About transgendered patients

Nurses General Nursing

Published

Hello all,

In addition to "working the floor" I also teach nursing, and two of my students this past week posed an excellent question. I had my (second year) students working on taking patient health histories, and the following question came up: If a nurse has a patient whom s/he suspects is transitioning from one gender to another (and the patient hasn't disclosed this information), how does one respectfully ask if a) this is indeed the case, and b) how far along is the patient in their process of transition. Additionally, when is a transgendered individual considered to be anatomically male/female? (I'm assuming that hormone therapy and surgery have been done). Finally, one more question: for transgendered individuals who have not yet made the physical transition, and even though they're using, say in this case a female name, when all of their ID is still in their birth/male names, I'm assuming that this patient would be identified for medical purposes as "male," even though he wishes to be addressed and treated like a woman (or vice-versa in the case of a woman transitioning from female to male).

Curious to know what others think!

Many thanks. :nurse:

Specializes in Operating Room.
Several years ago we had this in an LTC. A "female" patient known as (fake name) Susie Brown. Wore makeup, ladies clothes, ladies jewelry. Had breasts, wore a brassiere, but also had a member. Legal name (fake name) John Brown.

Her chart said Susie (John) Brown.

When we sent her out (we always called her by female prounouns at her request) we always put in parentheses at the top of the page ("transgender male to female), and explained to EMTs. Never had much of a problem. The worst complainers were some older lady CNAs who were astonished and possibly disgusted at what they believed was weird and immoral - they were told to respect the patients wishes and keep their opinions to themselves and off campus.

Susie Brown always had a private room just so any other lady (or male) patients wouldn't be freaked out if they saw her in the bathroom.

Also had a lady patient who had a very masculine husband, he had long hair, mustache, beard and sideburns. Some days he came to visit in his work clothes. Other days he came in wearing a bra, ladies sweater, skirt, hose and heels. He even wore Christmas earrings to the facility Christmas party, looked very festive! Always went by his male name. One brave nurse asked him about his "interesting choice of clothing on his off days" and he very simply smiled and said he felt more relaxed wearing ladies clothes. The wife never acted like anything was amiss, so she must have been aware of this for years.

I say, whatever makes 'em happy and just go with the flow.

This brings up an excellent point. Not all transgendered people are interested in surgery. Some are transvestites who simply prefer to wear clothes that identify with the opposite gender. Doesn't mean they always dress this way and it doesn't necessarily mean they are gay either.
Specializes in CVICU, Obs/Gyn, Derm, NICU.
I usually start out by saying, "these are questions we ask everyone" (and we do)

What was your sex at birth?

How do you identify today?

Well ...if I asked those questions to all my p'ts in Australia .... I would receive a daily spectrum of reply ranging from the obscene to comments about 'PC gone mad'. Many wouldn't be able to stop laughing and I would have problems completing the assessment.

Obviously if I suspect a p't is somewhere on the transgendered pathway .... then will ask.

If we had to ask these questions to all p'ts ....then we've gone political and political should be kept out of the workplace

Specializes in Med Surg, Home Health.

If anyone would like a link that gives an EXTENSIVE point of view on best practices in transgendered health care, check this out:

http://www.transhealth.ucsf.edu/trans?page=protocol-00-00

It's geared towards the current US system, of course

:redpinkhe Cinquefoil

Specializes in Infectious Disease, Neuro, Research.

I'm stating this on the basis of more than a few trans and homosexual members in my family. Your duty is to the majority of patients- not a colorful minority.

When possible, private rooms are best. When not, the residing population of your floor needs to be carefully considered, and which primary population (male or female) will accept the TG with less upheaval. Having a beat-down or cat-fight in the hall is frowned on by Admin, and will cause gray hair and legal upset.

Specializes in mental health, Alzheimer, dementia,.

Personally I think hospital need to update their clinical forms that they have patients fill out. One hospital I was at had male female and other with a space to write what your other is...I also agree with what someone said regarding having nursing students do a project with local LGBT companies. The main thing is to be respectful and non judgemental

Specializes in LTC, camp nursing, LTAC (new to this).

I am in western mass and we recently had a MTF, with out the surgery, pt in an acute hospital that needed LTC for rehab. Our challenge was bed management as we did not have a private room available. I was in admissions at the time and while we were trying to decide what to do the pt found placement in a competing facility with a private room. We never came to a clear agreement on what was the most appropriate thing to do and honestly, I think our admininstrator drug her feet hoping this admission would go away.

I think this is a complex issue and would love to hear how others have bed managed when there was not a private room available.

Specializes in PCCN.

I had a pt once that had not made it obvious how s/he was to be addressed. Was apparently MTF(with hormones, later found out), but no surgery yet. Thing was , based on appearance, we were told pt was female, and therefore was roomed with another female.Well, lets say that the pt still had male genitalia- the nurse who had him hadnt been told ( had to check a surgical site) and she came out of the room shocked( just from not being informed) And now we wondered should we move the pt? should we move the other pt? It actually all worked out in the end, as the other pt I believe had suspected gender change, they had great conversations,and she didn't mind.

I remember taking care of a transgendered person who dressed as female, but was anatomically male. We called (her) by the female name she asked to addressed by. In (her) chart, it stated, "phenotypical female, genotypical male." (She) had not had any surgery/hormones. (She) was assigned a private room as well.

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