I’d been looking for months for a surgeon to provide a gender-affirming revision to correct dog ears, which are the large folds of skin that are sometimes left behind on the sides of the chest after top surgery/masculinization double mastectomy surgery. I’d asked my contacts for recommendations, researched the internet, went down so many rabbit holes on Instagram. And then I found her, the golden goose, the trans advocate, the holy grail. Her before and after photos said it all, and what they didn’t say, she said through every post, story, and engagement. She was for US: the transgender and non-conforming (TGNC) community. She practiced what she preached and her surgery results reflected the care she took to make us feel seen and human. So I knew this was the one.
I followed a post and texted the practice. When I got no response I emailed. When I got no response I emailed again. What I received was a stock email requiring insurance information and no actual answers to my specific questions. After the stock email, I responded with my specific questions again and was sent a different stock email with instructions to download an app and upload my information and pictures. When asked my name, I gave it to them, asking to be addressed by it, but also noted that there would be a different name for my insurance. The next email did not address my concerns and on top of that, did not address me by my name. Instead they insisted that I give my legal name.
Even though I ended up having a positive consultation with the surgeon herself I left the whole experience feeling dejected and unsupported and decided to start the search again.
As a TGNC person, finding affirming health care and clinicians can feel out of reach. Dealing with intake paperwork, email and phone communications, and insurance all set up with the same biases can feel insurmountable. As a clinician, member of support staff, or insurance provider there are many small things that can make such a difference especially for a TGNC person who is used to being unseen in a health care setting.
"As a TGNC person, finding affirming health care and clinicians can feel out of reach. Dealing with intake paperwork, email and phone communications, and insurance all set up with the same biases can feel insurmountable."
Here’s how to make it an affirming experience for TGNC patients right from the start:
Create inclusive intake forms:
- Replace M/F with a fill-in-the-blank option for gender.
- Add a pronoun line to help normalize asking for pronouns and make the answer optional. (We all have pronouns!)
- Add a fill-in line by the legal name that asks for the name a patient uses instead and make sure you use it in all interactions.
Apply your intake form information to real live communication!
- On the phone or in person, get used to asking questions instead of assuming. Try, “How would you like to be referred to?” or “What pronouns can I use?”
- Once you get a patient’s name, gender and pronoun, write it in their chart. Make sure it is visible whenever anyone opens their chart for a visit and for communications.
- When putting together communications, think about whether what you’re sending will make a patient feel welcome, cared for, and seen.
In short, whether you are in person or communicating online or by phone and especially when working with TGNC patients, a good rule of thumb is always: just ask, instead of assuming!
There are so many easy, practical ways to make the health care experience affirming for TGNC patients from the first email to the last visit. Anyone can be an ally because regardless of your role in the health care system, everyone plays an important part in ensuring patients feel safe, affirmed, and heard.
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B Harriman (he/him/they/them) is an experienced creator, facilitator, and speaker specializing in support for TGNC and LGBQ+ youth and adults. Growing up as a transmasculine, nonbinary, and Latinx kid, B saw little reflection of himself in the world. That experience is part of the inspiration behind all of B’s work and they find great joy in creating community, sharing resources, and teaching tools to other TGNCNB folks. B is also the artist, writer and creator of a series of books and activities about a gender expansive hero named Mischief who’s on a mission to change the world.
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Violet is building the first-ever infrastructure for inclusive health care, through benchmarking, upskilling, and recognizing cultural competence in health care providers. They envision a world where every human receives equitable health care, no matter their race, sexual orientation, gender, ability, language, citizenship, or more.
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