Gender Identity Crisis

[~Zaria~]

Assalamu-alaikum,

Today I was faced with an interesting situation.

Ive actually been dreading this for some time, but I guess it was bound to happen sooner or later.....

Today, I met a 16 year old girl who was referred to our clinic by a psychologist with a 'Gender Identity' problem - and who is requesting 'Corrective surgery'.

She has been born and raised as a female thus far. However she tells me that:

- Since pre-school, she has identified herself as a boy.
- Her first kiss (in pre-school) was with a girl.
- Her friends would comment on her behaving like a boy - to which she replied: "i am a boy" (this occured at a very young age as well).
- She preferred 'male' toys as a child, and never played with dolls.

At present - even though she has developed and matured as a normal female - she has done everything possible to look like a boy:
- She dresses in masculine clothes.....including male underpants.
- She has strapped her chest wall - so that it appears flat.
- She speaks in a very deep voice.
- She exercises excessively, takes protein supplements to build muscle mass and does weight-lifting.

In fact, I was so confused when I met her initially - I had called for MS. X......then saw her and said - 'it looks like they made a mistake on your clinic folder'......then realised the situation, and tried to mumble my way out of that jam! :/

I realise that there are many possible 'Disorders of Sexual Differentiation' - which could medically explain this situation.

But I have a terrible feeling that these investigations are going to be normal - with a normal, female 46XX karyotype and normal hormonal levels.

And in this case......what do i do?

Firstly, i cant understand how a CHILD will perceive him/ herself as being of the opposite gender (without a medical reason).

And secondly - I do not want to be involved in the 'make-over' of this individual (should all work-up be negative).

Then, how do i manouevre myself out of this case?

Do I tell her: 'Ms X, you are a girl. Now start behaving as one, and hopefully you will soon feel the same'?

Even if I refer her to someone else, wont I be sinning - by 'directing' her towards those who will assist in her gender 'correction'?

What do I do?? : (((

[جوري]

You're not under obligation to treat a patient you don't wish to treat however you can' t abandon her and you must refer her to someone else (who that someone else is to your descretion)It can be another psychiatrist- she's not even emancipated yet to make that kind of life altering decision- I sure as hell didn't know what I wanted at age 16, you can't just up and get a sex change and take hormones, they need extensive counseling sometimes up to 20 plus years. You're a doctor you can do anything and no one can force you to do anything you're not comfortable with!
Are you in the U.S by the way? because that's part of medical ethics. I am not sure how things are run elsewhere per ethics but that's how it is here!

:w:

[~Zaria~]

You're not under obligation to treat a patient you don't wish to treat however you can' t abandon her and you must refer her to someone else

JazaAllah khayrun for your reply sis.

I realise Im not under obligation to treat her (if this goes against my belief system)........but neither do I feel obligated to refer her to anyone else.

Why should I refer a perfectly developed female for gender correction surgery?

The problem is, that I will most likely get a complaint laid to the superintendant if I were to I simply turn her away......:/

(who that someone else is to your descretion)It can be another psychiatrist- she's not even emancipated yet to make that kind of life altering decision- I sure as hell didn't know what I wanted at age 16, you can't just up and get a sex change and take hormones, they need extensive counseling sometimes up to 20 plus years. You're a doctor you can do anything and no one can force you to do anything you're not comfortable with!
Are you in the U.S by the way? because that's part of medical ethics. I am not sure how things are run elsewhere per ethics but that's how it is here!

She has been through a psychological/ psychiatry evaluation, and according to their assessment, they are satisfied that she is well adjusted as a male - and recommends assisting her in this regard.

Most gender-correction surgery is performed as early as possible/ as soon as the individual begins to strongly identify him/herself towards a particular gender --> this is with regards to cases where a medical condition is found e.g patients who are True Hermaphrodites (they have both male and female reproductive organs to varying degrees).

In these cases, the consent of a parent/ adult guardian would be required.

With regards to 'normal' individuals who are seeking 'corrective surgery', Im not actually sure of the protocols involved (apart from requiring a psychological assessment).

I guess my problem lies here:

How is it possible for a 4/5 year old child to identity himself with the opposite gender?

I cant imagine media influences having such a profound influence from this young.

Or what are we missing??

