Eight Tips for Creating a Trans-Affirming Health Care Environment
 
 
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Eight Tips for Creating a Trans-Affirming Health Care Environment
Transgender people have a gender identity which differs from the sex they were assigned at birth.  For the purpose of this article, the term transgender might be abbreviated as trans, and is used in the broadest sense of the word, encompassing all individuals who do not identify as cisgender.  Cisgender inviduals have a gender identity which is in alignment with the sex they were assigned at birth.

Transgender people interact with the medical community for the same mundane reasons as everyone else; they get the flu, break bones, have children, need check-ups and preventive care, just like their cisgender counterparts.  Many (though not all) transgender individuals also need medical assistance to meet their transition-related goals. 

For this reason, it is simply impractical to expect that transgender individuals will only be seen by transgender medicine specialists.  Add this to the fact that more transgender people are coming out and living authentically, it becomes clear that all health care professionals must be prepared to care for transgender patients effectively and respectfully.

Here’s the rub: health professionals receive remarkably little education on transgender patient care.  According to a 2011 survey of United States and Canadian medical schools, only 30% reported having gender transition-related content, while the majority had no trans-focused content at all (Obedin-Maliver et al, 2011).  A more recent survey of 319 physicians in Canadian residency programs revealed that only 12% felt that their training was adequate for them to care for this population (Coutin et al, 2018).

So, on one hand, we have an underserved population with health care needs, and on the other, a medical community that is unprepared to provide the needed care.

The good news: more often than not, transgender people seek medical care for reasons that have nothing to do with their gender identity.  In these instances, caring for these patients doesn’t require special medical knowledge.  What’s required is for health care professionals to treat these patients with compassion and respect.

Here are some tips, offered by Dr. Kyan Lynch, a trans health specialist at the University of Rochester Center for Community Practice, for health care professionals who want to ensure that their transgender patients feel welcomed, cared for, and respected.
  1. Ask, Don’t Tell

We live in a cisheteronormative society. 
That’s a complicated word for a simple truth: in our society, you are straight and cisgender until indicated otherwise. 
We live in a society in which lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) people have been persecuted historically, including at the hands of medical practitioners.  It can be scary, if not downright dangerous, for LGBTQI patients to come out in the medical context.  It can be safer not to disclose.
Gender identity and sexuality can be highly relevant to a patient’s care, influencing the tests you order, the diagnoses you consider, and the medications you prescribe.  If you want your patient to be honest, you need to ask them how they identify instead of making an assumption.  Ask, don’t tell.

  1. Be Respectfully Curious

In a health care setting, patients get asked a lot of questions.  Some of those questions are just part of the job.  You have to ask about their medical histories, social histories, and sexual histories.  You need to know intimate details about their lives and even their body parts.  In an exam room, questions come with the territory.
Sometimes, though, a transgender patient gets asked a question that doesn’t quite feel right.  A question that feels out of place or off topic.
As a health care provider, ask yourself, “am I asking for my clinical inquiry to help the patient? Or am I asking for my own curiosity?”
To a certain extent, follow your curiosity when you take patient histories.  Your clinical instincts shouldn’t be ignored.  Just make sure that you stick to satisfying your clinical curiosity, and not your social curiosity. 

  1. Names and Pronouns Matter

This one is simple but incredibly important.
Transgender people spend a disproportionate amount of their time battling for recognition.  Because we live in a cisheteronormative society (yes, there’s that $5 word again), trans people are constantly being told that they are wrong about who they are.  If our baseline assumption is that everyone is cisgender, it is easier to claim that trans people are confused or ill rather than face the fact that our centuries-old, deeply ingrained human-sorting system is imperfect. 
What does this look like in practice? Often, it’s as simple as a trans person being called the wrong name or pronoun (i.e. he, her, their).  Sometimes, these acts of misgendering are completely accidental. Too often, however, misgendering is done deliberately, to belittle, attack, or erase a trans person’s identity, and to degrade their dignity. 
Therefore, it can make a massive difference for a provider to use a patient’s affirmed name and pronouns.  It can be a first sign of care and respect.

  1. Do Your Own Research

Have you heard a transgender patient say, “at this point, I’ve done so much research into hormones and surgery, I think I’ve earned my honorary medical degree”?
The data back it up.  According to the 2015 National Transgender Discrimination Survey, 24% of transgender people who had sought medical care in the prior year reported having to teach their medical provider about transgender people in order to receive appropriate care.
Want to stand out as a trans-affirming provider? It can be as simple as educating yourself about transgender people and their medical care.

  1. Intersectionality is Critical

All transgender people live outside of the traditional gender binary.  As a result, all transgender people share in the struggle for legitimacy and respect in a cisheteronormative society. 
Beyond that, though, it would be hard to write an accurate statement which begins with, “all trans people…”.
The transgender community is diverse, expanding, and heterogenous in every way.  Just like people in other communities, transgender individuals are not one-dimensional.  They have multilayered identities that go far beyond gender. 
It is important to understand that these multiple identities intersect and interact.  The challenges faced by an undocumented gender non-conforming Latinx individual differ greatly from a newly out, white transgender college student, or an African American trans woman living in the South.  Be careful not to treat trans people with a cookie-cutter approach. 

  1. Let Your Office Speak for You

You have a lot on your plate.  Sometimes it’s hard to imagine adding one more thing to your to-do list.
So this tip is a little different.  Instead of adding another question or discussion to your time-limited patient visit, let your office do it for you.  Take a look at the following images and consider printing one or two out for your office walls.
Your patients will feel seen and cared for, even if you don’t actually discuss gender identity during the visit.

  1. It’s a Team Effort

One issue from what we’ve seen and heard that continually surfaces is inconsistency in allyship throughout the staff. 
If you work in a medical setting, implementing these tips in your own practice is wonderful.  But, you will not have the impact you are hoping for unless you ensure that everyone on your team is on the same page.  And that means everyone
One great way to ensure that your team is ready to affirm trans patients is by including transgender individuals on your staff.  

  1. Remember: Ally is a Verb

Being an ally isn’t something you are, it’s something you do.  The best way to be an ally to the transgender community is by continuing to educate yourself, through articles like this one and training such as the ones we provide at UR CCP.  Speak up when you hear transphobic language, lead by example by using affirmed names and pronouns, and when in doubt, listen, listen, listen!
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