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Transgender Care: Understanding People to Deliver Better Care

Word art in the shape of a transgender symbol with the prominent words being gender, transgender, health and healthcare
Graphic by Sidney R. Hinds III, Defense Centers of Excellence for Psychological Heath & Traumatic Brain Injury

More than one million adults in the U.S. PDF: identify as transgender. Of those, an estimated 2,450 transgender individuals serve an active-duty role in the U.S. military.

In order to give adequate, culturally sensitive care to these individuals, providers must understand unique stressors of the transgender experience.

Holly O’Reilly, a clinical psychologist with the Deployment Health Clinical Center (DHCC), discussed these stressors and care options for transgender service members at the 2017 Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury annual summit.

A transgender or gender non-conforming individual is someone whose sense of their gender identity does not match the sex assigned to them at birth. Some transgender people may present themselves as their preferred gender, using behaviors and clothing typically associated with their identity.

A disconnect between assigned gender and a transgender person’s gender identity can result in gender dysphoria. This medically diagnosed distress can show up in several different ways:

  • A mismatch between physical sex characteristics and one’s gender identity
  • A desire to get rid of one’s physical sex characteristics because of a mismatch
  • A strong desire for the physical sex characteristics of another gender
  • A strong desire to be a gender other than the one assigned at birth
  • A strong desire to be treated as another gender
  • A strong belief that one’s feelings and behavior are typical of a gender other than the one assigned at birth

“This condition is associated with clinically significant distress or impairment, in social and/or occupational areas of functioning,” said O’Reilly.

Transitioning to their identified gender can help a transgender individual’s mental health. Providers can play an important role in helping patients navigate the challenges of the transition process.

Delivering Better Transgender Health Care

A transition is the process of shifting away from a gender role assigned at birth. For many transgender people this can be a long, repetitive process. Proper assistance from a health care provider can ease some of the stressors involved in the process

  • Coming Out – “Coming out” refers to a transgender individual announcing their gender identity. A transitioning individual may have to come out multiple times to family, friends and colleagues. This process can be emotionally and mentally exhausting.

“For many individuals, this is a very, very stressful conversation, in part because this may lead to significant strain in a relationship,” O’Reilly said. “For some individuals, this will lead to the end of a relationship.”

Providers can help their patients by working on a plan for how they will come out. It may help to have patients write out letters in advance to prepare what they will say to others, and to help them anticipate questions that friends and family might have.

  • The Transition Process – Making the transition from one gender to another may involve a number of different changes in a transgender or gender non-conforming person’s life. Some may seek surgery or hormone therapy to better physically present as their preferred gender identity. A transgender individual may also change their name. This can present problems such as getting others to use their correct name, and getting a name change on legal documentation.
  • Physicality – During transition many experience distress based on mismatches between their gender identity and their physical traits. Factors such as height, hair growth and body contours can cause distress when they do not match that individual’s perception of their preferred gender identity.

Providers should make sure patients understand that the physical aspects of transitioning may take time, and vary from person to person.

“Encourage them to follow up with an endocrinologist and all medical care,” O’Reilly said. “They should continue to have physicals and take medications as prescribed to have optimal results.”

  • Transphobia – Many transgender or gender non-conforming individuals face discrimination, abuse or other negative reactions from others because of their preferred gender identity. This can include verbal harassment, denial of the same rights afforded to others, and more violent forms of abuse.

Providers should encourage patients to seek out supportive peers and mentors who can give them comfort and encouragement during and after the transition period.

“Whatever support they can get from their community in terms of personal stories, experience, tips and strategies can all be very helpful,” O’Reilly said.

Transgender individuals are also subject to microaggressions, or comments that, though not intended to be harmful, can damage their self-image and mental health.

“Anyone can perpetrate a microaggression, when you do I encourage you to be aware of it, to acknowledge it, to own it, to apologize and move forward,” O’Reilly said.

Most importantly, providers should seek out resources, education and literature on transgender culture to better understand, respect and treat potential patients. The DHCC Clinician’s Corner blog has more posts on transgender treatment for those interested in learning more. DHCC also has a list of terms important for understanding TGNC culture.


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This page was last updated on: October 10, 2017.