Implicit assumptions about who can be pregnant
Remember, kids, everything is worse for trans people – earthquakes, racism, fleas, pandemics, misogyny, Starbucks, everything. Miscarriages? Worse for trans people, obviously.
A 32-year-old man with obesity, Sam, arrived at the emergency room to be treated for intermittent abdominal pain that had been going on for 8 hours, according to a case described in the New England Journal of Medicine in 2019.
We can see where this is going already.
A triage nurse chalked this up to his “untreated chronic hypertension” and designated his symptoms as “nonurgent.”
Sam told the nurse that he was transgender, had taken a pregnancy test that was positive, had not menstruated in years, and had “peed himself” earlier that day. Yet the nurse still “deployed implicit assumptions about who can be pregnant” because she had “no clear classificatory framework for making sense of a patient” like him.
Or to put it another way, Sam had fucked up her-his body so thoroughly that the nurse was confused. No doubt that does add complications to a miscarriage, but then maybe we need to recognize that fucking up your body that thoroughly has its downsides? Maybe the issue is more medical/physical than political? Maybe this isn’t a particularly good example of How Society Oppresses Trans People?
Essentially, because of deep-seated assumptions that only women can be pregnant, the fact that Sam could be pregnant just didn’t compute.
The deep-seated assumptions are correct though. It’s true that only women can be pregnant.
It took several hours for a physician to discover that Sam was actually pregnant and in labor. Tragically, Sam delivered a stillborn baby after no heartbeat could be found.
… Sadly, this outcome [might] have been able to be avoided if the nurse had not had the assumption that men can’t be pregnant.
It’s not an assumption, it’s reality. In the context of a medical emergency it can be dangerous to appear to be the sex you’re not.
Big emphatic subhead:
Pregnancy, and pregnancy loss, isn’t limited to women
Yes it is. That’s exactly what it’s limited to.
In reality, many people who are not women (nonbinary people, transgender men, and others) get pregnant. One 2019 Rutgers study suggested that up to 30 percent of transgender men have unplanned pregnancies.
I wonder who those “and others” are. Or not so much wonders as understands that that “many people” is just the typical hand-waving. The people are not all that “many” and in any case they are all women. By definition.
Naturally, those pregnancies can also be lost, just like cisgender women’s. The emotional toll of a miscarriage or stillbirth is devastating for anyone, regardless of gender, but there are additional factors weighing on transgender people’s recovery from this loss.
So you see, kids, you have to remember to always add “additional factors weighing on transgender people” to every bad thing that happens to anyone anywhere.
i assumed since the right wing nut jobs appear to be on the ascent since oh., maybe about reagan, that only white christian ladies could. that way way too many brown and black and red people and people who live in sandy dry places were breeding far too much. and that is why they white christians need to maintain their supremacy. must’ve been a catholic hospital
Ok, hold it right there. This is not a subtle clue.
The problem here isn’t “ believing only women can be pregnant.” That’s what I believe, as does Ophelia and most of the other regulars of B & W. And would we have diagnosed this patient with non urgent chronic hypertension, after they say “I’m a tran man who had a positive pregnancy test and now my belly really, really hurts.” No f*cking way.
So who would ignore it? Someone with two beliefs. Not just “only women can get pregnant” but also — necessarily — “Trans Men Are MEN!!!!”
Maybe they should think of dropping that, seeing it both requires indoctrination and leads to problems.
This is tragic. There will be more such instances as there are more instances of FTM transitioners. It will be mitigated by there being more healthcare professionals who are aware of the existence of transmen.
But, for me, the main culprit is the propagation (by experts who should know better) that there is really an existing fact called “gender” and that people can have a really-existing “gender” that conflicts with their “sex.”
It is difficult to know how to encompass the insanity that goes along with that belief. Supposedly people with male sex organs think and behave a certain way while people with female sex organs think and behave another way.
Supposedly there is a connection between your sex organs and your personal identity. How this happens isn’t clear but it’s real.
But, mysteriously, there are some people who have the opposite “gender” to their sex organs. How this happens isn’t clear but it’s real. They have the wrong body. They hate their bodies. This hatred isn’t pathological, and something to be discouraged through therapy. This hatred is to be affirmed as the natural, inevitable result of their somehow having a different “gender” from the “gender” their sex organs would normally have given them.
