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Chapter 24: Integrated Care of the Transgender and Gender Nonbinary Person

Anna Goldman; Ole-Petter R. Hamnvik

INTRODUCTION

Variations in gender identity are common. Survey studies estimate that 0.6% of the adult population of the United States—or 1.4 million individuals—identify as transgender.1 Additionally, an increasing number of individuals identify as having a nonbinary or fluid gender or a gender outside of the male/female spectrum. As a result, all health care providers will encounter transgender/gender nonbinary (TGNB) individuals in their practices (Table 24-1). Furthermore, the health care needs of TGNB individuals are multifaceted, involving trans-specific health care from generalists and from a wide variety of specialists. Unfortunately, despite the large number of TGNB individuals and despite the increasing social awareness and acceptance of variations in gender identity, the TGNB population continues to face major challenges in accessing and obtaining good health care. Most health care providers typically receive only limited formal training in addressing the needs of this population, which can contribute to the distress that TGNB people face and their avoidance of the health care system. In this chapter, we will outline the contributions of the various members of the multidisciplinary team other than the prescriber of gender-affirming hormone therapy and the surgeon, whose roles are discussed in another chapter. We will also provide practical advice on creating a welcoming clinical environment for TGNB individuals.

TABLE 24-1 Glossary of Terms Used in Transgender Health
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TABLE 24-1 Glossary of Terms Used in Transgender Health
Affirmed gender The gender that corresponds to an individual’s gender identity.
Cisgender (cisgender man, cis man, cisgender woman, cis woman) Individuals with gender identities that align with the sex recorded at birth.
Gender-affirming treatments (including gender-affirming hormone therapy and surgical procedures) Medical or surgical treatments that masculinize or feminize the body.
Gender dysphoria Distress that is caused by a discrepancy between an individual’s gender identity and the sex recorded at birth.
Gender expression, gender role One’s gender presentation to the world, which may or may not correlate to an individual’s gender identity or sex recorded at birth.
Gender identity An individual’s innate sense of being male, female, both, or neither.
Gender marker Indicator of gender on official documents. This may be male/female only, or additional gender markers may be available depending on the jurisdiction. Changing the gender marker on official documents is often a part of the gender affirmation process.
Gender nonbinary, genderqueer, gender-nonconforming Identity label that may be used by individuals whose gender identity and/or role does not conform to a binary understanding of gender as limited to the categories of man or woman, male or female.
Mental health professional (MHP) A professional with specific training in behavioral health and counseling, such as psychologists, psychiatrists, and social workers. MHPs who are involved in providing care to transgender/gender nonbinary individuals should be knowledgeable about gender-nonconforming identities and expressions and the assessment and treatment of gender dysphoria.
Misgender To refer to someone, usually a transgender/gender nonbinary person, using words that do not ...

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