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 www.wpath.org. These internationally their birth-assigned sex and/or the stereotypes recognized protocols are flexible guide- associated with that sex. A transgender woman lines designed to help providers develop is a woman who was assigned male at birth and individualized treatment plans with their 10 Tips for Working has a female gender identity. A transgender man patients. is a man who was assigned female at birth and with Transgender has a male gender identity. For many transgender Another resource is the Primary Care Patients individuals, the lack of congruity between their Protocol for Transgender Patient Care produced by Center of Excellence for gender identity and their birth sex creates stress An information and resource publication Transgender Health at the Univer- and anxiety that can lead to severe depression, sity of California, San Francisco. You for health care providers suicidal tendencies, anti-social behavior, and/or can view the treatment protocols at increased risk for alcohol and drug dependency. www.transhealth.ucsf.edu/protocols. Transitioning - the process that many These protocols provide accurate, transgender people undergo to bring their peer-reviewed medical guidance on outward gender expression into alignment with transgender health care and are a their gender identity - is a medically necessary resource for providers and support staff treatment strategy that can effectively relieve this to improve treatment capabilities and stress and anxiety. access to care for transgender patients. Transgender people are Transgender Law Center advocates in courtrooms, boardrooms and legislatures as the legal and policy medically underserved heart of the grassroots movement to create a world where people who don’t fit narrow gender stereotypes Access to affordable, quality health care is central are free from prejudice and we can all live as our au- to avoiding negative health consequences, yet thentic selves. most insurance companies exclude medically necessary care and services for transgender This publication is made possible with support from: people, including mental health therapy, hor- Community Clinics Initiative - a joint project of Tides monal therapy, and surgeries. In addition, many and The California Endowment, David Bohnett Founa- transgender people have had negative tion, Horizons Foundation, Liberty Hill Foundation, The experiences in health care settings, including California Endowment, and The California Wellness providers and office staff who have lacked the Foundation. information necessary to provide sensitive services. Discrimination in the provision of ser- Transgender Law Center vices causes transgender people to delay or avoid [email protected] necessary health care, including care that is not p 415.865.0176 f 877.847.1278 transition-related, often to the point of putting www.transgenderlawcenter.org their overall health at severe risk. © Transgender Law Center 2011 situations where a patient has a rare or unusual 3. REMEMBER TO ALWAYS REFER TO TRANSGENDER finding, asking a patient’s permission is a necessary PEOPLE BY THE NAME AND PRONOUN THAT CORRE- first step before inviting in a colleague or trainee. SPONDS WITH THEIR GENDER IDENTITY. Use “she” for Many transgender patients wish to maintain control transgender women and “he” for transgender men, over who sees them unclothed. Therefore, when TIPS even if you are not in the patient’s presence. for improving services for patients are observed without first asking their transgender people permission, it can quickly feel like an invasion of 10 4. IF YOU ARE UNSURE ABOUT A PERSON’S GENDER privacy and creates a barrier to respectful, IDENTITY, OR HOW THEY WISH TO BE ADDRESSED, ASK competent health care. POLITELY FOR CLARIFICATION. It can be uncomfort- able to be confused about someone’s gender. It 8. IT IS INAPPROPRIATE TO ASK TRANSGENDER Transgender Law Center recognizes that can also feel awkward to ask someone what their PATIENTS ABOUT THEIR GENITAL STATUS IF IT IS gender is. However, if you let the person know that many health care providers are eager UNRELATED TO THEIR CARE. A person’s genital sta- you are only trying to be respectful, your ques- tus—whether one has had surgery or not—does not to provide a safe, welcoming treatment tion will usually be appreciated. For instance, you determine that person’s gender for the purposes of can ask, “How would you like to be addressed?” or environment for members of the trans- social behavior, service provision, or legal status. “What name would you like to be called?” In order gender community, yet may not have had to facilitate a good provider-patient relationship, the opportunity to access information it is important not to make assumptions about the 9. NEVER DISCLOSE A PERSON’S TRANSGENDER identity, beliefs, concerns, or sexual orientation of STATUS TO ANYONE WHO DOES NOT EXPLICITLY NEED about the needs and experiences of this transgender and gender non-conforming patients. THE INFORMATION FOR CARE. Just as you would not marginalized population. With this barrier needlessly disclose a person’s HIV status, a person’s in mind, we have created this pamphlet 5. ESTABLISH AN EFFECTIVE POLICY FOR ADDRESS- gender identity is not an item for gossip. Having it ING DISCRIMINATORY COMMENTS AND BEHAVIOR known that one is transgender can result in ridicule to work in partnership with providers and possible violence towards that individual. If IN YOUR OFFICE OR ORGANIZATION. Ensure that all to improve quality of care and provider- staff in your office or organization receive transgen- disclosure is relevant to care, use discretion and inform the patient whenever possible. patient outcomes. der cultural competency training and that there is a system for addressing inappropriate conduct. 10. BECOME KNOWLEDGEABLE ABOUT TRANSGENDER HEALTH CARE ISSUES. Get training, stay up to date 1. WELCOME TRANSGENDER PEOPLE BY 6. REMEMBER TO KEEP THE FOCUS ON CARE RATHER on transgender issues, and know where to access GETTING THE WORD OUT ABOUT YOUR SERVICES THAN INDULGING IN QUESTIONS OUT OF CURIOSITY. resources. AND DISPLAYING TRANSGENDER-POSITIVE CUES IN In some health care situations, information about YOUR OFFICE. You can use LGBT community centers, biological sex and/or hormone levels is important services, newspapers, and Internet resources to for assessing risk and/or drug interactions. But advertise your services. Posters, buttons, stickers, in many health care situations, gender identity and literature about transgender people can dem- is irrelevant. Asking questions about a person’s onstrate that you are transgender-friendly. You can transgender status, if the motivation for the rewrite your intake form to include “chosen name” question is only your own curiosity and is unrelated in addition to “legal name,” as well as a third, blank to care, is inappropriate and can quickly create a option for “sex/gender” where someone can more discriminatory environment. accurately describe their gender. And single-use re- strooms are a welcome addition for many, including 7. KEEP IN MIND THAT THE PRESENCE OF A TRANS- transgender people. GENDER PERSON IN YOUR TREATMENT ROOM IS NOT ALWAYS A “TRAINING OPPORTUNITY” FOR OTHER 2. TREAT TRANSGENDER INDIVIDUALS AS YOU HEALTH CARE PROVIDERS. Many transgender people WOULD WANT TO BE TREATED. You can show respect have had providers call in others to observe their by being relaxed and courteous, avoiding negative bodies and the interactions between a patient and For more information or to get help, facial reactions, and by speaking to transgender health care provider, often out of an impulse to train please contact Transgender Law Center. clients as you would any other patient or client. residents or interns. However, like in other .