Providing Culturally Safe and Welcoming Care for Transgender and Gender-Diverse Patients

By: Zoe Robinson, VP Finance and Reporting

Over Christmas 2020, I made a trip to the hospital emergency room. This was an uncomfortable experience, for a variety of reasons but particularly at intake because I had to share my OHIP card which had my deadname listed. For anyone who doesn’t know, my “deadname” is my old name prior to changing it during my transition. The intake nurse refused to use my chosen name because my government issued ID said something different and refused to ensure my chosen name would be communicated to the triage nurse. The use of my deadname caused anxiety for me. It was uncomfortable and I felt disrespected.

This is a common experience for many transgender people. Creating a culturally safe and welcoming environment for transgender and gender-diverse patients will improve the quality of care.

I began my transition as a transgender woman in 2018 and completed my legal name change in December 2021. Prior to December 2021, I used my chosen name, Zoe, even though my government issued identification still had my deadname. Completing administrative forms is a challenge when you have different names, and many forms don’t provide a space to list your legal name and your chosen name. Changing your administrative forms by adding spaces for your legal and chosen names, adding a field “Sex Assigned at Birth,” and adding options to the gender field, such as “Male, Female, Non-binary, Two-Spirit, Other” will be a welcoming first interaction for a transgender individual.

Other ways to create a culturally safe and welcoming treatment environment include:

• Listening to your transgender or non-binary patients. Let them guide you on the pronouns they use, the names they use for their body parts, and how they describe their transition experience.
• Patients may choose he/his, she/her, they/them, or something different as their pronouns. When introducing your name, say your name and what pronouns you use, then ask the patient what pronouns they use. For example: “Hi, I’m Zoe, and I use she/her pronouns. What pronouns do you like to use?” Follow their lead and use the pronouns they used. If you have a name tag, have your name and pronouns displayed.
• Be aware of the person in front of you not just the sound of their voice. I haven’t changed my voice, so it is lower than most women. I have been called “sir” while people are looking at me only because of the sound of my voice, missing all the visual cues that clearly identify me as a woman. This is more of a problem when on the phone and a person can’t see me. All of us sound different – don’t assume that a person with a deeper voice is male. Avoid using gendered terms when referring to them, or just avoid using gendered terms altogether.
• Not everyone is comfortable with scientific, anatomically correct terms for body parts. Listen to your patient and mirror the use of the terms they use for their body parts. Consider not using gender-referenced body parts and replace with non-gender terms. For example: breasts becomes chest; uterus / ovaries / testes become internal reproductive organs / gonads / pelvic region; sexual body parts become genitals. Your patient may use other terms specific to the language of their community.
• Treat the medical issue presented and diagnosed – don’t assume the issue is related to being a transgender or non-binary person or because they are in transition. Avoid asking questions about the patient’s transition unless the question is directly related to the medical issue and diagnosis. Discussing unrelated or irrelevant issues for an unnecessary length of time should be avoided. This scenario is known as “Trans Broken Arm Syndrome.” Always explain why you’re asking questions that may seem unnecessary or irrelevant, so the patient understands why and how the information is related to the medical issue presented and diagnosed.
• Strive to support your transgender and non-binary patients’ journeys to a healthy life. Create an environment that supports Gender Euphoria, affirming the transgender patient’s journey and helping them find what feels good while treating their medical issues.

I’m a runner – I have completed marathons and I run regularly. I also have a history of back issues. I hurt my back from running in the fall of 2021 and sought physiotherapy treatment. The clinic I visited created a culturally safe and welcoming environment for me. Their intake forms had spaces for my legal and chosen name. They had pride flags prominently displayed. The physiotherapist introduced herself with her pronouns and asked me what pronouns I used. My experience was positive as opposed to my intake at the hospital emergency room. As a side note, the triage nurse and the emergency room doctor were kind and created a safe space for me.

No two transgender people are the same, their journeys and experiences are very different. Learning about the experiences of transgender and non-binary people will help you, as a physiotherapist, provide excellent care that is sensitive to the needs of your patients.

More information on transgender people and transgender care can be accessed at:

• Canadian Physiotherapy Association – Women Health Division: “Introduction to Culturally Safe Care for Trans People in Physiotherapy” webinar
• Rainbow Health Ontario
• Sherbourne Health Centre
• Sick Kids – Transgender Youth Clinic
• The 519 (The 519 has an excellent resource for creating authentic and culturally safe spaces)
• Women’s College Hospital

This article is part of a series in support of the College’sEquity, Diversity and Inclusion initiatives. We look forward to sharing more posts in the coming year that explore pertinent societal issues, inspire meaningful conversation, and promote equity and inclusion.