Gender identity and expression are complex aspects of human experience. They encompass how we see ourselves and present to the world. Understanding these concepts is crucial for providing inclusive healthcare and respecting diverse identities.

Gender dysphoria can significantly impact mental and physical health. Healthcare providers must be aware of its manifestations and treatment options. Overcoming barriers to care and implementing inclusive strategies are essential for supporting transgender and nonbinary individuals.

Understanding Gender Identity and Expression

Gender identity and expression

• Gender identity: Internal sense of being male, female, neither, or another gender
  • Cisgender: Gender identity matches sex assigned at birth (e.g., assigned female at birth and identifies as a woman)
  • Transgender: Gender identity differs from sex assigned at birth (e.g., assigned male at birth but identifies as a woman)
  • Nonbinary: Gender identity exists outside the male-female binary (e.g., genderfluid, agender, or genderqueer)
• Gender expression: External presentation of gender through behavior, clothing, hairstyle, voice, or other characteristics
  • May or may not correspond with gender identity or societal expectations of masculinity or femininity
• Sexual orientation: Emotional, romantic, or sexual attraction to others (e.g., lesbian, gay, bisexual, pansexual)
  • Distinct and separate from an individual's gender identity and expression

Gender Dysphoria and Healthcare for Transgender and Nonbinary Individuals

Gender dysphoria manifestations and impact

• Gender dysphoria: Distress resulting from a mismatch between gender identity and sex assigned at birth
  • May present as persistent discomfort with primary or secondary sex characteristics (e.g., genitals, breasts, facial hair)
  • Can contribute to negative self-image, anxiety, depression, and other mental health challenges
• Physical manifestations may involve a desire to change or remove sex characteristics through medical interventions
  • Hormone therapy: Masculinizing (e.g., testosterone) or feminizing (e.g., estrogen) hormones to align physical characteristics with gender identity
  • Gender-affirming surgeries: Procedures to modify primary or secondary sex characteristics (e.g., chest reconstruction, genital surgery)

Barriers to healthcare access and inclusive care strategies

• Stigma and discrimination in healthcare settings
  • Lack of provider knowledge or sensitivity regarding transgender and nonbinary health needs
  • Misgendering or refusal to use preferred names and pronouns, creating an unwelcoming environment
• Limited access to gender-affirming care
  • Inadequate insurance coverage for hormone therapy or surgical interventions, leading to financial barriers
  • Scarcity of healthcare providers experienced in transgender and nonbinary health, especially in rural areas
• Strategies for inclusive care:
  1. Educate healthcare staff on gender identity, expression, and specific health needs of transgender and nonbinary individuals
  2. Use inclusive language and ask for preferred names and pronouns, respecting individual identities
  3. Provide gender-neutral facilities (e.g., restrooms) and forms with diverse gender options
  4. Establish policies prohibiting discrimination based on gender identity and expression
  5. Collaborate with experienced providers and refer patients as needed to ensure comprehensive care