Blog Viewer

The concept of people identifying as a gender other than what was assigned to them at birth has been around for centuries in some cultures, including Native Americans.¹ However, its emergence into Western culture and healthcare is more recent.^2-4 Studies have shown that medical professionals receive limited to no education regarding transgender patients.^5-6 Since it is likely health care professionals will begin having more interactions with patients who identify as transgender, it is important to have some insight and understanding about who they are.

In August of 2016, I was one of the presenters for ASHP Section on Clinical Practice Advancement webinar ‘A Pharmacist’s Role in Caring for Transgender and Gender Non-Conforming Patients.’ I became involved as one of the presenters because as a resident I spent three months working in a clinic caring for transgender and gender non-conforming patients. Like the majority of healthcare workers, I had no training on this patient population. When I began at the clinic I was unaware of what to expect- I had never knowingly interacted with a transgender person, professionally or personally. I was unaware of what to expect, and honestly a little apprehensive. However, once I began working with the clinical team and observed a few patient visits, all my concerns dissipated. Providing care to transgender patients has been one of the most rewarding experiences in my career.

When I first learned of patients identifying as transgender, I had a difficult time grasping the concept. Then a colleague asked me when I began identifying as a female. Then I realized that it was not a conscious decision I ever made in my life, I just always knew I was a female. My colleague explained that the situation is the same for our transgender patients. However, some patients choose not to seek care (or ‘come out’) earlier in their life for many reasons such as social stigma, fear of losing their job, financial concerns, or losing their relationships, etc.

I’d like to share some terminology/information I learned during my training in the transgender clinic that may help you in your interactions and understanding of transgender patients.

1. Gender Dysphoria: This is a DSM-V diagnosis defined as “discomfort, distress or functional impairment caused by incongruence between gender assigned at birth and affirmed gender.” It’s important to note that in order to have this diagnosis, patients must be having significant problems with their gender that are impacting their quality of life.

2. Cisgender: someone who identifies with their sex assigned at birth (example: a person born with a vagina who identifies as a female).

3. Transgender: someone who identifies as a different gender than the one assigned at birth (example: a person born with a vagina who identifies as male)

4. Transgender man: A person assigned female at birth who identifies as a man (trans-male)

5. Transgender woman: A person assigned male at birth who identifies as a woman (trans-female)

A good way to remember whether trans-male or trans-female is the appropriate term is that you always state the gender they identify as, not what they were assigned at birth. 

These are just a few terms to help you gain some insight on transgender persons. If you are interested in learning more about this patient population, there are many resources available. For a pharmacist perspective, you can access the ASHP Transgender Webinar or review Pharmacists caring for transgender persons, an article recently published in AJHP. 

1. "The 'Two-Spirit' People of Indigenous North Americans." The 'Two-Spirit' People of Indigenous North Americans. First People. Web. 07 Oct. 2016. Accessible at: http://www.firstpeople.us/articles/the-two-spirit-people-of-indigenous-north-americans.html
2. Arcelus J, Bouman WP, Van Den Noortgate W, Claes L, Witcomb G, Fernandez-Aranda F. Systematic review and meta-analysis of prevalence studies in Eur Psychiatry. 2015 Sep;30(6):807-15.
3. Reed, B., Rhodes, S., Schofield, P. & Wylie,
 (2009). Gender variance in the UK: Prevalence, incidence, growth and geographic distribution. Retrieved March 20, 2016, from http://www.gires.org.uk/assets/Medpro-Assets/GenderVarianceUK-report.pdf
4. Reisner SL, Bradford J, Hopwood R, Gonzalez A, Makadon H, et al. Comprehensive transgender healthcare: the gender affirming clinical and public health model of Fenway Health. J Urban Health. 2015 Jun;92(3):584-92.
5. Hayes V, Blondeau W, Bing-You RG. Assessment of medical student and resident/fellow knowledge, comfort, and training with sexual history taking in LGBTQ patients. Fam Med 2015;47:383–7.
6. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA 2011;306:971–7.