There are nearly 1.2 million transgender and non-binary (TGNB) individuals living in the U.S. (Wilson & Meyer, 2021). Thirty percent of TGNB people report having experienced discrimination from their healthcare provider. Even more alarming, 20% of TGNB people have been refused treatment from their healthcare provider simply based on their gender identity (Kachen & Pharr, 2020). They sought help—and they couldn't get it.
With this as the backdrop, it is understandable why TGNB people are more likely to delay receiving necessary healthcare than their cis-gender counterparts (Kachen & Pharr, 2020). Poor health outcomes extend to mental health as well. Forty-eight percent of TGNB people represent racially and ethnically marginalized people groups (Wilson & Meyer, 2021), exposing them to cumulative stressors of discrimination and systemic barriers to basic needs (e.g., food and housing security and healthcare accessibility). This creates a "perfect storm" that severely impacts mental health. TGNB individuals experience higher rates of trauma and sexual abuse, and higher rates of mental illness than their cis-gender counterparts (Lefevor et al, 2019). TGNB people are nine times more likely to attempt suicide than the cis-gender population (James et al, 2016.)
This is a serious problem. What is most frightening is that those of us who are mental health and medical providers who have pledged to "do no harm" are doing serious harm and we often don't even realize it. We can do better.
Here are a few steps we can take to make our treatment rooms feel like places of safety, so TGNB people will access the care they need.
Use Correct Pronouns/Names
We need to stop seeing names and pronoun usage as optional. You wouldn't dream of calling your partner, child, or colleague named "Helen," "Jennifer" just because you preferred that name and it was easier for you to remember. Pronouns and names are important. Pronouns are how we tell people who we are. They are our outer expression of our inner world. They are not "preferred"—they are who we are. When we repeatedly use incorrect names or pronouns we create an environment where people feel unseen. When we use accurate pronouns we communicate our values and our inclusion of all people (PFLAG, 2022).
Make Space
Using gender-neutral language in signage and intake paperwork can be an easy way to signify that TGNB people are not only seen, but welcomed to our practices. Using terms like, "reproductive services" and "well-person care" are ways to signify that all gender identities are considered (Strousma & Wu, 2018). Rather than having two options for gender on intake paperwork use a blank line instead, so that patients can self-identify. Having wall art that is representative of all people who might receive care, including various races, abilities, genders and family constellations says, "Your experiences are valued." Providing single user, gender neutral restrooms to make experiences like giving a urine sample, or simply relieving oneself, less stressful.
Take Responsibility
Implicit bias happens when we make associations with certain people groups outside of our conscious awareness. This happens to all of us. Our brains categorize vast amounts of information quickly—it's just the way we are designed. Although natural, it's problematic because we sometimes act in hurtful ways when we don't mean to. Usually, we aren't even cognizant that we've done anything wrong. Unfortunately, the other person is keenly aware.
Becoming aware of our biases so that we can adequately address them is imperative so that we don't unintentionally act in discriminatory ways. Interpersonal discrimination by healthcare providers and insufficiently trained providers are reasons that TGNB individuals avoid interactions with healthcare providers (Nolan et al, 2019). Fortunately, they are largely preventable. PFLAG offers a Trans Ally Toolkit for beginners. World Professional Association for Transgender Health's (WPATH) offers certification for providers to become TGNB competent professionals.
Let's not let another day go by. We can create space for people to live richer lives with some simple steps to let them know they are safe in our care. The cost for us is minimal. The cost for 1.2 million TGNB individuals is their lives.
Written by Kelly Duggan Shearer, LMFT, LPCC, Systems, Families, & Couples PhD student