What we talk about when we talk about Caitlyn: A nurse’s guide to transgender care
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Caitlyn Jenner aside, you’re not likely to run into a lot of transgendered people as a nurse. Still, it’s a good idea to know how to handle the unique challenges and differences of genderqueer and transgendered patients. Years ago, I worked in a clinic that advertised both its gay-and-lesbian friendliness and its acceptance of GQ and TG patients. The learning curve was steep, but I came away with a few very basic tips.
First of all, let’s define our terms. “Cisgender” refers to a person born in a body that they feel fits them. “Transgender” refers to a person, regardless of whether they are in transition or plan to transition (that is, live as another gender), who feels that they are a gender that does not match their physical body. “Genderqueer” means that the person doesn’t feel they fit into the typical binary, male-or-female definitions of gender. It denotes a fluidity of gender, a rejection of traditional gender identities altogether, an embrace of a third gender defined by that person, or a lack of gender, period.
Remember here that “gender,” which is your role in society as determined by your plumbing, is typically understood to be separate from sex, which is your biological status determined by your plumbing. Got it? Yeah, it was hard for me at first, too.
Second, some basic etiquette. If a person comes to you and identifies as a woman, do not refer to them as “him,” if he started out as a man. That’s just rude. It’s also seen as a type of veiled violence or aggression by a lot of GQ or TG folks. If she presents as a she, she’s a she. If he presents as a he, he’s a he.
If you don’t know, ask. No, seriously. If you ask a person which pronoun they use to describe themselves, or how they’d like to be referred to, they’re not going to get offended. Provided, that is, that you do it in a respectful, open way, as a request for information.
Don’t ask about top surgery or bottom surgery unless it’s pertinent to the situation at hand. Curiosity is normal, but it doesn’t always have to be satisfied.
Likewise, the mechanics of sex are none of your business.
Third, it’s wise to keep a few things in mind about the challenges faced by TG and GQ folks, especially young people.
Transgendered and genderqueer kids are more likely than their cisgendered peers to be victims of domestic violence. They’re more likely to abuse drugs and alcohol. They’re more likely to be runaways or end up homeless. If you’re screening for those things, be prepared to take a little more time with somebody who is TG/GQ. Life and family situations aren’t easy for teenagers of any stripe, and can be much tougher for teenagers whose families find their very existence to be unnatural or offensive.
TG and GQ adults, as well as kids, are much more likely than cisgendered folks to be the target of violence in public. Back in the 1970s and 1980s, gay people got rolled (that is, beaten up for being gay); people who suck now target TG and GQ folks much more often. (Gay people still get rolled, by the way. People who suck live in every decade.)
As a result of stresses that come from gender-identity mismatch, some TG/GQ folks have extensive psychiatric histories. That doesn’t mean they’re crazy, any more than it means anybody else is. Remember that the world is a harsh place for people who aren’t typical, and that some people will have been psychoanalyzed over and over in an attempt to “cure” them.
Finally, be aware of the reactions of your colleagues. It’s up to everybody to make a healthcare facility a safe space for everybody else. Sometimes, well-meaning people need a little education on the fly.
If you screw up, be honest about it. Apologize. Treat people with respect, and think before you speak. Remember that the one TG/GQ person you meet is not going to want to be your ambassador to the world of gender identity, and that it’s not his or her job. Do a little quick Wikipedia-ing for basic information if you need to.
And remember that everybody—whether or not you agree with, understand or approve of them—is somebody’s child.
Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at firstname.lastname@example.org.
By Agatha Lellis