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Among those who are transgender or gender diverse, the process of gender emergence, or “coming out,” is defined as the experience of becoming self-aware or the act of disclosing to others that one is transgender or gender diverse (TGD). This developmental process involves both recognizing and accepting one’s identity as a transgender or gender diverse person and achieving a state of readiness to present this identity to others both publicly and privately.

Health care professionals can play a supportive role in the lives of their patients who identify or are beginning to identify as TGD in multiple ways. This chapter explores the nuance of gender identity emergence in adulthood, addresses various pathways toward gender affirmation, and speaks to relevant clinical considerations for practitioners. In caring for this population, health care professionals must confront their own unconscious and conscious biases. Such biases may affect clinicians’ interactions with TGD CLIENTS? therefore steps must be taken to overcome these internalized assumptions. It is also important for health care professionals to recognize that their TGD patients are unique individuals, with varied histories, experiences, and backgrounds. No one pathway for coming out fits all people.


Given the history of pathologizing gender diversity and gatekeeping of gender-affirming care within the medical and behavioral health fields, many TGD people will present to care with a history of previous unsatisfactory or outright traumatic experiences.1 Such experiences can cause patients to feel trepidation, anger, sadness, or other emotions about not only the clinician but also the health care system as a whole. In addition, experiences in which the patient has had to educate their clinicians can be a consideration in their access to care, as “many [TGD] people are forced into the role of educating their clinicians about the medical and emotional needs of [TGD] individuals, while also correcting misinformation and combating stigma and bias.”1 It can be exhausting and may drive people away from care when they have to educate a medical or mental health professional about gender identity and care. Further, it can negatively impact clients’ ability to trust clinicians, engage in treatment, and can detract from time spent delivering key therapeutic interventions.

To provide the best care for their patients, clinicians must appreciate the adverse historical impact of medical and behavioral health professions on adult TGD patients and demonstrate accountability in current interactions with adult TGD patients. Chapter 11, “Principles of Trauma-Informed and Gender-Affirming Care,” reviews the basic principles of offering care that acknowledges the burden of trauma that many TGD patients bring to health care encounters, but also acknowledges the inherent strengths and resilience that allow people to recover and heal. Trauma-informed care involves asking for and using a patient’s correct pronouns and names, respecting their right to self-determination with regard to identifying as TGD, and supporting them in exploring their gender ...

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