Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Caring for transgender and gender-expansive patients, Part 2


Transgender and gender-expansive patients often feel uncomfortable in healthcare settings and avoid care. Be sure to use every patient’s chosen name/pronoun and take care not to misgender.

Knowing the current awful environment regarding transgender and gender-expansive (TGD) healthcare, it’s reasonable to ask, “What can I do to improve this?” Here are actions every practitioner can take to improve their ability to create a safe, welcoming, affirming environment:


1. Use their chosen/affirmed name and pronouns; don’t misgender.

Cisheteronormative bias is an unconscious bias grounded in the incorrect belief that all people are, or ought to be, heterosexual/straight and cisgender. Don’t assume someone’s gender based on their appearance (gender expression) or the sound of their voice. Instead of using “Sir/Ma’am” or “Mr./Ms./Mrs.” reflexively based on a guess about someone’s gender identity, ask people for their chosen name and pronouns. And then use them.

Consider introducing yourself like this: “Hi, I’ll be your [role] today. My name is [your name] and my pronouns are [your pronouns]. How would you like me to address you? What are your pronouns?”


2. Avoid “Transgender Broken Arm Syndrome.”

“Transgender Broken Arm Syndrome” arises when we fail to see that TGD patients are just like everyone else and have the same health needs as any other human being. A TGD person’s health is not solely defined by their gender identity.

How this plays out in practice: a reflexive loss of general competence when caring for a TGD patient, such as, (1) “I can’t take care of you; I was never taught how to take care of a transgender person.” (2) An inordinate focus on a patient’s TGD status or their transition status. This often involves inappropriate questioning about any gender-affirming surgery, particularly the status of the genitals that has no relation to the clinical presentation or reason for the appointment. (3) Attributing every clinical presentation’s cause to any hormone that the patient may be taking for gender-affirmation.


3. Utilize a trauma-informed approach to care.

We often don’t know the lived experience of our patients and how physical or psychological trauma may have impacted their health. When completing an examination or asking questions, tell patients what you are going to do / why the exam or information is important and give them an opportunity to decline. Know that chest and genital physical examinations may be particularly traumatizing for some TGD patients and that use of anatomical terms for the chest/breast or genitals may cause some TGD people psychological distress by exacerbating gender dysphoria/incongruence. Ask the patient if they have terms that they use to describe their anatomy (and then use them).








This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.