Nursing Care For Transgender Patients

Your job is to make every patient feel safe and unjudged, and transgender and gender-nonconforming (GNC) patients still encounter prejudice in healthcare settings that most patients never face. Nurses carry an outsized share of this work. Patients confide in nurses, often trusting them more than physicians, and nursing has ranked as the most honest and ethical profession in Gallup's annual poll for more than two decades. Most nurses want to provide affirming care; what many lack is experience and proper training. This guide covers the transgender and GNC community, the barriers they hit in healthcare, and concrete steps for caring for them well.

Barriers Transgender Patients Face

For many transgender patients, healthcare is intimidating and often inaccessible. They are more likely than cisgender patients to be uninsured, which puts cost between them and care. A Kaiser Family Foundation analysis found 19% of transgender adults lacked health insurance, compared to 12% of cisgender adults, and 19% reported cost-related barriers to care versus 13% of cisgender adults.

Past experience drives avoidance. Transgender patients frequently delay necessary appointments and procedures because of how they were treated the last time they sought care, whether that meant being misnamed, misgendered, or having their pronouns ignored. Without sensitivity around how that information is handled, a provider can accidentally out a patient to family or friends, putting their safety at risk. On top of the emotional and financial barriers, transgender patients run into outdated policies and intake processes built around heterosexual, cisgender assumptions.

Bias and Discrimination

Most providers do not misgender patients out of malice. The problem is systemic. Some clinicians were socialized to believe that being transgender or GNC is wrong, and even those who want to help often were never trained to do it. The system itself disproportionately harms trans and GNC patients through bias, stigma, and dated policy. Broad hostility also keeps trans and GNC people out of nursing careers, which would otherwise bring lived experience to the field, and it has left a thin research base on transgender care. Many nurses and providers want to do right by these patients but do not have their organization's support for training.

The fix has two parts: more education on caring for trans and GNC patients, and honest acknowledgment of personal bias followed by action to limit the harm it causes. Internal bias leads to mistakes, like conflating sex with gender or making assumptions about a patient's medical transition. Some patients face direct discrimination, including providers who refuse to treat them or insist on using a legal name the patient does not use.

Creating a More Supportive Environment

Once you understand your own bias and learn more about trans and GNC patients, you can build an affirming space. Every patient and situation is unique, so treat these as general guidelines.

Respect body privacy. It is generally not acceptable to ask about a patient's genitals, gender-affirming surgeries, hormone therapy, or other transition details. When those details are directly relevant to care, ask carefully and sensitively, and do not share the information with other staff unless it is medically necessary. Assume this information is deeply personal, and tell patients ahead of time when it will need to be shared with another provider for treatment.

Communicate without causing distress. Ask open-ended questions in a direct but sensitive way. You can ask about a patient's gender; be more careful asking about their sex. When it is clinically relevant, a specific question works better than a vague one, such as asking the patient to describe what kind of genitalia they have and the symptoms they are experiencing. When you are unsure about anything related to gender, ask for clarification instead of assuming.

Note your patient's pronouns. Use the terms patients use for themselves and their partners. A patient may use he/him, she/her, or they/them regardless of how they present, and some use less common pronouns like ze/hir or ze/zir, so ask before addressing them. Introducing yourself with your own pronouns can put trans and GNC patients more at ease.

Be careful with forms. Most intake forms still require a sex field, which can be painful or triggering to answer, so be ready to offer support. When a patient's name and gender do not match their insurance or records, never ask for their "real" or given name. The National LGBT Health Education Center recommends asking what name appears on the insurance, confirming date of birth and address, then continuing to address the patient by the name they originally gave you.

Update your intake forms. Revise patient intake forms to include transgender and GNC options. The National LGBT Health Education Center publishes a guide and templates for this.

Treat the whole person. Gender identity is one part of a patient, so care for them as a whole person without inflating or narrowing their identity. Consider their trans or GNC identity within their larger cultural, emotional, physical, and psychological life. Cultural congruence matters for everyone and especially for LGBTQ+ patients, which means understanding and respecting those intersections.

Advocate. If you hear coworkers misgendering patients or making transphobic comments, speak up. Advocate on issues like gender confirmation surgery and fertility treatment too.

Key Terms and Concepts

Keep these in mind when working with members of the LGBTQ+ community. The list is not exhaustive, and terms vary across communities and cultures. The Human Rights Campaign maintains a fuller glossary.

• Cisgender: Someone who is not transgender
• Transgender: Someone who does not identify with the sex assigned at birth
• Nonbinary: Someone who does not identify exclusively as a man or woman; may identify as a mix of genders or none, and does not conform to gender expectations
• Crossdresser: Someone who wears clothing typically associated with a different gender
• Drag king or queen: Someone who performs for entertainment; may or may not be transgender
• Agender or genderless: No gender identity or expression; sometimes used interchangeably with gender-neutral
• Genderqueer: Someone who does not identify within the gender binary
• Bigender: Having two gender identities or expressions, simultaneously, at different times, or in different situations
• Intersex: An umbrella term for someone born with sex characteristics (genitals, gonads, chromosome patterns) that do not fit typical binary male or female bodies; variations are wide and do not always show at birth
• Lesbian: A woman of any gender identity who is emotionally, romantically, or sexually attracted to other women
• Gay: Someone emotionally, romantically, or sexually attracted to people of the same gender identity or expression
• Bisexual: Someone with the capacity for emotional, romantic, or sexual attraction to more than one sex, gender, or gender identity
• Queer: A multifaceted term used in different ways, covering sexual and gender identities other than straight and cisgender
• Asexual: Lack of sexual attraction or desire for others; may still have romantic attraction
• Pansexual: Someone with the potential for emotional, romantic, or sexual attraction to people of any gender identity or expression (not interchangeable with bisexual for everyone)
• Gender dysphoria: Distress arising from a conflict between a person's gender identity and the sex they were assigned at birth

For more, see our guide to LGBTQIA2S+ key terms and definitions for nurses and healthcare providers.

Toward Equitable, Gender-Affirming Care

Health equity is the core idea: safe care for everyone, regardless of sexual orientation, preference, or identity. That requires a nonthreatening environment for all patients, including transgender patients, and a system where trans and GNC patients are not treated as special cases. The goal is to shift systems and social conditioning so the trans and GNC experience is recognized as part of normal care rather than an exception.

Helpful Resources for Nurses

• National LGBTQIA+ Health Education Center. Publishes Providing Affirmative Care for Patients with Non-Binary Gender Identities, with practical guidance on names, pronouns, and affirming scenarios.
• Centers for Disease Control and Prevention. Patient-Centered Care for Transgender People covers stigma, discrimination, access barriers, patient-centered strategies, and outdated or offensive terms to avoid.
• National Clinician Consultation Center. Free expert consultation and clinical resources for providers, with a focus on HIV/AIDS and conditions like hepatitis C.
• UCSF Transgender Care. Academically researched, free guidelines on primary and gender-affirming care, including hormone therapy, menses in transgender men, and fertility options.
• GLMA: Health Professionals Advancing LGBTQ Equality. Publishes transgender health resources, including facts, guidelines, and learning modules for providers.