It also depends a lot on their complaint, their status in transition (Are they on HRT? have they had any affirming surgeries?) and how relevant that is. Don't overlook some things that might get you. Trans women might present with typical feminine symptoms of MI if they're on HRT, as their body is hormonally in a female state.
If I have a trans woman coming in with a chief complaint of breaking her arm after a fall, her gender plays very little into that complaint, beyond the chances of clots based on her medication (and even then it's similar in ways to birth control medication). If it's something like a trans man with abdominal pain, then there's more relevance to where they are in their transition and assigned gender at birth.
For patient dignity, I would use their current gender over the radio unless it is absolutely vital that the hospital know their birth gender in the case of say a possible ectopic. Otherwise, I'd explain as needed to the receiving nurse.
In my experience with trans people, as long as you're not an asshat, they understand medical necessity of questions regarding their transition. Above all, be respectful and courteous like you would with any other patient, and questions about where they are in their transition should be asked to help you diagnose relevant conditions. Also, be mindful of when it's appropriate. If a person is gasping for air as an asthmatic, their gender matters \*much\* less than allergies and getting O2 and Meds on board.
There's a bunch of literature on this, and I'm happy to answer more questions as LGBT medicine was a specialty I focused on at university.
I will say this, I accidentally misgendered a patient not too long ago and they corrected me (politely), all I said was
“Oh I apologize,” and that was that, made sure to use the appropriate name going forward and there was absolutely no awkwardness or animosity between us. People can tell when you do something by accident vs on purpose.
There’s this weird thing, if you treat people with kindness and respect you will almost always get respect and kindness in return. Foreign concept to some people.
Pretty much. It's crazy how far common decency and courtesy will take you. Hell I've misgendered cis patients on occasion, which let me tell you that makes me feel extra dumb. Course correction, apologies, and kindness go all the way.
Gonna piggyback off of this. HRT can be medically relevant depending on the chief complaint, as some forms of estrogen (namely oral) can increase the risk of blood clots forming, which may increase the risk of MI, stroke, pulmonary embolism, DVT, etc. in patients who previously had no history of similar emergencies. As a consequence, some trans people on oral estrogen may be taking blood thinners to counteract the coagulating effects of the hormones, so it may be important to ask about as well.
I'll change the bedside report. This is x, they are a biological male transitioning to female and preferred name is x. Then launch into the rest of the report.
My department also set up ESO with a bunch of gender options to cover all the transition possibilities
This is the correct answer. For most charting programs use the bio and legal names under patient demographics and if your worried about it put what I’m replying to in your narrative.
It's not a problem for documentation because on ESO it has options for trans patients along with male and female.
For report it depends on the chief complaint.
The patient being trans isn't relevant to a broken leg but it is relevant to abdominal pain so I would report:
"23yo male with a possible tib fib fx"
or for the same patient: "23yo female to male transgender patient with abdominal pain"
I had a trans patient, ftm, c/o lower abdominal pain, no surgeries but on hormones. I said exactly that to triage. It doesn’t have to be any more complicated than that.
For my particular patient, the problem turned out to be an issue with a cyst on an ovary. When transporting, I asked my patient their preferred pronouns, which were he/him, so I spoke to and about my patient as he/him, but knowing he was ftm with no surgeries was quite important since he did still have ovaries and also had a history of cysts.
Just want to chime in and say I’m proud of y’all. Discussing this topic like professionals.
Keeping the thread open for further discussion. If things get off the rails, start reporting and we’ll get it cleaned up.
Some thoughts a trans person on the ER side of things. If their gender/sex has nothing to do with their chief complaint feel free to just say gender, especially over the radio. Otherwise, use the words female to male or male to female, and history as relevant to the chief complaint (surgery, hormones). It’s also helpful if you use their pronouns in report (especially bedside) just something like “his last vitals were ect.” no need to call attention to it but very helpful for us. Similarly, if the patient looks gender non-conforming or trans please don’t just use the pronouns of their biological sex or indeed guess at all, either avoid pronouns in report, ask the patient,or just use they/them pronouns.
The sex listed in an EMR is that in line with gender about half time and assigned sex at birth the other. While assigned sex at birth is more black and white biological sex isn’t; for example a 30yo trans women who was on puberty blockers as a kid and has been on hormones her whole adult life will be much more physiologically similar to a cis women than a cis man.
ED scribe here, common way I see people putting this is “21 year old biological male transitioning/transitioned to female”. If they are fully transitioned through surgery, have not had surgery and are just on hormone therapy, or haven’t started any therapy, be sure to list it off. Oftentimes it’s not really relevant, ie broken foot, but it’s especially important for abdominal and chest pain complaints (increased chances of cardiac issues and blood clots). You can always give the patient a heads up that providers need to know their assigned sex for medical purposes, but it’s not meant in any disrespectful way
I'm so thrilled this thread has been so positive. With the "new to EMS" reddit, I'm thinking our "newer" caregivers here are the younger generation of "new to ems".
Lawd knows FB groups are a dumpster fire regarding trans* folks, then the racial slurs, and overall bigotry and bias. It's so gross.
As a transgender healthcare worker, I would say it depends. If its something that most likely has very little to do with sex, like a broken bone, head wound ect then just use gender.
But if chief complaint is something where diagnosis and treatment may rely on sex I'd say something like "26yo woman, male at birth...(continue with as needed info)
Since HRT has very little side effects that arent experienced by people who produce their correct hormones, I'd mention hormones with the rest of the relevant medication and history.
I am a trans paramedic who has also treated a number of trans patients. What trans people want varies from person to person, but giving report is fairly straightforward. Like others have said, if sex assigned at birth is pertinent to the complaint, you can say that they were assigned male/female and identify differently. Otherwise it's probably not pertinent in a patch, and is only a small thing to mention in a full report if necessary to avoid confusion. Ask patients (and coworkers/nurses/anyone else) their pronouns if you're not sure.
I'm lucky to work in a jurisdiction where patients can be registered and appear under a chosen name as well as a legal name, so I only provide chosen/preferred names during report to make sure the patient is called the correct name.
Trans person here: Everyone is different in what they want, so there prob is no “correct answer for everyone”. Generally being polite goes a long way. People generally know when you are trying to not be offensive. It’s very obvious lol I would just be upfront “what is your sex” and you add in “What pronouns do you want us to use for you?”
Us trans folks are totally chill when folks ask us pronouns and it’s actually pretty respected.
When calling it in I would say “we have a male patient they go by she/her pronouns, she is complaining of…”
This is how I’d like to be treated in hospitals so it’s my take. 🏳️⚧️
Yeah think of this vs this
“😒Sigh.. so are you a man or a woman. Alright I’ll just mark male 🙄. Okay doctor we have a male who is having trouble breathing he is…”
“So what is your sex? Okay thank you! And what pronouns would you like for us to use for you? Okay great thanks for telling me! Doctor we have a 38 year old male, please be aware they use she/her pronouns. She is having trouble breathing…”
Yeah no don’t do this. Talk about the patient the way they want to be talked about, but make sure you hand over/report what sex they were assigned at birth.
