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In order to successfully engage transgender and gender diverse (TGD) patients in care, clinicians and the health care institutions in which they work must first prove that their facilities are safe and welcoming places to be. A double bind exists for many TGD patients wherein they seek, in an ostensibly free market, to be able to choose the health care professional and location that provides the best services for their needs. Regardless of a patient’s privilege, the reality is that between insurance, geographic limitations, and a declining number of primary care clinicians, many people have little choice over whom they have as their clinician and where they see that person. Therefore, it is incumbent on health care professionals and their practice settings to educate themselves about and institute best practices to ensure that TGD patients receive sensitive and appropriate care.

Epidemiological data show that TGD patients are probably part of every clinician’s practice. With a reported 3% or more of the population identifying as gender diverse in some way,1 it is a matter of when a clinician sees someone who is gender diverse, not if. As part of the commitment to optimize care for all patients, to serve patients with the utmost fidelity, to provide autonomy and choices, and above all, to do no harm, gender-affirming care is a requirement. It is not enough for clinicians to know how to prescribe hormone therapy, make a referral for gender-affirming surgery, or write letters supporting a person’s desire to update the legal documentation of their gender identity. It is necessary to understand and respond to the social and cultural factors affecting gender minority people in a clinical context to provide the best possible care. After all, gender is a social and cultural construct, and without this context, it is not possible to appropriately understand why gender affirmation is important or how many nonclinical factors are critical to making someone feel included in society.2

How can clinicians find out the social and cultural constructs faced by TGD people? The answer is by engaging TGD people themselves in conversations and decision making about practice transformation and care. In short, clinicians and administrative leaders of their practice environments must engage in outreach with gender diverse communities to understand how to provide holistic, gender-affirming care. Although not all community outreach and engagement personnel need to share the identity of the groups they seek to serve, it is crucial to have some people who do share those identities, and for those people to be in positions of influence.3 After all, as promoted by leaders in the disability rights movement, “nothing about us, without us.”4

This chapter discusses how to build and reach out to networks of TGD people, identify and combat implicit biases against TGD people, understand and address intersections of identities when engaging community members, and use these networks to liaise effectively ...

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