Is there possibly a valid biological reason for this - that we have not as yet found?

Or is this just a trial that Allah (subhanwataála) has placed on certain individuals - where they feel 'trapped' in the 'wrong' body? (Im dont feel comfortable with this reasoning though.....;/)

I kinda feel sorry for this young girl.
She has believed that she is a boy for as long as she can remember......when she was still an innocent child.

And she has gone to such drastic lengths to be able to feel like the opposite gender.

Im personally hoping that her investigations reveal some hormonal abnormality (even though this seems very unlikely from I can tell......).

At least then, I will be able to rationalise it.

Allah knows best.

:w:

[جوري]

Can you let me know what kind of doctor you're? that will actually play a large in the matter, if you're a GP or a GYN there's nothing you can do for her anyway. Referring her will take the responsibility off your hands and there's NO penalty for that under the law it is actually on your side. We have OB/GYn who are not comfortable performing abortions even in perfectly legitimate conditions that require them, that's why people go into partnerships and that's why we have consultants and referrals, exactly what do they want you to treat her for unless corrective and/or plastic surgery is your field of expertise I don't see how this would affect you under any circumstance? Just do what you normally would do for someone who seeks your help and set her on her way. I have had all kinds of patients I didn't like and some whom I didn't want to treat. I didn't abandon them until I made sure someone else was taking care of it, not that I had a choice anyway during my clerkships.

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[Who Am I?]

:sl:

I can relate to this in a way since I have a racial identity crisis. :hmm:

[glo]

What is your profession, Zaria? What I mean is, in what way would you be involved in this process?

[Insaanah]

:sl:

Firstly, i cant understand how a CHILD will perceive him/ herself as being of the opposite gender (without a medical reason).

How is it possible for a 4/5 year old child to identity himself with the opposite gender?

I cant imagine media influences having such a profound influence from this young.

Or what are we missing??

What was the family set up like as a child?

Does she have any siblings, and if so, are they male or female, and what number child is she?

Did the parents want a boy, and subconsciously it reflected in their mannerisms? We don't give children enough credit, they do pick up on this type of thing.

Does she have brothers, who were praised more than her as a child, so she felt that's what she needed to do to gain approval? Or did she feel she didn't get on with her sisters, or that they didn't like her, and thus felt closer to her brothers?

Sometimes (but not always) you find that men with homosexual feelings are brought up in matriarchal families. Was there an extended family with grandparents, uncles, aunts?

What did she watch TV wise as a child etc?

She may say everything was fine, but most likely if there were such factors involved as mentioned above, that she picked up on then, she might not be able to pinpoint them now, looking back after all these years, and she would most likely feel that everything was fine.

On the other hand, maybe it was none of these, Allahu a3lam.

Even if I refer her to someone else, wont I be sinning - by 'directing' her towards those who will assist in her gender 'correction'?

There's normally a conscience clause somehere, that enables you to refuse, but you must refer onwards. Not just doctors, but pharmacists also, who may not want to be involved in the supply of the "morning after" pill, can refuse to supply on grounds of belief, but must signpost to other places from where the patient may obtain a supply. Professionally, not referring isn't (in most cases) an option, even though you may feel uncomfortable and may feel complicit in it. As to whether it's sinning, Allahu a3lam, but as sister منوة الخيال said, you can at least take the responsibility off your hands, that's something you can do, and perhaps within the constraints you're in, the only option you have.

[~Zaria~]

What is your profession, Zaria? What I mean is, in what way would you be involved in this process?

I am training as an endocrinologist (which deals with hormonal-related problems - e.g. diabetes, thyroid, adrenal, male/female reproductive problems, etc).

I work in a public sector hospital - which means that I cannot actively chose which patients are referred to me.

Unfortunately, individuals who are seeking gender correction surgery are being referred to us in increasing numbers (this is a relatively new trend in my country, and esp. in an impoverished public health sector as ours).

When such individuals are seen for the first time, we try to exclude any hormonal/ genetic basis for their problem.

For me, finding something wrong would be the best scenario (as weird as this sounds) - as it means that the person has a genuine medical cause for his gender crisis.

However, in the far majority of cases - the person is completely 'normal' both physically and biochemically......yet is requesting gender corrective surgery.

