How to be a Trans Inclusive Health Care Professional

THIS IS IMPORTANT AND YOU CAN HELP!

Trans people experience a wide range of barriers to health care including overt discrimination, uninformed health care professionals, systemic discrimination, and personal biases. As a result, trans people frequently have negative experiences in health care settings and often avoid accessing health care services even when it is necessary. Ultimately, this leads to significant health disparity. This is compounded by having intersectional identities and experiences that also experience health care bias (fatness, racial minorities, disabilities, neurodivergence, sex workers, previous incarceration, current or past drug use, etc.)

Trans people have a significantly higher risk of suicide, especially youth. The single biggest protective factor against this increased risk is having supportive people in their life that respect their name and pronouns. That’s all it takes (though the more support the better of course).

So as a health care professional, what can you do to help? Here are some suggestions.

DON’T ASSUME

Don’t assume you know someone’s gender. Not based on their legal gender marker, their presentation, their body shape, their voice, their experiences, or the clinical service they are accessing. Trans men can be pregnant, birth, and body feed their children. Trans women can have a low voice. Nonbinary people come in all shapes, sizes, and presentations. Not every trans person is able to or cares to change their gender marker.

Don’t assume someone’s pronouns or the language they prefer based on their gender (or any of the other above information). People can use any pronoun regardless of their global gender identity. Pronoun preference can shift day to day, depending on context, or depending on the people they’re with. Other gendered terms are separate from pronouns. People can prefer seemingly conflicting terms (such as preferring Mx., sir, guy, sister, and Mom) and this is perfectly fine.

Don’t assume a trans person’s transition trajectory. Don’t assume every trans person wants to transition in any way, what components they will want to include in their transition, or what order or length of time they will take to access and engage with the options available to them. There are not only two pathways for transitioning. There is no set end point to transitioning. It is a highly variable and individual process that spans many many years if not the rest of their life.

So if you’re not supposed to assume any of these things, how do you find them out so you can interact respectfully and provide the appropriate care? You use neutral language for everyone (not just the people you suspect of being trans) until they specify or until you confirm by asking specific questions. Knowing what questions to ask and how to ask them in a specific and respectful way comes with practice. It is your choice whether you want to practice on your own time (via accessing formal training opportunities or informally interacting with trans people on a personal level) or over the course of your professional career.

RESPECT NAMES, PRONOUNS, AND GENDER IDENTITIES

You don’t have to understand every gender identity in order to respect them.

When you get someone’s name or pronouns wrong (which you will, we all slip up sometimes), correct yourself and move on. Do not apologize, especially not repeatedly or profusely. By apologizing, you are putting the focus on you and the mistake you made and forcing the trans person into the socially conventional role of either thanking you for the apology or excusing the original mistake, neither of which is acceptable.

Repeating what you said with the correct pronouns, name, or other language is necessary to cement the correct version in your brain. The more you de-emphasize the mistake and emphasize the correct version, the faster your brain will adapt and stop making mistakes in the first place.

If someone else corrects you, say ‘thank you’ (not ‘sorry’), repeat it correctly, and move on.

If people around you are making mistakes, make sure to correct them if you feel it is safe to do so. It is often easier to hear when other people make mistakes than when we do it ourselves. The more you correct someone else, the more you are emphasizing the correct version to yourself and others. You can correct others by interrupting them and stating the correct pronoun/name/language, by repeating what they said but using the correct pronoun/name/language, or by continuing on with the conversation, ensuring to use the correct pronoun/name/language with added emphasis.

This goes for documentation and patient records as well. Find a way to include preferred names, pronouns, and other important language in your patient demographics tracking system. Document using the patient’s preferred name and pronouns. If these don’t match their legal information, start with a note that states that you will be referring to [legal name] as [preferred name] and using [preferred pronouns] for the remainder of the patient’s chart. If you have to do this at the beginning of every chart note, then do it. It’s important.

IT IS YOUR JOB AS A PROFESSIONAL TO BE OR BECOME INFORMED

It is not your patient’s job to educate you on the basics of trans identities, trans health care, trans bodies, or how to respectfully interact with them.

It is your job to know what aspects of trans experiences and medical care relate to your scope of practice. If you are a medical doctor and do not understand that trans men do not need prostate exams and trans women do not need pap smears, you have a significant amount of learning to do to be considered a competent medical professional (for anyone, not just trans people).