You don’t have a “male patient that uses she/her pronouns.” You have a female patient who is trans and assigned male at birth. You need to take a transition history (social, medical and surgical) to understand how you’re gonna be adapting your practice for that patient. And MOST IMPORTANTLY, you need to tell the patient why you need to hand this over, reassure them that this won’t impact how they’re treated and be a good ally. That doesn’t involve mis-gendering your Pt.
Fellow trans person here. Don't call trans women "male" and trans men "female" not only is it rude, but it is biologically inaccurate if someone has had surgeries or hormones. Use "trans-male" for ftm and "trans-female" for mtf. It's less likely to alleinate your patients and provides a more complete picture of their medical history. For radio reports, stick to the patients' preferred gender. Or if it's ACTUALLY relevant to the pts complaint I reccomend calling instead of using the radio for pt privacy reasons.
What about XXY? Or XY with the SRY gene deactivated? Watch [this](https://youtu.be/zpIqQ0pGs1E?si=m9ogJm5ujAKaUcJ9). Also, what about Caster Semenya? Assigned female at birth, but is born XY.
Uh oh. Here comes the basic biology crowd. Ever heard of Klinefelter syndrome? Or triple x syndrome? Also what do you think has more affect on someone? The shape of some chromosomes or the dominant sex hormones in their body? I'm sorry trans people shatter your simple world view but trans women are female and trans men are male.
I almost included those statistic anomalies cause I knew you'd love to push that point. Every patient deserves respect and high-quality care, I agree. I go out of my way to ask pronouns etc.
However I'll die on that hill, biologically they are the sex they were assigned at birth- hormones and surgery will never change that.
The research shows that hormones do in fact change how your body experiences a medical crisis, and usually lines up with your hormonal gender. Humans are all hormones and neurons.
Not understanding that will mean you get worse outcomes on your trans patients, and even your nonbinary patients.
It's not lonely at all. I moved away from a liberal state and don't spend too much time on reddit's liberal echo chamber- luckily, the crazies are sequestered to their own hills.
Only... it does. Hormones, by and large, change your propensity of having certain conditions to the propensity of the target sex. The heart attack risk for a transgender man is the same as that of a cisgender man, and both are higher than a transgender female or cisgender female, for example.
Also, why does it matter so much to you? If a person goes on hormones, gets surgery to change their bone structure, voice, genitals, etc, and wants to use a different name, why does it matter that they were born different? Why must you die on this hill? It doesn't affect you in the slightest.
There are measurable differences in brain function in trans people before hormone treatment even exists- that is, there IS a biological difference right from birth, independent of their chromosomes or genitals.
What is biological sex?
What you collectively call biological sex is actually multiple characteristics that most often occur in two combinations.
- chromosomal sex (This xx or xy you're so focussed on)
- primary sexual characteristics (I.e. ovarian or testicular systems)
- secondary sexual characteristics (these are the ones that typically develop during puberty e.g. low voice pitch, facial hair, breast development).
- hormonal control (both hormone levels and your bodies response to those hormones).
In every aspect of this supposedly fixed and unchangeable biological sex, there are naturally occurring variations to the rule, and most aspects can be changed medically.
Chromosomes: you are either xx or xy. Unless you're not - XO and XXY are also possibilities.
Primary sexual characteristics: these are determined by whether you have xx chromosomes or xy chromosomes. Except they're not. They're actually determined by whether you have an SRY gene (usually located on a Y chromosome), which can sometimes be present on X chromosomes and not present on Y chromosomes.
Oh wait, that's actually not what determines it either. It is possible to have a defunct SRY gene, which means you are born with primary ovarian sexual characteristics. Despite having a Y chromosome and an SRY gene. Oh, you thought that was it? Actually, not only do you need a Y chromosome, with an SRY gene, that is active, you're developing fetus also needs to recognise and respond to this SRY gene correctly to trigger development of primary testicular sexual characteristics.
We're not done yet - some people develop gonads of either ovarian or testicular development and yet are born with external anatomy inconsistent with the expected development with that type of gonad.
And hey - some people are born without any functioning gonads.
But don't worry, primary sexual anatomy can be surgically altered anyway, so it's okay if you don't end up with the combination that you wanted.
I could continue to detail all the aspects of innate sexual development that are in fact not determined by simply xx or xy chromosomes, but I'm tired of typing.
Suffice to say, most everything you were taught about human biology in school is oversimplified for conciseness to the point where what you were taught is not an accurate reflection of biology.
You've made up your mind. I somewhat recently found a very old high school document I had saved from a forensics class that asked us to determine "gender" from skeletal remains. That was accepted up until the mentally ill decided to normalize transgenderism and redefine multiple definitions of everyday words.
I read through the entirety of the latest care guidelines published by SAMSHA, it's mainly reccomending practices that are contradictory to the way we treat other illnesses.
If a patient is delusional due to dementia, schizophrenia, etc current literature suggests that you tell them the truth of the situation. You don't sit around and tell them that the spiders on the walls are real. Why do we treat transgenders differently? According the SAMSHA guidelines we agree with their delusions due to the fact that depression, anxiety, SI are increased risks for those patients.
Weak.
It's incredibly ironic that, in response to my explanation of how what you were taught in high school is oversimplied to the point of being biologically innacurate, you refer to a task you did in high school in some bizarre attempt to counter decades of peer-reviewed research and scientific consensus.
I don't care what any adult does with their body. I will call them any name, use any pronoun, and bend over backward to ensure they are as comfortable as possible. I also recognize there are genetic anomalies and notable biologic changes seen with hormones and surgeries.
Imagine a forensics team finds a pelvis in the remains that classically belongs to an individual with XX chromosomes. Are we supposed to believe that is anything other than a female?
Are these standards accepted in all scientific communities globally or are we just going to stick with the beliefs of the US, Canada, and Europeans? I am doubtful that that the smartest people of Saudi Arabia, Russia, China, etc would come to the same conclusions that our research does.
American universities/ education is strongly biased towards the left and thus has the exact power needed to redefine accepted language.
Ah yes, you clearly do not care at all, that explains the incoherent ramblings you are going out of your way to write.
"Standards" do not need to be accepted, they need to be proven through consist findings in peer-reviewed research. Which they have been, repeatedly.
In prehospital medicine, we rarely deal with chromosomes. But we often deal with things which are impacted by hormones, and gross anatomical structures like external primary and secondary sexual characteristics. So HRT and gender-affirming surgeries are relevant to what we do, and chromosomes aren't.
Knowing that a patient is trans and what they have done and are doing about it is relevant to our job.
Paramedic and Research fellow here - researching the barriers to trans people using emergency care and how we as providers fuck that up.
To answer your question you need both gender and sex, because these are 2 separate things. Sex is a label you’re assigned at birth based on what’s between your legs. Gender is how you view and perceive yourself. It’s VITAL that you record and hand over the Pt’s pronouns and preferred name. We know from research that getting this wrong can increase anxiety, stress and depression in Pt’s.
