Wednesday, November 14, 2012

Best Practices Checklist for Providing Medical Care to Trans Patients


I have been asked by some organizations to provide them with a pamphlet or list of best practices that they could share with medical practitioners regarding the care of trans patients.

I suggest as a substantial resource for outlining trans medical care standards  the materials provided by the Center of Excellence for Transgender Health, which can be accessed here.  

What I've done is write up a checklist that others can share with medical practitioners that is succinct and that includes practical suggestions highlighting key concerns raised by many trans people.  This checklist is founded on the presumption that transphobia is unacceptable in health care practice, and that care providers wish to provide high quality care to all patients, including sex and gender minorities.

Best Practices Checklist for Providing Medical Care to Trans Gender and Gender-variant Patients

Compiled by Dr. Cary Gabriel Costello

  1. Members of your practice group have received cultural competence training in interacting with trans gender and gender-variant individuals, and medical training in the needs of trans gender and gender-variant patients. ( An outline of standards of care is available from the Center of Excellence for Transgender Health.)
  1. Your medical records are kept in such a manner that the name the patient uses appears at the top of files. (If that name differs from the patient's legal name or the name on the patient's insurance card, it is the name that the patient uses which is first seen by any staff interacting with patients, so that the patient is always called by the name the patient uses.)
  1. Patient records prominently display the pronoun that the patient uses, and staff are careful always to use that pronoun.
  1. Sex/gender characteristics are recorded in the following manner based upon patient self-identification:
        a.  Patient's gender identity: male____ female____ self-designation_________
        b.  Patient's gender identity matches the sex patient was assigned at birth: yes____ no____
        c.  Patient is intersex/has a DSD/is physically sex-variant: yes___ no____
  1. At least one member of your practice is able to supervise hormone replacement therapy for individuals who gender transition medically.
  1. Members of your practice can present interested patients with a list of practitioners in the area who perform transition-related surgeries, including orchiectomy, chest reconstruction, and genital surgeries. Staff are aware that patients may wish to access all, some, or none of these services.
  1. When a trans gender/gender-variant patient visits, the patient is treated with discretion, and attention is not drawn to the patient's status as a gender minority. For example, a patient's trans gender status is not discussed where other patients can overhear; other medical staff are never invited into the examination room to educate those other staff about trans bodies unless the patient volunteers to serve as an educator; pelvic examinations are never performed with the bed facing the door so that the patient's genitalia might be exposed if the door were unexpectedly to open.
  1. When a trans gender/gender-variant patient is examined, practitioners use language to describe body parts that does not undermine the patient's gender identity; e.g. for a trans man, say “chest” not “breasts,” “pelvic exam” not “vaginal exam;” for a trans woman, say “genitals” not “penis.” If robes are provided to patients, they should not be gender-marked in a way that undermines the patient's gender identity.
  1. Trans gender and gender-variant patients and the general patient pool are protected from uncomfortable situations in waiting rooms, testing facilities, etc. For example, the presence of a visibly trans gender person in a mammography waiting room can cause stress for the trans person and for the other patients. The solution to such situations should always center the patient's gender identity—for example, allowing the patient to wait in a private room. Trans women are never asked to wait in a room that says “men” and trans men are never made to wait in a room that says “women.”
  1. Medical staff are prepared for patients to “come out” about being trans gender or gender-variant. Staff respond with composure and empathy, and focus on the patient, not on how member's of the patient's family or community will react. Staff are able to inform the patient about what medical transition entails if the patient is interested, and can provide the patient with a list of therapists in the area who work with clients who are considering medical transition.
  1. Members of your practice are aware that children can have trans gender or gender-variant identities, and are able to refer these children and their families to appropriate pediatric and family therapists for support.
  1. Treating trans gender and gender-variant patients respectfully and well is one of the criteria of medical staff review. Those who do so are credited; any staff who treat trans gender/gender-variant patients disrespectfully are disciplined.



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