Communicating With Patients Who Have Nonbinary Gender Identities

Abstract

The increasing visibility of transgender people and others who do not conform to traditional gender norms challenges us to think about gender in new ways, and to use new terminology when communicating with patients. People who describe themselves as nonbinary have a gender identity that is not exclusively girl/woman or boy/man. A small but growing body of research indicates they experience high levels of societal victimization and discrimination, and are misun derstood by health care clinicians. Using language that is inclusive of all gender identities can reduce these burdens and barriers. In this essay, we use a case scenario that illustrates ways to interact respectfully and affirmatively with non binary people throughout the patient care experience.

Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample

“…Primary care, general internal medicine, and family practice physicians need more epidemiological knowledge and information to manage the diverse clinical presentations they see in practice with transgender patients. [12,20] Implementing informed consent protocols for treatment will bring physicians into greater contact with transgender patients, including those who present with diverse gender identities and presentations. [60] Demographic measures of gender identity that include binary and non-binary response options are recommended to inform future research and clinical care with transgender populations.…”

“…[19] People generally lack basic knowledge and competency of non-binary gender identities and experiences, including family members, employers, healthcare providers, and larger societal systems. [20] Not conforming to the male-female gender binary or gender social norms may expose non-binary transgender people to gender-related stressors from multiple sources. Conversely, it could be that nonbinary people have better health because subverting gender norms or not identifying with societal male-female stereotypes offers freedom from gendered expectations and removes some stressors.…”

“…[11] These gender identity differences in desire for gender affirmation vs. actual hormone utilization could suggest unique access to care barriers for non-binary transgender individuals, such as stigma in clinical care settings, including the provision of medical gender affirmation in accordance with gender binary protocols. [20,23] To that end qualitative data reveal that non-binary participants tend to be less likely than binary participants to have discussed their gender identity with their provider or disclose being transgender). [6,24] In the context of research demonstrating that healthcare avoidance due to past or anticipated discrimination from one's healthcare provider influences access to care for transgender individuals, [18] experiences of discrimination and avoidance could be driving differences by gender identity in access to gender affirming care.…”

Dealing With Uncertainty and Lack of Knowledge in Diverse Sex Development: Controversies on Early Surgery and Questions of Consent

“…71 Third, health professionals need to move beyond binary gender concepts, for example, by using inclusive language and creating ambiguity, in their everyday work. 72,73 When it comes to issues of medical interventions, factoriented decision-making aids and good knowledge transfer might be especially useful. In this context, a clear analysis of the legal situation regarding irreversible interventions in early childhood and medical indications is also of importance.…”

In This Issue: Continuity, Relationships, and the Illusion of a Steady State

“…7 An essay by Keuroghlian et al sheds further light on issues faced by people who do not conform to traditional gender norms and elucidates the use of inclusive, nonbinary language in patient care. 8 In a cluster-randomized trial in 15 practices, a relationship with a performance coach is found to increase the rate of provision of multiple components of the Ottawa Model for Smoking Cessation. No effect is seen in cessation outcomes.…”