Looking for ways to make clinical settings more trans* friendly

I am a student seeking literature about how to effectively provide safe space for trans individuals in a clinical (medical) setting. Our program places great emphasis on safe space, however there is no information on how to remove exclusionary facets that may be taken for granted (such as providing gender neutral washrooms and pronoun options on health history forms). I have spoken to our instructor and she would like to include the material but our curriculum requires them to provide applicable sources for any information presented in class. Any ideas?

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Hey there,

That’s an awesome question, thank you for working towards making medical settings more trans* friendly!

There are so many ways to answer this, I’m not sure where to start! I will do my best to keep it brief.

Let’s begin with what you’re looking for: it sounds like you’re seeking academic sources for the information you’d like to present to your class. That could be tough, because the trans* community is only just being heard lately. If you wish, you could use this blog as a source, and I can provide a few recommendations and resources based on my interactions with the trans* community, but I can’t be sure that any of them will be considered “academic” sources. Also, I am not a trans* person. I have cis privilege and can’t know all the ins and outs of what makes a visit to the doctor feel more or less awful for a person whose gender doesn’t match their sex. I’ve worked really hard to try and listen to trans* voices, and I will do my best to raise the microphone in this post.

I think you’ve made two excellent suggestions right off the bat – having gender-free washrooms and more choices on health history forms are a great start! Any single-locking bathroom can become a unisex or gender-free restroom. If your space has gendered washrooms, you could make both of them co-ed or “family” bathrooms, or you could create a policy that protects your clients’ right to self-identify and use washrooms accordingly.

Now for medical forms: Definitely ask for gender pronouns! Ask everyone! And respect pronouns. If you slip up, correct yourself and move on.

But you might consider going even further than that, in order to make your forms more inclusive.

If you need to ask about a person’s plumbing on a form, instead of putting “sex: m (), f ()”, you could put “sex assigned at birth: m (), f (), intersex (), prefer not to disclose ()” You may also like to add an option for them to add more information, for example: “These options do not capture my sex assigned at birth. My sex was identified at birth as _________” This would be more inclusive of intersex folks – even if you don’t have intersex clients, it gives them visibility where normally they would have none.

If you have to ask about their assigned sex, as you say – you should ask for their gender and their pronouns too. Too often trans* people are treated as their assigned sex. A question about gender could look something like this:

“How do you identify your gender?
girl/woman ()
boy/man ()
trans* ()
non-binary ()
two-spirit ()
none of these match my gender identity, I identify my gender as:_______.
prefer not to disclose ()
My gender pronouns are  ___/___  (ex. he/his, she/hers, they/their, ze/hir, etc.)”

Another thing that needs to be emphasized is the importance of learning about trans* identities and how to treat trans* people respectfully – in other words, to treat them as fellow human beings. TransWhat? is an awesome website chock-full of great information about trans* identities and ways to do allyship – it’s an awesome 101-guide that tackles a lot of important issues briefly and frankly.

It may also be useful to consider how the language you use may be gendered, and how it may render trans* and non-binary folks invisible. When talking about health trends among “women”, might it be more inclusive to say “people with breasts”, or “people with uteruses”? Breast and cervical cancer can affect men and non-binary folks, too. Conversely, you could say “people with prostates”, or “people with penises”. Of course, reproductive issues are important to keep in mind when working with trans* folks. Trans* men may need access to birth control, paps, and mammograms, while trans* women may need regular prostate exams; and non-binary folks may need any of those services. Make STI testing and various forms of birth control readily available. Trans* and non-binary people are also parents! Know what the options are for trans* and non-binary folks wishing to conceive and be ready to discuss them.

One thing I’d like to highlight is the importance of knowing the difference between sex and gender, and having an understanding of, and compassion for, the experience of gender dysphoria. Gender dysphoria is the discomfort and anxiety caused by the knowledge that your assigned sex and gender do not match. It can take many forms and varies in intensity from person to person, and often (but not always) there is a lot of focus on how a person’s body doesn’t match the gender between their ears. For this reason, going to the doctor can be a huge trigger for trans* folks – they may feel some really intense and unpleasant emotions. Explaining a procedure and why it is necessary (ex. a pap), or asking what language to use when referring to a person’s intimate bits if you need to examine them, can help to alleviate some of that discomfort. A general, “is there anything I can do to make this easier for you?” is also a good start. To learn more about the difference between sex and gender, I recommend checking out the Gender Bread Person, version 2.0. It’s not the most scientific breakdown, but it’s an easy way to quickly illustrate that sexuality and gender are not cut-and-dry concepts. On a more academic note, it may be helpful to review the Gender Dysphoria entry in the Diagnostic and Statistical Manual for Mental Disorders (DSM-V) to better understand dysphoria and appropriate treatments for it.

Another reputable source of invaluable information resides at the the World Professional Association for Transgender Health (WPATH)- that is, the Standards of Care for the Health of Transsexual, Transgender, and Gender-Non-Conforming People, Version 7. This journal article was published by Routledge in the International Journal of Transgenderism, and is the definitive clinical guide for medical professionals. WPATH also has lots of other great resources that could be relevant to your query. Another wealth of scientific and academic information that you may find useful can be found at TransPulse –  community-based research (CBR) project investigating the impact of social exclusion and discrimination on the health of trans people in Ontario, Canada. Check out their Research and Study Results section. This article may be of particular relevance.

Speaking of journal articles, there are a lot of them out there! I was really surprised to find so many while researching for this post. I’ve done a few cursory Google searches, and it looks like academia is clueing into the need for research on trasngender folks and their health needs afterall. If you’re a University of Guelph student or alumni, hit up McLaughlin library and search for journal articles with key words like “transgender” “access” and “health”. If you’re not a U of G student, why not hit up the Guelph Public Library?

Okay, I’m going to stop there – basically, there’s no shortage of information if you know where to look. I think this brings me to one of the most important things I can pass along to anyone working to remove barriers and act as an ally:  do your own research!

Cheers,
❤ Liz

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