Trans and Gender Diverse People and Health Care Services

We begin the 2021 BMJ STI Podcast series with the first episode focusing on Trans and gender diverse people and health care services.

We consider the question: Why do health care services need to adapt and promote provision of inclusive and non-discriminatory care independent of gender and sexual preference?

In June 2020, the New Yorker published a column written by Masha Gessen, who is transgender and non-binary, describing their personal experience as a trans patient in an emergency room in the USA. Clinicians required them to undertake a pregnancy test before having a CAT scan despite Masha informing them that they were on testosterone and had undergone a radical hysterectomy in the past. The details of their experience echo that of countless others and brings into focus the need to deliver trans and gender diverse inclusive health care. As it stands the current health care model fails to provide ‘agency’ to and only aids the ‘erasure’ of transgender and non-binary patients.

We use this podcast to probe into transgender and gender diverse persons health care and identify how services could adapt in order to provide inclusive health care.

Join Dr. Fabiola Martin, Dr. Jae Sevelius, and Dr. Graham Neilsen as we explore these questions and more!

Highlights:

Most health care systems need make practical changes to accommodate trans and gender diverse people: such as unisex toilets, preferred name on registration forms, organ inventory forms
Training of staff on how to communicate in an inclusive way to all people
Professional feedback to service providers who have not been able to provide gender inclusive care
Small changes may be used to change the care environment:
- –2-step questions to determine sex and gender e.g.
  - -‘What is your gender identity?’
  - -‘What sex and gender were you assigned at birth?’
- -Use an ‘organ inventory’ instead of making assumptions e.g.
  - -‘Could you tell me which operations you have had and if any organs/parts of your body were removed? ‘
- -The telehealth care, catalysed by COVID-19, may remove some of the barriers, such as distance and access to specialists, but more research is needed.
- -Clinicians and researchers can seek guidance from patients as “experts of their own experience” to implement health service improvements.