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Healthcare Considerations of the Transgender Patient

October 14, 2021
October 14, 2021

Defining Transgender

Being transgender (also referred to colloquially as ‘trans’) involves special considerations when it comes to healthcare. According to GLAAD, transgender is an “umbrella term for people whose gender identity differs from the sex they were assigned at birth.” However, every person within this category may choose to describe themselves differently, and not use the term transgender at all. That makes it very important to “Use the descriptive term preferred by the person. Many transgender people are prescribed hormones by their doctors to bring their bodies into alignment with their gender identity. Some undergo surgery as well. But not all transgender people can or will take those steps, and a transgender identity is not dependent upon physical appearance or medical procedures.” Planned Parenthood reminds readers that “Transgender people have the same basic health care needs as cisgender people. They also have health care needs related to their transition and require competent care.” If healthcare industry is going to foster diversity and inclusion and eliminate bias, providing quality, affirming quality healthcare of the transgender patient population is an important component of this commitment. 

Healthcare challenges for the transgender population  

The Commonwealth Fund offers that "The approximately 1.7 million trans people in the United States face significant hardships that increase their risk of poor health outcomes. First, two of five (39%) report having low incomes (i.e., earning less than $30,000 a year per household), which can have negative effects on health. In addition, trans people are more likely than the general population to face discrimination in education and employment, abuse by the police, harassment in public spaces, and physical, verbal, and sexual assault. Nearly all of these issues are worse for trans people of color." Being transgender comes with health challenges related to their status, for multiple reasons, including "the toxic stress of living as a trans person in America." The same source tells readers that "Trans people are more likely than their cisgender counterparts to report poor physical health, experience mental health issues like anxiety and depression, and have substance abuse problems. Forty percent have attempted suicide, compared with 4.6 percent of the general population."

Transgender access to healthcare

Planned Parenthood states that "Accessing health care can be challenging for transgender people. Not all nurses and doctors are sensitive to trans issues or informed about the health care needs of transgender people." In addition, when treating transgender patients, some might feel uneasy with revealing a gender identity, sharing the wish to transition medically, or even undergoing a physical examination. The Commonwealth Fund reminds us that "Transgender people often face barriers to getting the health care they need. One of five transgender adults is uninsured. Trans people often skip health care because of cost: nearly half (48%) have postponed medical care when sick or injured and avoided preventive care (50%) because they couldn't afford it." Imagine the potential suffering involved when "Trans people often hide their gender identities from health providers out of fear of retaliation and harassment. Only 40 percent of trans people report being out to all their medical providers. It's understandable that many would want to conceal this information: 28 percent of trans people report experiencing verbal harassment in a medical setting and 19 percent report having been refused medical care by providers because of their gender identity. Because of stigmatization and harassment, 28 percent of trans people report avoiding care altogether."

Best practices for nurses providing transgender care

The Commonwealth Fund also offers that half of transgender patients "report having to teach their medical providers about transgender individuals' health care needs and appropriate medical care. Lack of awareness on the part of medical providers—in part because of lack of training—has serious implications for care quality. Moreover, when people veil their identities in medical settings, their providers miss important information that should inform screening, diagnosis, and care." Clinicians need to understand what can happen for transgender patients experiencing hormonal imbalances as well as other issues connected to their identities.

Nurse Journal offers the following 7 suggestions for creating a more supportive healthcare environment when working with transgender patients:

  1. Understand and respect a patient's body privacy. Physical details should not be mentioned unless relevant to a patient's care.
  2.  Communicate in a way that does not distress your patient. Direct questions should be relevant to care Never make assumptions.
  3. Make note of your patient's pronouns and preferred name. Ask about pronouns before addressing a patient. Introduce yourself by stating your own preferences. Get clarity on name usage.
  4. Be mindful when filling out healthcare forms. Ask "the patient what the name on their insurance is and confirming their date of birth and address, then continuing to address them by the name they originally provided."
  5. Update your organization's patient intake forms to include transgender and gender non-conforming (GNC) options.
  6. Administer care to the whole person. An approach to use is to "consider a patient's transgender or GNC identity within their larger cultural, emotional, physical, and psychological being."
  7. Advocate on behalf of your patients. Speak up immediately when you witness misgendering or transphobic speech. Be a patient advocate "on issues like gender confirmation surgery and fertility treatments."

Create an inclusive culture to manage and address equity

A workforce and organization that understands the importance of recognizing unconscious bias, diversity in the workplace, cultural competence, and health literacy not only improves peer-to-peer and caregiver-to-patient relationships, but also has the power to influence your organization's culture, place in your community, and bottom line. Explore HealthStream solutions that support healthcare workforce diversity and inclusion.