My part in this story would involve: prescribing male hormones to a female wanting to change (i.e testosterone) or female hormones to a male wanting to change (i.e oestrogen).
This would be required at mega doses and life-long, starting before the surgery even occurs --> to achieved the 'desired' outcome.

In other words - this young girl is actually asking me to prescribe testosterone (at a dose that would even exceed male requirements) - to enable her 'metamorphosis'.

If you are feeling confused right now......dont worry - so am I!

:sl:

What was the family set up like as a child?

Does she have any siblings, and if so, are they male or female, and what number child is she?

Did the parents want a boy, and subconsciously it reflected in their mannerisms? We don't give children enough credit, they do pick up on this type of thing.

Does she have brothers, who were praised more than her as a child, so she felt that's what she needed to do to gain approval? Or did she feel she didn't get on with her sisters, or that they didn't like her, and thus felt closer to her brothers?

Sometimes (but not always) you find that men with homosexual feelings are brought up in matriarchal families. Was there an extended family with grandparents, uncles, aunts?

What did she watch TV wise as a child etc?

She may say everything was fine, but most likely if there were such factors involved as mentioned above, that she picked up on then, she might not be able to pinpoint them now, looking back after all these years, and she would most likely feel that everything was fine.

On the other hand, maybe it was none of these, Allahu a3lam.

Wa-alaikumsalam,

She had been consulted by both a psychologist and psychiatrist, and so I did not go into great detail with regards to her social background.

However i do know that:

- she has an elder brother.
- her parents are divorced (as is commonly seen here).
- her mum does not approve of this - hence she is now living with her gran. (her parents would tell her that she is merely 'going through a phase that would soon pass' as she was growing up).
- Im not sure what she has been exposed to in the media as a child (before 4/5 yrs)

There's normally a conscience clause somehere, that enables you to refuse, but you must refer onwards. Not just doctors, but pharmacists also, who may not want to be involved in the supply of the "morning after" pill, can refuse to supply on grounds of belief, but must signpost to other places from where the patient may obtain a supply. Professionally, not referring isn't (in most cases) an option, even though you may feel uncomfortable and may feel complicit in it. As to whether it's sinning, Allahu a3lam, but as sister منوة الخيال said, you can at least take the responsibility off your hands, that's something you can do, and perhaps within the constraints you're in, the only option you have.

In the past, I had been 'shielded' from these sorts of cases - as a collegue in our division was the 'expert' in this field......and so, the rest of us happily asked these patients to sit in front of her door.
She has now left......and Im not sure what will become of the rest of her patients either.
(It gets really disturbing......:/)

In this case, I would ideally like to tell the young girl: 'You are a normal female. Go home, put on a dress and all will be ok!'

I dont think thats going to work though!

And I also feel guilty to refer her to someone who wouldnt mind helping her.

---> Would it not be similiar to this scenario:
A man walks into your shop requesting a bottle of beer.
You tell him that you do not supply alcohol......BUT here are the details, address and phone number of where you can buy some!

I would be consciously referring her to someone who i KNOW would embark on 'turning' her into a male!

: (

[جوري]

In this case, I would ideally like to tell the young girl: 'You are a normal female. Go home, put on a dress and all will be ok!'

Again sis, you don't have to tell her anything by way of advise, simply refuse to prescribe the medication as it is unnecessary- and that's actually what you have to say. I don't see an organic disease that merits treatment with testosterone or any other hormones. .
I have come across two or three people like that and the doctors who refused to treat them. In fact a funny incident once where the the she male asking for treatment was denied by a lebanese doctor who was actually a maronite (christian) and this particular she male was telling me how that doctor is the 'devil' for refusing her/his 'treatment'.
I really fail to understand why refusing to prescribe hormones is a problem in this case.
Let's reverse gears a bit and say a patient came to you asking for narcotics or pain relief and they came to you as a referral from a 'pain clinic' do you not make an executive decision on whether or not this person is abusing the system or is in actual need of medications? Do you just hand out prescriptions for the asking? You can actually lose your license when audited for that!
Don't make it into something it is not. Simply refuse to prescribe it is your privilege!
You can't also be made responsible religiously for referring someone. Else practically everything you do will have some ramifications.

