The goal of this kit is to increase the availability and accessibility of LGBTQ health care by giving both patients and providers ways to participate in LGBTQ health education, advocacy, and activism. Providing LGBTQ health care is just like providing culturally-competent health care for any other minority group; it is important to learn the relevant terminology and the types of conditions those in the community are most vulnerable to. There is no difference in the actual content of the care provided; they require care in all areas of medicine, and even ‘LGBTQ-specific’ care such as HRT and plastic surgery are well-established practices outside of the growing field of LGBTQ health.
What Is This kit?
A printable "LGBTQ+ Health Care Kit" comprised of a series of educational brochures about the importance of pronoun usage in medicine, how to collect and record sexual orientation and gender identity (SOGI) data for patients, how to work with medical school and hospital administration on increasing LGBTQ acceptance and inclusion, and evidence-based medicine related to the LGBTQ community specifically.
What Are the Goals of This Kit?
The goal of this kit is to increase the availability and accessibility of LGBTQ health care by giving both patients and providers ways to participate in LGBTQ health education, advocacy, and activism. Providing LGBTQ health care is just like providing culturally competent health care for any other minority group; it is important to learn the relevant terminology and the types of conditions those in the community are most vulnerable to. There is no difference in the actual content of the care provided; they require care in all areas of medicine, and even ‘LGBTQ-specific’ care such as HRT and plastic surgery are well-established practices outside of the growing field of LGBTQ health.
Who Is This Kit for?
Anyone, but especially those in health care! Providers may benefit from this kit by increasing their familiarity with LGBTQ terminology, learning how to appropriately recruit, interview, and document LGBTQ patient visits, provide aid to LGBTQ providers in training, and encourage institutional and administrative change at all levels of care. Patients may benefit from this kit as it can help to educate patients who are allies and create a safe space for LGBTQ patients.
How Can I Use This Kit?
This kit is made to be shared digitally and/or printed so that physical copies may be distributed. Some potential areas of distribution may include clinic websites, staff lounges, patient waiting rooms, presentations (grand rounds, journal club), community outreach events, and more!
“Hi! I'm [name], and my pronouns are [insert here]. How may I refer to you?”
Inclusivity Do's and Don'ts
DO: offer your pronouns first upon meeting
DO: say a quick sorry if you accidentally use incorrect pronouns, correct yourself, and move on
DON'T: assume other people's pronouns; use “they/them/theirs” until otherwise specified
What Are Gender Pronouns?
Pronouns: words used to refer to people, such as the common ones She/her/hers, He/him/his, They/them/theirs, and Ze/hir/hirs.
Alex said she wants to watch a movie. Sam loves dogs; that dachshund is his. Jean prefers to use their car over mine.
Pronouns and gender identity are not the same thing, so be careful not to say “female” or “male” pronouns when you really mean “she/her/hers” or “he/him/his”. For example, if someone identifies as a woman, any pronouns they use are female, even if they use they/them/theirs. Anyone can choose to use any, multiple, or no pronouns at all, in which case one should simply refer to that person by their name!
Gender Identity: one's personal experience and concept of their own gender(s). Everyone has a gender identity.
Cisgender: a person whose gender identity aligns with the sex they were assigned at birth (eg, being assigned female at birth and identifying as a woman).
Transgender: a person who identifies in terms of gender as anything other than the sex they were assigned at birth. This can include identifying with a different binary gender (male or female), both binary genders (bigender), a gender besides male or female (non-binary or genderqueer), no gender (agender), or more.
LGBTQ+: The lesbian, gay, bisexual, transgender, queer, “plus” community. The “plus” may include questioning, intersex, pansexual, asexual, aromantic, and much more.
Active Ally/Advocate: a person who respects and uplifts the LGBTQ+ community by actively examining their own prejudices, listening to the voices of LGBTQ+ people, and fighting for LGBTQ+ social justice.
Why are pronouns important?
Using people's pronouns is crucial to respecting who they are.
Sharing pronouns can be risky for non-cis people due to societal discrimination, so we create a more inclusive environment by offering up our own pronouns first, signposting a space in which others can feel safer to share theirs as well.
I keep messing up people's pronouns! What do I do? How do I improve?
