LGBTQ+ Gender Affirming Health Care

Gender-affirming health care means different things for different individuals of the LGBTQ+ community. Can learning and incorporating a collection of tools from which healthcare providers can utilize better fit the individual’s health goals and needs?

LGBTQ+ Health Care

• Accessing medical care can often present frustrating and undermining obstacles for the LGBTQ+ community.
• Transgender and non-binary individuals face gender and sexuality bias by healthcare providers, researchers, and electronic health records, a study found.
• As a step forward, transgender and non-binary researchers from across the United States and Canada describe how health record data can be modified to be more inclusive and representative of a gender-diverse population. (Kronk CA, et al., 2022)
• Gender-affirming care describes medical, psychological, and social support services provided to individuals who are transgender, non-binary, or gender expansive.
• The goal is to assist individuals in aligning their sense of self with their outward appearance to improve overall well-being.
• One aspect of gender-affirming care involves transitioning socially – this can include a name change, dressing, presenting, and using pronouns in a way that affirms an individual’s gender identity.

Gender-Affirming

• Gender-affirming care helps to reduce gender dysphoria – the distress an individual can experience when their assigned sex at birth does not align with their gender identity.
• This reduction in distress and discomfort can have a significant positive impact on mental health and overall well-being, especially in a healthcare setting.
• Trans and gender-diverse individuals often face higher rates of mental health challenges, including depression, anxiety, and suicidal ideation. (Sarah E Valentine, Jillian C Shipherd, 2018)
• Gender-affirming care, combined with mental health support, can help reduce risks by providing individuals with the tools, resources, and interventions needed to alleviate distress and promote a positive self-image.

Language

• Curiosity about the LGBTQ+ community can show up in aggressive and invasive ways.
• One way discriminatory bias takes place in health centers is the language providers use.
• A third of transgender individuals in the U.S. have had negative experiences with healthcare providers.
• 23% said they’ve avoided seeking medical care due to fear of mistreatment. (James SE, et al., 2015)
• Official patient intake forms may ask for a patient’s sex, using terms like female-to-male or male-to-female.
• The categories tend to center on cisgender individuals.
• The “other” category on various health care forms can alienate non-binary individuals and those that don’t fall into fixed categories. (Kronk CA, et al., 2022)
• language healthcare providers use is important for providers to avoid making assumptions about a patient’s preferred name and pronoun.
• Providers need to ask how the individual patient would like to refer to their body.
• Use the words/language the patient uses to describe themselves.

Finding Care

• Finding gender-affirming healthcare providers can be difficult.
• Many providers lack knowledge and training on the needs and experiences, can be discriminatory, and often have no indication when entering the facility that the provider is gender-affirming.
• Gender-affirming care is any care in which a member of the LGBTQ+ community has their needs properly met, feels safe, and comfortable, and feels their gender is respected.
• A review found that TGNC individuals prefer therapy and referrals by their primary care physicians because they know more about them holistically, see them as a whole person, have established a professional relationship, and are more accessible. (Brooker AS, Loshak H. 2020)

Ways to make healthcare clinics more gender-affirming include: (Jason Rafferty, et al., 2018) (Brooker AS, Loshak H. 2020)

• Showing signifiers of a positive and safe space by using rainbow flags, signs, stickers, etc.
• Explaining and maintaining doctor-patient confidentiality.
• Having pamphlets or posters available relating to LGBTQ+ health.
• Reworking medical forms to include more than just male and female options.
• Diversity training for all staff.
• Staff use of patient-asserted names and pronouns.
• Use of patient-asserted names and pronouns in medical records without creating duplicate forms and charts.
• If available provide gender-neutral bathrooms.

While the medical healthcare industry has a ways to go, healthcare clinics across the country are recognizing their responsibility to provide quality care to all. With improved data, healthcare professionals can better identify the unmet needs of LGBTQ+ patients and develop more effective solutions. We at Injury Medical Chiropractic and Functional Medicine clinic understand the importance of a safe space, what it means, and how to create it by offering dedicated care for the LGBTQ+ community by using gender-affirming language, not asking weird questions, and taking the awkwardness out of the visit.

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References

Kronk, C. A., Everhart, A. R., Ashley, F., Thompson, H. M., Schall, T. E., Goetz, T. G., Hiatt, L., Derrick, Z., Queen, R., Ram, A., Guthman, E. M., Danforth, O. M., Lett, E., Potter, E., Sun, S. E. D., Marshall, Z., & Karnoski, R. (2022). Transgender data collection in the electronic health record: Current concepts and issues. Journal of the American Medical Informatics Association: JAMIA, 29(2), 271–284. doi.org/10.1093/jamia/ocab136

Valentine, S. E., & Shipherd, J. C. (2018). A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clinical psychology review, 66, 24–38. doi.org/10.1016/j.cpr.2018.03.003

James SE, Herman JL, Rankin S, Keisling M, Mottet L, & Anafi, M. The report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.

Brooker AS, Loshak H. Gender affirming therapy for gender dysphoria: a rapid qualitative review. Ottawa: CADTH; 2020 Jun.

Rafferty, J., COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, COMMITTEE ON ADOLESCENCE, & SECTION ON LESBIAN, GAY, BISEXUAL, AND TRANSGENDER HEALTH AND WELLNESS (2018). Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics, 142(4), e20182162. doi.org/10.1542/peds.2018-2162