Transgender woman

Transgender Patients: Considerations for Care

As nurses, it is important to be culturally sensitive to all patients, respective of diversity, and appropriate care. As social acceptance has grown, awareness of gender identity and sexual preferences has increased. The term “transgender” is used for individuals who don't identify with the gender they were assigned at birth.

The word transgender may also include different types of gender identities, such as genderqueer (persons who do not completely identify with either gender), gender nonconforming (persons who express their gender differently than social expectations), or transsexual (generally associated with persons pursuing medical treatment such as hormones or surgery) (Hein & Levitt, 2014; Substance Abuse and Mental Health Services Administration [SAMHSA], 2012).

Gender identity is how a person feels about themselves internally, which is more concerned with the social norms about roles, qualities, and attributes, such as masculinity and femininity. Sex assigned at birth refers to the genitalia of the individual, which may or may not be associated with gender identity.

It is also important to remember that gender identity does not necessarily correlate with sexual orientation. Transgender individuals may identify as lesbian, gay, bisexual, or heterosexual. In addition, the term “transition” means the period of time when a transgender person is learning how to cross-live socially as a member of the sex category they identify with, which may involve changing names and gender on legal documents, and/or medical interventions to physically change sex designation (Centers of Excellence for Transgender Health, 2016; Hein & Levitt, 2014).

When caring for patients who are transgender, the first step is for the healthcare professional to self-reflect: “Do I have potential bias toward a patient who is lesbian, gay, bisexual, or transgender?” Awareness of potential bias can assist with being able to work through any emotional responses and help the healthcare professional seek out the appropriate information.

One concern in working with transgender patients is that the healthcare professional may offend the transgender patient. It is important to have open discussions with the person: “Which gender do you identify with? Do you prefer to be called he or she? What name do you prefer?” Some patients may refer to themselves by slang or derogatory terms. It is important for healthcare professionals to be aware of these self-references to decrease an unintentional reaction to the language.

Additional questions to ask yourself: “Is the patient transitioning? What does that mean to the patient--is there a physical transition occurring, such as hormone use and/or surgery?” A key point to remember is that if a healthcare professional unintentionally offends a transgender patient, an apology demonstrates caring and sensitivity (AMSA, 2014; SAMHSA, 2012).

Transgender patients face many barriers, including overt or unintentional bias, which may cause delays in seeking medical care. Studies have demonstrated that approximately 48% of transgender individuals have delayed or avoided medical care (Hein & Levitt, 2014).

There are other risks associated with transgender individuals, including decreased ability to obtain insurance, higher risk of being a victim of violence or sexual assault, increased risk for drug abuse, higher risk of sexually-transmitted diseases and HIV infection, lower availability of social support, and increased incidents of mental health disorders such as anxiety, depression, and suicide attempts (American Medical Student Association, 2014; SAMHSA, 2012). When caring for transgender patients, assessments should include identifying these potential risks so that they may be addressed.

Nurses have an ethical responsibility to treat all patients with dignity and respect. It is important to gain awareness and understanding of the population of transgender patients and to provide culturally sensitive care. If you are caring for a patient who is receiving medical treatment for transitioning, including hormone therapy and surgery, learning about the specific care required is invaluable. The Center of Excellence for Transgender Health (2016) is one option to review these treatments.

For more information on providing culturally competent care across healthcare populations take this course on, Cultural Competence.

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American Medical Student Association. (2014). Transgender health
Centers of Excellence for Transgender Health. (2016). Transgender patients
Hein, L. & Levitt, N. (2014). Caring for…transgender patients. Nursing Made Incredibly Easy, 12(6), 28-36.
Substance Abuse and Mental Health Services Administration. (2012). Top health issues for LGBT populations:  Information & resource kit.