Should the doctor treat a trans gender woman whose presenting PSA.

[Elite Engineer]

Discussion came up at work. If a man to woman transgender presents PSA in a urine sample,

is the doctor obligated to notify the patient? I'm not sure, because in one sense the doctor could be causing

psychological trauma to the patient, while in the other case, the patient has a high chance of prostate cancer. 

[CharonY]

What is the indicated risk of elevated PSA levels in transitioned persons? If there is no additional risk attached to it, reporting does not make sense (but why was it tested in the first place? On top of it, serum PSA is not a great marker (high false positive rate) and urinary PSA is even less reliable. 

[Elite Engineer]

Doesn't have to be PSA. Let's say the doctor has evidence of prostate cancer. What direction does the doctor take?

[Strange]

Why does the transgender issue make a difference?

[Elite Engineer]

Psychological trauma. The patient is no longer the gender they identified with at birth. 

[CharonY]

10 minutes ago, Elite Engineer said:

Psychological trauma. The patient is no longer the gender they identified with at birth. 

That is a weird proposition. It is not as if transgender person (transitioned or not) suddenly forgot everything between birth and confirming their gender identity. And of course if there is any medical indication the persons should be notified. People have all kinds of differences and believe or not, if you have them, you are rarely traumatized with what is going on. I can pretty much guarantee you that a positive cancer diagnosis is going to be the most traumatizing event they are going to deal with.

[pavelcherepan]

On 12/6/2017 at 9:51 AM, Elite Engineer said:

Psychological trauma. The patient is no longer the gender they identified with at birth. 

Let's see. On one hand we have a potential for psychological trauma, and on the other - a deadly condition if left untreated. How does this kind of question even come up?

[CharonY]

1 hour ago, pavelcherepan said:

Let's see. On one hand we have a potential for psychological trauma, and on the other - a deadly condition if left untreated. How does this kind of question even come up?

I am not even sure where the potential for trauma comes from. Gender transition is typically only possible as adult and therefore they clearly unaware that they still have a prostrate in these cases. It really sounds like an extremely weird extrapolation just because something also to happen to be transgender.

[pavelcherepan]

1 hour ago, CharonY said:

I am not even sure where the potential for trauma comes from. Gender transition is typically only possible as adult and therefore they clearly unaware that they still have a prostrate in these cases. It really sounds like an extremely weird extrapolation just because something also to happen to be transgender.

Well, I just took the initial assumption for it's face value. And even then it's really hard to make a case that a psychological trauma can be as bad as... well... dying.  And I wouldn't completely write off the possibility of someone actually getting psychological trauma from the news, but once again it completely fades in comparison to the other possibility.

[CharonY]

9 hours ago, pavelcherepan said:

And I wouldn't completely write off the possibility of someone actually getting psychological trauma from the news

Perhaps. The reason why I think that is that the transition process is a lengthy process with a lot of counseling. Depending on what and how much is being done, the persons undergo a profound change in their bodies and usually are very well informed regarding the process and often understand their anatomy better than, well, non-transitioning folks. As such they will all know that their prostrate will remain and probably understand that they are susceptible to this form of cancer. It is equivalent to a women having a hysterectomy while keeping their ovaries and fallopian tubes. These women are likely not be more traumatized by the news of ovarian cancer as any other woman. I.e. regardless how I arrange the elements, I fail to see how transgenderism is adding an issue to the whole scenario. 

 

[studiot]

I think we should separate this into two questions.

 

1) Should you tell them?

Yes, they will find out sooner or later anyway and could sue you if you hide it. Early diagnosis may help treatement if needed.

2) How do you tell them?

This is where the rest of their circumstances should be taken into account in the telling.

[Arete]

Would you have the same concern telling a person with de la Chapelle syndrome that identifies as male that they are genetically female and sterile? 

[studiot]

I note that the treatment for many of these unusual conditions includes "Reassurance".

[Ken Fabian]

Of course the doctor tells the patient; if the PSA levels are indicative of potential prostate cancer then it's important that follow up tests are done. To withhold such information would be negligence/malpractice. I suspect anyone who has gone through the sex change thing would be well informed about the medical implications, including the ongoing potential for prostate problems.

[CharonY]

I think the whole discussion only arises because most people do not understand the process or the perspective of transgender people. Therefore, there are many "what if" scenarios that for actual transgender persons are likely to be very straightforward. 

[Elite Engineer]

9 hours ago, studiot said:

I think we should separate this into two questions.

 

1) Should you tell them?

Yes, they will find out sooner or later anyway and could sue you if you hide it. Early diagnosis may help treatement if needed.

2) How do you tell them?

This is where the rest of their circumstances should be taken into account in the telling.

Yes this is what I was trying to ask.