Mani ihtada fainnama yahtadee linafsihi waman dalla fainnama yadillu AAalayha wala taziru waziratun wizra okhra wama kunna muAAaththibeena hatta nabAAatha rasoolan

17:15 Who receiveth guidance, receiveth it for his own benefit: who goeth astray doth so to his own loss: No bearer of burdens can bear the burden of another: nor would We visit with Our Wrath until We had sent an apostle (to give warning).

else simply handing someone a butter knife would be a cause to go to hell.

and Allah swt knows best,

:w:

[~Zaria~]

^ If I refuse to prescibe hormones to her (as is my plan) - would mean that I also tell her that she is discharged from our care (as there is no need to see her at the clinic if she is not being actively treated).

Problems with this is:

1. Im not able to discharge her, as our clinic is the only unit that specialises in the care that she is looking for.

2. If no one else is willing to assist her in my dept (which is very likely) - I need to refer her to someone who will.
--> I dont think this scenario can compare to handing someone a butter knife (which has many uses, not only for harm).
In this case - I would be sending her to someone who I know would assist her to become a male.
And i feel that i am still wound up in the process (unwillingly).

Unfortunately, to be honest, i dont think i have many other options.....

I pray I dont have to see such individuals again.
Ameen.

[جوري]

^ If I refuse to prescibe hormones to her (as is my plan) - would mean that I also tell her that she is discharged from our care (as there is no need to see her at the clinic if she is not being actively treated).

Problems with this is:

1. Im not able to discharge her, as our clinic is the only unit that specialises in the care that she is looking for.

2. If no one else is willing to assist her in my dept (which is very likely) - I need to refer her to someone who will.
--> I dont think this scenario can compare to handing someone a butter knife (which has many uses, not only for harm).
In this case - I would be sending her to someone who I know would assist her to become a male.
And i feel that i am still wound up in the process (unwillingly).

Unfortunately, to be honest, i dont think i have many other options.....

I pray I dont have to see such individuals again.
Ameen.

I'd treat her like I would a person with munchausen syndrome or hypochondriasis. Schedule appointments and see her give her a checkup and don't send her home with prescriptions. Usually endocrinologists here are also internists who go for a fellowship therefore you can just treat her as a general practitioner and have follow ups and don't release her until she herself decides to go somewhere else.
And as a last note. You don't know if the person you send her to will be assisting her or not, simply referring someone doesn't denote that the other doctor will take that case on. I have seen many of those unfortunately with cancer patients, who doctors with excellent 'track record' refuse to treat them because of a known morbidity/mortality rate. So you place undue burden on yourself and you have to take it easy, believe me these aren't the difficult cases that you should lose sleep over..

:w:

[Muhaba]

Well, since you are a Muslim, you can explain to her that as a Muslim treating her to change her gender or referring her to someone else who will do the same is a sin. Then you can explain to her about the Islamic rule of not altering God's creation.

You couold go for spiritual councelling, tell her that everything God creates is just right and shouldn't be changed; that if she were meant to be a male then God would have created her male and not female. everything that happens is according to God's knowledge and Wisdom; nothing happens randomly so there is no reason why someone should want to change their gender.

Also explain to her that we are all God's creation and equal in God's Sight, that men and women are equal in God's Sight and that both were created for specific roles to play in the world and that each of those roles are equally important; the man's role is no more important than the woman's role and the woman's role is no more important than the man's role.

Show her the verses of the Holy Quran about Mary mother of Jesus (Maryam alaiha assalaam): Mary's mother had vowed to give the child she was pregnant with to serve Allah but when she had the child it was a girl. so she wondered how a girl could serve God since a woman's work is different from a man's: But Allah said that He knew what she bore and that the male is not like the female. Yes, Allah said in the Quran that THE MALE IS NOT LIKE THE FEMALE. That is because a male cannot do the work of a female.

normally people say that the female is not like the male because they think that the male's work is better than the females. But Allah didn't say that the female is not the male but that the male is not like the female. In that particular case, a female was better suited for the work that was to be done. God gave Mary great honor. Likewise God has given all women great honor in the very important work that they have to do which is childbearing and rearing. Men no matter how strong they are, can not raise children as well as women. This is because a woman's psychology is better suited for tolerating children. most men can't tolerate children so can't raise them as well as a woman. this is why children raised by single fathers suffer more psychologically than children raised by single mothers.
furthermore, a woman's job in the world is unique and irreplaceable but not given much credit. rather it is looked down upon. but if you compare a woman's work with a factory you can see how important it is. think of how much a car manufacturing company earns and how important they are. every woman is more important than the most important manufacturing company. this is because the human being is produced inside the woman!

when your patient learns of these facts, she may look at her in a different light. If she shows interest, you can guide her to an Islamic scholar who might help her learn about Islam.