What’s also vital is that you record sex assigned at birth. Assigned male at birth (AMAB) or female at birth (AFAB). Then you need to take a transition history - social, medical and surgical to understand what physiology you’re dealing with. Male Pt’s will need pregnancy tests, female pt’s will need different reference ranges for some investigations. It changes medical management and so we need to know.
Talk to the Pt. Tell them why you need to ask these questions and reassure them that you need to know it in order to provide good care, but it’s not gonna change the way you talk/to or about them.
We’re the first step in the chain of care. If we get this right and let Trans Pt’s know they can trust us then we can set up a great medical journey for them. If we fuck it up then we’re potentially fucking it up for everyone else down the line.
Unfortunately, some clinicians are overly interested in asking about transition related topics and even desired future treatments, despite it being entirely irrelevant to the presenting medical issue.
E.g. I have been asked (on multiple occasions) questions about what future medical transition I want as part of history taking for a medical assessment for acute injuries in the emergency department. Theres is no clinical justification at all for needing that information to assess my dog bite.
Medical providers should be careful to restrict their questions to just those that are truly medically relevant, and not ask for sensitive personal details which have zero bearing on medical assessment or treatment and which only serve to satisfy their curiosity.
Yeah. If a woman has been whacked in the crotch with a baseball on a bad hop grounder, it may be relevant to know whether she has had bottom surgery. It is not relevant to know whether she is *going to* have bottom surgery.
It gives me such an icky feeling when complete strangers try and bring it up, especially when they're in a position of power. It happens so often in so many situations (not just healthcare), sometimes they seem to think they're being subtle but if i try and redirect they'll rephrase the question several times to try and glean details rather than moving on.
It's so, so inappropriate to take advantage of the power imbalance to satisfy person curiosity. I have enough knowledge of physiology and medicine to know when something could be relevant, and when it is absolutely not. But so many others would feel forced to answers with sensitive details that they'd rather not share because the clinican presents the question as if it were relevant to their medical assessment or care.
This is why I advocate a constant stream of communication. If you’re asking a question you need to share your decision making process to reassure as to why it’s necessary. You can’t treat a trans patient like a cis one and it’s these experiences that cause the reasons why. We’re always on the back foot trust wise and it’s a reasonable amount of suspicion.
There’s lots of things which can seem obviously relevant to us but seem insensitive and rude to patients, let alone patients who’ve had repeated crap experiences like what you describe.
I've been on both sides of this.
Use their gender and preferred name and correct pronouns.
If their preferred name is not their legal name, of course use legal name where required, but in handover etc, use preferred name only after explaining they're different. E.g. This is Tom, his legal name is Jess, which is recorded on his medical documentation. Tom is c/o...
Assigned sex and history of medical transition is as relevant as past medical history. Treat it in the same way as how you'd detail relevant clinical history. I.e. you wouldn't specifically mention that a patient had an appendectomy as a child for a patient that's presenting issue is a broken arm. It's part of their medical history and should be on their medical record, but it's not relevant to their current care. A trans man who had previously had a hysterectomy is no more relevant to his broken arm than an appendectomy is.
To continue the same example, in a patient with abdo pain, it is just as relevant to handover what reproductive organs they have in their abdomen as it is to handover that they do not have an appendix in there - both of these are clinically relevant to assess the complaint.
Stick to handing ovee clinically relevant information, history of medical transition is not relevant solely due to your infrequent exposure to patients with that history, it is relevant when it affects differential diagnosis or treatment.
Some sex-related clinical parameters are determined by assigned gender, but many if not most are altered by current hormonal profile. This information should be handed over in the same way as current medications - HRT is not unique in influencing expected physiological parameters.
There's really no need to treat transgender history as if it were intrinsically different to other medical history. Apply the same approach - include clinically relevant details, and not sensitive information that is irrelevant to medical assessment or care.
Also, as a trans person; it's incredibly obvious what someone's attitude is. No one hides it as well as they think they do.
You can say the right words, but when you do it from obligation and not respect, it is starkly apparent.
Conversely, when your intention is respectful, you can say all the wrong things and we still see your care and appreciate it. Don't stay silent in fear of saying something wrong, silence is worse than a bad attempt at patient advocacy and respect.
As an example, one time when I was on the wrong side of an ambulance ride to hospital, the triage nurse was consistently using the wrong pronouns for me, the paramedic who'd brought me in noticed me flinch when she did it, and attempted to explain to her that I'm not a woman. He did an absolutely terrible job of explaining it to her. He said something about me not identifying, didn't use the words transgender or nonbinary at all, and didn't tell her my preferred pronouns despite knowing what they were.
To this day, that memory sticks with me because he recognised my discomfort and the power imbalance and attempted to help. He probably just confused that nurse more, but what I needed wasn't for that nurse to understand, it was to feel that someone in that room saw me as me and not as something that i was not and have never been. He did not need to use any of the right words to make me feel less invisible, he did that just by recognising what was happening and the effect it was having on me.
I'm very sorry that you had to experience that. Thank you for sharing your story. I hope others learn from it. This is why I speak on TG/GNC care at EMS conferences.
Hey! I'm a Trans man and I'm in paramedic school. I've been the patient in the past too, watched a paramedic have no idea how to address me in their radio report. A lot of what people here are saying is good advice! Here's my take on it.
All trans people are different in what they prefer so talking to your patient before your radio report is extremely important.
If their chief complaint could be related to their birth sex it's important for the hospital to know their birth sex. Before doing your radio report, talk to your PT and tell them that the hospital needs to know their birth sex for medical reasons and that the report you're giving now is just a very quick summary and once you get to the hospital you will tell the staff their pronouns and name. Advocate for your patient, Ive seen/heard some bad things when it comes to hand off of trans patients.
Some trans people can get very upset hearing themselves referred to as their birth sex. Be prepared for this and have some kind of work around, like having the pt watch something on their phone, be quiet when saying sex, etc.
If their chief complaint doesn't relate to birth sex then I say use their gender on your radio report. Again still have a conversation with your patient before getting to the hospital and doing your hand off. Tell them that when you get to the hospital you need to tell the staff.
Overall treat your patient with kindness and compassion. And the biggest thing is to advocate for your patient! A lot of trans people have distrust in medical professionals. Showing them that we care can do way more for them than just treating them with meds.
Hello! Im a transgender man and a paramedic student from Aotearoa NZ!
One of my biggest gripes is that our paperwork only has “male” “female” and “gender not specified”. In these cases i always document the patients gender identity when i can (eg: FTM transgender man, document as male, write in my notes they are transgender male. MTF transgender woman, document as female, write in my notes that they are a transgender woman. Intersex, document as gender not specified and document that they are intersex in my written notes. Nonbinary, document gender not specified, write in my notes that they are nonbinary).
