10 ways for healthcare providers to be a better ally to transgender and non-binary people

Photo by Zackary Drucker as part of Broadly's Gender Spectrum Collection. Credit: The Gender Spectrum Collection.
Photo by Zackary Drucker as part of Broadly's Gender Spectrum Collection. Credit: The Gender Spectrum Collection

1. Check in with yourself.

We all have biases, assumptions, and stereotypes about gender with room to grow. What are yours? What are your beliefs about gender identity? What were you taught about gender growing up? When did you know you were a girl or a boy, a woman or a man? What does it mean to be a man or a woman to you?
What are your beliefs about transgender people? How about non-binary people? What stereotypes were you taught? How does it affect how you interact with trans and non-binary patients?

2. Educate yourself.

Learn about the trans and non-binary community. Learn about their long history. Attend conferences, workshops, online training, and coursework. Read books and journal articles and keep up to date on local, state, national, and worldwide trans and non-binary issues.

3. Consider your privilege.

When was the last time people acted with surprise when you revealed your sex assigned at birth or gender? When was the last time you were stared at or sneered at by strangers? Have you ever been called the wrong name for you in the waiting room attached to a “miss” when you are a mister? When was the last time this happened, and everyone turned to look at you?

When was the last time you had to explain something in your medical history that had nothing to do with the current reason you were there? For instance, perhaps you had a yeast infection three years ago, but right now, you’re there for the possible flu; however, the provider insists you tell them all about that yeast infection.

What other privileges can you think of that trans and non-binary people might not have? Is there anything you can do to lessen the impact of these differences in privilege?

4. Ask about pronouns.

Make it a best practice to ask all patients what pronouns they use. Many electronic medical records now allow for this to be added to a patient’s chart, allowing everyone on the care team to know how to refer to them correctly.

If that sounds daunting, use a stepwise process. Start first by introducing yourself to every patient with your own pronouns.

"Hi, my name is Alexander Gilmer, and I’m a pharmacist. I use he/him/his. I’m here to talk to about your medication, would that be ok?”

Likely most non-trans or non-binary people will miss that you even mentioned your pronouns, BUT your trans and non-binary people will not have. Starting the conversation with your pronouns can open up the conversation in ways it wouldn’t have been otherwise.

Once you feel comfortable introducing yourself with your pronouns, start introducing yourself with your pronouns, then asking the patient’s.

“Hi, my name is Alexander Gilmer, and I’m a pharmacist. I use the pronouns he/him/his, what pronouns do you use?”

Some patients will not understand why you are asking them this or even what the question means. For the most part, that usually means they are not trans or non-binary. If they are trans or non-binary and they bristle at this question, use the pronouns that match their gender presentation (i.e., if they’re dressed feminine, use she/her and vice versa). Either way, a simple explanation of why you’re asking the question can be helpful.

“I’ve learned I can’t tell someone’s pronouns just by looking at them, so I ask all my patients.”

5. Listen.

Listen to how people refer to themselves. Listen when they tell you their pronouns and their name and then use them.
Listen when trans and non-binary people are speaking their truth. Believe them when they discuss how something feels for them or what their experience has been.

When a trans or non-binary person decides to tell you their story, recognize this is a privilege. It can carry a lot of weight and be a very daunting thing to do. Ask them questions but understand they may not want to answer some or any of your questions. Respect that desire.

6. Advocate.

Advocate for trans and non-binary people, especially when they are not in the room. If you hear someone being derogatory or discriminatory, speak up. If you hear someone use the wrong pronouns, speak up. It is EXHAUSTING and disheartening for trans and non-binary people to continually have to correct pronouns.

Advocate for policies that address trans and non-binary issues. Advocate for and use inclusive language. Try they/them instead of gendered pronouns, partner instead of husband/wife, people or patients instead of men or women. Try people who menstruate rather than women when discussing periods.

7. Don't ask patients what their "real" name is.

What they’ve already told you is their real name. If you need a legal or administrative name for medical or billing purposes, ask using those terms. Or ask if they could be under a different name in the system.

Otherwise, consider why you need or want to know that information.

