A 21-year-old transgender man presents to urgent care with 2 days of dysuria, urinary frequency, and suprapubic discomfort. His chart lists male gender, and the medical assistant initially documents “male patient with possible prostatitis.” His vital signs are temperature, 98.8°F; heart rate, 88 beats/min; blood pressure, 118/72 mm Hg; respiratory rate, 14 breaths/min; and oxygen saturation, 100% on room air. He appears comfortable and nontoxic. Examination reveals mild suprapubic tenderness without guarding or rebound; there is no costovertebral angle tenderness. During a private, anatomy-based history, the patient shares that he has a vagina and uterus, has not had genital surgery, and recently had receptive vaginal sex with a new partner. He is taking testosterone but is not using contraception. Urinalysis shows leukocyte esterase and nitrites.
Which of the following is the most appropriate next step?
- Treat for prostatitis because the patient’s chart lists male gender.
- Avoid asking about anatomy or sexual practices because these questions may be intrusive.
- Treat for uncomplicated urinary tract infection and consider pregnancy and STI testing based on anatomy and exposure.
- Refer the patient to the emergency department because all genitourinary symptoms in TGD patients require higher-level care.
Click to see the answer
Correct answer: c. Treat for uncomplicated urinary tract infection when appropriate and consider pregnancy and STI testing based on anatomy and exposure.
Rationale: TGD patients may have anatomy that differs from assumptions based on appearance or the electronic health record. A focused organ inventory and sexual history can prevent missed diagnoses and guide appropriate testing, including pregnancy and STI testing when clinically relevant. Testosterone should not be considered contraception.
For an in-depth review of this topic, access the full course.
Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