See Chapter 3, verses 35 - 37 about the birth of Maryam Alaiha assalam

[~Zaria~]

^ JazakAllah khayrun ukthi.

I like your approach : )

[جوري]

That's indeed a lovely approach, the question however remains does she see you as a doctor or as a spiritual counselor? Do you know her well enough to explore the grounds of the philosophical & religious with her and what her reaction will be with that and how that reconciles with doctor/patient ethos? I come from a place where doctors don't make house calls and call patients 'clients' I hope the situation where you're practicing differs from that for those attempts to be successful!

[~Zaria~]

^ I said that i like the approach.
I didnt say that I think it would work, lol ;p

Seriously though, I would like to think of myself as both: alhamdulillah, a doctor and if my patients give me the chance (and sometimes even if they dont : ) ), a 'spiritual counsellor' as well.

We cant subtract Allah (subhanawataála) from anything in life......including when we are trying to help others.

And we should be trying to include some part of dawah in our conversation, whenever we get the chance.
In fact, even if we dont get the chance in a conversation, one who is 'fluent in dawah' knows how to 'lead' a conversation towards the greatness of Allah and His Oneness.

May Allah make us all of these type of people.
Ameen.

In this case, I guess its worth a try - what can I lose by speaking about Allah? (The worst that could happen is that she lays a complaint against me for trying to educate her about Islam. My counter-argument would be: 'She thinks shes a BOY.....she needs all the advise she can get!' : ) )

From her first visit to me though, I can tell that she is quite fixated about gender-swopping (considering the lengths that she has already taken to try and convince everyone).
I dont think that she sees females as a 'weaker' gender, but rather that she has strong desire to actually be a male and that she is attracted to other females.

From my side, I think its my duty as a muslim to, insha Allah, guide her towards the right path.

(And if she doesnt want my advice, then why is she in my office?
Its a package deal : D )

[جوري]

In this case, I guess its worth a try - what can I lose by speaking about Allah? (The worst that could happen is that she lays a complaint against me for trying to educate her about Islam. My counter-argument would be: 'She thinks shes a BOY.....she needs all the advise she can get!' : ) )

:D lol.. well I am glad you understood what I was deriving at without me saying it bluntly (at least per 'worst part' of your statement) but yeah that will be interesting conversation indeed... sob7an Allah.. Good luck sis I wish you well in shaa Allah..

:w:

[IbnAbdulHakim]

i sincerely hope you refer this back to a knowledgeable and enlightened individual (scholar from ahlus sunnah upon a madhab) and let us know how it goes.


There is no way in high heaven I will attempt to advise you on this.

[Muhammad]

:wasalamex

SubhanAllaah, a very difficult encounter. It seems that you don't have much choice on the issue of referral, because if you choose not to treat someone, and you didn't refer them, would that get you into trouble?

On the issue of giving da'wah, that is a very good thought. Just be careful in the way you approach it. I am reminded of the story of the Nurse suspended for prayer offer!

In any case, remember to perform Istikharah. May Allaah (swt) guide you in making the right decision and grant you every success in your career, Aameen.

[Alpha Dude]

On the issue of giving da'wah, that is a very good thought. Just be careful in the way you approach it. I am reminded of the story of the Nurse suspended for prayer offer!

Yeah, I thought of something similar. It might not be a good idea to say your counter argument to them either, if it comes to it... I know it sounds logical and all, but it's the kind of thing that could be taken wrongly and used against you later.

