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This chapter introduces the most current terminology used to describe sex, gender, and sexual orientation; reviews key demographic and epidemiologic metrics of transgender and gender diverse (TGD) populations; describes some of the social and health inequities faced by these populations; and explores the critical need for gender-affirming health care for all patients. Depending on their level of experience in providing care for the TGD community, some readers may be unfamiliar with these basic concepts, while others may have some preexisting knowledge. Many of the definitions, concepts, and models introduced in this chapter are discussed in greater detail in subsequent chapters of the textbook, as are the practical aspects of delivering health care for these populations. References to the appropriate chapters are given where feasible.
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Terminology is constantly changing. Terms that were acceptable 20 years ago (e.g., “transsexual”) are considered offensive and are now no longer used. Likewise, what is acceptable terminology today will also continue to evolve and may one day become outdated. A simple way to avoid misgendering a patient (i.e., referring to a person by a pronoun or other gendered term, such as Ms./Mr., that incorrectly indicates a person’s gender identity or that is personally inappropriate or offensive) is for health care professionals to ask each patient specifically how they self-identify and what their pronouns are. Asking these questions is a basic first step in providing gender-affirming care.
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Health care professionals should also familiarize themselves with the concepts of sex and gender which are core determinants of health and wellbeing. In addition to the biological differences of sex, which can have a profound impact on specific disease risks, pharmacological effects, and screening recommendations for cancer and other illnesses, social and economic aspects of gender play important roles in access to quality health care, including mental health treatment and preventive services, that can lead to different health outcomes based on gender. To provide the best care for all patients, clinicians must recognize the ways in which both sex and gender influence health care access and outcomes and work to equalize inequities so that all patients receive respectful and responsive care.
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Although the terms “sex” and “gender” are often used interchangeably, these terms have distinct definitions. Sex refers to a person’s physical characteristics—the anatomical, genetic, and biological traits that have traditionally been categorized as either female or male. The term sex assigned at birth specifies sex as defined by anatomical and other biological sex characteristics and designated at birth (Table 2-1). It is important to note that, contrary to traditional expectations, sex is not a binary variable—that is, many people are born with variations in sex development that are beyond traditional societal notions of binary female or male bodies. Acceptable terms used to describe these variations include intersex and differences of sex development.
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