For many transgender and nonbinary people, finding inclusive healthcare is elusive. They frequently struggle to find healthcare providers who are knowledgeable about their medical and healthcare issues—such as hormone replacement therapy and gender-affirming surgery—and who are sensitive to their unique experiences, including trauma histories.
Their concerns are especially pronounced where imaging is concerned, which could keep some patients from obtaining the ultrasound scans that they need. A survey published in the American Journal of Roentgenology found that 70% of transgender patients had negative experiences. Respondents cited various issues, including deadnaming, personal discomfort, and failure to protect privacy.
As the population of transgender and nonbinary individuals continues to grow, healthcare professionals have a tremendous opportunity to better understand and meet their needs.
Plan Ahead for Privacy, Comfort, and Inclusive Healthcare
Opportunities to create a respectful and inclusive environment begin long before the imaging encounter. Here are a few suggestions for making trans people feel safe and comfortable.
- Make sure everyone in the office understands the importance of using the correct pronouns and names for patients. This applies not only to interactions with the patient but also to all reports and paperwork. For example, in the American Journal of Roentgenology survey, almost 25% of respondents said that they were misgendered in the radiology report.
- Avoid personal pronouns and gendered terms such as "sir" or "ma'am" when talking to new patients. Ask the patient how they want to be addressed.
- Likewise, avoid personal pronouns when talking about new patients.
- Ask about the patient's sexual orientation, gender identity, and personal pronouns on the intake forms. However, give patients the option to disclose these in a private conversation—or not at all.
- Don't "out" patients. Recognize that some transgender patients don't want to share information about their identity and medical history. Definitely do not ask such questions from the front desk.
- Provide all-gender or gender-neutral restrooms.
- Ask whether the person's chosen name differs from their legal name; their chosen name may not be the same as the one in the electronic health record (EHR) or on insurance documents.
- Provide reading material that affirms LGBTQ+ patients.
- Take measures to ensure privacy and comfort during the scan. Understand that some trans patients may prefer more coverage than the typical gown, so if they need to undress, provide adequate draping. Be sure to discuss these measures with the patient before the actual scan.
Obtain a Detailed Health History
Emphasize the importance of a complete health history, including hormone therapies and surgeries. This is always a good practice, but it's especially important for transgender patients to fully disclose any hormone treatments or surgeries that might affect the imaging results. Hormone therapy and surgery may affect abdominal and pelvic scans—or the choice of modality.
For example, in a transwoman, transvaginal ultrasound may be a more effective tool for prostate examination than digital palpation because the prostate is anterior to the new vagina in transwomen who have undergone sex reassignment surgery.
Privacy concerns make some patients wary of sharing such personal information, and it may not be in the EHR. Have the conversation in private and reassure the patient that everything will remain confidential.
Preparing for an Ultrasound Scan
Most ultrasound exams require no other preparation than wearing comfortable clothing. There are exceptions, however, and providers need to make sure the patient knows what to expect.
For example, some scans, such as a pelvic ultrasound, require the patient to drink water before the test to obtain better images. In other cases, such as abdominal ultrasound, the patient may need to refrain from eating or drinking for eight or more hours. And one type of ultrasound—the transvaginal ultrasound—is invasive; patients need to understand exactly what the procedure involves.
After the Scan: Understanding Results
Explain to your patients the process of interpreting ultrasound results, including how long it will take to receive them. Will they receive a call or a letter? Can they access the results through the patient portal?
If appropriate, discuss the potential need for follow-up tests or consultations based on the ultrasound findings.
Nonbinary Healthcare: Safe, Appropriate, and Compassionate
Another large challenge is the paucity of scientific and medical knowledge when it comes to caring for the transgender community. The field needs more research and healthcare providers need training and education.
Keep in mind that transgender and nonbinary identities and needs vary. As with any patient, there's no one-size-fits-all approach. Each individual's experience is unique, and healthcare providers must approach each patient with an open mind and a willingness to understand their specific needs.
That said, clinicians, staff, and imaging centers can make the ultrasound experience much more comfortable and respectful. By planning ahead, creating an inclusive environment, and ensuring patients have the information and support they need, healthcare providers can ensure that all patients, regardless of their gender identity, receive the compassionate and competent care they deserve.