Overcome your fear and shame. It's okay not to be perfect at something the first time you try it! You may be afraid to hurt people's feelings or to be reprimanded for messing up. However, the joy and affirmation that comes even just with trying can be extremely valuable to LGBTQ folks around you. The vast majority of people will be kind and understanding when mistakes are made so long as responsibility is taken along with a commitment to do better.
Practice pronouns internally as often as you need. For example, if someone tells you they go by she/her and you are having a hard time remembering, take a few minutes a day to think about them using sentences which require the use of their pronouns. Examples of sentences include, “today she went to lunch with me” “I liked her water bottle” “She and I get along well”, etc. Consider what it is that makes you think of this person as one gender or another and how you might challenge and change those assumptions.
Learn how to make a quick apology and move on. A simple, “sorry, I meant _ !” will do just fine. Over-apologizing interrupts the dialogue and centers the conversation on you and your (dis)comfort as opposed to that of the person who got misgendered.
Get used to the singular “they”. Believe it or not, the use of the singular they has been a part of the English language for hundreds of years, and you use it all the time! For example, take the following sentences:
“When someone makes a mess, they need to clean it up.”
“The teacher captured their student's attention.”
“That's John's notebook—it belongs to them.”
Think consciously and critically about your own pronouns. Pronouns are for everyone. We all use pronouns in English. Why do you use the pronouns that you use? What do you feel when you and others use them? How would you feel about using different pronouns, or multiple types of pronouns? Remember, anyone cis or trans can use any pronouns they want at any time!
Zoom allows participants to type in their own names which will show up on screen. One can add their pronouns to their zoom name in several ways:
Via Zoom Web Browser:
Go to zoom.us/signin
Click edit in the name row
Add your pronouns to the last name section
Via Zoom Application:
Open zoom, and when you click “Join meeting” there is an option to enter your name beneath the Meeting ID
Once in a meeting, either right click your video or click the “…” on the upper righthand corner of your video and hit “rename”
Beyond adding pronouns to one's personal ID, consider also introducing yourself verbally in meetings with your pronouns, introducing others in meetings with their pronouns, and, if relevant, adding pronouns to the titles of zoom meetings (for example, ‘Meeting with Dr X (xe/xir)’).
Email Sign Offs
Many people in academia edit their email signoffs to reflect their academic statuses. Some students and faculty of all genders have chosen to include their pronouns as part of this. For example, a common sign-off is:
In order to edit your sign-off, go to Settings→ Mail→ Signature. Here, you can write whatever you want!
Notifying Coworkers. You may wish to speak directly with your coworkers about changing local practices. It is important to explicitly include yourself in this change as well.
A suggested email script:
My name is ______, and I am about to work with you in ______. I wanted to make sure the staff was aware that I use the pronouns ______. If you have any questions please refer to the “LGBTQ+ Health Care Kit” attached. I greatly look forwards to working together!
A suggested in-person script:
Hi X, my name is . I just wanted to let you know before we start that I go by pronouns. I hope you will join me in embracing the practice of requesting and utilizing pronouns from all our patients and coworkers. Thanks!
A suggested email script for notifying patients:
Our office would like to announce a new LGBTQ+ Health Initiative to further diversity and inclusivity within our program and bolster our ability to provide top-quality services to all our patrons.
Upcoming changes include the addition of new pronoun and gender identity options on intake forms, the inclusion of pronouns on physician IDs, and a new bookshelf containing local and national LGBTQ+ health resources.
If you have any questions please refer to the “LGBTQ+ Healthcare Kit” attached and do not hesitate to reach out to us. We greatly appreciate your participation and know that [Insert Office Here] is always here for you!
Hi X, my name is ___, and I use ____ pronouns. How may I address you? Would you like me to include your pronouns in your patient notes?
ID Pins. Some providers choose to attach pronoun pins to their IDs, which are generally worn everywhere in the hospital. We encourage everyone no matter their gender identity or pronoun set to use these to help make their hospitals a more informed and accepting space!
Pronouns in lectures and presentations. We as a society are still learning and creating the best terminology for all types of bodies and identities. You will at some point note binary language used in lectures, in text, and in your overall career. It is always helpful to bring this language to people's attention when possible.
Many providers are adjusting their language to be more specific, changing from wording such as “men or women” to “biological male or female”, “genetic male or female”, and more. Using “they” in place of “she/he” is another great example. It is not perfect, but it is a work in progress, and in the past patients, students, and providers have successfully worked together to produce up-to-date inclusive phrases drawn from their local communities. Provider input holds a lot of weight in these conversations and is extremely valuable!