‘I was never taught that in school’ is never a good reason not to know something. All regulated medical professions have an expectation of continued learning and keeping up with medical advances and new research. Would you prescribe someone the same medication now that you did twenty years ago even if it was no longer recommended and newer medications that are cheaper, more effective, and with fewer side effects had since been developed? No? Then don’t treat a trans person according to twenty year old ‘best practice’ guidelines. Those are no longer best practice. The world of trans care is changing rapidly. It is your job as a professional to stay up to date.

YOU DON’T NEED TO KNOW EVERYTHING TO BE A GOOD HEALTH CARE PROFESSIONAL

Even if you are doing your best to stay informed, there will be times when you’re not sure whether you’re missing something or whether their experiences as a trans person simply aren’t relevant. You don’t need to know everything. But…

You need to be willing to admit when you don’t know something.

You need to do the work to learn what you need to know when you identify a gap in your understanding or knowledge.

And you need to be able to find the information you need and assess whether the source is reputable, scientifically based, and whether it holds bias (hint: there is always some bias if it is a scientific source so it’s important to be aware of it).

TRUST THE PATIENT

Trans people’s experiences are incredibly nuanced, intersectional, and often very internal. You cannot judge what a trans person (or anyone, really) is struggling with internally by looking at them. Therefore, you cannot judge what care would be best without first understanding and accepting what they are telling you about their experiences, struggles, joys, and desires.

It is your patient’s job to be as honest with you as they think is safe and necessary in order access the care they need. Sometimes this involves misrepresenting their identity or hiding parts of their medical history. The more informed you are and the more respectful you are, the more likely your patient will trust you, the more honest they are likely to be with you, and the better the care you can provide.

Don’t question their lived experience because it is outside your area of experience or expectation. Trans people are not exaggerating when they describe the systemic barriers they face such as long wait times, repetitive updates and submissions of forms, lack of appropriate processes for changing legal documentation, etc. You can be shocked and disgusted that that is the way the system is but unless you have your own lived experience of navigating these barriers with a trans person and have found a way around or through them, you have no right to argue against them, suggest that they are doing something wrong, or simply haven’t tried hard enough.

TRANS PATIENTS ARE STILL PATIENTS

At the end of the day, trans patients are still patients. If you’re not sure how to proceed, draw on your clinical knowledge and treat the patient in front of you, not the trans patient you are assuming they are.

Don’t know whether the testosterone that a trans patient is taking may be relevant to the reason you are seeing them? Go back to the basics. What affects does testosterone have on a human body? What body systems might it affect? Are these relevant to your patient’s current concerns? You can follow a similar thought process for any component of trans experience or medical care.

If you think something might be relevant, explain your reasoning to the patient in terms they would understand and ask some clarifying questions. If you’re still not sure, make a note of it and move on to the next part of your assessment. Then, before you see the patient for their next visit, learn more about it.

As with any patient, consider the whole health of the patient, mental health included. If there is a component of their trans identity or trans specific medical care that you are worried is causing concern for other aspects of their health, consider ALL the consequences of interrupting that behaviour or medical care before making a recommendation.

Often, trans people have to compromise their physical health and wellbeing in order to protect or maintain their mental health and wellbeing enough to function in society. If you then suggest that they change their behaviour in order to protect or improve their physical health, that change could cause significant damage to their mental and emotional health (which is much harder to get help with and recover from). So, before making any recommendations, ensure that you understand the patient’s reasons for engaging in that behaviour or pursuing that avenue of medical care. You may not be seeing the big picture, or your version of the big picture might be different from your patient’s.

WHERE TO GO FROM HERE

I hope this has helped clarify a few things and point you in the right direction. Simply by reading this, you are already showing you are a better health professional to trans people than the majority. That is how low the bar is. Please help raise it.

Below you will find recommended resources. These are a place to start, not a sum total of what you need to know. If these links are outdated or broken, please let me know. I will try to keep it up to date. But again, if you are a health professional, you have the skills to find these resources on your own.

Beyond these links, how are you supposed to learn more about trans people (or other minority groups that differ from your experience)? Here are a few options:

  • Talk to a trusted friend or family member who is trans (or other minority) outside of a professional-patient relationship
  • Read descriptions of trans experiences written by trans people (such as this blog)
  • Attend a lecture or other learning opportunity presented by a trans person
  • Pay a trans person to provide education to you and your staff or assess your clinic/practice on the basis of trans inclusion

Reach out if you are struggling to find specific resources. If you are a trans person and would like to add suggestions to this post for how health professionals can be trans inclusive, please leave a comment!! The more experiences and voices the better.

REFERENCES AND RECOMMENDED RESOURCES

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