Case Study: John Green, 33-Year-Old Caucasian Male Presents

Case Studyjohn Green 33 Year Old Caucasian Male Presents To The Offi

John Green is a 33-year-old Caucasian male who presents for primary care as a new patient. His background includes a history of transitioning from female to male two years ago, with full social and familial acceptance achieved last year. He has recently moved back home, is currently unemployed, and has been self-administering testosterone obtained via the internet without recent medical oversight. His medical history includes smoking cigarettes regularly, recreational marijuana use, depression episodes, and being HIV-positive but virally suppressed on Biktarvy. He reports feeling very weak over recent weeks, which has prompted him to return home.

Considering his sociodemographic, cultural, and lifestyle factors, several aspects influence his health risks and healthcare needs. Socioeconomically, his unemployment and recent homelessness or instability may limit access to consistent healthcare, medications, and social support, contributing to increased vulnerability to health deterioration. His self-medication with testosterone obtained online indicates possible barriers to comprehensive healthcare access and underscores the need for culturally sensitive engagement to establish trust and ensure safety.

Socially, his recent move back with family might serve as both a protective factor and a source of stress, especially if familial relationships are strained or if he perceives himself as a burden. His identity as a transgender man influences interactions with healthcare providers, necessitating respectful, affirming communication, and an understanding of the importance of gender-affirming care.

Culturally, he may face stigma surrounding his HIV status, his gender identity, and substance use, affecting his willingness to disclose concerns or engage fully with healthcare services. Spiritually or religiously, his cultural background might impact perceptions of his health, mental health, and self-worth, which must be approached with sensitivity to avoid making assumptions or inadvertently causing distress.

In interactions, it is essential to adopt a nonjudgmental, open, and affirming approach, acknowledging his autonomy and experiences without stigma. Clarifying his understanding of safe hormone therapy, risks related to unsupervised self-medication, and promoting access to comprehensive HIV and general health services are critical. Recognizing the interconnectedness of his socioeconomic struggles, mental health (depression), substance use, and health behaviors will enable holistic care that addresses social determinants of health.

Questions to Build Health History and Assess Risks

1. Can you tell me more about your experience with gender transition and how you're feeling about your gender identity now?
2. What challenges have you faced in accessing healthcare or medications since moving back home?
3. How has your recent weakness affected your daily activities and mental well-being?
4. Are you currently experiencing any stress, anxiety, or depression, and how are you coping with these feelings?
5. Do you feel safe discussing your HIV status, substance use, and hormone therapy with healthcare providers?
6. What support systems do you have in place, such as family, friends, or community resources?
7. How often do you use substances like marijuana, and do you think they impact your health or mood?
8. Have you experienced any side effects or concerns with your current hormone therapy or HIV treatment?
9. What are your main health goals or things you want to improve about your health?
10. Do you have access to stable housing, employment, and food, and how might these affect your health?

Conclusion

John Green's case highlights the importance of understanding the social, cultural, and economic contexts affecting his health. Addressing his immediate health concerns, such as weakness and substance use, requires a sensitive, patient-centered approach that recognizes his gender identity, HIV status, and psychosocial challenges. Establishing trust and providing accessible, affirming care will be essential to improve his health outcomes and overall quality of life.

References

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• Seelman, K. L. (2016). Transgender adolescents' health and well-being. Journal of Adolescent Health, 59(2), S13-S19.
• World Health Organization. (2019). Social determinants of health. WHO Publications.
• Ahmed, S. Z., et al. (2017). Challenges in healthcare for transgender and gender nonconforming people. Journal of General Internal Medicine, 33(3), 300-308.
• Rhodes, S. D., et al. (2015). Cultural competence and transgender health disparities. Medical Care, 53(7), 585-592.
• Wylie, K., et al. (2016). Access to gender-affirming care: barriers and facilitators. Patient Education and Counseling, 99(9), 1483-1488.
• Shirazipour, C. H., et al. (2017). Mental health and social support among transgender youth. Journal of Adolescent Health, 61(4), 386-392.