A 25-year-old patient tells the nurse he is living a miserable existence. All his life, he states, he has thought, felt, and acted like a woman while living in the body of a man
He has lived as a female and dressed in feminine attire for more than a year. He has decided to change jobs so as not to compromise the new identity and now wishes to "take the next step" with surgery. The first patient request the physician will likely address is: a. "Will you order estrogen therapy?"
b. "Can you refer me for psychotherapy?"
c. "Will you alter my medical records?"
d. "Please give me something to make me a man.".
B
Psychotherapy to help anticipate and deal with the psychological issues and adjustments involved in gender reassignment would be undertaken before hormonal therapy and sexual reassignment surgery. Although privacy concerns exist, owing to the unusual nature and possible social stigma associated with gender reassignment, altering medical records would be unethical and an unlikely request. The scenario suggests that the patient prefers life as a woman and would probably not seek to increase his masculinity.
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