March 31st is the Transgender Day of Visibility. Here at GW we are proud to support our transgender community, and wanted to share the message that we are here for you. Today is not just about encouraging awareness of the transgender community, but it serves as a call to action for members of the medical community to foster a healthcare system that values and respects everyone’s gender identity.
If you are new to the GW community and are looking for some resources, look no further than our very own Multicultural Student Services Center. They offer not only programming and ways to get involved, but also access to health and wellness resources. As aspiring professionals, or current practitioners within the medical community, it is important to appreciate the difference between gender identity and sexual identity in order to provide appropriate care for transgender patients.
Visibility matters in Healthcare. Transgender patients face unique challenges and barriers, including limited access to gender-affirming care. It is important to know that visibility plays an impactful role in addressing those changes, visibility helps to break down stereotypes and misconceptions about transgender people, which may lead to more empathetic and affirming care. If your practice has transgender-specific treatments or quality of care, be sure to publicize them.
When transgender individuals see themselves represented in healthcare settings, they are more likely to seek out and engage with healthcare services. Remember to acknowledge your patients. Visibility goes a long way toward eliminating stereotypes and misconceptions about transgendered individuals. Doing so can lead to more empathetic and affirming care.
As future healthcare providers, medical students have a unique opportunity to champion transgender visibility and inclusivity. If you are not sure where to begin, a good place to start is to educate yourself: seek out opportunities to learn about transgender health during your medical studies. Attend workshops and lectures, or join student-led initiatives focused on LGBTQ+ health.
Advocate for inclusive policies and practices such as those described by GW’s LGBTQIA+ Community Support, a resource for all members of the GW community.
As always, offer support to those in need. Continued allyship with your transgender peers and patients will foster understanding and a more connected patient community. Listen to their experience, validate their identities, and advocate for their needs within healthcare settings in your school, including the introduction of gender-neutral facilities, the use of inclusive language on patient forms, and training on transgender health for faculty and staff.
Let us commit to creating a healthcare environment where transgender individuals feel seen, heard, and valued. By promoting visibility, fostering inclusivity, and advocating for gender-affirming care, medical students, staff, and faculty can make a meaningful difference in the lives of our transgender patients and contribute to a more diverse and inclusive healthcare system for all.
Trans and gender diverse people often report encountering many barriers to care when seeking health care services. According to researchers, some of these barriers include trans and gender diverse people being uninsured/underinsured, patients having to teach their providers about transgender health, experiencing transphobic discrimination during healthcare visits, and a general lack of healthcare providers knowledgeable about transgender health (Safer et al., 2016; Warner & Mehta, 2021). Citing the 2015 United States Transgender Survey, Warner & Mehta write that “Among the conclusions provided, 33% of respondents seen by a healthcare provider within the year prior to completing the survey reported having at least one negative experience related to their gender identity” (Warner & Mehta, 2021, pg. 3359).
Providing a safe and nonjudgmental healthcare environment is necessary when interacting with any patient. Many trans and gender diverse people report that many of the solutions are relatively simple and will improve the quality of care for everyone. In an effort to continue the discussion on supporting the trans community, particularly in healthcare settings, this article will serve as a follow-up post to our recent article International Transgender Day of Visibility, and provides tips on how to interact with trans and gender diverse patients.
Tips:
Use a patient’s personal name and pronouns: A simple way to make trans and gender diverse patients comfortable is by using their personal name and pronouns. If you are unsure of how to refer to your patients, ask what their pronouns are and how they would like to be referred to. You can also offer your name and pronouns first and offer them the opportunity to share their information. In an article in Healthline, KB Brookins also suggests providers evaluate their intake forms and include information fields such as “Legal name for insurance, chosen name/nickname, sex assigned at birth (if necessary), sex listed on insurance, pronouns, gender identity, sexual orientation (if necessary)” (Brookins, 2022). Consider leaving open fields for people to write in their responses instead of checking off a set number of boxes. Using a person’s correct pronouns and name will build trust between patients and providers and this will encourage patients to return for future appointments.
