Pronouns and Affirming Care

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Hi everyone! We’re back this week to talk about pronouns and gender affirming care. With Gender Affirming Care and Trans Rights being constantly threatened in today’s political landscape, it is crucial to discuss the importance of gender affirming care while also providing you with information and resources to find affirming care near you.

What is gender-affirming care?

 Gender-affirming care refers to the life-saving healthcare of gender-diverse (i.e. transgender, nonbinary, or gender nonconforming) individuals of all ages, ranging from mental health care, medical care, and social services [1]. More than 1.3 million doctors across the United States recognize that it is medically necessary to support individuals in affirming their gender identity [1]. To this end, health care that affirms patients' gender identity improves mental health outcomes as well as the utilization of mental health services, social functioning, and overall quality of life (Bindman et al., 2022). Gender affirming care utilizes a patient-centered approach, drawing on evidence-based care to support gender diverse patients (Bindman et al., 2022). Gender affirming care requires the provider to support and validate their patient’s gender identities, while documenting and using their preferred names and pronouns (Bindman et al., 2022). In addition, providers will provide individuals with resources and information regarding transition-related care (for example, regarding hormone replacement therapy or surgery- depending on the individual; Bindman et al., 2022).

Academic research on health care experiences of gender diverse patients–

 Research has aimed to characterize the health care experiences of gender diverse patients (specifically individuals who identify as nonbinary), noting how they tend to have frequent negative health experiences which includes misgendering, invalidation, and pathologization (Bindman et al., 2022). Nonbinary refers to an individual whose gender identity is neither male or female, and includes diverse identities such as genderqueer, gender nonconforming, agender, Two Spirit, genderfluid, feminine of center, third gender, and more (Bindman et al., 2022). It is highlighted that gender minorities experience intensified health and mental health care needs, which are exacerbated by marginalization in health care (Bindman et al., 2022). For individuals in gender minorities who are also black, indigenous, or people of color (BIPOC), they experience even higher rates of health disparities (such as intersectional stigma surrounding racism and transphobia; Bindman et al., 2022).

In an effort to cope with negative health care experiences, Bindman et al. (2022) found that individuals engage in identity concealment (i.e. concealing/not disclosing one’s nonbinary or LGBTQIA+ identity). Moreover, individuals might avoid seeking care altogether in fear that they will experience stigma, discrimination, invalidation, etc. (Bindman et al., 2022).

1. Misgendering

 Misgendering refers to a person using gendered language to describe another that does not align with that person’s affirmed gender (Bindman et al., 2022). Bindman et al. (2022) reported that common among nonbinary participants is the inaccurate documentation of their gender identity by health care providers. This frequent misgendering by medical professionals leads to discomfort, stigma, and other negative health outcomes and emotions (such as stress; Bindman et al., 2022; Knutson et al., 2019). It is important to understand the role assumptions play in misgendering, as providers might see someone’s birth name and make assumptions regarding that person’s gender identity. It is also important to consider the experience of queer BIPOC, as they report being both misgendered and racialized by health care providers (Bindman et al., 2022).

2. Invalidation

 In addition to nonbinary individuals reporting being misgendered by medical professionals, they also experience feeling invalidated by their providers (Bindman et al., 2022). This invalidation intensifies for nonbinary individuals when the reason they are seeking care is related to their nonbinary identity (Bindman et al., 2022). This invalidation can lead to the patient feeling frustrated or upset, especially after they previously corrected the provider on their pronouns or name (Bindman et al., 2022).

3. Pathologization

 Another negative outcome reported by some gender diverse patients is pathologization, as Bindman et al. (2022) note that some patients describe how documenting their gender in their charts led to diagnoses of psychiatric conditions such as gender dysphoria, for example- despite the fact that patients were not presenting with distress (i.e. a required symptom for a diagnosis of gender dysphoria). This pathologization can be disconcerting for patients who are seeking care and can contribute to being a barrier for treatment. 

What to look for in a provider?

First, it is important to look for affirming care (that is, focus on gender-affirming care) when considering which provider is right for you. It might also be important to ensure the provider is culturally competent, for example in understanding minoritized groups or identifying as part of a minoritized community themselves. 

 When looking for the right provider for you, consider finding a professional with similar identities- whether that be gender identity, race, disability status, etc.- these aspects of identity might make you feel more comfortable, safe, and understood by a provider. For example, perhaps someone who is LGBTQIA+ might feel more comfortable and understood by finding a provider who is also LGBTQIA+. Additionally, as mentioned by Bindman et al. (2022), a queer BIPOC might seek an affirming provider who is also a queer BIPOC so that they can avoid misgendering and intersectional stigma (such as microaggressions).

The role of an affirming therapist–

Knutson et al. (2019) note the best practices for affirmative therapy include recognizing and validating the client’s gender identity, using gender pronouns congruent with the client’s gender identity, and using the client’s chosen name (rather than their assigned name). Another aspect of affirming care that clinicians should also consider is creating inclusive intake forms and paperwork for all clients (that is, providing more inclusive options for gender identity such as options including transgender man, transgender woman, or nonbinary; Bindman et al, 2022). More to this end, it is important to create intake forms that don’t pathologize but simply document a patient's gender (Knutson et al., 2019).

Sources

[1] https://www.hrc.org/resources/get-the-facts-on-gender-affirming-care Bindman, J., Ngo, A., Zamudio-Haas, S., & Sevelius, J. (2022). Health care experiences of patients with nonbinary gender identities. Transgender Health, 7(5), 423–429. https://doi.org/10.1089/trgh.2021.0029

[2] Knutson, D., Koch, J. M., & Goldbach, C. (2019). Recommended terminology, pronouns, and documentation for work with transgender and non-binary populations. Practice Innovations, 4(4), 214–224. https://doi.org/10.1037/pri0000098