Which LBTQ+ organizations are affiliated with institutions?
Medical Student Pride Alliance. MSPA has 81 chapters in 34 states and Puerto Rico. Each chapter is affiliated with a medical school and is comprised of students and faculty who are passionate about LGBTQ health and advocacy.
AMA Advisory Committee on LGBTQ Issues. This committee advocates for LGBTQ health and justice-related policy reform with issues pertinent to students, doctors, and patients.
EBM is a crucial part of clinical practice guidance. There is a large body of evidence showing that the open use of pronouns significantly affects health seeking behavior and health outcomes in LGBTQ+ patients!
On “Alternative” Pronouns
Alt/neo/gender-neutral/gender-inclusive pronouns include a wide array of evolving options such as they/them, xe/xir/xey, ze/hir/hirs, ey/em/eirs, and fae/faer/faers.
Schmidt S. Merriam-Webster adds non-binary pronoun “they” to dictionary
On September 17, 2019, the Merriam-Webster Dictionary added a definition to the word they, stating that it can now be used as a singular pronoun for an individual who is nonbinary.
Language influences mass opinion toward gender and LGBTQ equality
Three large scale studies in Sweden showed that using gender-neutral pronouns decreases the mental salience of males. This means that when people use gender-neutral pronouns, they are less likely to treat male as the default.
Decreasing male salience is associated with more favorable attitudes towards women and LGBTQ individuals. Using gender neutral pronoun benefit more than just LGBTQ+ individuals.
On LGBTQ+ Health Disparities
Healthy People 2020 LGBTQ
The LGBTQ+ population, in particular LGBTQ+ youth, face increase health disparities compared to the general population. Some of these disparities include decreased access to health insurance due to employment discrimination, increased mental health and substance use disorders from bullying and minority stress, and a shortage of health care providers who are not only knowledgeable but also culturally competent in LGBTQ health. LGBTQ youth are particularly at risk, with a higher likelihood of experiencing housing insecurity and a 2 to 3 times higher likelihood of attempting suicide.
On LGBTQ+ Health Outcomes
Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Trans Youth
This study looks at whether using LGBTQ youth's chosen name in multiple contexts (at home, at school, at work, and with friends) would lead to improved health outcomes. According to this study, “an increase by one context in which a chosen name could be used predicted a 5.37-unit decrease in depressive symptoms, a 29% decrease in suicidal ideation, and a 56% decrease in suicidal behavior”.
Trans youth population is known to have high suicide risk. Comparing to cis-male adolescents, trans adolescents are 2.5 times more likely to have attempted suicide (Suicidality Disparities Between Transgender and Cisgender Adolescents). Furthermore, 30% to 50% of trans youth reported engaging in suicide behavior at some point in their lives (Transgender Adolescent Suicide Behavior). Because of the known high burden of suicide in this population, a 56% decrease in suicidal behavior is very significant in this context.
Affirming Transgender Youths' Names and Pronouns in the Electronic Medical Record
A single specialty gender clinic survey of transgender youth (N=204, age 12 to 26 years) showed that 79% reported that they would prefer to have both their name and pronoun documented in their EMR.
Mental Health of Transgender Children Who Are Supported in Their Identities
A community-based national sample of transgender, prepubescent children (n = 73, aged 3 to 12 years), who have socially transitioned showed no elevations in depression and slightly elevated anxiety relative to population averages when compared to cisgender children in the same age range.
When compared to children who are living with gender dysphoria who not socially transitioned, socially transitioned transgender children have notably lower rates of internalizing psychopathology.
On Physician Health Outcomes
Pronouns and Advocacy in Medicine
A recent study examined experiences of TGNB medical students and physicians. The researchers found that 22% of participants reported barriers attributable to their gender identity while applying to medical school and 43% while applying for residency. They also found that 78% of participants censored themselves during training to avoid disclosing their TGNB identity and that 69% heard derogatory comments about TGNB individuals during their training or practice. This illuminates ways in which phobic attitudes and blatant discrimination might undermine TGNB individuals (or anyone else who struggles with prejudice and discrimination) who are patients.
On Physician LGBTQ Health Training
Keeping our promise to LGBTQ+ patients
A 2018 study of students at 10 medical schools found that around 80% felt “not competent" or “somewhat not competent” at treating sexual and gender minority patients.
