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 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.

How to “come out” as an ally to patients.

What you can do: 

• Have affirming office decor. This can be anything from having the TGNC flag visible or having a TGNC mug on your desk. Many TGNC individuals look for hints and signals that a space is going to be friendly and affirming. 
• Have easily accessible and visible resources for TGNC individuals. If you have a display of pamphlets or a document of providers, make sure to list TGNC resources and friendly spaces.
• Create gender inclusive spaces. For example: Make sure all your restrooms have sanitary products available for individuals who may still menstruate. 
• Share your pronouns first upon meeting your patient. Then ask for theirs. This can be another great way to build trust. 
• Have TGNC resources, discounts, etc. available year-round instead of only during Pride celebrations. Many companies mean well and use Pride celebrations to show their support, but then forget that TGNC individuals could benefit from resources and offerings all year. 

How to address health disparities and increase access.

What you can do: 

• Adjust policies, resources, and internal tools to include TGNC patients. For example: Do you know how to note in a patients' charts what their legal and non-legal names are?
• Collect necessary demographic and patient information (e.g. gender, sex, pronouns, legal name, non-legal name, etc). If possible, including these on initial paperwork is a great way to allow the patient to share this information before their visit. 
• Accept health plans that affirmatively and explicitly cover medically-necessary health services for TGNC patients (e.g. GAHT, surgeries, PreP, etc). 
• Require/encourage ALL staff to be trained on TGNC issues and care. This includes front desk staff, billing/coding staff, janitorial staff, etc.
• Don’t rely on the TGNC patients to educate you. 

Health insurance barriers for TGNC individuals.

• It is important for the office to process insurance using the name the patient’s insurance is under. Many TGNC patients are denied coverage because the office uses their non-legal name. It is important someone on staff collect this information to reduce instances where coverage is denied or the individual must pay a significant amount.
• It is common for TGNC patients to struggle to afford or not have comprehensive insurance coverage making medical costs high/unaffordable. Having a sliding-fee option available or a payment plan program can be beneficial. 
• Female transgender and non-binary patients may still need annual examinations which would be billed under the gender marker M (e.g. prostate examinations) and male transgender and non-binary patients may still need annual examinations which would be billed under the gender marker F (e.g. breast or chest exams). It’s important that billing and coding staff have training and knowledge about how to navigate this. 
• Certain gender-affirming medications may require pre-authorizations for TGNC patients. If you are planning to offer these medications to patients, it is important to be prepped and ready for the pre-authorization process. 

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Gender identity, expression, and sexual orientation.

• A person’s gender identity does not dictate their sexual orientation or gender expression. People of any gender can have any sexual orientation or gender expression, etc.
• The following outdated terms may still be used in various medical diagnoses, research, medical coding, etc., but should not be used with the patient, unless specifically requested by the patient: transsexualism, transsexual, transvestite.
• A person’s gender expression (external appearances of one’s gender identity, usually expressed through behavior, clothing, haircut, or voice) may or may not align with their gender, sex, or personal pronouns. Do not assume someone’s gender based on how they look, sound, or act. 

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