Clinicians should find out any hormones the patient is taking, how they take them and understand the effects these treatments have. They will also need to ask about gender-affirming surgeries. Using that particular term will help tell the patient that you understand that these are, in fact, affirming. He challenged clinicians to give thought to how they can improve their management of trans and nonbinary or gender diverse patients.
“What are some strategies within your institution? What are some systems that make this challenging? What are some possible fixes? What can you do in your role? And what support do you need?” he said. “I really just want you all to think about this in your care, how to integrate this.”
Subtleties of Terminology
Lina Rosengren, MD, MPH, assistant professor of medicine at the University of North Carolina, Chapel Hill, tried to shepherd the audience through the labyrinth of terms associated with the care of patients who identify as lesbian, bisexual, gay, transgender, queer, intersexual, asexual (LGBTQIA+).
“The need to describe many intersecting identities has led to lots of different terms, and these terms evolve over time and with cultural trends,” said Dr. Rosengren, who identifies as queer. “Queer is very widely used within the queer community as a label of those sexual and romantic orientations as well as gender identity.” She said it’s a “very inclusive term without being explicit. … Plus, LGBTQIA+ is a mouthful.”
She offered these definitions. Sex is the assignment at birth based on chromosomes, anatomy and other factors. Gender is a social construct, with gender identity being the sense of who you are, and gender expression being how you present your gender identity.
“It’s very important to recognize that gender norms vary greatly across cultures, nations and regions,” Dr. Rosengren said. “The best way to identify your patient’s gender is to ask—and mirror the language they use.”
Sexual orientation is a person’s preferences for their sexual and romantic partners.
When considering sexual behavior and risk, she said it’s important to separate identity from behavior.
“An individual’s risk for sexually transmitted infections and HIV [human immunodeficiency virus] is actually a function of their sexual behavior—and not their anatomy or their identity,” she said. “Not all gay men have anal sex. Not only gay men have anal sex. Sexual behaviors are fluid.”
Specifying the pronouns you use for yourself and that you would like others to use when referring to you can be helpful, but only if this is backed up with appropriate care. One concern is that some people may think displaying pronouns is enough, and others may feel it’s an oversimplification. Some people may feel forced into a pronoun that doesn’t quite feel right to them.