This lack of training takes a toll on patients. Approximately 50% of transgender respondents reported having to teach their health care providers about transgender care. Nearly 8% of LGB individuals and 25% of transgender and gender non-binary individuals reported being denied health care outright.
What Is SOGI Data?
SOGI stands for Sexual Orientation and Gender Identity.
The options for Sexual Orientation listed in the template are:
Do you think of yourself as:
“Lesbian, gay, or homosexual”
“Straight or heterosexual”
The options for Gender Identity listed in the template are:
What is your current gender identity:
“Female-to-Male (FTM)/Transgender Male/Trans Man”
“Male-to-Female (MTF)/Transgender Female/Trans Woman”
“Genderqueer, neither exclusively male nor female”
“Additional gender category, please specify:”
“Decline to answer”
The options for sex assigned at birth are:
What sex were you assigned at birth on your original birth certificate (check one):
Sexual Orientation: an enduring pattern identified by an individual regarding their attractions towards certain genders.
Sex Assigned at Birth: The label of ‘male’ or ‘female’ doctors assign babies upon brief visual assessment of genitalia following delivery.
AFAB: “Assigned Female at Birth”
AMAB: “Assigned Male at Birth”
When to Use SOGI Data
SOGI data should be gathered for everyone, as everyone has a sexual orientation and gender identity. In addition, there is no way to tell someone's sexual orientation or gender identity simply by looking at them. Listed below are various ways to assess patient identities- note that all methods should be utilized together, as patients may be more comfortable using one modality over another.
Personal introductions (“My name is Dr X. My pronouns are Y. How may I refer to you?”)
During the information-gathering part of the interview (“How do you identify? What genders/body parts are you attracted to/currently engaging with?”)
In many instances patients will not disclose LGBTQ identification at all, even if asked directly, because they do not feel safe or comfortable in the situation. Patients may also disclose an identity but request it not be disclosed in the chart. This may result in inconsistencies in forms and charting. If you are able to ascertain a patient's current identities and forms/charting preferences, it is appropriate to update the charts to reflect that. This may require regular check-ins as feelings, identities, and recording-related decisions may change over time.
The following statistics highlight the importance of the widespread use of SOGI data:
US Transgender Survey: ~33% of trans patients in 2014 had negative experiences with health care providers, such as being verbally harassed or refused treatment.
Lambda Legal Survey: >50% of LGB and 70% of trans patients in 2014 experienced discrimination while seeking health care.
UCLA Williams Institute: At least 4.5% of US adults (~11 million people) identify as LGBTQ and are underserved in medicine.
Why Do We Need SOGI Data?
The collection of SOGI data has bigger implications than one might think, even if one believes their medical practice does not have any LGBTQ patients. First, a lack of disclosure should never be confused for a lack of presence. Second, everyone has a sexual orientation and gender identity. SOGI data is in no way exclusive to LGBTQ patients. SOGI data is just a small part of a much larger conversation that should happen between provider and patient on a regular basis to provide competent biopsychosocial care.
Some specific and vital effects of collecting SOGI data are listed below:
Helping current LGBTQ patients feel more comfortable to be themselves in a clearly established safe space. There are 2 important things to note here;
a) Just because a patient is openly LGBTQ does not necessarily mean that they feel comfortable sharing information in a health care setting.
b) Just because a patient has not disclosed an LGBTQ identity does not necessarily mean they don't identify as LGBTQ. There are many reasons a patient may choose not to come out to their providers, including needing care for unrelated reasons, worries about their provider's reactions, worries about others finding out.
Helping future LGBTQ patients by providing those in the community with more health care options, which can improve both health care utilization and health outcomes; it is a well-known phenomenon that hospitals which gain reputations for good care will be more successful in recruiting patients from the populations they are targeting.
Helping non-LGBTQ patients in various ways:
a) Make people feel safer in a practice which is explicitly more open, accepting, and striving to stay up to date on best health practices.
b) Provide education on sexual orientation, gender identity, and the LGBTQ community.
c) Provide patients an opportunity to discuss exploring their orientation/identity with their providers.
Helping providers receive better education and provide better care for their patients.
