Introducing your own pronouns before asking your patient’s not only shows you’re aware people’s pronouns might differ from their gender expression and you respect that, but shifts the power imbalance just slightly because you’re offering information about yourself before asking about them.

When in doubt? Use neutral pronouns (they/them)!

Especially when you’re talking about genitals or other areas that may bring dysphoria to a trans person, ask them what language they want/like to use to describe those areas. Or mirror the language they’re already using.

If you need to use biological terms, do so without gendering them. You can discuss a uterus without describing it as “female anatomy” or a penis without calling it “male genitals”.

Remember: transmasculine, intersex, and non-binary folks can get pregnant, and might menstruate, and it can feel incredibly dysphoric to have their bodies doing something so commonly associated with women.

Considering shifting language to neutral terms like “pregnant people”, “chest feeding” and “tampons and pads” (as opposed to “feminine hygiene products”). You can talk about “people who menstruate”, when relevant, as well.

Rather than guessing or making assumptions, try openly asking a client who they might be having sex with and how they’re doing it. Trans, nonbinary, and gender non-conforming people can be sexually active with people of any gender. Of course, you want to ensure you’ve already created as safe a space as possible so they know they can share this information with you.

But it’s important to ask these questions, as they help your patient know they can discuss sex with you and ask you questions, too. After all, your patient might think testosterone can stop them from getting pregnant or want to engage in penetrative sex but doesn’t know how to ask for phosphodiesterase inhibitors… You can help them navigate these things!

Your patient’s first line of contact is through reception and that first impression is extremely important in creating a safer space.

Ensuring all staff receive positive space training (ideally one created and delivered by 2SLGBTQ+ people!) can make a big difference. They should learn not to assume someone’s gender and pronouns based on their expression, and have a method to list people’s names in a visible spot, if they differ from their legal names.

It’s also great when a question about pronouns is on the intake form and then can be somewhere visible on the patient charts so reception is aware and can avoid misgendering patients.

Have trans-friendly referrals handy, for a variety of specialists your patients may need to see. For example, fertility clinics, endocrinologists, psychiatrists, etc.

To tell if they are trans affirming, you can check out their advertising and patient recommendations, or even call and speak to them yourself.

True, you can’t guarantee your patient will have an affirming experience there, but you can do your best to advocate for them and smooth the process.

Consider asking your patient if you can call ahead on their behalf and let them know the situation - at the very least, that might avoid some very uncomfortable confusion or misgendering when your patient arrives!

Social determinants of health including racism, transphobia, and invalidation at both personal and systemic levels can be detrimental to both mental and physical health.

There may be non-medical ways you can support, advocate for, or refer your patient based on their situation. A conversation with their parents encouraging them to support their child’s identity, a referral to a social or therapeutic program or letter of support could go a long way in improving your patient’s overall health.

Also, remember that while there are of course risks with providing medical transition medication, there are also risks associated with a person being denied these things.

At the end of the day, if you are reading this in the hopes of making your practice more inclusive for trans, non binary, and gender non-conforming patients, that motivation to improve is a huge component, and one that will continue to evolve.

And even when equipped with additional knowledge, be careful not to make assumptions about a patient's journey; not all trans people want hormones, or surgeries.

Everyone's path is different, so as we mentioned above: when in doubt of how to best support your patient, do your own research and then ask them as respectfully as possible.

If you do make a mistake: apologize, correct yourself, and move forward committed to improving your practice to support all of your patients with welcoming, informed, and inclusive care.