[جوري]

'clients' have more right here than doctors and of course even the doctors the shrewd Zionist ones have it made.. It is always the ones in training or starting out that are treated worst than pu. They can give a written statement and revoke it verbally before going into surgery and then sue you for doing what they've requested verbally because you didn't get it in writing. In closure this is a pretty litigious society and you'd be surprised how fast you burn out.
Walhi I was so delusioned when I fought for this career like it was dear life. I remember the first thought that came to my head at the end of the very first day of my OB/GYN rotation, is ''wow it never gets better, it doesn't matter how far you think you got in life, it is going to be **** all the way'' walhi that's what I said and I always recall that when I advise people not to get into medicine plus the migraine I had that day and the juice my mom gave me when I came home which caused me to throw up.
I am sure others haven't had the crappy experience I have had and perhaps had I been in another country I'd have hated it more or loved I really can't tell and don't care at this stage.
We often think things are greener else where. But people have changed, ethics of medicine has changed and it is just a business. when I went into medicine as cliche as it sounds my biggest joy was to actually feel that I have the knowledge and the skill to help others seeing so many loved ones drop dead around me from things that could have been easily helped with the right person in the right place.
Of course now I believe in fate and divine Qadr completely. If someone didn't drop dead of that heart attack or chocking on a chicken bone they'll have been hit by a car or have an embolus somewhere.
I have lost respect for the institution, with the exception of a few doctors I can count on one hand and who are completely old school, I have lost all respect for doctors, I'd rather die than seeking medical attention and often treat myself when deathly sick and worst of all I have no feelings of care or concern for the patients which is the saddest thing of all. There were days when one case would haunt me for three months and then came days when I'd see 13-25 people per day and not remember a single one of them when I lay my head on the pillow at night, just the thought of dragging myself back there in the morning was all I could stand and yet you'd not think it would get worst and it always does.
Not to be so grim and completely go off on a tangent but Sr. Zaria try to not burn out fast it is inevitable and if you can postpone it until your fifties or sixties it is better than in your thirties.

:w:

[~Zaria~]

SubhanAllaah, a very difficult encounter. It seems that you don't have much choice on the issue of referral, because if you choose not to treat someone, and you didn't refer them, would that get you into trouble?

Wa-alaikumsalam,

This case is a bit tricky because the patient is not physically sick as such (should all her investigations be normal).
In other words, she is requesting an elective procedure on a healthy body.

Technically, our health sector does not have the resources for genuine cases of medical need, let alone these types of cases......

However, it still would be within her right to lay a complaint against me if I do not make an effort to direct her to someone who will be willing to help her.

Things get even more complex when patients post-'corrective surgery' and those who are already on hormonal therapy, request that you re-prescribe their meds for them (e.g if they lose their script or if their principal doctor is on leave).
What does one do in this situation?
--> Heres an individual in transition between sexes and is now dependant on the hormones that have already been initiated.

Ive had this happen to me a few times so far, and Ive point blank turned them down.
I refuse to be part of someones 'transition', and I dont think I could ever justify prescribing mega doses of testosterone to a female (or what used to be a female) or vice versa.

Medicine has become far too complicated for simple folk like me :/ .......

[~Zaria~]

We often think things are greener else where. But people have changed, ethics of medicine has changed and it is just a business.

Assalamu-alaikum ukthi,

I am having problems opening this page as well, but I just wanted to respond to your comments.

Theres a lot of hurt, frustration and anger - all mixed into one - in your words.
I understand that you may feel hard-done by a system that you have tirelessly served.

However ukthi, dont let one, or even two.....or even ten negative experiences that you may have had with your collegues or patients dishearten you and cloud your perception as a whole.

Theres a chinese saying: "Fall down seven times, stand up eight" : )

No matter how many times you may have tried and failed.....or no matter how many times you have despaired at your working enviroment.......or no matter how unfair you may think the system is.......dont give up.

Stand up, and try again!

Life is a test.
Our families are tests (Im certain that mine is my biggest test, lol ;P)
Our collegues are tests.
Our patients are tests.

And this world is not perfect.

The health system has many flaws and evils within it.

But ukthi, there is 'bad' in almost everything......even insaan.
But inherent good in these same things as well.
We have to learn how to optimise the good in all things.

Mufti Menk once said: "Paradise would lose its value if Life was to be Perfect".
SubhanAllah.

