Meeting with a patient for the first time.

What you can do:

• Allow people to self-identify and mirror their language. It may feel difficult to keep up with the expanding gender terminology, but you can let the patient guide you.
• If someone has legally changed their name do not ask what their “old name” was. 
• Always use your patient’s correct, gender-affirming pronouns. If you don’t know, it’s okay to ask. In fact, most TGNC patients will appreciate you asking and it is a great way to build trust.
• Ask the same questions every time no matter who the person is, without assuming that everyone is heterosexual and/or cisgender. This can help us all continue to learn, grow, and create affirming spaces for everyone.
• Don’t assume the reason the person is seeking care is because they are TGNC. Complete the initial appointment as you would with any other person seeking care and allow the patient to express their thoughts, concerns, and symptoms openly.

Health disparities: Minority Stress Framework.

The primary health disparity for TGNC individuals surrounds minority stress, which is one of the primary compromising factors for TGNC individuals.

The Minority Stress Framework: 

• Prejudice events
• Stigma: Expectation of rejection and discrimination
• Concealment vs. disclosure
• Internalized transphobia

TGNC Individuals are likely to experience the following, which can be beneficial to explore in therapy:

• Internalized transphobia: A TGNC person's internalization of negative societal attitudes and application of these negative attitudes towards themself.
• Cognitive dissonance: An unpleasant state that arises when an individual holds beliefs, attitudes, or behaviors that are at odds with one another.

Minority stress has been found to lead to increased levels of depression, anxiety, and substance use.

It can also lead to lack of adherence to health-promoting behaviors (e.g. annual physicals, medication adherence, smoking, etc). 

TGNC mental health considerations.

• TGNC patients have higher rates of using alcohol and substances to cope, as well as engaging in disordered eating. In treatment, assess for substance use and eating disorders. 
• Do not assume TGNC romantic or sexual relationships are void of intimate partner violence concerns.
• Many TGNC individuals do not have comprehensive mental health care plans and may benefit from sliding-fee, payment plans, or pro-bono services. 
• TGNC individuals also have a long history of being over pathologized in mental health care. In addition, mental health has been used as a “gatekeeping” process to other gender-affirming care, which can lead to lack of trust, frustration, and hesitancy. 
• Overall, TGNC individuals have higher rates of being exposed to violence and assault; however, this number is significantly increased for transgender women of color. 

Taking action for long-term change (Dr. Bartel’s 3 As):

Awareness: 

• Who are TGNC individuals? 
• What can you do to listen to their stories and experiences? 
• How can you take time to learn more

Action: 

• Awareness doesn’t make change happen, it just increases knowledge that change is needed.
• Ask yourself, what can I DO to facilitate change?

Accountability:

• You have to “walk the walk” if you want others to follow.
• How can you model the behaviors you want to see and make sure others do, too?