Transgender Education for Healthcare Providers

Written by Allison Scott

Caring for Transgender Patients

Nurses work with a wide array of people every day and are focused on providing the best care possible for their patients. They play a central role in the healthcare industry, whether that means getting an extra pillow, taking vitals, or communicating with other medical professionals.

They also are tasked with providing ethical and unbiased care to all individuals, including the culturally sensitive care of transgender patients. Anyone seeking treatment deserves the same respectful and compassionate experience, but healthcare workers should be aware of the specific needs of their transgender patients to provide them with equitable care.

Being informed about the transgender community and how the healthcare industry has impacted gender-diverse people is undeniably essential in caring for transgender patients. There are nuances and biases that all providers should be aware of because they shape the lens through which patients view the healthcare industry, and negative experiences can create a barrier to receiving care.

Here are a few things to remember when treating a gender-diverse patient to ensure they receive efficient, effective, and respectful care.

Understanding the Transgender Community

In the United States, roughly 1.6 million people identify as transgender. That is about 1.3 million adults and 300,000 of those ages 13 to 17. That equates to 1.3 million adults and 300,000 people between the ages of 13 and 17—approximately 0.5% of the adult population and 1.4% of the youth population. A substantial number of them will require medical care.

Being transgender is when a person's gender identity does not match the sex they were assigned at birth. Sex refers to the physical characteristics a person is born with, including reproductive organs and hormones, while gender refers to a person's social and cultural identity. Gender identities are internal, and may fall into the social norms of masculinity or feminity —also known as a binary approach to gender—or a non-binary identity.

Non-binary people do not fall into either social category and may identify as neither man nor woman, fluctuate between the two, have multiple gender expressions, and more. While their sex assigned at birth will be part of their anatomy unless they undergo gender-affirming medical care, nurses and other medical professionals must understand the difference between sex and gender.

There are specific healthcare considerations that the transgender community requires, and continued education and attention from nurses and other providers are paramount to their health and well-being.

Gender-Diverse Patients and Healthcare Avoidance

Unfortunately, it is not uncommon for those in the transgender community to avoid seeking medical care. This can happen for many reasons, including:

  • Discrimination: Bad experiences in their past may lead transgender people to avoid medical appointments to prevent having another bad experience. One study by the U.S. Transgender Survey found that one-third of transgender patients had a negative experience related to being transgender, including being verbally harassed or having to educate their healthcare providers on gender identity to receive proper care.
  • Denial of care: More than just a bad experience, some transgender people are denied medical care because they are transgender. This makes it challenging to pursue medical treatment, even when it is vital to their health and well-being.
  • Inadequate care: When a transgender person seeks medical care, it can often be subpar. Insufficient care happens if their concerns go unaddressed or medical professionals lack the knowledge to treat them.
  • Anxiety: Bad experiences are shared more often than good ones, so transgender people may have been made anxious by hearing the negative experiences of others.

Regardless of the reason, healthcare providers need to be able to offer a welcoming environment to all patients, including those who identify as non-binary or transgender.

''Transgender Broken Arm Syndrome''

Needing immediate medical attention is never a pleasant situation. Patients have to endure pain and discomfort, not to mention the fear of what might happen or how things could go wrong.

But the transgender community faces distinct challenges in healthcare. One is ''transgender broken arm syndrome''—a phenomenon in which a healthcare provider cannot see past a person being transgender and assumes all medical concerns are directly related to their gender identity or expression.

This syndrome can be conscious or unconscious, making it difficult for some to identify. However, this can be extremely problematic for the patient's health. Honing in on one aspect of a patient and being fixated on it as a root cause can distract healthcare providers from giving a prompt, correct diagnosis.

For nurses, it is essential to provide equitable care to every patient regardless of race, gender, or any other characteristic. That means asking the right questions to understand their needs, communicating with them about what is going on, and completing all appropriate tests for the situation.

This intentional action to give equitable treatment to everyone can ultimately lead to more confidence in receiving a positive healthcare experience for the trans community.

Gender, Sex, and Healthcare

When treating a transgender patient, it is important to keep a few things in mind. Notably, transgender people may not have a listed legal gender that matches their body or identity, and their forms of identification may also not be accurate for their body or identity.

Of course, this information is critical for providing the best care possible because it is vital for nurses and doctors alike to know as much about their patients as possible. This enables healthcare providers to assess the most appropriate course of action to resolve the symptoms and or concerns of the patient.

Remember, too, that healthcare and a person's gender identity or sex at birth are interconnected. For example, a trans man visiting an OBGYN for healthcare procedures like Pap smears and breast exams may feel ostracized if their gynecologist is discriminatory or insensitive, even though these regular physicals are necessary for his well-being.

A patient's gender identity is part of who they are as a person, so being respectful and inclusive in the care provided is incredibly important across the board, especially for those in the trans community.

