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The Transgender Pregnant Male; Unique Challenges to the Transgender Peripartum Period
Abstract Number: F-63
Abstract Type: Case Report/Case Series
INTRODUCTION: Transgenderism or gender identity disorder describes those whose gender identity is different from their biologic sex(1). Gender identity disorder is poorly understood and, as listed in the DSM V, is still considered a mental disorder(2). However, awareness of the condition appears to be increasing because of greater societal acceptance and available hormone treatment(1). A survey of 50 transsexual men found that the majority desire to have children(3). As a result of increased societal awareness and acceptance, healthcare providers should be an advocate for decreasing the possible discrimination these patients face.
CASE: A 27 y/o AA G1P0 presented at 36 5/7wk with mild preeclampsia. This patient is a female to male transgender who was on testosterone replacement. In preparation for bilateral mastectomy prior to pregnancy, the patient stopped hormonal therapy for 2 weeks as instructed to avoid adrenal suppression perioperatively. He inadvertently conceived during this hormonal break following the mastectomy. An IUP at 20wk gestation was discovered after he sought care from his family physician for amenorrhea. Although the female fetus was exposed to testosterone as it had been restarted after the mastectomy, US showed no evidence of virilization. He was admitted and induced at 36 5/7wk for mild preeclampsia. He failed induction and had an uncomplicated cesarean section and postoperative course.
DISCUSSION: Transgenderism is a condition in which a person experiences discrepancy between the sex assigned at birth and the gender he/she identifies with. The term transsexual man denotes a female-to-male transsexual person(3). Transgenders desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body congruent with the preferred sex through surgery and hormone therapy. These patients frequently report adverse healthcare experiences, from insensitivity and ignorance to discrimination and hostility(4). Lombardi reports insensitive behavior among health care providers (referring to transgender women as “he” and “him”) suggesting that cultural sensitivity is lacking(5). A multidisciplinary meeting involving anesthesiology, obstetrics and nursing is essential to discuss special social needs, ensuring that each healthcare provider understands the proper lingo and pronouns appropriate for the transsexual patient. Although on L&D we normally care for female patients, there should be increased sensitivity and awareness regarding the transsexual patient. As healthcare providers, we have to disprove the assumption that pregnancy is the ultimate “female signifier” and respect the transgender individual’s identity.
1. Murphy TM. Perspect Biol Med 2010;53:46-60
2. Wierckx et al. Hum Reprod 2012;27:483-487
3. Spack NP. JAMA 2013;Vol 309,No 5:478-484
4. Levy A, Crown A, Reid R. Clinical Endocrinology 2003;59:409-418
5. Lombardi E. American Journal of Public Health 2001;91:869-872