Do not ask personal questions not related to care: Trans and gender diverse people are subjected to frequent and invasive questioning about their bodies or any medical procedures they may have experienced. This form of questioning is deeply personal and can make trans and gender diverse people uncomfortable. Vermeir, Jackson & Marshall write “Many trans people encounter HCPs [healthcare providers] who ask inappropriate questions regarding their trans identity or bodies, or questions that are irrelevant to their care” (Vermeir, Jackson & Marshall, 2018, pg. 16). To avoid these uncomfortable situations, Vermeir et al. suggests that providers maintain professional boundaries and ask questions that are directly related to the reasons behind a patient’s current visit. “Participants recommended that HCPs remember that a patient’s purpose is not to satisfy one’s interest, and that even if a question is relevant to one’s care, it must be asked with sensitivity and appropriateness” (Vermeir, Jackson & Marshall, 2018, pg. 16).
Learn more about the community from multiple perspectives: Understanding the transgender community allows providers to better understand their patients’ needs and provide a high standard of care. It may seem easy to ask your patients about the history and current state of the transgender community, but some trans and gender diverse people report that they feel burdened when placed in this position. There are organizations, novels, memoirs, historical accounts, and other resources that may serve as appropriate sources of information. Resources will be listed in the ‘Reference’ section. Here is a brief selection of titles:
John Hopkins Center for Transgender and Gender Expansive Health offers healthcare services to transgender youth and adults. Their ‘Clinician Resources’ section also offers “a variety of clinical resources from Johns Hopkins and beyond to help you provide high-quality care to patients” (John Hopkins University, 2023). These resources are an excellent way to learn from other clinicians and providers.
These tips are just a starting point for treating transgender and gender diverse patients with respect and dignity. Vermeir, Jackson & Marshall also suggest that educational organizations broaden the scope of their curriculums to include transgender health and healthcare. The authors say “...we believe that there is also a need for education organizations and regulatory bodies to incorporate this topic into their curriculums and continuing education opportunities to promote HCPs’ cultural competence including an acknowledgment of the power differentials between HCPs and trans patients” (Vermeir, Jackson & Marshall, 2018, pg. 15). Ultimately, healthcare providers must listen to transgender and gender diverse patients and unlearn any biases they may have about the transgender community. By incorporating these and other tips into your practice, you will build trust with your trans and gender diverse patients making it easier to meet their healthcare needs.
Safer, J.D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., Sverlius, J. (2016). Barriers to Health Care for Transgender Individuals. Current Opinion in Endocrinology, Diabetes, and Obesity, 23(2), 168-171. https://doi.org/10.1097/MED.0000000000000227
Vermeir, E., Jackson, L.A. & Marshall, E.G. (2018). Improving Healthcare Providers’ Interactions with Trans Patients: Recommendations to Promote Cultural Competence. Healthcare Policy, 14(1), 11-18. https://doi.org/10.12927/hcpol.2018.25552
Warner, D.M. & Mehta, A.H. (2021). Identifying and Addressing Barriers to Transgender Healthcare: Where We Are and What We Need to Do About It. Journal of General Internal Medicine, 36(11), 3559-3561. https://doi.org/10.1007/s11606-021-07001-2
LGBTQ+ news outlets and civil rights organizations are reporting that across the country local, state and federal legislatures are continuing to introduce legislation that targets the transgender community. The Human Rights Campaign’s (HRC) President Kelley Robinson noted in an a recent interview that the organization is “currently tracking over 400 bills against our community” (Riedel, 2023, para. 9) and the HRC released a new report which found that “more than one-fifth of trans youth live in states that have passed bans on gender-affirming care for minors” (Factora, 2023, para. 1). For many transgender individuals, supportive family members, and friends and allies, the onslaught of anti-trans bills and legislation feels stifling and overwhelming. To honor this year’s International Transgender Day of Visibility, this article will offer resources and tools to help transgender people and allies in the fight for safe and affirming healthcare.
Most legislation seeks to limit children’s and teen’s access to gender-affirming services, though some journalists note that certain states are now moving to limit trans adults’ access to care. Independent journalist and activist Erin Reed “is particularly concerned about a new type of gender-affirming care ban that includes trans adults….These new bills would, in effect, force trans adults to detransition by restricting the gender affirming care they may already have been accessing.” (Haug, 2023, para. 5)
Them, an online LGBTQ+ news outlet, reported that “Bills targeting the rights of trans youth at school and in health care are also gaining ground…These include school-based bills, which often target trans students’ privacy around using their correct pronouns and names at school, as well as bills targeting pronoun use more generally” (Haug, 2023, para. 12).