So the answer is to alter the body to conform with the “gender.” So that, presumably, one can look like a man/woman while thinking and acting manly/womanly.
But nobody has to go the whole route of SRS, hormones, or anything. We have to recognize “non-binary” people. We have to realize that there are multiple sexes and genders. Some people are “gender-fluid” and slip in and out of “genders” with ease. (Perhaps this ability could be taught to those with gender dysphoria? To teach them how to reconcile their situation without needing expensive surgeries and hormone therapies??)
And, obviously, there are transwomen who love their penises, some of whom (who?) have deliberately coerced transmen into penetrative sex in order to get them pregnant. As well, there are transmen who deliberately get pregnant and give birth in order to try to create a child who has no mother. Even though pregnancy and birth would ordinarily be considered the role of the “female” gender and, as such, be unbearable (unintended pun) for a transman.
And then there are those weirdo “detransitioners” who, if you consider them seriously for a moment, would serve to give one pause about all of this gobbledy-gook.
Like, why is “gender” connected to sex but somehow isn’t connected to sex? Why are there 2 genders to conform to 2 sexes? Unless they’re both “spectrums.” In which case, how is it that the vast majority of people are magically able to precisely link-up their sex and their gender?
I could introduce the non-related topic of “intersex” but that’s enough confusion for today.
Sastra, #2. I’m not sure that I believe the claim that Sam told the nurse about the pregnancy. If there is any chance that a patient presenting with those symptoms could be pregnant – and saying ‘I am pregnant’ suggests the possibility – no nurse is going to ignore that. I followed the link to the New England Journal of Medicine and although one needs to register to see the full article the first paragraph can be seen:
No mention of a claim to be pregnant, but not enough to go on, so I went to the healthline site that Ophelia quotes from. Some way down the page, after the quoted part about the stillbirth it goes on to say:
So Sam had not known of the pregnancy until the phycisian had made the examination which led to the discovery of a foetus with no heartbeat, and the nurse is being guilt-tripped for treating a transman as a man.
I can imagine another scenario: a nurse who has no opinions at all regarding transgenderism, but doesn’t expect to question a patient’s declared sex. This patient said he’s a man, no idea why he’d tell me about a positive pregnancy test, can’t be pregnant, let’s put him on the low priority for now. Never heard of anyone lying about their sex before. He said he’s a Transylvanian man or something, but we treat anyone the same regardless of where they’re from.
The nurse didn’t employ implicit assumptions. The woman lied to the nurse. She said she was a man. The nurse didn’t do anything wrong, just believed her when she said she was a man. That’s what the trans radicals have been asking us all along, isn’t it? TMAM!!!
Also, there’s no evidence whatsoever that the fetus was alive when the woman arrived at the hospital. Given she’d been abusing herself hormonally for years, and was in denial about her sex, it’s possible the fetus had been dead for days.
If she stays on the hormones, she won’t have to worry about a repeat. She’ll be sterilized, problem solved.
Medical professionals are all in on the trans bullshit because it’s more business. You want us to create an iatrogenic illness in you that we will then have to treat you for for the rest of your life? Sounds great! They’re sometimes happy to pretend they don’t know that only women get pregnant, because trans people are big spenders, medically speaking.
Butterflies & Wheels discussed this case in May, in the comments here (hat tip Roj Blake). The source of this whole discussion is the paper in the New England Journal of Medicine here, in their Perspective section for opinion pieces.
I found the NEJM paper interesting enough that I paid for access, and I posted this comment on the paper…
… disputing the claim of the lead author that a “man” was classified correctly.
Thanks Dave. Another interesting discussion.
‘One 2019 Rutgers study suggested that up to 30 percent of transgender men have unplanned pregnancies.’ I wonder how that compares with the percentage of women more generally. A recent Guttmacher Institute study suggests that the current number is something like 7% globally: ‘In 2015–19, there were 121·0 million unintended pregnancies annually (80% uncertainty interval [UI] 112·8–131·5), corresponding to a global rate of 64 unintended pregnancies (UI 60–70) per 1000 women aged 15–49 years.’ I suspect ‘transgender men’ know less than women in general about pregnancy, and probably believe at least to some degree that ‘being a man’ means they are less likely, or unlikely, to get pregnant. I’d say ‘I wonder if anyone’s done any research on this’ but I’m sure the answer is no. (I’m a bit baffled though at what sounds like a high number of ‘transgender men’ having straight sex with men.)
30%! Good grief. At least that’s the “up to” point…
The article creates “facts” that are not true:
1)That Sam had told the nurse she was pregnant.
2)That the stillbirth might have been avoided if the nurse had not ignored 1) above.
I believe the technical term for this is “lying.”
Interesting that the editor did not notice the conflict between 1) and the later passage quoted above by AoS.
Interesting that the case was originally reported in the NEJM, the same New England Journal of Medicine that just published this:
https://www.nejm.org/doi/full/10.1056/NEJMp2025974
Why would anyone think hiding essential information that’s as essential as blood group and medication allergies is a good idea? Seems Sam’s sex turned out to be rather important after all, didn’t it? And once again, intersex people are roped into being a prop in TA advocacy. From things I’ve seen on Twitter, people with DSD are tired of being used in support of TA claims of “sex is a spectrum”. Apart from pirating the phrase “assigned at birth” for their own ends, trans activism doesn’t really have anything to do with the needs of intersex people. How many trans people are actually intersex? How many people with DSD are actually trans? I’m not interested enough to actually register to read the rest of this, but I’d be willing to bet that the lip-service inclusion of intersex people is dropped fairly quickly, as it usually is once the appropriated DSD terminology has served its purpose.
I forgot to include in my comment #4 my initial reason for doubting Sam’s claim to have informed the nurse of his/her transgender status and pregnancy.
I’m not aware of the systems in place in American hospitals for assessing ER patients without immediate life-threatening conditions but in the UK a triage system is in place, entailing a Q&A session with a trained triage nurse. By its very nature, triage is carried out prior to any diagnosis and treatment. After the basic name, address, etc. one of the first questions that a woman (and I assume a transman) will be asked is ‘are you pregnant, or is there a chance that you may be pregnant?’ In fact, the last two occasions that I had to attend A&E after minor accidents the triage nurse running through the questions asked me the question, purely (I think) as a tension-breaker. The pregnancy question is vital because it can effect the type of treatment, particularly the types of drugs that can be given.
If the same is the case in the US then unless Sam declared himself male as opposed to transmale the pregnancy would have been one of the first things that the nurse learnt and would have determined the treatment.
There’s also a question of whether the hospital had patient notes in Sam’s ‘deadname’, which may have been useful if Sam had given that information, but that aspect isn’t mentioned as far as I can see.
One last thing: the very first line in the initial quoted piece really grates on me.
Is it just me or does this sound as though obesity is an illness like anorexia or bulimia, rather than something one is, usually though not always owing to a lifestyle choice? People do not have obesity in the same sense that they have anorexia or covid or cancer. In fact, I don’t see why the obesity is mentioned there at all. If anything, it belongs further down where the details of Sam’s case are discussed. “A triage nurse chalked this up to his “untreated, obesity-related chronic hypertension” would have been more apt, I think.
wonder who those “and others” are. Or not so much wonders as understands that that “many people” is just the typical hand-waving. The people are not all that “many” and in any case they are all women. By definition.
I am guessing they might be Otherkin. And the oppressive, evil medical establishment fails to recognize that some of their patients (the others) may be about to birth a litter of puppies?
Unless there is an obvious emergency, patients are often asked to fill out some information about themselves. I wonder if Sam ticked M or F on that form.
AoS, in the US, that question is also asked. I get asked it regularly, and I’m 60 years old and have gone through menopause. Not to mention, my medical records include information about my hysterectomy. I still get asked. They take few to no chances.
From the initial NEJM paper (May 2019):
and the paper blames the triage nurse:
That paragraph blames the nurse — “the nurse deployed implicit assumptions about who can be pregnant” — yet the nurse ordered a pregnancy test.
