The use of the correct name and pronoun are essential to affirming a person’s identity and showing respect. Often the first step that someone who is gender diverse takes to affirm their gender is to choose a name that is different from their birth name. After changing their name, many people refer to their birth name as their “dead name.” When someone accidentally or intentionally refers to a person by their birth name, this is called “deadnaming” (Clements, 2017). Misgendering, or the use of an incorrect name or pronoun, can be extremely upsetting to someone who identifies as gender diverse. If you accidentally misgender someone, the best way to handle this is to apologize and do your best to not allow this to happen again. When you are not sure about a person’s pronouns, ask them which pronouns they want you to use (Human Rights Campaign, n.d.-a).
Gender-Specific Treatment vs. Identified Gender
Patients who are gender diverse will arrive in the healthcare environment due to illness or injury that is similar to their peers who are cisgender, but they may also be seen due to an illness or injury related to the gender they were assigned at birth, not the gender with which they identify. For example, someone who identifies as male may be seen due to a gynecological concern, or a female-identified person may seek treatment for testicular pain. Patients who are experiencing medical care that is inconsistent with their identified gender should be approached with sensitivity. Physical examinations can be stressful for patients who have gender dysphoria, regardless of the reason for the examination (Klein, Paradise, & Goodwin, 2018). Child life specialists are in the unique position to provide procedural preparation and support that is sensitive to the patient’s gender identity. Honest, straight-forward communication is essential in such situations. Many healthcare professionals become unsure about how to discuss gender identity in relation to gender-specific body parts. Such conversations should be approached in a sensitive manner, as would be done for any child or adolescent, keeping in mind that the patient knows what body parts they have, whether this is consistent or inconsistent with their gender identity. As with any child or adolescent, patients who identify as gender diverse should be asked what word(s) they use to identify their genitalia. Patients should not be asked about their private body parts unless that is necessary for the treatment or procedure that they are undergoing (Clark, Vealè, & Zaleski, 2018).
People who identify as gender diverse often experience difficulty with insurance coverage. Insurance denials for transgender-related services can be a significant barrier to receiving proper healthcare for people who identify as gender diverse. One study found that approximately 25% of people who identified as gender diverse, specifically transgender, were denied insurance coverage based solely on their gender identity (James, Herman, Rankin, Keisling, Mottet, & Anifi, 2008, cited in Rafferty et al., 2018). The denial of treatment for gender dysphoria in pediatric patients is often based on the idea that gender dysphoria is a mental disorder and not a physical disorder. Based on this assumption, gender affirmation treatment, such as hormone therapy, is often deemed to be unnecessary by insurance providers (Rafferty et al., 2018). People who identify as gender diverse may also be denied insurance coverage for examinations and treatments related to the gender that they were assigned at birth, especially if they have changed their gender marker on their legal paperwork. For example, someone who identifies as male but was assigned female at birth and has female genitalia may be denied access to a PAP test. In addition, youth who identify as gender diverse may or may not have parental support related to their gender identity. Those who do not have parental support run the risk of not having access to health insurance and parental consent for healthcare (Torres et al., 2015).
Uninformed Healthcare Providers
The healthcare setting can often be an unwelcoming environment for people who identify as gender diverse due to many factors, including providers’ insufficient knowledge or competency regarding care for patients who identify as gender diverse. Many people who are gender diverse report that they have had to educate medical staff on caring for a person who is gender diverse. This is an additional hardship to accessing medical care that should not be the responsibility of the person who is gender diverse (Torres et al., 2015). The American Academy of Pediatrics (Rafferty et al., 2018) recommends that provider education include information about the best practices for the care of youth who identify as gender diverse and their families.
People who identify as gender diverse often worry about whether the clinical environment will be a safe place for them (Rafferty et al., 2018). A safe environment is the responsibility of not only the healthcare provider, but all staff within the healthcare setting. Education and training about terminology and other gender diverse topics should be provided to all staff (Klein, Paradise, & Goodwin, 2018). People who are gender diverse report that the correct use of name and pronoun is one of the most important aspects that leads to feeling safe within the healthcare environment (Torres et al., 2015). Healthcare settings should ensure that their electronic medical record systems include options for the inclusion of preferred names and pronouns so that all staff have access to this information. Providing access to gender-neutral bathrooms is another way to ensure that people who identify as gender diverse feel safe (Torres et al., 2015). The healthcare environment itself can be more welcoming by including pictures of diverse families and people in public areas and including gender-neutral language on intake forms (Klein, Paradise, & Goodwin, 2018).
Due to various healthcare challenges and previous negative experiences, many people who identify as gender diverse avoid healthcare settings. There is limited research regarding youth healthcare avoidance, but one study found that 25% of adults who identified as transgender had avoided going to a necessary doctor’s visit in the last year because they were afraid of being mistreated (James, Herman, Rankin, Keisling, Mottet, & Anifi, 2008, cited in Rafferty et al., 2018). Maintaining a confidential, safe clinical space is an important step to gaining the trust of gender diverse youth and their families (Rafferty et al., 2018). Child life professionals can advocate for and work toward fostering an emotionally safe clinical environment, in both inpatient and outpatient settings. This includes advocating for the use of correct name and pronoun and providing supportive and sensitive care for youth who identify as gender diverse by all members of the healthcare team and clinical staff. Setting the foundation for early successful medical experiences may minimize healthcare trauma and lessen healthcare avoidance later in life.