So be positive! : )

And remember, no matter how difficult you own life may be, or how tiring a call can get, etc. - there are people lying in hospital beds, all across the world, who are most definitely going through far worse.
We should be constantly grateful that we are the ones standing on the other side of the bed.
Alhamdulillah.

Allah (subhanawa'tala) has given us all different abilities to be able to serve others during our life.
So, keep doing what you are meant to be doing.
Insha Allah, there is reward in all that we do - if we remember that we are doing it not for anyone else - but soley for the pleasure of Allah.

:wa:

[Hamza Asadullah]

Asalaamu alaikum, I'll add my ten cents (or dirhams) to this.

Firstly due to the field you have specialised in then the area of gender change hormonal treatment comes under your field therefore you will increasingly get similar cases throughout your career of males and females wanting gender change treatment and surgery etc. The particular subject matters are of course very complicated and difficult for a person with normal thinking to comprehend particularly for those of faith. Therefore maybe you should think about specialising further like dealing with diabetes in particular or moving away from the area of hormonal treatment otherwise you will have to deal with a lifetime of such issues and one day you will be cornered and will have to deal with it directly.

Also it was mentioned about giving dawah to a patient. That certainly is not recommended if it means you risk getting into trouble if the patient makes a complaint because in the UK for example a professional giving dawah to their patient is a sackable offence. Even if it isn't then in order for such dawah to work then you will have to have some sort of trusted relationship with the patient and approach it in an indirect manner so as you not seem like you are trying to 'talk them out of it' which will only cause their defence barriers to go up. I think psychological counselling would be a far better option.

Maybe try and talk her into seeing a psychiatrist. Of course such issues must be dealt with sensitively because such a person would have already made their mind up that they do not see themselves as their current gender and anyone telling them anything else would just be seen as someone who does not 'understand' them and who they are. So you must to be gentle and sensitive and not come across in such a way. Once a trusted relationship between the both of you has been formed then your advice will have far more credibility and as their barriers will have been broken down.

Maybe speak to her Mother if you can to understand her situation better and get advice from some consultants or higher up doctors particularly Muslim Doctors in your field to ask them what they would do in such a situation.

Most of all ask of Allah to help and guide you in this and all matters. May you do what is best for her and what will please Allah in all aspects of your life. Ameen

[جوري]

professional giving dawah to their patient is a sackable offence.

That along with things others of same line that may not have anything to do with religion at all. Say for instance a doctor is a breast cancer survivor, and she often takes the opportunity to solicit her patients to go to events or donate to cause or talk of her personal experience in an unprofessional manner she'll be subject to a disciplinary review and a loss of license which is a whole lot worst than getting sacked. Getting sacked means you up and go elsewhere and start fresh, losing license means losing practice and after the hell that one goes through a license is at least the only thing one has to their name even if out of work..

just my two cents..

Jazaka Allah khyran for the above.. I also wanted to add that people who want gender reassignment are probably less than 1% of the population so it won't be something she sees every other day but a rare event. I have only seen one case personally and the person had already gone through the surgery and everything and it was still very much a man I felt very bad for that person for never reaching this and never reaching that wala 7wala wla qiwta illa billah..

:w:

[~Zaria~]

JazakAllah khayrun for the advices.

Asalaamu alaikum, I'll add my ten cents (or dirhams) to this.

Firstly due to the field you have specialised in then the area of gender change hormonal treatment comes under your field therefore you will increasingly get similar cases throughout your career of males and females wanting gender change treatment and surgery etc. The particular subject matters are of course very complicated and difficult for a person with normal thinking to comprehend particularly for those of faith. Therefore maybe you should think about specialising further like dealing with diabetes in particular or moving away from the area of hormonal treatment otherwise you will have to deal with a lifetime of such issues and one day you will be cornered and will have to deal with it directly.

Wa-alaikumsalam,

I think I chose this field because of the diversity it provided me (theres so many hormonal systems), as well as its relaxed working hours - which is perfect for a female.
Diabetes makes up most of the patient load, but to do only this would be mind-numbing :/

These types of cases are not as common, but because this falls within my scope - I unfortunately would encounter it more often than any other physician.