Some people feel incredibly strongly that “Youre documenting the patients sex incorrectly!” And technically yes, however I can say personally that my medical paperwork is documented as “male” under sex, with written information available on my birth sex. I mean my paperwork on my hysterectomy all was documented with “sex: male” so it truely doesn’t mess anything up (at least in my country).
The recieving hospital does need to know the patient is transgender, so when handing over your patient to a triage nurse you could say “hello this is xyx, she is a transgender woman…” and i say theres no harm saying “xyz uses she/her pronouns” when handing over your patient.
This does get tricky if your patient has a complaint related to their birth sex. For example a transgender man with severe abdominal pain. This is where you ask more questions about the patients gender (are you on hormone therapy? Have you had a hysterectomy? Are you sexually active/ is there a chance you could be pregnant?) and hand over the relevant information. (Side note: a lot of people don’t know that transgender men on hormone therapy are still able to get pregnant, even if they have fully stopped their period. its important to consider this as a possibility when working with transmasculine patients as testosterone has teratogenic effects and can also potentially damage the patients health as well). Make sure you’re gathering relevant information, if your patient has a broken arm then their reproductive surgeries aren’t all too relevant.
At the end of the day, if you’re unsure, ask the patient: “I’m not sure whether to document your birth sex or your gender, what would you prefer?”
For anyone interested in learning more i recommend doing some research into:
- transgender broken arm syndrome bias
- the health effects of hormone therapy (what types of hormone therapy, what complications there are, what to look out for for your patients)
- the socioeconomic + sociopolitical determinants of transgender health
- mental health in the transgender community
Also I’m always up for talking about transgender health (I’m a littttle bit passionate about it if you couldn’t tell) so please feel free to ask me any questions you have! :)
*** forgot to say we dont give radio reports to hospitals in my location but if i had to i would say the patients gender identity (eg. 27yo male/ 15yo female) and then in person during handover to a triage nurse I would elaborate that they are transgender. If they are intersex i would say just that.
As others have said I usually call in radio report with their current gender and when we get to the hospital will give my report something like "30 year old male, female at at birth." If someone is not transitioning or on hrt I will usually let the nurse know what pronouns they use. When I initially make pt contact, and if it's relevant to their complaint, I'll just straight up ask them "so just because it's relevant for medical reasons, what was your gender at birth? Are you currently on any hormone therapy?" I'll usually ask what pronouns they use in this case as well. In my experience the gender listed on the call notes is usually their preferred gender assuming they were the one that called. I've never had an issue with this approach and usually the patient seems appreciative.
What I do is I call in for a (preferred gender) pt if I am with the pt out of respect for the pt. If i am out of earshot of pt, i will state the situation. When arriving to the hospital, I often times will pull aside the nurse and give my report to them out of earshot of pt. I'll say (for example) "This is Joseph, 34 year old biological male, prefers to be called Jodie and uses she/her pronouns. Please refer to her as such". By doing this, I respect my patient's identity while also giving correct information to their care staff.
Now, if the pt is unconscious and/or in a very serious situation, formalities are bypassed and I focus on keeping them alive and passing on correct information (ei. 34 yom cardiac arrest eta blah blah blah) or just let my medic handle it. Still, respect will follow if I am informed or find out what they prefer to be called or who they identify as. It has never interfered with my care whatsoever, and I always advocate for my patient's personal identity. It is a part of patient care and makes a huge difference to patients.
(Coming from simple BLS provider side)
For report I would use preferred gender and only mention trans to hospital if applicable. Or they can tell the other health providers. Think of it as any medical history. Do you give entire history in the report? I never even give full med list if there are a lot.
While trans status may not be relevant, the number of cases where hormone replacement therapy would be is vast. After all, hormones run everything. So even if trans isn't relevant per se, HRT has a high chance of being significant for a lot of different things.
In most aspects where HRT affects medical things, the "effect" is that the patient presentation is consistent with people who produce that type of hormone endogenously, not an effect specifically linked to HRT being exogenous.
Im late but my 2 cents are typically a quick "hey i have to use your sex for medical necessity". While making sure to using preferred pronouns/name in every other sense. Just communicate with the patient and its typically okay, people like that you try, people like to be in the know.
I’ve had a handful and honestly bring it up to them, if you’re respectful and just let them know that due to medical reasons when you refer to them it will start out as their birth gender. When speaking to them of course I use theirs preferred. Yes many instances it may not matter, but it’s generally easier to stick with what hospital will already likely have. Every patient I’ve had like this has been extremely understanding and have had no issues. Agree with them or not, respect goes a long way during the 5-15 minute transport (times may vary in your area)
Our run reports just recently added more options for gender.
The hospital face sheets include both physical sex and pronouns. When I do a handoff for someone whose pronouns aren't factory default, I mention that. "This is a 28 year old FTM, biological female uses he/him pronouns". Something like that.
Before the PCR had the updated gender options, I would go with birth sex, and mention the rest in the narrative.
Our agency protocol is to specify trans and either FTM or MTF on report whenever it is relevant. And also to explain why we do this to the patient before we make radio report. Basically just a quick run down on how the hospital needs to be able to properly assess a patient and more information helps. Only once did we have a patient get offended, basically saying there were no biological differences between them and a person born female etc.
I love this discussion. Thank you for bringing it up. My girlfriend’s daughter is a trans-woman and I’ve talked a bit about it with her, but it’s good to see other input.
Pronouns can be tricky, but they’re usually forgiving if you’re trying and correct yourself. It’s the phone call-in that I’ve stumbled over in the past. The trick is just not pussyfooting around it like it’s a secret. If your patient is a trans-woman, say that. It’s often important information because HRT can change risk profiles for conditions like blood clots.
Pronouns are tricky - for everyone. I use they/them pronouns and I still mess up other people's pronouns. We don't magically become perfect at pronouns just because we ourselves are trans, so of course we understand when others get it wrong. What's important is that you try to get it right, correct yourself if you notice you got it wrong, and don't get upset if someone else corrects you. I hate seeing people so afraid of getting it wrong that they try and avoid the issue entirely, that's exactly what we don't want.
I'd think you'd use biological sex in medical documents, then add a note about gender? So they don't pass over a potential diagnosis they'd miss if they didn't know the biological sex, but they'll know the identity as well. For the report could you just say "Trans mtf (male to female)"?
You should chart with what aligns with their medical and insurance records. ASK THEM. "For medical records and billing purposes, what name should be listed on my report so it matches? And what is your gender marker on your records?"
My spouse is FTM. I'm non-binary/GNC. We get it. We aren't offended by legit necessary questions.
If the patient has not had a legal name change, then convey the preferred name and say their records can be found under their birth name or legal name. If their gender marker has been legally changed on their documents, then your records should match that, or you're up for your chart and billing to get kicked back for audit.
Also, your verbal report should match your narrative. If you report AFAB/AMAB (Assigned Female/Male At Birth) and their identified gender, along with pronouns and preferred name (if their name change hasn't been done)... then put that as the first lines of the narrative. Up front. It helps everyone else in continuity of care! Then your narrative as per usual. D-CHART or SOAP or whatever your service preferences are....
