Dermatologist shares best practices for care of transgender, intersex patients
CHICAGO — It is important for clinicians to realize that there are many barriers to a person’s gender transition, Jennifer L. MacGregor, MD, said here at the American Society for Dermatologic Surgery annual meeting.
“We ourselves are big barriers as physicians because we have the ability to delay parts of a transition and to decide what procedures someone is getting,” she said. “In the community, we are called gatekeepers; we can make it difficult.”
Biological sex is the sex assigned at birth, based on organs that the doctor can see.
“Doctors usually do not have genetic information but will assign male or female based on what they are seeing,” MacGregor, an associate at Union Square Laser Dermatology in New York, said.
Intersex is the preferred term for people who do not fit into either category and may be the result of ambiguous genitalia or a phenotype-genotype mismatch, she said.
Gender identity is how a person perceives their own gender. A cis person aligns with their biological sex.
Nonbinary is a term for anyone who does not align with either gender and is also known as gender queer or gender fluid, she said.
Through gender expression, people illustrate their gender using fashion, behavior, and likes and dislikes.
“Gender expression is super unique and varied,” MacGregor said. “There are as many unique gender expressions as there are people in the world. Gender expression is tied to their aesthetic preferences, so when they come to see you that will influence what they are looking for.”
By looking at a person, you cannot tell if they are transgender, she said.
“It’s OK to not know exactly how to talk about it,” she added. “It’s OK to ask what name they go by and what pronouns they prefer.”
In taking a patient history, there are five pieces of information that can educate a clinician on a patient’s preferred pronouns and gender identity:
- preferred name;
- gender identity: male, female or nonbinary;
- legal name;
- sex assigned at birth: male, female or intersex; and
- preferred pronouns.
“When people come to your office, assure them that their legal ID information will be kept secure and private,” MacGregor said. “Note that in some states people will have changed their legal name and legal sex.”
A legal name will not be as important to many patients, so she recommended not documenting this as the first thing.
Additionally, MacGregor encouraged clinicians to use gender inclusive forms and have restrooms that are gender neutral.
“When you see patients, avoid making judgments about past treatment decisions,” she said.
She recommended using vague and nonjudgmental language:
- What other providers are you seeing?
- Tell me about your goals.
- How can I help you?
- Tell me what you see.
“We can be really important health care providers to these patients. We can address their aesthetic issues as well as acne, rashes, scars, hair loss or growth, and hormonal side effects. ... Don’t focus on the traditional views of beauty and use specific language when discussing facial features,” MacGregor said.
The literature has been sparse, but there is more information coming out so clinicians do not alienate patients based on their gender identity. – by Abigail Sutton
MacGregor JL, et al. Diversity: Preparing yourself to work in a changing landscape. Presented at: American Society for Dermatologic Surgery annual meeting; Oct. 24-27, 2019; Chicago.
Disclosure: MacGregor reports no relevant financial disclosures.