Helping hospitals provide targeted quality improvement interventions related to the LGBTQ community by utilizing a user-friendly standardized measurement which supplies data that can be stratified by both sexual orientation and gender identity to help improve health outcomes and close the health gap between those inside the LGBTQ and those outside of it. The more hospitals and providers that model exemplary use of SOGI data and high-quality care of LGBTQ patients, the more others will follow suit, creating a ripple effect which will ultimately benefit us.
There are many resources to further explore LGBTQ health education and advocacy. Here are a few which we recommend!
The Nuts and Bolts of SOGI Data Implementation: A Troubleshooting Toolkit by Human Rights Campaign
The World Professional Association for Transgender Health (WPATH) Standards of Care 2012
“The World Professional Association for Transgender Health promotes the highest standards of health care for individuals through the articulation of Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People. The SOC are based on the best available science and expert professional consensus. This is the 7th version of the Standards of Care since the original 1979 document. The first 6 versions were published in 1979, 1980, 1981, 1990, 1998, and 2001. Version 7 of the Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People will be available in several additional places for wide distribution and ease of access.”
HRC Healthcare Equality Index 2020 Promoting Equitable and Inclusive Care for LGBTQ Patients and Their Families
“In its 13th year, the Healthcare Equality Index (HEI) is the national LGBTQ benchmarking tool that evaluates health care facilities' policies and practices related to the equity and inclusion of their LGBTQ patients, visitors and employees. The HEI 2020 evaluates more than 1,700 health care facilities nationwide. Every year, we recognize the health care facilities that participate in the HEI for their dedication and commitment to LGBTQ inclusion.”
The GLMA Handbook on LGBTQ Health
“A comprehensive resource bringing the full scope of LGBTQ health concerns, prevention, and treatment options into clear and approachable language. Written by LGBTQ health care professionals, the Handbook also explores the impact of public policy, political, and resource/funding issues on the health and well-being of LGBTQ people.
The two-volume Handbook examines a broad range of topics crucial to the health of LGBTQ people. Volume One is devoted to the overall health of the LGBTQ population and preventive care, while Volume Two examines disease management. Additional topics covered include sexual health, intersections of race and sexuality, and LGBTQ health worldwide, as well as the concerns of specific populations including elders, families, youth, and transgender individuals.”
Providing Inclusive Services and Care for LGBTQ People: A Guide for Health Care Staff National LGBTQIA+ Health Education Center by Fenway Institute
“We provide educational programs, resources, and consultation to health care organizations with the goal of optimizing quality, cost-effective health care for the lesbian, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minority (LGBTQIA+) people.”
LGBTQ Cultural Competency Trainings by Whitman-Walker
ETR Workplace Posters
LGBTQ Health Precedents in Medical Institutions
Precedent: Medical schools across America are currently creating and implementing LGBTQ health-related initiatives! Examples of school provisions are listed below.
Safe Zone Training: Ohio University-Dublin, UNC School of Medicine, Virginia Tech Carilion School of Medicine, Eastern Virginia Medical School (EVMS), Paul L. Foster School of Medicine, Rutgers New Jersey Medical School, UC Davis School of Medicine
Pronouns Stickers and/or Pins: Hackensack Meridian School of Medicine, NYU Grossman School of Medicine, University of Rochester School of Medicine and Dentistry, Northwestern University Feinberg School of Medicine, University of Chicago Pritzker School of Medicine, School of Medicine University of Louisville, UCF College of Medicine, GU Medicine, UAB School of Medicine
LGBTQ Best Practices Pages: UW Medicine, NYU Grossman School of Medicine, Vanderbilt University, University of Maryland, University of Michigan Medical School, UMass Medical School, UC Davis
Out and Ally Lists:
Northwestern University Feinberg School of Medicine, University of Rochester School of Medicine and Dentistry, Chicago Medical School at Rosalind Franklin University of Medicine & Science, Boston University School of Medicine, Duke University School of Medicine, Emory University School of Medicine, Harvard Medical School, Yale School of Medicine, Johns Hopkins University School of Medicine, Medical College of Wisconsin, NYU Grossman School of Medicine, Paul. L Foster School of Medicine, Perelman School of Medicine, Rutgers New Jersey Medical School, Stanford University School of Medicine,
University of California, Davis, School of Medicine, University of California, San Diego, School of Medicine, University of Illinois College of Medicine, University of Iowa Carver College of Medicine, Washington University School of Medicine, Rutgers Robert Wood Johnson Medical School, Brody School of Medicine
Have more school resources to contribute? Please reach out to us!
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Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.
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