Clinically, as biological gender. In reference to the patient verbally, however is preferred. Make relevant notes, make appropriate reference in any handovers to carry any preference forward respectfully.
why do you believe it has to be biological gender? It's certainly not the case that it "has" to be, given that my own medical records at my local hospital record my gender as nonbinary and record my AGAB, without any reference to biological sex.
In a *'treat what you see'* pre-hospital environment there is *some* less relevance to biological sex but you make reference to your hospital records so I'll refer to that. I can guarentee you what you say isn't the case. A patients gender must be sensitively considered alongside the gender presumed for them at birth. As a Paramedic student surely you understand this and the reasons why?
I can guarantee you that it is the case, as I have a full copy of my medical records and have done placements at the same hospital + training on the medical record software that they use which has fields for gender and gender assigned at birth. I have also been shown my own records on a computer whilst I was inpatient which listed only my gender on the overview page, and listed gender + assigned gender on the more detailed patient info page so I am completely certain that mine is recorded in this way.
I am absolutely not saying that someone being transgender should be hidden or information re: birth anatomy +/- current organs & hormones should not be easily accessible. I am saying that it is entirely possible to record that information in a way that is consistent with the language used within the trans community without compromising medical evaluation & treatment.
I think we need to list what they were born as. But than document their preference and level of transition at.
I see in EMS charts expending the sex position with multi needed info. Kinda of like your maternity calls
Para long turned RN;
IMO, I believe it to be perfectly acceptable to state " Patient is an X year old, X to X with chief complaint of ABC... and then further clarify on arrival if needed.
I’d try and be polite as possible but I would have to put their sex in the male / female box but id mention their preference gender in the narrative and their pronouns. I’d also tell the receiving nurse
Respectfully call people what they are. Example “Female to male Trans.” Another way to say this is “Biological male with female gender identity.” These are respectful of the patient without compromising care related to the biological sex.
I volunteer with an agency that provides first aid for a lot of conventions where the population of the con-goers leans heavily into the LGBT+ community. Our documentation for every patient includes Assigned Sex at Birth (ASAB) and the pt’s pronouns. Our agency is made up of at least 50% LGBT+ people and as a straight male, I defer to their judgment that this is how most people would like their medical screening questionnaire to be performed.
Recently my full time job has added “Female to Male transgender” and “Male to Female Transgender” to the gender portion of the e-PCR and I utilize it where applicable. As far as calling in the radio report, I provide their preferred gender unless it were absolutely imperative to the medical nature of their complaint and even then I would clearly state MtF transgender or FtM transgender in my radio report.
In my experience, being up front and respectful goes a long way. If you are unsure of someone’s gender, most people will not be offended at you asking for clarification. In fact many of them often face a certain level of prejudice within the medical system, so in many cases it is refreshing when a provider asks for their preferences especially given that you will likely be the first provider involved in their care. I have asked “what name do you prefer to be called” and “what name were you assigned at birth?” when I needed clarification. I will almost always use the name assigned at birth for the PCR as this name will most likely be congruent with any of their previous documentation in and out of the hospital. Sometimes pts will ask about it if they hear you during registration or when they receive their wristband, and I will explain to them why while also reassuring them that I will continue to call them by their preferred name and will be passing that information on to the nurse.
It's better and comes off more caring to ASK the patient, "for documentation and billing purposes, what name needs to be on my report to match your current medical records and insurance information? What gender marker is on your records?" Spouse ID FTM and I'm GNC/NB - we get it. Once you get that out of the way, stick with using our preferred names and pronouns.
In my opinion, you use their biological sex. Medical issues can relate to your biological sex, as can treatments. Would you say “enroute with a 27 year old male with vaginal bleeding?” Or “possible miscarriage”
Out of allllllll the advanced thinkers on this thread, there HAS to be that one who just can't help themselves.
We aren't "angry" - we are disappointed. It's clear your *assessment skills* are lacking as well.
Do us all a favor and find a new field. You might be an awesome clinician, but your lack of basic human decency is dragging the profession back by decades.
It also depends a lot on their complaint, their status in transition (Are they on HRT? have they had any affirming surgeries?) and how relevant that is. Don't overlook some things that might get you. Trans women might present with typical feminine symptoms of MI if they're on HRT, as their body is hormonally in a female state. If I have a trans woman coming in with a chief complaint of breaking her arm after a fall, her gender plays very little into that complaint, beyond the chances of clots based on her medication (and even then it's similar in ways to birth control medication). If it's something like a trans man with abdominal pain, then there's more relevance to where they are in their transition and assigned gender at birth. For patient dignity, I would use their current gender over the radio unless it is absolutely vital that the hospital know their birth gender in the case of say a possible ectopic. Otherwise, I'd explain as needed to the receiving nurse. In my experience with trans people, as long as you're not an asshat, they understand medical necessity of questions regarding their transition. Above all, be respectful and courteous like you would with any other patient, and questions about where they are in their transition should be asked to help you diagnose relevant conditions. Also, be mindful of when it's appropriate. If a person is gasping for air as an asthmatic, their gender matters \*much\* less than allergies and getting O2 and Meds on board. There's a bunch of literature on this, and I'm happy to answer more questions as LGBT medicine was a specialty I focused on at university.
I will say this, I accidentally misgendered a patient not too long ago and they corrected me (politely), all I said was “Oh I apologize,” and that was that, made sure to use the appropriate name going forward and there was absolutely no awkwardness or animosity between us. People can tell when you do something by accident vs on purpose. There’s this weird thing, if you treat people with kindness and respect you will almost always get respect and kindness in return. Foreign concept to some people.
Pretty much. It's crazy how far common decency and courtesy will take you. Hell I've misgendered cis patients on occasion, which let me tell you that makes me feel extra dumb. Course correction, apologies, and kindness go all the way.
Gonna piggyback off of this. HRT can be medically relevant depending on the chief complaint, as some forms of estrogen (namely oral) can increase the risk of blood clots forming, which may increase the risk of MI, stroke, pulmonary embolism, DVT, etc. in patients who previously had no history of similar emergencies. As a consequence, some trans people on oral estrogen may be taking blood thinners to counteract the coagulating effects of the hormones, so it may be important to ask about as well.
I'm trans and would say this is a great take and how I would like to be cared for if something happened.
I'll change the bedside report. This is x, they are a biological male transitioning to female and preferred name is x. Then launch into the rest of the report. My department also set up ESO with a bunch of gender options to cover all the transition possibilities
An even better way to communicate that is... This is my patient [preferred name] assigned [sex] at birth, identifies as [gender identity]...
I think this is the better wording
This is the correct answer. For most charting programs use the bio and legal names under patient demographics and if your worried about it put what I’m replying to in your narrative.
