Transgender Patients: Implications for Emergency Department Policy and Practice

Abstract

August 2005 31:4 young woman trauma patient has arrived in the A department (ED). When her clothes are cut off, her breasts and male genitalia are apparent. Will the care she receives be inf luenced by this discovery? Ideally, gender expression and identity should not make a difference in health providers’ care delivery. But in reality, negative attitudes and lack of knowledge can compromise the care of transgender (TG) patients. What if she were your child? Would you want her to be treated, as any other patient, with dignity and respect? What if she is subjected to ridicule and shame, with inappropriate examinations or inadequate treatment? ‘‘Transgender’’ is an umbrella term for several distinct but related groups, which include cross-dressers, gendervariant individuals, and transsexuals (TS). Transsexuals often express the feeling of being ‘‘trapped inside the wrong body,’’ and they may undergo medical and surgical treatments (sexual reassignment/transition) to align their outer appearance with their gender identity. ‘‘Gender identity’’ refers to the internal sense of feeling male or female, regardless of biologic sex, and it may be firmly expressed by even very young children. Some TG persons do not completely identify with either gender. Gender expression and gender identity are unrelated to sexual orientation. Transgender people may define themselves as heterosexual, gay, lesbian, or bisexual. Public policy and legislation affecting TG status and rights vary. To date, six states, 62 cities, and 10 counties have passed laws prohibiting discrimination on the basis of gender identity or expression. Eight states have transgenderinclusive hate crime laws. However, most health insurance policies specifically exclude all procedures related to being TS. In fact, transsexual people are routinely denied health policy coverage solely because they are TS. Even those who