Your most important skill in your work with transgender, nonbinary and gender expansive youth is your ability to listen.
Establishing Trust with Youth Seeking Gender Affirmative Medical Care
Remember: the young person (and their caregiver) has a gender history when they come to their appointment. This history may create a barrier to their feeling safe with you, and could compromise your ability to provide informed and affirmative care.
Use open-ended questions to establish rapport.
Begin by asking about your patient’s interests and strengths
- What do you like at school?
- What do you like to do during your free time?
- What is something that you feel like you’re really good at?
Transition to more personal questions about gender identity
- Tell me about your gender history
- When did you start thinking about this?
- Has your feelings about your gender changed over time?
- How does your gender feel in terms of your body, or in terms of changes to your body?
Gauging Gender Dysphoria
Seek to identify the patient’s current sense of living in their own body
- Are you having any sad feelings about your gender? Can you describe them?
- Are you feeling anxious? In what ways?
- Are there experiences at home or at school related to gender that are making youfeel unsupported or depressed?
Are there specific parts of your body that are causing these feeling?:
- Breast development?
- Menstrual cycle?
- Hair growth?
Clarify the patient’s goals related to their gender expression
- In the best-case scenario, how could I support you?
What are you looking for?
- Social transition?
- Non-pharmacological changes?
- Body changes?
Conducting Physical Exams
Conducting a physical exam can be an incredibly stressful experience for a young person. There are some ways to decrease this discomfort
- Remind them that you are there for them, and that your only interest is inhelping them achieve their goals and be healthy
- Explain specifically what will be taking place and why
If pubertal development is a priority, make sure patient knows what puberty is and how it is measured.
- Consider using pictures and asking which looks most like their body now. “Where do you think your body is?”
- Describe the connection between the physical exam and the goals they have stated.
- Describe each step that will take place during the examination, and ask permission to proceed:
“Now I would like to measure the size of your testes; is it ok for me to look in this area?”
- Provide patient a sense of control over what is taking place with their body
If anxiety is too high, offer the option of doing exam on the next visit
- If they’re willing to do the exam, offer options for how it will be conducted
“We can do the exam at any time during the appointment. Do you want to doit now, and get it over with? Or we can wait until you feel more ready. Which option do you prefer?”
“To get the information I need to help you reach your goals, I only need to do (explain). Would that be ok for today?”
“Would you prefer for me to examine you under a cover?”
Summarizing the Visit
Your patient, and most likely their caregiver, may be feeling overwhelmed simply bybeing at the appointment. They have also absorbed a great deal of information. It is critical they leave with clear directions about next steps.
Provide a “roadmap” illustrating the necessary steps for meeting their goals
- Are there other providers or professionals with whom they will need to work?
- Are there specific labs or other steps they will need to take?
- What might be the expected time frame?
Identify potential barriers of which they need to be aware
- Medical guidelines?
Ask for their feedback
- How was today’s visit for you?
- When I see you next time, is there something you would like for me to do differently?
- Do you have any advice for me about how I can be as supportive as possible for my gender patients?