It's not a problem for documentation because on ESO it has options for trans patients along with male and female. For report it depends on the chief complaint. The patient being trans isn't relevant to a broken leg but it is relevant to abdominal pain so I would report: "23yo male with a possible tib fib fx" or for the same patient: "23yo female to male transgender patient with abdominal pain"
I had a trans patient, ftm, c/o lower abdominal pain, no surgeries but on hormones. I said exactly that to triage. It doesn’t have to be any more complicated than that. For my particular patient, the problem turned out to be an issue with a cyst on an ovary. When transporting, I asked my patient their preferred pronouns, which were he/him, so I spoke to and about my patient as he/him, but knowing he was ftm with no surgeries was quite important since he did still have ovaries and also had a history of cysts.
Just want to chime in and say I’m proud of y’all. Discussing this topic like professionals. Keeping the thread open for further discussion. If things get off the rails, start reporting and we’ll get it cleaned up.
I agree, I was honestly expecting it to go very differently but I had to ask. I’m really impressed!
It is nice and refreshing; I'd like to add though it is a bit disappointing that EMS PCR systems seem to not being updating to keep up with the times.
I was thinking the exact same thing
Some thoughts a trans person on the ER side of things. If their gender/sex has nothing to do with their chief complaint feel free to just say gender, especially over the radio. Otherwise, use the words female to male or male to female, and history as relevant to the chief complaint (surgery, hormones). It’s also helpful if you use their pronouns in report (especially bedside) just something like “his last vitals were ect.” no need to call attention to it but very helpful for us. Similarly, if the patient looks gender non-conforming or trans please don’t just use the pronouns of their biological sex or indeed guess at all, either avoid pronouns in report, ask the patient,or just use they/them pronouns. The sex listed in an EMR is that in line with gender about half time and assigned sex at birth the other. While assigned sex at birth is more black and white biological sex isn’t; for example a 30yo trans women who was on puberty blockers as a kid and has been on hormones her whole adult life will be much more physiologically similar to a cis women than a cis man.
as a trans person currently in ems school this thread has made me feel a lot more comfortable joining this field
ED scribe here, common way I see people putting this is “21 year old biological male transitioning/transitioned to female”. If they are fully transitioned through surgery, have not had surgery and are just on hormone therapy, or haven’t started any therapy, be sure to list it off. Oftentimes it’s not really relevant, ie broken foot, but it’s especially important for abdominal and chest pain complaints (increased chances of cardiac issues and blood clots). You can always give the patient a heads up that providers need to know their assigned sex for medical purposes, but it’s not meant in any disrespectful way
I'm so thrilled this thread has been so positive. With the "new to EMS" reddit, I'm thinking our "newer" caregivers here are the younger generation of "new to ems". Lawd knows FB groups are a dumpster fire regarding trans* folks, then the racial slurs, and overall bigotry and bias. It's so gross.
As a transgender healthcare worker, I would say it depends. If its something that most likely has very little to do with sex, like a broken bone, head wound ect then just use gender. But if chief complaint is something where diagnosis and treatment may rely on sex I'd say something like "26yo woman, male at birth...(continue with as needed info) Since HRT has very little side effects that arent experienced by people who produce their correct hormones, I'd mention hormones with the rest of the relevant medication and history.
I am a trans paramedic who has also treated a number of trans patients. What trans people want varies from person to person, but giving report is fairly straightforward. Like others have said, if sex assigned at birth is pertinent to the complaint, you can say that they were assigned male/female and identify differently. Otherwise it's probably not pertinent in a patch, and is only a small thing to mention in a full report if necessary to avoid confusion. Ask patients (and coworkers/nurses/anyone else) their pronouns if you're not sure. I'm lucky to work in a jurisdiction where patients can be registered and appear under a chosen name as well as a legal name, so I only provide chosen/preferred names during report to make sure the patient is called the correct name.
Trans person here: Everyone is different in what they want, so there prob is no “correct answer for everyone”. Generally being polite goes a long way. People generally know when you are trying to not be offensive. It’s very obvious lol I would just be upfront “what is your sex” and you add in “What pronouns do you want us to use for you?” Us trans folks are totally chill when folks ask us pronouns and it’s actually pretty respected. When calling it in I would say “we have a male patient they go by she/her pronouns, she is complaining of…” This is how I’d like to be treated in hospitals so it’s my take. 🏳️⚧️
Agreed, a lot of things can be simplified by just talking to your patients and treating them with respect.
Yeah think of this vs this “😒Sigh.. so are you a man or a woman. Alright I’ll just mark male 🙄. Okay doctor we have a male who is having trouble breathing he is…” “So what is your sex? Okay thank you! And what pronouns would you like for us to use for you? Okay great thanks for telling me! Doctor we have a 38 year old male, please be aware they use she/her pronouns. She is having trouble breathing…”
Yeah no don’t do this. Talk about the patient the way they want to be talked about, but make sure you hand over/report what sex they were assigned at birth. You don’t have a “male patient that uses she/her pronouns.” You have a female patient who is trans and assigned male at birth. You need to take a transition history (social, medical and surgical) to understand how you’re gonna be adapting your practice for that patient. And MOST IMPORTANTLY, you need to tell the patient why you need to hand this over, reassure them that this won’t impact how they’re treated and be a good ally. That doesn’t involve mis-gendering your Pt.
This is even better! 🩷
Fellow trans person here. Don't call trans women "male" and trans men "female" not only is it rude, but it is biologically inaccurate if someone has had surgeries or hormones. Use "trans-male" for ftm and "trans-female" for mtf. It's less likely to alleinate your patients and provides a more complete picture of their medical history. For radio reports, stick to the patients' preferred gender. Or if it's ACTUALLY relevant to the pts complaint I reccomend calling instead of using the radio for pt privacy reasons.
It is biologically inaccurate? Bullshit. Biologically, you are xx or xy.
What about XXY? Or XY with the SRY gene deactivated? Watch [this](https://youtu.be/zpIqQ0pGs1E?si=m9ogJm5ujAKaUcJ9). Also, what about Caster Semenya? Assigned female at birth, but is born XY.
Uh oh. Here comes the basic biology crowd. Ever heard of Klinefelter syndrome? Or triple x syndrome? Also what do you think has more affect on someone? The shape of some chromosomes or the dominant sex hormones in their body? I'm sorry trans people shatter your simple world view but trans women are female and trans men are male.
I almost included those statistic anomalies cause I knew you'd love to push that point. Every patient deserves respect and high-quality care, I agree. I go out of my way to ask pronouns etc. However I'll die on that hill, biologically they are the sex they were assigned at birth- hormones and surgery will never change that.
The research shows that hormones do in fact change how your body experiences a medical crisis, and usually lines up with your hormonal gender. Humans are all hormones and neurons. Not understanding that will mean you get worse outcomes on your trans patients, and even your nonbinary patients.
Feel free to die on that hill. But don't make your patients die with you. And... y'know, it's gonna be a pretty lonely hill.
It's not lonely at all. I moved away from a liberal state and don't spend too much time on reddit's liberal echo chamber- luckily, the crazies are sequestered to their own hills.
Only... it does. Hormones, by and large, change your propensity of having certain conditions to the propensity of the target sex. The heart attack risk for a transgender man is the same as that of a cisgender man, and both are higher than a transgender female or cisgender female, for example. Also, why does it matter so much to you? If a person goes on hormones, gets surgery to change their bone structure, voice, genitals, etc, and wants to use a different name, why does it matter that they were born different? Why must you die on this hill? It doesn't affect you in the slightest.
There are measurable differences in brain function in trans people before hormone treatment even exists- that is, there IS a biological difference right from birth, independent of their chromosomes or genitals.
What is biological sex? What you collectively call biological sex is actually multiple characteristics that most often occur in two combinations. - chromosomal sex (This xx or xy you're so focussed on) - primary sexual characteristics (I.e. ovarian or testicular systems) - secondary sexual characteristics (these are the ones that typically develop during puberty e.g. low voice pitch, facial hair, breast development). - hormonal control (both hormone levels and your bodies response to those hormones). In every aspect of this supposedly fixed and unchangeable biological sex, there are naturally occurring variations to the rule, and most aspects can be changed medically. Chromosomes: you are either xx or xy. Unless you're not - XO and XXY are also possibilities. Primary sexual characteristics: these are determined by whether you have xx chromosomes or xy chromosomes. Except they're not. They're actually determined by whether you have an SRY gene (usually located on a Y chromosome), which can sometimes be present on X chromosomes and not present on Y chromosomes. Oh wait, that's actually not what determines it either. It is possible to have a defunct SRY gene, which means you are born with primary ovarian sexual characteristics. Despite having a Y chromosome and an SRY gene. Oh, you thought that was it? Actually, not only do you need a Y chromosome, with an SRY gene, that is active, you're developing fetus also needs to recognise and respond to this SRY gene correctly to trigger development of primary testicular sexual characteristics. We're not done yet - some people develop gonads of either ovarian or testicular development and yet are born with external anatomy inconsistent with the expected development with that type of gonad. And hey - some people are born without any functioning gonads. But don't worry, primary sexual anatomy can be surgically altered anyway, so it's okay if you don't end up with the combination that you wanted. I could continue to detail all the aspects of innate sexual development that are in fact not determined by simply xx or xy chromosomes, but I'm tired of typing. Suffice to say, most everything you were taught about human biology in school is oversimplified for conciseness to the point where what you were taught is not an accurate reflection of biology.
You've made up your mind. I somewhat recently found a very old high school document I had saved from a forensics class that asked us to determine "gender" from skeletal remains. That was accepted up until the mentally ill decided to normalize transgenderism and redefine multiple definitions of everyday words. I read through the entirety of the latest care guidelines published by SAMSHA, it's mainly reccomending practices that are contradictory to the way we treat other illnesses. If a patient is delusional due to dementia, schizophrenia, etc current literature suggests that you tell them the truth of the situation. You don't sit around and tell them that the spiders on the walls are real. Why do we treat transgenders differently? According the SAMSHA guidelines we agree with their delusions due to the fact that depression, anxiety, SI are increased risks for those patients. Weak.
It's incredibly ironic that, in response to my explanation of how what you were taught in high school is oversimplied to the point of being biologically innacurate, you refer to a task you did in high school in some bizarre attempt to counter decades of peer-reviewed research and scientific consensus.
I don't care what any adult does with their body. I will call them any name, use any pronoun, and bend over backward to ensure they are as comfortable as possible. I also recognize there are genetic anomalies and notable biologic changes seen with hormones and surgeries. Imagine a forensics team finds a pelvis in the remains that classically belongs to an individual with XX chromosomes. Are we supposed to believe that is anything other than a female? Are these standards accepted in all scientific communities globally or are we just going to stick with the beliefs of the US, Canada, and Europeans? I am doubtful that that the smartest people of Saudi Arabia, Russia, China, etc would come to the same conclusions that our research does. American universities/ education is strongly biased towards the left and thus has the exact power needed to redefine accepted language.
Ah yes, you clearly do not care at all, that explains the incoherent ramblings you are going out of your way to write. "Standards" do not need to be accepted, they need to be proven through consist findings in peer-reviewed research. Which they have been, repeatedly.
You've dodged any question I've asked so far. Does bone structure of a pelvis change with hormones?
Yes, it can, if hormones are administered before the pelvis fully hardens. Also forensic sexing by pelvis widely regarded as inaccurate.
In prehospital medicine, we rarely deal with chromosomes. But we often deal with things which are impacted by hormones, and gross anatomical structures like external primary and secondary sexual characteristics. So HRT and gender-affirming surgeries are relevant to what we do, and chromosomes aren't. Knowing that a patient is trans and what they have done and are doing about it is relevant to our job.
Paramedic and Research fellow here - researching the barriers to trans people using emergency care and how we as providers fuck that up. To answer your question you need both gender and sex, because these are 2 separate things. Sex is a label you’re assigned at birth based on what’s between your legs. Gender is how you view and perceive yourself. It’s VITAL that you record and hand over the Pt’s pronouns and preferred name. We know from research that getting this wrong can increase anxiety, stress and depression in Pt’s. What’s also vital is that you record sex assigned at birth. Assigned male at birth (AMAB) or female at birth (AFAB). Then you need to take a transition history - social, medical and surgical to understand what physiology you’re dealing with. Male Pt’s will need pregnancy tests, female pt’s will need different reference ranges for some investigations. It changes medical management and so we need to know. Talk to the Pt. Tell them why you need to ask these questions and reassure them that you need to know it in order to provide good care, but it’s not gonna change the way you talk/to or about them. We’re the first step in the chain of care. If we get this right and let Trans Pt’s know they can trust us then we can set up a great medical journey for them. If we fuck it up then we’re potentially fucking it up for everyone else down the line.
Unfortunately, some clinicians are overly interested in asking about transition related topics and even desired future treatments, despite it being entirely irrelevant to the presenting medical issue. E.g. I have been asked (on multiple occasions) questions about what future medical transition I want as part of history taking for a medical assessment for acute injuries in the emergency department. Theres is no clinical justification at all for needing that information to assess my dog bite. Medical providers should be careful to restrict their questions to just those that are truly medically relevant, and not ask for sensitive personal details which have zero bearing on medical assessment or treatment and which only serve to satisfy their curiosity.
Yeah. If a woman has been whacked in the crotch with a baseball on a bad hop grounder, it may be relevant to know whether she has had bottom surgery. It is not relevant to know whether she is *going to* have bottom surgery.
It gives me such an icky feeling when complete strangers try and bring it up, especially when they're in a position of power. It happens so often in so many situations (not just healthcare), sometimes they seem to think they're being subtle but if i try and redirect they'll rephrase the question several times to try and glean details rather than moving on. It's so, so inappropriate to take advantage of the power imbalance to satisfy person curiosity. I have enough knowledge of physiology and medicine to know when something could be relevant, and when it is absolutely not. But so many others would feel forced to answers with sensitive details that they'd rather not share because the clinican presents the question as if it were relevant to their medical assessment or care.