Healthcare Issues in Transgender Patients

It is a best practice for people to get routine healthcare checks on an annual basis to monitor their health. Things like dermatology exams, yearly physicals, and eye exams can help catch serious health concerns early and make getting the necessary treatment much easier and more effective.

However, transgender people have heightened healthcare risks that nurses and other medical professionals must be aware of, whether physical or mental health-related. The impact of these risks has the chance to shape the livelihood of trans people and can drastically influence their quality of life if left untreated.

Remember that medical care needs can vary from person to person and it is recommended to consult the relevant professionals in different specialties before diagnosing or assuming medical conditions. The following risks are necessary for nurses to know and are updated on to provide the best care possible for trans patients.

Mental Health Risks

Mental and physical health are intertwined, and a high percentage of mental health conditions in the transgender community makes it even more of a concern. One study published in Transgender Health found that 31% of transgender people had a major depressive diagnosis, and 12% were diagnosed with general anxiety disorder, approximately six times higher than the cisgender control group.

In addition to anxiety and depression, trans people experience eating disorders, substance abuse, and suicidal ideation at higher rates than the general population. This could be due to a number of factors, including:

  • Social ostracization: Lack of representation and acceptance of trans people in society can lead to feelings of being othered. This can lead to mental health conditions because it can cause a person to feel like an outsider.
  • Poverty and job discrimination: Although it is illegal to discriminate, it happens. And transgender people are at risk of being discriminated against in the workforce and, therefore, may experience poverty. This can cause a lot of stress and negatively affect their mental health.

Knowing the causes of the high rate of mental health conditions within the transgender community makes it much more consequential to be supportive and inclusive as a nurse.

Gender-Affirming Treatment

While not applicable to every person in the transgender or gender non-conforming community, some will pursue various forms of gender-affirming medical treatment.

Some medical treatments for transgender people may include:

  • Hormone therapy: If a person desires to have their physical body better align with their gender identity, they may opt to go the hormone replacement therapy route. For a transgender man, this treatment is used to increase testosterone and promote masculine characteristics. For a transgender woman, this treatment is used to increase estrogen and develop more feminine characteristics.
  • Gender-affirming surgeries: Separate from hormone therapy, or in addition to it, transgender people may elect to get gender-affirming surgeries. This can include:
    • Facial reconstruction: This surgery allows people to appear more masculine or feminine and align with their gender identity.
    • Chest surgery: Often referred to as ''top'' surgery, this procedure makes it possible for trans men to reduce their chest size and for trans women to enhance their chest size.
    • Genital surgery: Often referred to as ''bottom'' surgery, this procedure reconstructs the genitals of a transgender person.

Some people may know exactly what they want, and others may request input from medical professionals to help influence their decision. Remember to share options respectfully and stress the importance of their personal choice and feelings in the decision.

Cancer Risks in Transgender Patients

Another risk to keep in mind is the disparity in cancer diagnoses and treatment in transgender patients. Due to several factors, including a lack of access to healthcare and the prevalence of discrimination within the medical industry, transgender people are at an increased risk of being diagnosed with late-stage cancer.

Some disparities in the risk of cancer among transgender patients include:

  • Breast cancer: While it is possible to get breast cancer regardless of sex, it is more likely for a person assigned female at birth to be diagnosed. This is primarily due to the steps taken to catch breast cancer in women through breast exams and mammograms. However, transgender men and women may not get regular breast exams or have access to the necessary tests to diagnose early.
  • Testicular and prostate cancer: Although testicular and prostate cancers are only present in people assigned male at birth, it is possible for transgender women not to be adequately tested for these diseases. Like breast cancer, this can delay diagnoses and allow cancer to spread, which makes treatment that much more challenging. One study based on information from the National Cancer Database found that transgender patients with prostate cancer or bladder cancer could be twice as likely to die than cisgender patients with the same diagnosis.

Keep this in mind when treating transgender patients to ensure the proper testing and preventative exams are made available.

Transgender Parenthood and Reproductive Healthcare

Another healthcare concern for the trans community is parenthood and reproductive healthcare. Out of a desire to become a parent, transgender patients may wish to preserve their eggs or sperm before undergoing hormone replacement therapy or gender-affirming surgeries.

However, there can be challenges for transgender people pursuing parenthood. Specifically, transgender men who become pregnant can experience discrimination, harsh societal judgment, and issues obtaining the necessary medical care.

As a healthcare provider, it is best to speak openly and honestly with patients who identify as transgender to respect their wishes to receive reproductive healthcare while also looking out for their best interests medically. Explain the possible risks or complications, including any limitations resulting from a lack of research. However, also try to maintain an encouraging and respectful tone to balance medical opinions with what the patient wants.

Parenthood is a new phase of life that impacts everyone differently. With substantial personal, physical, and financial responsibility, it is a decision that requires planning and dedication to feel confident and successful. Of course, it is a personal decision that everyone has the right to decide for themselves. Therefore, not passing judgment or trying to deter anyone is vital.