Also it was mentioned about giving dawah to a patient. That certainly is not recommended if it means you risk getting into trouble if the patient makes a complaint because in the UK for example a professional giving dawah to their patient is a sackable offence. Even if it isn't then in order for such dawah to work then you will have to have some sort of trusted relationship with the patient and approach it in an indirect manner so as you not seem like you are trying to 'talk them out of it' which will only cause their defence barriers to go up. I think psychological counselling would be a far better option.

Maybe try and talk her into seeing a psychiatrist.

I try to be selective when speaking about religion to anyone, and ensure that I use the word 'God' vs Allah in discussion.
In this way, it appears that I am speaking in general, rather than Islamic terms.

If a patient leads a discussion towards religion (e.g asking about my hijab, or fasting, etc) - I would make of an effort.
Or if I feel that there is a need for the patient to reflect on his/ her purpose in life and relationship with God.

For example, a short story from this week:
I see a lady in her 60s for her diabetes. She mentions to me that there is a strong family history of stomach cancer.....and now she is experierencing worrisome symptoms (cant swallow, loss of weight, etc.) So, I suggest referring her for more tests.
At which point she starts to cry, and says she wishes she could die.....and were it not for her animals (17 dogs, 6 cats and a number of geese) - she would have over-dosed herself by now.
So, I ask her - does she think about what lies ahead (after this life)?
To which she replies: 'I can SEE the other side - and it is beautiful, and I cant wait to get there.'
I try again - trying to lead her thoughts about this.
But shes pretty adamant about this......and so i stop here, realising its a losing battle.

You have to know when to let it go, and when to pursue something.

With regards to the gender-confused lady - I likely would say:
'God has created you this way-as a female - and to Him, you are perfect. Think about how displeasing it would be to your Creator, if you try and change what He has created for you......' or something to this effect.

If theres no positive response from her, I will have to let it go.
But if I sense that she is willing to discuss it further, I will try my best, insha Allah.

Surely, this can not be unethical/ unprofessional if I dont mention a specific religion? (but rather referring only to its principles?)

I am devising a way out of these scenarios for the future, insha Allah......just need to think it through.



:wa:

[~Zaria~]

Assalamu-alaikum,

Just thought I would provide an update to this case.....

The young lady's blood tests are completely normal.
Alhamdulillah.

Unfortunately, she still wants to be a man.

A collegue of mine has referred to her to the plastic surgeons (who hopefully will turn her away due to lack of resources/ skill ).

Jazaka Allah khyran for the above.. I also wanted to add that people who want gender reassignment are probably less than 1% of the population so it won't be something she sees every other day but a rare event.

There were THREE patients at our clinic with this problem today - the young girl as mentioned above, another male - who is now female (post corrective surgery) and is on female hormones, and another who was looking for gender re-assignment.

SubhanAllah, I didnt get to see any of them today : ))
(I was so happy at this! : D )

It truly is a confused world out there.....



:wa:

[Dagless]

I know you've sorted it out now but the questions were pretty interesting :p
My 2p:

Firstly, i cant understand how a CHILD will perceive him/ herself as being of the opposite gender (without a medical reason).

People are more than just a combination of their physical parts. Depends what you define as gender too. You mentioned a psych has already seen her/him, so surely the weight of diagnosis it on them?

And secondly - I do not want to be involved in the 'make-over' of this individual (should all work-up be negative).

As already mentioned; you could refer it to someone else due to moral reasons.

Do I tell her: 'Ms X, you are a girl. Now start behaving as one, and hopefully you will soon feel the same'?

That would be like telling someone with a broken leg to start walking and hopefully they'll soon walk normally :p

Even if I refer her to someone else, wont I be sinning - by 'directing' her towards those who will assist in her gender 'correction'?

If you didn't direct her/him then isn't that a case of not fulfilling your duty? Whether they decide to go through it or not would be their choice, not yours.

Btw weren't there eunuchs or effeminate men in the prophet's (saw) time?

Not that I condone any of this, but just throwing stuff out there ;)

[CosmicPathos]

That would be like telling someone with a broken leg to start walking and hopefully they'll soon walk normally

broken leg is a broken leg, there is no evidence to support that shes a broken girl, especially if HPA axis and ovaries are working just fine. You cant really compare a broken leg with how one feels/sees himself.