A 2022 report by UCLA Williams Institute found that 1.6 million people in the US age 13 and over identify as transgender. According to Annals of Emergency Medicine, over 40% of transgender patients avoid the emergency department (ED) due to negative past experiences, fear of discrimination, and long wait times. Given the unique health challenges and disparities transgender patients face, it is crucial for ED providers to be aware of specific considerations to ensure equitable and effective care for this vulnerable population.
Cultural Competency, Safety, and Respect
One of the most important aspects of the healthcare provider/patient interaction is making transgender patients feel safe, given the negative experiences many have endured in the past. Creating a welcoming, supportive environment actually starts in the waiting room – and sometimes even before. A 2024 JAMA Original Investigation highlights the importance of implicit cues like having organizational policies and LGBTQ materials on the ED website and in the waiting room to help transgender patients feel more comfortable seeking care and/or disclosing their status.
Making it easier and more comfortable for transgender patients to disclose gender and sex when necessary is key from the start to the finish of their ED visit. Staff and providers must understand and use the correct pronouns and terminology to establish and maintain effective communication and trust. Training all emergency department personnel on transgender issues, inclusivity, language, and other important aspects is crucial to providing a safe environment and top quality care. The National LGBQTIA+ Health Education Center offers valuable resources including webinars, online learning, toolkits, CME courses, and training programs.
Privacy and Confidentiality
Transgender patients may fear discrimination or violence if their gender identity is disclosed without consent. According to the National Center for Transgender Equality, HIPAA laws require most healthcare providers to protect transgender patient privacy. Transgender patient diagnosis, medical history, sex assigned at birth, and anatomy should not be disclosed to anyone without patient consent or shared with other medical providers unless there is a specific need to do so.
Comprehensive Medical History
When taking a medical history, it’s important to avoid making assumptions about any patient’s gender, sex, or sexual orientation. The EMRA Transgender Care Guide recommends providers start by asking patients their preferred name and pronouns if not already noted. Subsequently, ask open-ended questions that allow patients to describe their gender identity and sex in their own words. The EMRA Guide also recommends providers take detailed sexual and social histories of transgender patients to ensure appropriate care and resources can be provided. In addition to other standard medical history questions, it’s important to ask about hormone use, surgical history, and any complications from gender-affirming procedures, as these can impact current health conditions and treatment decisions.
Conducting Physical Exams
Providers should use a gender-affirming approach when conducting physical exams. In addition to continued use of the patient’s correct name and pronouns, it’s important to use general terminology for body parts, or ask patients if they have a preferred term. According to Transgender Health, physical privacy and spatial considerations are extremely important to transgender patients. An important note: examinations should only be performed on body parts relevant to the specific visit.
Clinical Care Nuances
Patient’s hormone use and surgical history are two important factors to consider when assessing current health conditions and treatment options. For example, transgender women (assigned male at birth) receiving gender‐affirming hormone therapy experience a much higher rate of venous thromboembolism, ischemic stroke, and myocardial infarction than cisgender men and cisgender women according to Fundamental and Clinical Pharmacology. Surgical history, such as chest reconstruction or genital surgery, may also impact diagnostic and treatment plans. Understanding these nuances is crucial for ensuring accurate assessments and appropriate care.
Mental Health Considerations
Transgender individuals have higher rates of mental health issues, including depression, anxiety, and suicidal ideation, often due to societal stigma and discrimination. A 2019 study in Transgender Health showed that 58% of transgender patients had at least one mental health diagnosis compared to 13.6% of cisgender patients. It’s important that emergency medicine providers maintain awareness of mental health risks in transgender patients in the event that mental health resources, support, or assessments are needed.
Recap
Treating transgender patients in the emergency department requires a thoughtful and informed approach. To provide equitable and effective care, ED healthcare providers must develop cultural competency and ensure that transgender patients feel respected and safe throughout their visit. Provider awareness of trans-specific factors throughout the patient visit is paramount and patient privacy and confidentiality must be maintained. As the number of transgender individuals seeking emergency medical care continues to grow, it is imperative that emergency medicine providers remain committed to the highest quality care for transgender patients and to creating a more compassionate and effective healthcare system for all.
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