Caring for Transgender Patients: Diversity and Inclusion

Creating a safe environment for transgender patients in a medical facility is paramount to making a space feel inclusive. Establishing a safe and encouraging space for people of all gender identities can help make sure they receive the best care possible.

Seeking out inclusive information and best practices is one of the most significant ways nurses can approach caring for transgender patients' diversity and inclusion. Being mindful of the language used to speak to the patient and the appearance of the medical facility can be an impactful way for nurses to be more inclusive and welcoming.

Furthermore, continually seeking out information about the trans community and reviewing medical research pertaining to trans people can improve feelings of inclusion.

These efforts come together to build confidence in a medical field that does not always feel inviting. Remember to keep these efforts in mind when working with patients, especially those belonging to trans or non-binary communities.

If you're working towards becoming a nurse, check out our NCLEX exam resources for help towards passing your licensure tests!

Using Gender-Neutral and Gender-Affirming Language

A big part of being in the medical field is interacting with people. As such, speaking in a way that supports, encourages, and validates people is imperative. Gender-neutral and gender-affirming language is one of the best ways to do that.

Medical terms are typically geared toward a binary approach to sex and gender, but that does not mean adjustments are impossible for nurses and other medical professionals regarding the transgender community.

Using gender-affirming language that validates how a person identifies and respects how they choose to present themselves goes far in building an inclusive, positive environment. A few examples of this are:

  • Preferred names: Many people in the trans community will no longer identify with their birth name and choose instead to have a different name that better fits their gender identity. Their old name, often referred to as a ''dead name,'' may appear on medical documents or official documentation, but using their preferred name is the best way to respect them and their preferences.
  • Pronouns: Similarly to preferred names, pronouns are also a large part of gender identity. Asking someone about their preferred pronouns and using them is another way to be inclusive.

Even the terms ''mother'' and ''father'' can be binary and lacking inclusion, so make a note to refer to trans men with children as fathers and trans women with children as mothers, too.

Creating an Inclusive Space

Healthcare professionals can provide a more supportive, meaningful experience for their patients if their medical care facility feels inclusive. Seek out ways to encourage inclusivity by:

  • Using pronouns: On badges or name tags, include pronouns to provide a non-verbal cue that the medical facility is inclusive. This can also encourage patients to share their pronouns because it is seen as the norm in the office.
  • Choose inclusive decor: Medical offices often feature inspirational posters, informative pamphlets, and other resources for their patients in the waiting room or exam room. Take advantage of this common practice and make it more welcoming by adding an LGBTQ+ or trans flag, an encouraging message that reads, "Everyone is welcome here," or something similar.

Although these efforts may feel small, they can make a massive difference in helping all patients feel comfortable, encouraged, and included when seeking medical care.

Transgender Education for Healthcare Providers

Like almost everything else within the medical field, continued education is critical. Through training, seminars, and following recent research, transgender and LGBTQ+ education for healthcare providers can help nurses have more confidence in fulfilling their day-to-day job requirements.

One of the best ways to encourage transgender education for healthcare providers is by regularly seeking out information. Reading articles, surveys, and even non-medical findings about the transgender community can help nurses better understand their patients. As time passes, more medical revelations come about, and more value can be brought to patients as a result.

Even talking with other nurses can help. It can be beneficial to share learnings from recent medical research, discuss inclusivity in the workplace and healthcare, and continue the conversation to normalize it as part of medical care.

Staying updated on transgender issues, specifically the community's medical concerns, can help nurses better understand their patients and their experiences. In turn, the result will be better healthcare and the ability to live healthier lives.

The Importance of Further Research

Unfortunately, the medical research field severely lacks transgender health studies and analyses. This can make treating transgender patients difficult because there are medical unknowns regarding the proper steps to take. It can also reduce the confidence of nurses and other healthcare providers because the risks of recommending the incorrect treatment plan are higher due to a lack of information.

As time passes, though, more and more medical research is being conducted to ensure trans people can get the best care possible. Studies are being done to assess the health risks transgender communities face most often and to account for the experiences trans people encounter regularly.

This context is foundational for nurses and other medical professionals to be up-to-date on best practices and the highest quality standard of care for trans patients.

Ultimately, being informed and educated on the needs specific to the transgender and non-binary communities can help make a huge difference in their quality of care and overall health and well-being. Doing so can quite literally change lives.

Frequently Asked Questions

  • What is gender inclusive care?

    Gender-inclusive care is medical care that does not discriminate based on a patient's gender identity or expression and seeks to provide the best care possible.

  • How does being transgender affect healthcare?

    Being transgender can impact healthcare greatly. Many transgender people experience discrimination, refusal of testing they need, and even anxiety about obtaining medical care. All of these can complicate a person's access to treatment and their health overall.

  • How can one provide gender-affirming care?

    Healthcare providers can provide gender-affirming care by communicating pronouns and preferred names with their patients. Seeking out best practices for inclusivity and keeping up with research for all genders can also be helpful.