Resources for healthcare professionals.
If you encounter a trans patient in your career, it is important to make them feel accepted, safe, and understood. Trans people commonly experience sub-standard and traumatising interactions with healthcare professionals, and the only way to end this trend is through education and empathy.
Hormonal Management of Trans and Gender Diverse Adults
MJA Position Statement Endorsed by RACP, ESA, AUSPATH.
Australian Standards of Care for Trans and Gender Diverse Children and Adolescents
MJA Position Statement.
Informed Consent Guidelines
Protocols for the Initiation of Hormone Therapy for Trans and Gender Diverse Patients.
Sample Informed Consent Form for Feminising Hormone Therapy
Feminising hormone therapy is used for transgender individuals who are assigned male at birth.
Sample Informed Consent Form for Masculinising Hormone Therapy
Masculinising hormone therapy is used for transgender individuals who are assigned female at birth.
Primary Care Training Module
Primary healthcare for transgender, non-binary, and gender-diverse patients.
Hormonal Therapy for Trans and Gender Diverse Adults.
Medical Education Resource on LGBTIQ+ Health
Collaboration between the University of Melbourne, Monash University, and AMSAMedEd.
Trans Health Research Studies
Insights into the current status of Australian transgender healthcare, and the diminished health of trans citizens.
Language and the Word "Trans"
The most important thing to remember about the term “transgender” is that it is an adjective, not a noun or a verb. Here are some examples of correct, and incorrect, uses of the term.
CORRECT: He is a transgender man.
INCORRECT: He is transgendered.
CORRECT: He is a trans man.
INCORRECT: He is a transman.
CORRECT: Those patients are transgender.
INCORRECT: They are transgenders.
CORRECT: Transgender people.
Transgender people are not some other species that would necessitate phraseology like “transgenders”, and being transgender is not an event that happens to a person, as implied by “transgendered”. Trans men are men, first and foremost, with “trans” just functioning as an extra descriptor; it is preferred by many modern transgender people that a space be kept between “trans” and “man” (or “person” or “woman”). Much in the same way that a cis man is still a man, a trans man is still a man too.
There are variations in preference the world over, and some older communities don’t really care about terms like “transgendered” or “transgenders”. Language evolves. However, from a modern Western point of view, these words are linguistically incorrect, and should not be used unless a person indicates that they speak this way.
When interacting with trans patients, it's important to remember that they may have bodies which are different to most men and women. The way that you speak has the potential to make your patients feel affirmed and accepted, or alternatively, uncomfortable and frightened.
A trans man is a man, regardless of his hormonal or surgical status. If you are discussing health needs with a trans man, for instance, do not ask him if he is "fully a man", when what you really want to ask is, "what surgeries have you had to affirm yourself?" Regardless of what surgeries a man has had, and what he chooses to do with his body, he is still a man. Tying the legitimacy of a man's identity with the medical treatments he can access/wants to undergo is an incorrect and outdated way of looking at gender identity. If a man has not had any surgeries, he is still "fully a man".
If you are discussing reproductive health with a trans patient, it's important to remember that they may have the ability to become pregnant or produce sperm, but this does not make them a woman or a man. If you are speaking with a transmasculine person about their reproductive health, employ the phrase "people who can become pregnant", rather than just saying "women". Similarly, if you are talking with a trans woman or a transfeminine person, you might say "people with prostates" or "people with penises".
You do not necessarily need to use this language with cis patients, but with trans people, it is a matter of treating your patients with respect and taking basic measures to avoid triggering gender dysphoria. Referring to organs and bodily functions specifically is also inclusive of intersex individuals who may have many different variations in anatomy.
The medical podcast Sawbones is highly recommended if you are struggling to get used to this change in terminology. Dr Sydnee McElroy, a cohost on the program, underwent a change in mindset throughout the show, and switched from cisnormative language to phrases which include all kinds of bodies and experiences. All Sawbones episodes are valuable for normalising inclusive language (particularly more recent ones), and this episode is a great overview of sex and gender.
Image credit: Gender Spectrum Collection.
Being disrespected can be very frightening for trans people, because they may immediately need to worry about their safety and the quality of their medical care.
In 2019, a transgender man was threatened with an axe in an Australian hospital. He was also stripped against his will, in front of other patients, and treated like a second-class citizen. When patients took photographs of him naked, none of the nurses helped him. Throughout this experience he was also "deadnamed", which means his birth name was used despite his requests to be addressed differently. While in hospital, a nurse told him, “You were born a woman, you will behave like a woman.” Despite suffering lung cancer, he "cancelled all post-operative appointments and vowed never to return, even if it killed him".
Even when medical visits do not escalate to such extremes, trans people often experience humiliation and gender dysphoria, due to uncaring and uneducated medical professionals.
The documentary Southern Comfort is worth watching (available here for free). It follows transsexual man Robert Eads throughout his final year of life, as he was dying of ovarian cancer. His death was the result of multiple doctors refusing to treat him, purely because of his trans status. His story is one among thousands.
Trans people are extremely aware of the medical community's history of abusing, erasing, and harming LGBT+ people, particularly gender-diverse individuals. It is important to remember that your trans patient may have been directly abused by doctors and/or nurses, but even if they have not, they will be aware of mistreatment that their friends and peers have been subjected to. A trans person walking into a doctor's office may be more scared than you realise. Making them comfortable, and helping them to feel safe, is the only way to treat them humanely. You can achieve this through the following:
Understand that gender dysphoria can be severe and can greatly affect health. Avoid provoking a trans person's dysphoria at all points.
If a trans person indicates that they wish to be called by a specific name, use that name.
If a trans person says they are uncomfortable with certain terms, avoid using those terms in front of them. For instance, if a trans man's chest must be discussed, he may prefer you just say "chest" instead of "breasts". If discussing the genitals, ask the patient beforehand which words they are sensitive to, if any.
Understand that a patient's gender being affirmed is not optional. If a trans person is misgendered or deadnamed in hospital, they may leave while still injured/unwell, like the man in the afore-mentioned article did. They may suffer panic attacks, extreme dysphoria, mental distress, and other physiological symptoms. All of this can be avoided by ensuring that all healthcare workers who interact with the patient take the time to refer to them correctly.
Treat a trans person as the expert on their own identity. If a patient comes to you saying that they need to be addressed a certain way, or that they have a particular experience, they should be listened to. When speaking about a trans woman, for example, do not say “he identifies as a woman”. Treat her as the gender she is, just like you would a cis woman.
Do not bring up a trans person's gender in situations where it is completely irrelevant. For example, if a trans woman presents with a broken arm and requests to be addressed with she/her pronouns, questions about her transition and her genitals are likely not helpful in treating her arm. Do not assume every trans person wishes to discuss their transition, unless it is actually medically relevant. Do not assume every trans person wishes to talk about their childhood or their relationship with their parents.
Videos About Trans People and the Medical Community
Image credit: Gender Spectrum Collection.