5 ways radiologists can better understand and respect transgender patients

When it comes to transgender patients, radiologists can be confused due to unfamiliarity with specific preferences or needs, a pair of researchers with the Southern Alberta Institute of Technology in Canada said this month in Radiography. Taking those patients’ unique considerations to heart and educating radiology staff about transgender realities can make a big difference in how the population receives medical care.

Asking the right questions at the right times is crucial, S. Pederson and V. Sanders wrote in their editorial, but it can be difficult to know how to approach those topics at all. To start the conversation and ensure quality care, they recommend these five tips.

Familiarize yourself with the differences between gender identity, expression, biological sex and sexual orientation.

With a current spectrum of more than 20 known genders, the binary model has long been “obsolete,” Pederson and Sanders said. In addition to familiarizing themselves with the differences between transmale, transfemale, cisgender and non-binary identities, radiologists should recognize the key differences in a handful of terms that are often confused with one another.

Gender identity is how we think about ourselves, the authors explained, while gender expression is the outward way we express ourselves. Biological sex—the most important factor for radiology purposes—is determined by a patient’s reproductive organs, regardless of how they self-identify, while sexual orientation is who we’re attracted to, both physically and emotionally.

Recognize the difficulties the transgender population faces on a daily basis.

In today’s political and cultural landscape, the transgender population is harassed verbally, sexually and physically—and often, Pederson and Sanders said. Many have been dissuaded from using public restrooms, as well, so it’s understandable that the medical setting is especially fragile.

“Many transgender individuals do not seek medical treatment when they need it for fear of harassment, and also because some physicians are not accepting transgender patients due to lack of knowledge in how to treat them,” the authors wrote. 

It’s especially important to be cognizant of children who may identify as transgender, they said, since the younger demographic has a 75 percent rate of suicidal behavior and self-harm. In addition, many of those kids don’t have their parents’ full support.

Never assume a patient’s biological sex.

Since the transgender community is highly marginalized—“they feel unsafe every time they leave their houses,” Pederson and Sanders wrote—it’s important to make transgender patients feel protected in the clinical setting. IDs aren’t the most reliable source for determining sex, since individuals are often required to wait at least a year before changing their gender on any identification documents.

If a patient checks into the radiology department with an ID that says “Keith,” but that person identifies as “Kathy,” calling the name on their ID could publicly out them as transgender, which is a sizeable risk in a climate where transgender suicide, depression and homelessness rates are disproportionately high, the authors said.

Realize that making a transgender patient comfortable is no different than making a cisgender patient comfortable.

“The most important thing to keep in mind when performing an X-ray examination on a transgender or non-binary patient is don’t make it weird,” the authors wrote. “As soon as you feel awkward, then the patient will feel awkward and the whole exam will be uncomfortable.”

Treating transgender patients may come with some unique considerations, but when it comes to making them comfortable in the operating room, Pederson and Sanders suggest relying on techniques physicians already use, like humor. Radiographers have to adapt to varying patient personalities and scenarios on a daily basis, they said, and are already trained in helping anxious patients and those with physical, mental and emotional challenges cope.

“Helping a transgender or non-binary patient feel comfortable and respected during an exam is no different from what we are already doing,” the authors said.

Consider a "SIGE" form.

Pederson and Sanders said a lot of confusion could be cleared up with a generalized form patients could complete prior to their exams. Rather than go through the awkward motions of determining whether a patient has male or female sex organs by asking them directly, each patient would complete sex, identity, gender and expression (SIGE) paperwork.

The form the authors designed asks for a preferred name and preferred pronouns off the bat, they explained, and asks the patient to identify where their reproductive organs are currently located. A short paragraph above the questions explains why they’re being asked—because ionizing radiation could be harmful to any reproductive organs that might still be in place.

By asking every patient, regardless of gender, to fill out the form, physicians would be removing any potential bias, Pederson and Sanders said. Hospitals could also consider altering their PACS to account for transgender patients, or investing in sensitivity training for their staff.

“Awareness of the gender spectrum is of the highest value to healthcare professionals when dealing with gender-diverse patients,” the authors wrote. “Once we understand the spectrum and adjust our knowledge and skills appropriately, we can effect better patient care.”