In 2008, the American Medical Association, American Psychological Association, American Psychiatric Association, and National Association for Social Workers independently determined that medical and mental health procedures associated with gender transition are medically necessary, not elective or cosmetic. Nearly 7 years later, insurance companies are just starting to catch up with this thinking and are changing their policies as a result. Many aspects of healthcare are, and will continue to be, affected by the transgender patient. “Transgender” is the term used for people whose gender identity or expression differs from their assigned sex at birth. Gender reassignment surgery is a major component of treatment. During the next 5 to 10 years, the new transgender patient will essentially transform cosmetic surgery from a boutique industry for the affluent to bona fide healthcare that saves lives. Here’s how to prepare your practice for the new transgender patient:
Learn the Ropes
For the transgender patient, cosmetic surgery is healthcare. Growing numbers of employers and insurers are recognizing this and covering the procedures. Your patients will expect coverage. Designate an administrator to help your transgender patients navigate these uncharted waters. Such assists can go a long way toward helping patients feel comfortable in your practice.
Invest in Training
Make sure your staff knows how to address and treat the transgender patient. This can be achieved by cultural competency and sensitivity training. I frequently find that the provider is culturally competent about the experience and treatment needs of the transgender patient, but his/her office and support staff are not. This creates a negative treatment environment for the patient.
Get to Know Your Patients
The new transgender patient is typically under 25, underemployed, and struggling with associated mental health issues and/or lack of life functioning and management skills. This is a dramatic paradigm shift. Until now, transgender patients were middle-aged, affluent Caucasians who could pay out of pocket for gender-reassignment procedures. It is important to get to know all you can about the new transgender patient. Consider attending a conference. There are many transgender conferences held annually throughout the country. The largest is Southern Comfort, held in Ft Lauderdale, Florida, every September.
Tell Patients What they Need to Hear
Darker skin responds differently to surgery and healing than lighter skin. Given the rise in ethnic and minority patients seeking gender-conforming surgeries, it is prudent to alert them that you can and will take measures to avoid scars and other wound-healing issues. I have had Hispanic and African American transgender patients very concerned about their upcoming procedures because the surgeon had not communicated such specific knowledge.
Manage Expectations
The new transgender patient may not have a well-developed sense of self. Also, he/she may have unrealistic medical requests and may need to be coached on what available procedures are most appropriate. In addition, many transgender patients believe that transgender-related medical procedures will fix everything in their lives and make them “happy.” This is not always the case. Our collective sociocultural programming tells us that gender is a fixed binary system, rooted in biology and inherently unchangeable. That programming is more entrenched in the social consciousness than most people realize and it is incredibly hard to rewire, even if a person understands that it isn’t a good match in their case. Current medical science has accomplished much in achieving approximation of biological femininity/masculinity, but it isn’t perfect. Patients need to do mental work, too. I have known of many post-transitioners who are deeply unhappy because whenever they look in the mirror, they still see the man who was rather than the woman who is, or vice versa/
David Baker-Hargrove
David Baker-Hargrove, PhD, LMHC, is a psychotherapist in Orlando, Fla. He provides transgender-inclusive consulting and training to businesses, colleges and universities, and healthcare facilities and professionals. He can be reached at [email protected].
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