Considerations for Care of Transgender Patients- Practice Management

Recently, a close family friend, a provider none the less, posted on Facebook that he was looking for feedback regarding LGBTQ-friendly providers in our local area. This was in the interest of making a list of “friendly” providers in the area to refer locals for care. My immediate response was to say that “We are!!” Of course, we are. We own two sole-provider practices in a rural outside of a major metropolitan city. I manage the two practices where my husband is the sole provider for over 1,000 active patients, and we have been in practice for 16 years. We are most assuredly LGBTQIA friendly.

Sadly, my response was followed by this: “I am sorry to say we travel almost two hours for care for our daughter. This is not for specialized care; this is for primary care.”

In fact, I dipped my toe in our local primary care pool again two weeks ago so she could just have a flu shot, only to have her misgendered multiple times. This, by a provider who knows us very well, one who I like to think of as a friend. When this provider misgenders my child, who unfortunately had a significant adverse reaction to the flu shot, I felt so betrayed. Sentimental shock set in- anger, anguish and agony gave way to sadness and defeat. For you see this human has graced the threshold of my own home and provides care for my other babies. I don’t know how to fix this.

I did acknowledge the digression. She apologized. It happened again. I did not acknowledge the digression. The final email, which was kind, included appropriate pronouns, but the damage was done. I was left to question intent. My husband was furious and protective. Those who know my husband know that he is not the one who gets angry. He is the measured, quiet and reserved of the two of us. In this case, I knew he was right and justified in his vehement defense, in his steadfast position. He said, “We will pull them all.” He is correct. He is absolutely right.

Days later, I was on a practice manager forum on Facebook looking for billing tidbits, marketing ideas, and human resources, only to stumble on the following: “Good morning! We have a sensitive subject with a patient that we are trying to figure out the best way to handle. We have a young, male patient that has been with us for several years, Phase 1 now into Phase 2. It is clear by his appearance that he is transitioning to female by his clothing and hair and other things. What is the best, most sensitive way to approach this as in, would you ask if they have a new preferred name? We want to handle it with respect and sensitivity but also respecting their decision. Thoughts?”

Forty-eight substandard responses later (OMG, “hand them another form to fill out”, are you kidding me?!), I was laser focused on one that was absolutely abhorrent.



I have done the author a courtesy she did not extend to her patient- the courtesy and kindness of anonymity. That is me calling her an ass and another person indicating that they had “the same thing” and actually called the patient’s DENTIST to discuss.

To be clear I do not identify as LGBQIA so I don’t have prospective for that part of our family community. I am the mother of a perfectly made, incredibly kind, intelligent, well-adjusted TRANSGENDER daughter and this is the treatment the “T” most assuredly receives when we seek care---whether it be care for a flu shot, braces, broken arm or tooth ache. Right now, I am the one who is on the receiving end of the cruelty. I am the healthcare advocate, the navigator and for this brief moment am in the driver seat-- and I am in a race against time trying to change the world before they can destroy her. A race, I know I will not win.

Let me break this down for you. This same twenty-four hours I also received a call out from a fellow parent of a beautiful transgender daughter who is 11-years-old. They just admitted her to the hospital because she tried to kill herself. According to her parent, she has identified as female since she was three, came out at five, transitioned at eight and has been confident in her identity her entire life. I am here to tell you that there is absolutely nothing wrong with this little girl. What is wrong is the fact that the education, medical and other institutionalized structures surrounding this beautiful human are telling her that something is wrong with her. That this beautiful little girl is subject to the harm that the above practice thinks is a, “humdinger.” That somehow another person’s personal identity is comedy.

THAT is what is wrong. There is absolutely nothing wrong with this beautiful, fragile, gorgeous, kind, young soul. Everything is wrong with the adults that perpetuate the confines of the binary that surround her and tell her that her self-actualization, her identity, how she SEES herself is at question. These are the people who gaslight others into thinking that they are crazy, less than human.



I have recognized the need for provider education for quite a while, but I am now doubling down. Providers are contributing to the problem. If you are a medical, dental or mental health provider in the community and you are not welcoming to all of your patients regardless of race, religion, gender identification, sexual orientation or otherwise you are part of the problem. Safe spaces for everyone are not a luxury. According to The Trevor Project National Survey on LGBTQ Youth Mental Health 2020:

“Transgender and nonbinary youth who reported having pronouns respected by all or most people in their lives attempted suicide at half the rate of those who did not have their pronouns respected.”

According to the Human Rights Campaign Foundation 2018 LGBTQ Youth Report:

  • Seventy-seven percent of LGBTQ teenagers surveyed report feeling depressed or down over the past week;

  • Ninety-five percent of LGBTQ youth report trouble sleeping at night;

  • LGBTQ youth of color and transgender teenagers experience unique challenges and elevated stress -- only 11 percent of youth of color surveyed believe their racial or ethnic group is regarded positively in the U.S.;

  • More than 70 percent report feelings of worthlessness and hopelessness in the past week;

  • Only 26 percent say they always feel safe in their school classrooms -- and just five percent say all of their teachers and school staff are supportive of LGBTQ people;

  • Sixty-seven percent report that they’ve heard family members make negative comments about LGBTQ people.

Providers take an oath to “do no harm.” Doctors put years into schooling to learn their craft to heal in their area of specialty. I am here to sound the alarm, to be the canary in the coal mine. Our children are being harmed. Standing around during a huddle and laughing at the “humdinger” is HARMFUL. It is psychological warfare. You are harming another human being. Because the human isn’t aware that you are standing around comparing before and after photos does not mean that the harm isn’t happening. You are part of the problem. You are harming my child, our children.


Here is my offer: if you are provider or work in healthcare and want help- reach out to me. I will help you make your office a welcoming space. If you want education for your staff or to just talk, reach out. We should never have another day when a staff huddle includes a before and after review of patient photos- unless you are a plastic surgeon and your are performing affirming surgery.

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