Some trans and non-binary people love the name they received at birth, but for many, it is a reminder of a painful time or a time when they felt invisible. When a trans or non-binary person chooses to use another name that is different from the name given at birth, the old name may be referred to as their deadname. By using that old name, you are deadnaming them and essentially erasing their identity.

Imagine if someone decided to call you by a name that wasn’t your own, especially if it was a name typically thought of as a gender you are not (Abby if your name is Mark). Names are extremely important, regardless of whether you are trans or not.

Remind others of this as well.

8. Unless necessary to their current visit or to update their chart, do not ask about surgeries they have or have not had.

Historically, medical providers have made it a practice to investigate trans bodies, often without consent. It is not uncommon, even today, for entirely inappropriate and unnecessary questions or procedures to be asked or performed. Some of these questions or procedures can be quite invasive.
Consider why you are asking the questions. Is it necessary to their care to know all about their vaginectomy or to examine their top surgery scars, if they’re seeing you about a broken bone?
If you do need to ask about their body and surgeries, ask for permission, and explain why it’s important.

 

“It’s important that we have current information about your medical health, is it ok if I ask some questions about your body and any possible surgeries you’ve had?”

Remember, patient care is a contract between you and the patient. One that, unfortunately, has been broken with a lot of marginalized communities, including the trans and non-binary community. For this reason, trans and non-binary patients can be very hesitant to discuss their histories or bodies with providers.
The more you build trust with your patient, the more honest they will be with you and tell you everything you need to know to provide the best care possible.

If you are interested in the surgeries that are available to trans and non-binary people, especially if you are a medical provider, research them yourself. There are a lot of excellent resources available online.

9. Remember there is no one way to transition.

There is no right way to be trans or non-binary. There is no right way to transition, and for everyone, it will look different. Some trans and non-binary people will only change their names and ask others to use different pronouns. Some will want to medically transition with hormone replacement therapy (HRT) and/or surgery.

These choices are very individual and are made for a lot of reasons. Some may not be able to afford hormones or surgeries. Some may not feel the need to alter their bodies to line-up with the gender they identify or may not feel the benefit of doing this outweighs the risk associated.

Some patients will want to just go on HRT but never feel the need to have surgery. Others may need surgical intervention but not wish to be on HRT.

None of these choices make them any more or less trans or non-binary.

10. Realize there is no one trans or non-binary narrative.

In the past, a trans narrative was developed by medical professionals. To receive treatment, trans and non-binary people had to express that they’d known they were the opposite gender since childhood, they wanted to do everything possible to “pass” (not be visibly trans), and that they felt a heterosexual attraction to the opposite gender once they had transitioned.

While it is now known that none of those three things are true for everyone, it is still a narrative that both providers and the community continue to propagate, thus complicating the situation for all involved.

Many trans and non-binary people have known since childhood that they were a different gender identity than the one they were assigned at birth. Most never had the vocabulary to voice this; thus, many trans and non-binary people come out in early adulthood or later (when they gain more access to different experiences).

However, some trans and non-binary people do not come to this realization (that their gender does not match the one they were assigned at birth) until significantly later in life for a variety of reasons. This does not make them any less trans or non-binary.

Some people fully transition to the “opposite” side only to realize they are more comfortable somewhere in the middle or even outside of gender altogether. Other’s gender fluctuates from day to day or situation to situation. Still others come out as non-binary, but then come to realize they are really more predominantly masculine or feminine (i.e., more closely trans men or trans women).

Additionally, gender is understood differently in many non-white cultures. Gender variance may part of society in a completely different way than what we see in white cultures. What we may interpret as gender variant may not be gender variant at all in another culture. Just as gender expectations and expressions have changed over time, they also differ between cultures.

There are a lot of ways healthcare providers can be better allies to the transgender and non-binary community. These 10 are a great start. If you are interested in educating yourself more, check out the following resources.

What are some ways you are an ally to your trans and non-binary patients?

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Alexander Gilmer

Alexander is a trans activist, educator, and consultant who specializes in transgender and non-binary healthcare. Connect on Facebook!

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