When & How to Talk to Your Patients About Their Gender & Sex

New patient questionnaires may be modified to include sex and gender data, and this may make a potentially touchy conversation easier for clinicians, says Mr. Orndorff. Some patients may not want to conform to a particular category regarding their gender or sexuality. “Younger people often seem to say they want to be nonbinary. What does that even mean?” he asks. “But our doctors are getting younger, too, so they may be more attuned to these things and feel comfortable asking a patient about their preferred gender or pronoun or sex.”

Mr. Beckenstein

Alexander William Rose Beckenstein, also a transgender man, is being treated by a rheumatologist for mixed connective tissue disease (MCTD). This rare autoimmune disease may be accompanied by arthralgia, Raynaud’s phenomenon and other symptoms seen in more common rheumatic diseases, such as systemic lupus erythematosus, scleroderma or even rheumatoid arthritis, and some patients go on to develop lupus or systemic sclerosis.² His rare autoimmune disease was diagnosed when doctors noticed elevated markers in his blood tests related to his top surgery, a procedure to alter his breasts for his transition to male gender.

“I find having an autoimmune disease while being FTM [female-to-male transitioning] very ironic, considering I do not feel like my body is my own. It seems like my immune system also sees my body as a foreign entity and attacks it,” says Mr. Beckenstein, who lives in New York City. During some interactions with medical professionals for his MCTD treatments, he says he has been “sadly surprised by the lack of desire for knowledge about how to make me feel more comfortable by using the right pronouns. My current doctor has been wonderful and fully respectful, but those interactions are few and far between.” He says some healthcare providers have made him feel like “just another female body,” rather than an individual with his own unique identity.

Mr. Beckenstein … says he has been ‘sadly surprised by the lack of desire for knowledge about how to make me feel more comfortable by using the right pronouns. My current doctor has been wonderful & fully respectful, but those interactions are few & far between.’

Sex Affects Risk

A patient’s sex affects his or her risk of developing certain rheumatic diseases, as well as potential treatment decisions, says Michael D. Lockshin, MD, director of the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery.