical practice.
Dr. Milton: If I had such a patient I would be doubly careful not to comment and just take care of the basic medical problem and get him out as fast as I could and hope never to see her or him again.
Dr. Rosen: As my exam was proceeding below the belt, he told me that he had two aluminum testicles implanted in a surgically designed scrotum. But he hastened to inform me that he still had to pee sitting down like he did when he was still a woman since his enlarged clitoris did not have a urethra down the center of it like a man. Hence, he could not use the male urinals in the bathroom. And his urethra exited behind his aluminum testicles, so he had to sit as he did before to empty his bladder. To avoid questions from the other boys and to make sure there weren’t hostile comments from the other boys, he tried to pretend he was having bowel evacuations when he went into the enclosed stalls in the men’s bathroom. He would always seek a private toilet whenever he could. If none were available, he would try to visit the bathroom when he thought there probably weren’t any boys in it using the urinals.
Dr. Ruth: Now that you have given us the details, I think I’d be prepared if a parent asked me about a child who felt he was transgendered. I think most women when I tell them that they still had to use the bathroom as they did when there were a female, would be horrified. I think the average person assumes there would be a magic total transformation.
Dr. Edwards: With all the scars and distortions on both the “top” and “bottom” operations, I can see when they come to realize who they really are, there could be some serious legal ramifications.
Dr. Rosen: At the last conference of the Association of American Physicians and Surgeons, the head of the American Pediatric Society discussed the transgender problems. She stated that children are in the stage of latency after going through phases of personality development and parents should just allow the development to proceed as they into their gender development period. She felt that most of the children would resolve into their genetic gender. So the rush to proceed with transformation before they become of age is really bad medicine. It could be interpreted as malpractice at some time in the future.
Please see Dr. Andersons article in Section 6 above.
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