It seems to me, the nurse correctly identified the patient as female, and possibly pregnant. But for the paper to create a narrative about Gender ID, that paragraph contradicts itself on facts about what the nurse was thinking and did.
Positive pregnancy test, but also claiming not to have known about the pregnancy? What, not even an inkling? No idea about how pregnancies come about? Not some kind of nagging feeling that led to the taking of the pregnancy test in the first place? And then no clue that when the test said “you’re pregnant”, it might mean they were pregnant? Who is it that’s making assumptions about who can get pregnant, I wonder.
(Of course, there is the small matter of some people not understanding the meaning of “positive” and “negative” in the context of a pregnancy test. They think it means “good” or “bad”, so maybe Sam’s “positive” test result was taken to mean “good news, you’re not pregnant!”)
Ha! Yes – positive pregnancy test=not negatively impactful news, hooray!
Catwhisperer @17,
This is purely anecdotal on my part, but from discussions with friends, there are apparently a surprising (to me) number of women out there who equate “my doctor told me I may have fertility problems” with “there is absolutely no chance I could get pregnant, so who needs birth control.” Lots of people really are awful at comprehending probability. I think it was Nate Silver who noted that the average person doesn’t really grasp what an X% chance means — they sort every possibility into, at most, five categories of “definitely won’t happen, probably won’t happen, coin flip, probably will happen, definitely will happen.”
So if “Sam” equated “I haven’t had a period in years” with “there is absolutely no chance that I could become pregnant,” that is, in my opinion, a dumb but common belief.
Re “not negatively impactful news”, I’m glad I wasn’t sipping my coffee when reading that line.
This unfortunately applies to more than pregnancy tests. My students assume positive feedback loop means good, and negative feedback loop means bad.
Screechy, I hear that all the time. Probability? 1 in a million chance someone will die? Well, I’m safe! No one’s gonna die! They are shocked…horrified…that the EPA regulations consider that worthy of being regulated. If no one’s gonna get hurt, well, why? To most people, one in a million means impossible. They don’t understand the idea of population size, etc.
Which may also be why the number of trans murders sounds worse to most people than the actual percentage. Which doesn’t explain why the number of women murdered elicits a yawn, since the numbers are astronomically higher.
The medical provider didn’t clock that you were female, and pregnant, but whose fault is that? It’s your own fault. If, besides using drugs and_or surgery to appear male, you changed your name to a typically male name, and got your identification and medical records to say that you are male, it’s your fault. You created this wholly avoidable mess by perpetrating a fraud on the medical providers. Any extra increment of psychological pain you may claim to feel as a result of your miscarriage or stillbirth is entirely self-inflicted. Poor, selfish you, putting your fantasy life and your ego ahead of your actual medical needs.
maddog1129 in #22, you’re understandably mistaken about what happened, because the initial NEJM paper bullshits the reader about what happened. My comment #16 cites the paper to show that the triage nurse:
1) Correctly identified the patient as female,
2) Ordered a pregnancy test.
Gender ID had no impact on the patient’s care or outcome.
Dave Ricks:
So the real “liar” here is the newspaper which created a whole politically correct nonsense puff piece?
Brian, here’s how I see the social dynamics, and I’m only realizing this today, long after I read the initial NEJM paper very carefully in 2019 to comment on it.
Maybe you know the Harry Frankfurt theory of bullshit, in his book and his interview, where bullshit is different than lying.
The bullshit of the 2019 NEJM paper is localized in the paragraph I cited above in my comment #16. I enjoy that paragraph like a Penn & Teller magic trick. When they trick you it’s entertaining, and when you see how they tricked you it’s entertaining again.
That paragraph tricks readers into thinking the ER triage nurse misunderstood and responded inappropriately. But as I reread that paragraph today, I see the nurse 1) Correctly identified the patient as female, and 2) Ordered a pregnancy test. The triage seems appropriate for a female who might be pregnant. Or if the case should have been handled differently, the problem was not Gender ID.
The Healthline article stems from the bullshit of the NEJM paper, and the NEJM paper works on the bullshit of that paragraph. I won’t call Healthline liars, any more than I would call the audience at a Penn & Teller show liars. They’re all tricked by the bullshit.