When I met Judy, I had just finished seeing what seemed like 100 diabetic patients, one after the other. As an endocrinologist, I specialize in the management of hormonal disorders, and this is business as usual for me: More than 60 percent of my patient visits focus on diabetes.
I picked up my last chart of the morning and saw that it was another new patient with Type 2 diabetes. Judy was 47 years old, and as a result of her illness, she already had suffered several heart attacks and developed eye and kidney damage. She also had blockages in the major arteries that supply her legs with blood, and she had dangerously high blood pressure. I flipped through Judy’s chart, noting no other unusual medical problems. Although she clearly had severely uncontrolled diabetes, the case seemed pretty routine.
Then I entered the room — and saw something far from ordinary. Judy had a beard. My morning of nonstop diabetes just got a lot more interesting.
Judy was obese and looked for all the world like a man who hadn’t shaved in two weeks. Her facial features were coarse, and she had a receding hairline and a big bald spot. Her hands were large and appeared masculine. Thick hair covered her arms. When she greeted me with a cheerful “Hello,” her voice was low and gravelly.
I panicked. Was this “she” actually a “he?” Did I incorrectly assume Judy was female based on her name? Did I miss a gender reassignment surgery in her medical history? Was she transgendered, and I missed that as well? How could I, a specialist in hormones, enter an exam room ignorant of my patient’s gender?
“So, Judy, what brings you here today?” I said as I scanned her chart again, covertly searching for anything I might have overlooked.
“I’m here to talk about my diabetes,” she replied.
“Your diabetes? Not … anything else?” If Judy truly were female, she definitely had other endocrine issues to discuss that might be slightly more urgent than her diabetes.
I needed to confirm her gender in a way that wouldn’t be insulting. I launched into a modified version of the usual questions I ask diabetic patients, bumping the ones I typically ask women closer to the top of the list.
I asked about what complications of diabetes Judy had, and when I felt we had built up a decent rapport, I asked about her menstrual periods. Preparing for a potentially awkward moment (Periods? What? Don’t you know I’m a man? What kind of doctor are you?) I held my breath.
She immediately replied, “Oh, I haven’t had any in over 10 years. They just stopped, for no apparent reason...”