Introduction to the transgender community MEDICAL PROTOCOLS The World Professional Association for Gender identity is our internal understanding of Transgender Health (WPATH) publishes our own gender. We all have a gender identity. Standards of Care for the treatment of The term “transgender” is used to describe people gender identity disorders, available at whose gender identity does not correspond to their www.wpath.org. These internationally rec- birth-assigned sex and/or the stereotypes asso- ognized protocols are flexible guidelines ciated with that sex. A transgender woman is a designed to help providers develop individ- woman who was assigned male at birth and has ualized treatment plans with their patients. 10 Tips for Working a female gender identity. A transgender man is a man who was assigned female at birth and has a Another resource is the Primary Care Proto- with Transgender male gender identity. col for Transgender Patient Care produced by Center of Excellence for Transgender Patients For many transgender individuals, the lack of con- Health at the University of California, San An information and resource publication gruity between their gender identity and their Francisco. You can view the treatment birth sex creates stress and anxiety that can lead protocols at www.transhealth.ucsf.edu/ for health care providers to severe depression, suicidal tendencies, and/or protocols. These protocols provide accu- increased risk for alcohol and drug dependency. rate, peer-reviewed medical guidance on Transitioning - the process that many transgen- transgender health care and are a resource der people undergo to bring their outward gender for providers and support staff to improve expression into alignment with their gender iden- treatment capabilities and access to care tity - is for many medically necessary treatment for transgender patients. strategy that can affectively relieve this stress and anxiety.

Transgender people are Transgender Law Center changes law, policy, and attitudes so that all people medically underserved can live safely, authentically, and free Access to affordable, quality health care is central from discrimination regardless of their to avoiding negative health consequences, yet most gender identity or expression. insurance companies exclude medically necessary care and services for transgender people, includ- ing mental health therapy, hormonal therapy, and surgeries. In addition, many transgender people Transgender Law Center have had negative experiences in health care set- [email protected] tings, including providers and office staff who p 415.865.0176 f 877.847.1278 have lacked the information necessary to provide sensitive services. Discrimination in the provision www.transgenderlawcenter.org of services causes transgender people to delay or avoid necessary health care, including care that is not specifically transition-related, often to the point of putting their overall health at severe risk. © Transgender Law Center 2016 finding, asking a patient’s permission is a necessary 3. REMEMBER TO ALWAYS REFER TO TRANSGENDER first step before inviting in a colleague or trainee. PEOPLE BY THE NAME AND PRONOUN THAT CORRE- Many transgender patients wish to maintain control SPONDS WITH THEIR GENDER IDENTITY. Use “she” for over who sees them unclothed. When patients are transgender women and “he” for transgender men, observed without first asking their permission, it can TIPS even if you are not in the patient’s presence. for improving services quickly feel like an invasion of privacy and creates a for transgender people barrier to respectful, competent health care. 4. IF YOU ARE UNSURE ABOUT A PERSON’S GENDER 10 IDENTITY, OR HOW THEY WISH TO BE ADDRESSED, ASK POLITELY FOR CLARIFICATION. It can be uncomfort- 8. IT IS INAPPROPRIATE TO ASK TRANSGENDER able to be confused about someone’s gender. It can PATIENTS ABOUT THEIR GENITAL STATUS IF IT IS Transgender Law Center recognizes that also feel awkward to ask someone what their gender UNRELATED TO THEIR CARE. A person’s genital sta- tus—whether one has had surgery or not—does not many health care providers are eager to is. However, if you let the person know that you are only trying to be respectful, your question will usu- determine that person’s gender for the purposes of provide a safe, welcoming treatment envi- ally be appreciated. For instance, you can ask, “How social behavior, service provision, or legal status. ronment for members of the transgender would you like to be addressed?” or “What name community, yet may not have had the would you like to be called?” In order to facilitate 9. NEVER DISCLOSE A PERSON’S TRANSGENDER STA- a good provider-patient relationship, it is important TUS TO ANYONE WHO DOES NOT EXPLICITLY NEED opportunity to access information about not to make assumptions about the identity, beliefs, THE INFORMATION FOR CARE. Just as you would not the needs and experiences of this margin- concerns, or sexual orientation of transgender and needlessly disclose a person’s HIV status, a person’s gender non-conforming patients. alized population. With this barrier in mind, gender identity is not an item for gossip. Having it we have created this pamphlet to work known that one is transgender can result in ridicule 5. ESTABLISH AN EFFECTIVE POLICY FOR in partnership with providers to improve and possible violence towards that individual. If ADDRESSING DISCRIMINATORY COMMENTS AND quality of care and provider-patient disclosure is relevant to care, use discretion and BEHAVIOR IN YOUR OFFICE OR ORGANIZATION. Ensure inform the patient whenever possible. outcomes. that all staff in your office or organization receive transgender cultural competency training and that 10. BECOME KNOWLEDGEABLE ABOUT TRANSGENDER 1. WELCOME TRANSGENDER PEOPLE BY GETTING there is a system for addressing inappropriate HEALTH CARE ISSUES. Get training, stay up to date on THE WORD OUT ABOUT YOUR SERVICES AND conduct. transgender issues, and find out where to access DISPLAYING TRANSGENDER-POSITIVE CUES IN YOUR resources. For free, confidential provider-to-provider OFFICE. You can use LGBT community centers, 6. REMEMBER TO KEEP THE FOCUS ON CARE RATHER information, visit www.project-health.org/transline. services, newspapers, and Internet resources to THAN INDULGING IN QUESTIONS OUT OF CURIOSITY. advertise your services. Posters, buttons, stickers, In some health care situations, information about and literature about transgender people can dem- biological sex and/or hormone levels is important for onstrate that you are transgender-friendly. You can assessing risk and/or drug interactions. But in many rewrite your intake form to include “chosen name” health care situations, gender identity is irrelevant. in addition to “legal name,” as well as a third, blank Asking questions about a person’s transgender status, option for “sex/gender” where someone can more if the motivation for the question is only your own accurately describe their gender. And single-use curiosity and is unrelated to care, is inappropriate restrooms are a welcome option for many, including and can quickly create a discriminatory environment. transgender people. 7. KEEP IN MIND THAT THE PRESENCE OF A TRANS- 2. TREAT TRANSGENDER INDIVIDUALS AS YOU GENDER PERSON IN YOUR TREATMENT ROOM IS NOT WOULD WANT TO BE TREATED. You can show respect ALWAYS AN APPROPRIATE “TRAINING OPPORTUNITY” by being relaxed and courteous, avoiding negative FOR OTHER HEALTH CARE PROVIDERS. Many trans- facial reactions, and by speaking to transgender gender people have had providers call in others to clients as you would any other patient or client. observe their bodies and the interactions between a patient and health care provider, often out of an For more information or to get help, impulse to train residents or interns. However, like in please contact Transgender Law Center other situations where a patient has a rare or unusual at www.transgenderlawcenter.org.