He was not what I expected. I had met his wife his wife that morning, an attractive woman in her 40’s and when she told me that I would be seeing her husband in the afternoon I pictured a man who would look manly, masculinity to match her femininity.
He looked to be in his early 50’s, and was quite effeminate. He was darkly tanned, almost bronze. His perfectly coiffed blond hair was long enough to cover his collar and parted on the side, with a layered cut that was popular in the 70’s. His clothes, a khaki shirt, khaki pants, khaki belt and khaki shoes, matched perfectly, so perfectly as to merit the term “ensemble”. His speech and mannerisms were distinctively feminine.
I shrugged off his appearance and greeted him in my usual fashion. His wife had told me he was in to have a mole checked so I asked him to remove his shirt. Without a word he unbuttoned it and set it over the chair. As he did I was suddenly aware of the reasons for his feminine appearance. He had breasts.
They were not the “man boobs” of an obese man, nor were they gynecomastia, the slightly prominent breast tissue sometimes seen as a side effect of medications. He had female breasts. Any doubts I may have entertained as to the nature of his bosoms, any thought that he was not striving to be a women disappeared when I saw the tan lines outlining his pale breasts. He had been tanning in a bikini top!
Wondering what to say, I quickly took a look in his chart. The medication list told the story. He was taking estrogen pills. He was in the process of a sex change.
The first thought that passed through my mind was, “Why didn’t his wife warn me about this?” Some form of heads-up would have been appropriate, something along the lines of “My husband is coming in to see you this afternoon for a mole on his chest, and by the way, he has boobs,” would have been nice. I struggled to come up with an appropriate response. (“Nice boobs, are they new?” did not seem appropriate…)
It was one of the rare times in my life that I had no idea what to say. I decided to say nothing at all. I examined the mole as if there was nothing at all out of the ordinary. I diagnosed the skin lesion, recommended a course of action and sent him on his way.
I never saw either one of them again. I have no idea if they stayed married or if he completed his transition. I do know that I will never forget him, and that I never know what I will find behind each exam room door!
At that when in doubt, the best response is to simply do my job.