A transgender person is someone whose gender identity differs from their sex assigned at birth. Sex is an assignment of “male” or “female” based on birth assessment of genitalia. An intersex assignment can also be made at birth based on ambiguous genitalia. Unlike sex, gender identity is self-identified, not assigned, and may or may not be congruent with sex. Thus, transgender persons include those who were assigned as being of male sex at birth but who identify as female and those who were assigned as being of female sex at birth but who identify as male. Further, some individuals identify outside the male–female binary, including those who identify as both, neither, or in between, and may identify with terms such as gender nonbinary, gender nonconforming, or gender fluid.1 Approximately 0.5% of people in the United States identify as transgender.2 Not all transgender patients desire physical alignment.
Transgender identity is not classified as a mental disorder.3 Transgender patients should have access to respectful, nondiscriminatory, and affordable medical care. According to the 2015 National Transgender Discrimination Survey, 28% of the transgender respondents reported postponing necessary medical care due to prior negative experiences. In addition, 19% of those surveyed reported being denied care because they were transgender.4 More than 50% of transgender persons reported that they had to teach their healthcare provider about the health care that they needed.5 Transgender individuals may abstain from seeking medical care in an office-based setting due to fear of mistreatment and only seek episodic care in free clinics and EDs.4,6 Thus, it is of great importance that emergency providers become aware of the special healthcare needs of the transgender patient.
The World Professional Association for Transgender Health is a nonprofit organization that works for high-quality and evidence-based care for transgender and gender nonconforming individuals. The World Professional Association for Transgender Health provides an online resource for identifying culturally competent caregivers based on geographic location (state).7
Table 299-1 contains a summary of current important terminology and definitions. Terminology is evolving and may change over time.
TABLE 299-1Terminology and Definitions ||Download (.pdf) TABLE 299-1 Terminology and Definitions
|Sex ||An assignment of “male” or “female” based on birth assessment of genitalia. “Sex” is identified as male or female on legal documents such as birth certificates, passports, and driver’s licenses, although some states are beginning to offer additional options (e.g., “other” or “X”) on legal documentation.8 |
|Gender or gender identity ||A person’s inner feeling related to being male, female, both, something else, or neither. It is self-identified, and although it is initially identified as the same as the birth sex, it can be changed as a person ages. Thus, gender does not always align with sex. |
|Gender expression ||The external expression of how one affirms their gender. Gender expression ...|