Our Patients Deserve Supportive, Gender-Affirming Care

The slope that ends in health inequities begins with our own unconscious bias.

Published in Hopkins Medicine - Spring/Summer 2023

Before I was a nurse and a lawyer, I was an officer in the U.S. Navy. When I accepted that my own gender identity didn’t align with the sex I was assigned at birth, it put me on a very different path. While I had to put away my uniform, it didn’t end the obligations I undertook when I swore my oath when I was first inducted into the Naval Academy and then when I was commissioned in 1985. Fulfilling that oath requires me to act when people are denied access to health care or endure the negative impacts of the social determinants of health simply because of others’ willful ignorance and bigotry. Those harms offend the notion that all of us are protected equally and entitled to the same rights and obligations in our society.  

In 2023, it’s even more important to be able to give supportive and affirming care when the context in which we provide that care has changed. This year alone, almost 500 anti-LGBTQ+ bills have been introduced at the state and federal levels. These efforts reflect the toxic mix of religiosity, politics and non-evidence-based policies that negatively impact the health of individuals and communities, particularly transgender youth who already face great vulnerability.  

 The slope that ends in health disparities and health inequities for transgender communities often begins with our own unconscious bias. A few of the fundamental take-aways that every practitioner working with transgender patients should know are: 

• Be authentic and apologize when you screw it up: Treat every patient with the dignity and respect you would want when you or your loved one seeks care. You might use the wrong name, the wrong pronoun, or ask a question using all the wrong words. When it happens, make a genuine apology. Then, pay attention and don’t make the same mistake twice. 

• Don’t make assumptions about someone’s gender or gender identity based on what you see or how they sound:  Don’t call someone “Mr.” or “Miss/Ms./Mrs.” based on your perception of their gender expression. Show respect in the tone of your voice and your nonverbal communications. 

• Use the appropriate name and pronoun: Ask the patient how they would like to be addressed and what pronoun to use. When they tell you what to use, then use them. Remember that not every patient identifies as male or female — they may identify as nonbinary or genderqueer or some other term. They may ask you to use a gender-neutral pronoun or use “they” as a singular pronoun. 

• Ask an appropriate question, at the appropriate time, in an appropriate way: The way to ask about sexual orientation and gender identity is in a straightforward manner like asking any other demographic information. “What’s your sexual orientation/How do you describe your sexual orientation?” and, “What’s your gender identity/How do you describe your gender identity?” Allow the person to use their terms or description rather than giving them a label to choose.  

• Avoid “Transgender Broken Arm Syndrome”: Transgender people experience illness or injury like anybody else. We know how to treat a broken arm; there is nothing different when a transgender person breaks theirs.

We live in a time when there is much willful ignorance, intentional misrepresentation of data and intellectual dishonesty about the science that underpins providing evidence-based, medically necessary, gender-affirming care. As professionals, we must ensure that policymakers, legislators and jurists make decisions based on the evidence and the science and not on emotion and fear-mongering. Our code of ethics demands it and our patients deserve it. 

A longer version of this article originally appeared on closler.org, a free and open access medical education website.