ransgender and gender diverse people are one of the most at-risk populations in the United States. Trans people earn less, are less likely to be in jobs with health care coverage, and face significant socioeconomic barriers in housing, education, and mental health.¹ All of these issues are even more prevalent for trans people of color.² Because of these adverse social determinants of health, trans people are more likely to suffer from serious health conditions. Researchers have also found that trans people often delay or avoid routine care because of fear of discrimination from the clinical team.³

It’s important that we deliberately build trust with transgender and gender diverse patients to combat discrimination and to support improvement of their health outcomes, both for routine care and for interventions like hormone therapy and surgery. By learning the appropriate terminology and simple strategies for better communication, we can demonstrate respect and inclusivity.

Who is the LGBTQ+ population?  

Our patients are placing their trust in us. By investing our time in grasping basic terminology and understanding sexuality, gender identity, and gender expression, we can promote a safe, affirming environment for all patients. 

Know the terminology

Quality of care relies heavily on open communication by both patients and providers. Let’s establish a basic understanding of the common LGBTQ+ terminology.  

Try not to think of these terms as labels you would apply to someone, but more as some of the ways that patients will self-identify. 

Just as health care constantly evolves, so too does terminology. Understand that as people reclaim identities, terms may change. View and download a pdf of updated terminology here.

Understand sexuality, gender identity, and gender expression 

While these three terms are frequently confused, the distinctions between them are very important. 

In order to differentiate between sexuality, gender identity, gender expression and biological sex, let’s take a look at the Genderbread Person below.

Note that individuals’ gender identity or expression do not indicate their sexual orientation or sex assigned at birth and vice versa.

What you can do: Best practices for exceptional care

#1: Embrace cross-cultural care 

Cross-cultural care focuses on the ability to communicate effectively with patients from diverse backgrounds. These three principles of cross-cultural care can help you create a safe space for your patient:

• Respect: Live by the golden rule and treat your patients as you’d want to be treated. 

• Curiosity: It’s okay to be curious; we’re only human. Before you ask a question, put yourself in the patient’s shoes, and appreciate that they’re likely feeling vulnerable and apprehensive. Make sure your questions are medically relevant and respectful.  

• Empathy: Establish rapport with your patients by asking appropriate questions, and encouraging open discussion based on mutual trust.

#2: Ask for pronouns and document appropriately in Epic

While we often don’t think twice about assuming people’s pronouns based on physical appearance, it’s important to recognize that pronouns don’t always parallel an individual’s appearance or gender identity. Misgendering, or using someone’s incorrect pronouns can be harmful even if unintentional. We can all recognize the conventional pronouns, but when it comes to gender-neutral pronouns like “they/them/theirs,” and “ze/zir/zirs,” many of us are still in the dark. 

Although it might seem counter-intuitive to use “they/them/theirs” as a pronoun for an individual, it’s actually a good, safe gender-neutral pronoun. In the event that somebody provides you with pronouns that you're not familiar with, it’s okay to ask them things like "How do you spell it? How do you pronounce it? What is the best way to use it in subjective and objective as well as possessive and reflexive?" As important as it is to ask a person's pronouns, it's equally important to use the pronouns they give you. It’s also ok to make a mistake. If you do, apologize, correct yourself and move on.  

One of the biggest ways we can respect and support our transgender and gender diverse patients is by documenting their chosen names and pronouns in Epic. Many times, these individuals’ legal identification doesn’t align with how they self-identify. By documenting their information appropriately, you’re respecting their identity and setting a precedent on how our clinics should treat all patients.  

#3: Create a welcoming environment 

Simple gestures, like signs of affirmation and acceptance (a pronoun pin on your badge, a rainbow sticker, etc.) or magazines and pamphlets that represent the patient population go a long way. Think about the details, like the paperwork you hand out. Design paperwork that is inclusive, not exclusive, by including space for chosen names, sexual orientation and gender identity. 

#4: Know where to refer a patient for more resources

The gender journey of every patient is unique. Although some people who identify as transgender or gender diverse desire to medically transition, not all do. It’s important as health care providers to not assume what someone’s journey might look like but to be aware of the services offered to patients.

We’re here to help—contact the U of U Health Transgender Health Program. 

#5: Expand you and your staff’s competency 

Sharing resources, like this article, and continuously building skills is an investment in your staff. 

Remember that you don’t have to be an LGBTQ+ health care expert—you don’t have to read every book or attend every training session. Here are some basic tips to improve communication with patients:

Originally posted October 2020