On a federal level, H.R.5 which was introduced in the House of Representatives earlier this year, would “require elementary and middle schools that receive federal funding to obtain parent consent before “changing a minor child’s gender markers, pronouns, or preferred name on any school form; or allowing a child to change the child’s sex-based accommodations, including locker rooms or bathroom” (Mizelle & Wilson, 2023, para. 4). While this bill passed in the House of Representatives, it is not expected to be voted on in the Senate.
Some states are moving to secure or expand the healthcare rights of transgender people. In Maryland, the legislature passed the Maryland Medical Assistance Program–Gender-Affirming Treatment also known as the Trans Health Equity Act and this is expected to be signed into law by Governor Wes Moore. This bill will go into effect on January 1, 2024, and many activists see the bill as one of the most positive pieces of legislation to date. The Trans Health Equity Act “would require Maryland Medicaid, beginning Jan. 1, 2024, to provide coverage for additional gender-affirming treatments…The expanded treatments include hormone therapy, hair alteration, voice therapy, physical alterations to the body, and fertility preservation” (Gaines & Sears, 2023, para. 9). Maryland’s bill could serve as a template for other states that seek to provide healthcare services to trans individuals.
While many anti-trans bills fail to become laws, their existence impacts the mental health of transgender people. The Trevor Project, an LGBTQ+ youth advocacy organization, reported in January that “state-level anti-trans laws negatively affected the mental health of 86% of trans and nonbinary youth between ages 13 and 24” (Factora, 2023, para. 6). Researchers found that trans and gender-diverse youth who receive gender-affirming care experience “lower rates of adverse mental health outcomes, build [their] self-esteem, and improve [the] overall quality of [their] life…” (Department of Health and Human Services, n.d., pg. 1; Green et al. 2022). It is important to support the transgender community and work alongside activists and organizers as they seek to expand trans people’s access to gender-affirming healthcare.
With any civil rights issue, it is vital to listen to activists, organizations and the people most impacted. Journalists and trans rights organizations are actively tracking new and upcoming bills that target their community and they often provide new, verified updates as soon as they’re made available. Organizations and individuals who are actively working to inform the public include:
Erin Reed is an activist, journalist, and content creator who shares updates on anti-LGBTQ+ legislation in the United States and around the world. She seeks to “achieve gender justice for queer and marginalized people through education and understanding” (Reed, n.d., para. 1). Her content is available via Twitter, TikTok, Instagram, and her Substack newsletter. Her website also features an informed consent HRT (hormone replacement therapy) map and an anti-trans legislative risk map. Both of these resources are updated frequently.
The Trans Formation Project is a grassroots organization “dedicated to tracking and educating about the anti-trans legislative crisis currently sweeping the United States” (Trans Formation Project, 2023, para. 1). The organization’s website features resources that educate people on the current landscape of legislation that impacts the lives of trans people. The organization tracks local, state and federal legislation and also has a ‘Legislator Scorecard’ for people interested in learning about their representatives’ stances on trans rights and the trans community.
The Human Rights Campaign (HRC) is another organization that seeks to support the LGBTQ+ community and strives to build an inclusive environment within the United States and around the world. The organization also actively tracks current legislation. The HRC provides resources to educate people on LGBTQ+ issues and the community. Their ‘Myths and Facts: Battling Disinformation About Transgender Rights’ and ‘Transgender and Non-Binary People FAQ’ are examples of some of the resources that affirm the lived experiences of trans and gender-diverse individuals.
Himmelfarb Library’s collection contains resources that discuss trans healthcare. Some of the titles include:
Our Diversity and Disparities in Health Care collection features over a hundred items and is an invaluable resource for users who wish to learn more about trans healthcare and how to interact with their trans and gender-diverse patients.
The amount of new discriminatory legislation and harmful rhetoric surrounding the trans and gender-diverse community is overwhelming. If you are mentally or emotionally impacted by the continuation of anti-trans sentiments and laws, please seek mental health services, if possible. SMHS’s Mental Health Resources page can connect you with mental health resources that may be beneficial. GW’s Counseling and Psychological Services (CAPS) provides mental health counseling to GW students and the community.
On this year’s International Transgender Day of Visibility, we recognize that the fight to protect and affirm transgender and gender-diverse people is still ongoing. In February 2023, Gabrielle Union-Wade and her husband Dwyane Wade gave an emotional and inspiring speech that called on people to continue to fight for trans rights. We would like to share their speech in an effort to remind people of the importance of this work:
