Gender Identity Crisis

[~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..

 

[~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
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

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.