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Yes, sir, I mean, m’am

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Ma’am or Sir?

Living in the south, I have learned to call patients “ma’am” or “sir.”  When I forget to use these titles I am sometimes gently reminded with the phrase, “You’re not from around here, are you?”
“No, I’m not.—I mean—No, sir, I’m not.”  But what if you are not sure which to call your patient? Recently I had a patient who is transgender, male to female.  And he is undergone some but not all of the steps toward physical gender re-assignment.  The patient preferred “ma’am” so I said “ma’am” the whole time.  The last set of physicians called the patient “ma’am.”  But the current set called the patient “sir” and the family called the patient, “him.”  My first thought was that if the patient considers herself female, we should respect those wishes and change the gender we have in the computer.  But I quickly realized that wouldn’t work.  Despite describing herself as female she was still, medically speaking, male—for example, she still needs to get her prostate screened for cancer.  It was quite an interesting experience to wonder how female someone has to become before we consider her a female.  Perhaps in medicine the answer is never.

What would you do in this situation?