A Pregnant Trans Man's Misdiagnosis Leads to Stillbirth

The case of a transgender man whose pregnancy was recognized too belatedly, resulting in a stillbirth, highlights the need for additional training for health care workers on how to treat trans patients, according to a new article in The New England Journal of Medicine.

"The point is not what's happened to this particular individual, but this is an example of what happens to transgender people interacting with the health care system," the lead author, Dr. Daphna Stroumsa of the University of Michigan, Ann Arbor, told the Associated Press.

The 32-year-old man, whose name and location were not revealed, was admitted to a hospital for treatment of severe abdominal pains, the AP reports. A nurse thought he was simply obese, not initially considering the possibility of pregnancy because his medical records classified him as male and he had a masculine appearance. But he did tell the nurse he was transgender. He had quit taking testosterone, which can suppress ovulation, because he had lost his health insurance. After some further examination, a pregnancy test was ordered, but the hospital personnel still did not consider his situation an urgent matter.

After the test confirmed his pregnancy, a doctor ordered an emergency cesarean section because part of the umbilical cord had entered the birth canal. A fetal heartbeat had shown up on an ultrasound exam, but once the man was in surgery, none could be detected. The child was stillborn.

A patient identified as female who had symptoms similar to the man's "would almost surely have been triaged and evaluated more urgently for pregnancy-related problems," the article's authors wrote.

"It's a very upsetting incident, it's a tragic outcome," Dr. Tamara Wexler, a hormone specialist at New York University's Langone Medical Center, told the AP.

"Medical training should include exposure to transgender patients," she added, noted that personnel already practicing can learn from their trans clients.

Nic Rider, a transgender health specialist and psychologist at the University of Minnesota, said health care workers need to overcome "implicit biases." Classifying patients as male or female "doesn't mean that we just throw out critical thinking or think about how humans are diverse," Rider told the news service.

Gillian Branstetter, spokeswoman for the National Center for Transgender Equality, called the case "not terribly surprising," given medical personnel's lack of awareness about transgender health matters. The situation must be addressed because "the consequences can be so dire," she told the AP.

The New England Journal article is available here to subscribers and those who register for limited access.