Part 2 - Culture Map Series: An Introduction to Transgender Health & Related PT Service

By Uchenna Ossai, PT, DPT, WCS, CLT

In my previous post, I introduced the history and culture of transgender patients. Here, I offer some steps to begin creating an inclusive environment for your transgender patients:

Investigate your implicit bias. Taking an honest and realistic inventory of your personal bias toward members of the LGBTQ community can be profoundly informative, allowing you to recognize the potential impact on your patient’s experience. As extensive research has shown, the implicit bias of medical providers harms the quality of care minority patients receive.

Understand and recognize that gender is a social construct, and sex is a biological status (chromosomes and genitals). Just like sexual orientation, gender identity is on a spectrum and is quite variable. Recognize that gender identity and expression are not the same thing.

Implement an anti-discrimination policy in your department or your private practice that includes sexual orientation, gender identity, and expression.

Have a basic awareness of discrimination laws in your state and/or city. This will help inform you about both the micro-aggressions and macro-aggressions that your patients are up against on a daily basis that can be a barrier to participating in and responding to healthcare interventions and prevention. Check your local ACLU chapter or The National Center for Transgender Equality (www.transequality.org).

Build a network of providers who have experience working with transgender clients.Lack of physical and emotional safety is a common barrier to accessing healthcare for transgender individuals.  Many patients have had negative experiences with their healthcare providers, which discourages regular healthcare visits.

Formally collect data about sexual orientation and gender identity (recommended by the National Institute of Health and Joint Commissions). Adjust your forms and clinic environment. On your forms, differentiate between “sex” and “gender.”  Under “gender,” include a space for “other” or “gender non-conforming.” Train your front desk staff to ask about preferred name and adjust patient greetings to exclude gender.

Do not accidentally “out” your patients. Be careful how you address this patient population in public and in your documentation. Even if you have forms that are gender-inclusive, your patients may not feel safe enough to answer honestly, and/or they may not be “out” to family, friends, or employer.

Ask. If you are not sure how to address your patient or handle certain situations, simply ask.

Do not assume that your patients are gay or straight. Sexual orientation and gender identity do not necessarily go hand-in-hand.

Do not ignore the underlying anatomy. Continue to do a thorough past medical and surgical history for effective preventative healthcare screening.

UC’s Top 5 Transgender Care Resources:

• (1) World Professional Association for Transgender Health (WPATH) – wpath.org
• (2) National LBGT Health Education Center: A Program of the Fenway Institute – lgbthealtheducation.org
• (3) The Center of Excellence for Transgender Health – transhealth.ucsf.edu
• (4) The Gay and Lesbian Medical Association – glma.org
• (5) National Center for Transgender Equality – transequality.org

References for Parts 1 and 2

• Safer, J.D., et al. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obesity. 23(2): 168-171.
• Unger, C. Care of the transgender patient: A survey of gynecologists’ current knowledge and practice. J of Women’s Health. 2015. 24(2): 114-118.
• Makadon H.J.; Mayer, K.M.; Potter, J.; Goldhammer, H., editors. The Fenway guide to lesbian, gay, bisexual, and transgender health. 2nd ed. Philadelphia, PA: ACP Press; 2015.
• Frost, D.M.; Lehavot, K.; Meyer, I.H. Minority stress and physical health among sexual minority individuals. J Behav Med. 2013. 9523-8.
• Grant, J.; Mottet, L.A.; Tanis, J., et al. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011. Available at thetaskforce.org/downloads/reports/reports/ntds_full.pdf.
• Mayer, K.; Garofalo, R.; and Makadon, H.J. Promoting the successful development of sexual and gender minority youths. Am J of Public Health. 2014. 104:976-981.
• Reisner, S., et al. Comprehensive transgender healthcare: the gender-affirming clinical and public health model of Fenway health. J of Urban Health. 92 (3): 584-92.

Author: Uchenna Ossai is treasurer of the Section on Women’s Health-APTA. She can be reached at treasurer@womenshealthapta.org.