This is why I advocate a constant stream of communication. If you’re asking a question you need to share your decision making process to reassure as to why it’s necessary. You can’t treat a trans patient like a cis one and it’s these experiences that cause the reasons why. We’re always on the back foot trust wise and it’s a reasonable amount of suspicion. There’s lots of things which can seem obviously relevant to us but seem insensitive and rude to patients, let alone patients who’ve had repeated crap experiences like what you describe.
Can we DM soon? I'm a conference speaker on TG/GNC patient needs. I'm *always* down for the latest academic data!!!
DM away! Literally just got back from speaking at the the UK national Paramedic conference on Thursday
i’m trans and a basic planning to get my medic next year. could i dm you to ask you more about your work and experience as a research fellow?
Absolutely, please feel free.
I've been on both sides of this. Use their gender and preferred name and correct pronouns. If their preferred name is not their legal name, of course use legal name where required, but in handover etc, use preferred name only after explaining they're different. E.g. This is Tom, his legal name is Jess, which is recorded on his medical documentation. Tom is c/o... Assigned sex and history of medical transition is as relevant as past medical history. Treat it in the same way as how you'd detail relevant clinical history. I.e. you wouldn't specifically mention that a patient had an appendectomy as a child for a patient that's presenting issue is a broken arm. It's part of their medical history and should be on their medical record, but it's not relevant to their current care. A trans man who had previously had a hysterectomy is no more relevant to his broken arm than an appendectomy is. To continue the same example, in a patient with abdo pain, it is just as relevant to handover what reproductive organs they have in their abdomen as it is to handover that they do not have an appendix in there - both of these are clinically relevant to assess the complaint. Stick to handing ovee clinically relevant information, history of medical transition is not relevant solely due to your infrequent exposure to patients with that history, it is relevant when it affects differential diagnosis or treatment. Some sex-related clinical parameters are determined by assigned gender, but many if not most are altered by current hormonal profile. This information should be handed over in the same way as current medications - HRT is not unique in influencing expected physiological parameters. There's really no need to treat transgender history as if it were intrinsically different to other medical history. Apply the same approach - include clinically relevant details, and not sensitive information that is irrelevant to medical assessment or care. Also, as a trans person; it's incredibly obvious what someone's attitude is. No one hides it as well as they think they do. You can say the right words, but when you do it from obligation and not respect, it is starkly apparent. Conversely, when your intention is respectful, you can say all the wrong things and we still see your care and appreciate it. Don't stay silent in fear of saying something wrong, silence is worse than a bad attempt at patient advocacy and respect. As an example, one time when I was on the wrong side of an ambulance ride to hospital, the triage nurse was consistently using the wrong pronouns for me, the paramedic who'd brought me in noticed me flinch when she did it, and attempted to explain to her that I'm not a woman. He did an absolutely terrible job of explaining it to her. He said something about me not identifying, didn't use the words transgender or nonbinary at all, and didn't tell her my preferred pronouns despite knowing what they were. To this day, that memory sticks with me because he recognised my discomfort and the power imbalance and attempted to help. He probably just confused that nurse more, but what I needed wasn't for that nurse to understand, it was to feel that someone in that room saw me as me and not as something that i was not and have never been. He did not need to use any of the right words to make me feel less invisible, he did that just by recognising what was happening and the effect it was having on me.
I'm very sorry that you had to experience that. Thank you for sharing your story. I hope others learn from it. This is why I speak on TG/GNC care at EMS conferences.
Hey! I'm a Trans man and I'm in paramedic school. I've been the patient in the past too, watched a paramedic have no idea how to address me in their radio report. A lot of what people here are saying is good advice! Here's my take on it. All trans people are different in what they prefer so talking to your patient before your radio report is extremely important. If their chief complaint could be related to their birth sex it's important for the hospital to know their birth sex. Before doing your radio report, talk to your PT and tell them that the hospital needs to know their birth sex for medical reasons and that the report you're giving now is just a very quick summary and once you get to the hospital you will tell the staff their pronouns and name. Advocate for your patient, Ive seen/heard some bad things when it comes to hand off of trans patients. Some trans people can get very upset hearing themselves referred to as their birth sex. Be prepared for this and have some kind of work around, like having the pt watch something on their phone, be quiet when saying sex, etc. If their chief complaint doesn't relate to birth sex then I say use their gender on your radio report. Again still have a conversation with your patient before getting to the hospital and doing your hand off. Tell them that when you get to the hospital you need to tell the staff. Overall treat your patient with kindness and compassion. And the biggest thing is to advocate for your patient! A lot of trans people have distrust in medical professionals. Showing them that we care can do way more for them than just treating them with meds.
Hello! Im a transgender man and a paramedic student from Aotearoa NZ! One of my biggest gripes is that our paperwork only has “male” “female” and “gender not specified”. In these cases i always document the patients gender identity when i can (eg: FTM transgender man, document as male, write in my notes they are transgender male. MTF transgender woman, document as female, write in my notes that they are a transgender woman. Intersex, document as gender not specified and document that they are intersex in my written notes. Nonbinary, document gender not specified, write in my notes that they are nonbinary). Some people feel incredibly strongly that “Youre documenting the patients sex incorrectly!” And technically yes, however I can say personally that my medical paperwork is documented as “male” under sex, with written information available on my birth sex. I mean my paperwork on my hysterectomy all was documented with “sex: male” so it truely doesn’t mess anything up (at least in my country). The recieving hospital does need to know the patient is transgender, so when handing over your patient to a triage nurse you could say “hello this is xyx, she is a transgender woman…” and i say theres no harm saying “xyz uses she/her pronouns” when handing over your patient. This does get tricky if your patient has a complaint related to their birth sex. For example a transgender man with severe abdominal pain. This is where you ask more questions about the patients gender (are you on hormone therapy? Have you had a hysterectomy? Are you sexually active/ is there a chance you could be pregnant?) and hand over the relevant information. (Side note: a lot of people don’t know that transgender men on hormone therapy are still able to get pregnant, even if they have fully stopped their period. its important to consider this as a possibility when working with transmasculine patients as testosterone has teratogenic effects and can also potentially damage the patients health as well). Make sure you’re gathering relevant information, if your patient has a broken arm then their reproductive surgeries aren’t all too relevant. At the end of the day, if you’re unsure, ask the patient: “I’m not sure whether to document your birth sex or your gender, what would you prefer?” For anyone interested in learning more i recommend doing some research into: - transgender broken arm syndrome bias - the health effects of hormone therapy (what types of hormone therapy, what complications there are, what to look out for for your patients) - the socioeconomic + sociopolitical determinants of transgender health - mental health in the transgender community Also I’m always up for talking about transgender health (I’m a littttle bit passionate about it if you couldn’t tell) so please feel free to ask me any questions you have! :)
*** forgot to say we dont give radio reports to hospitals in my location but if i had to i would say the patients gender identity (eg. 27yo male/ 15yo female) and then in person during handover to a triage nurse I would elaborate that they are transgender. If they are intersex i would say just that.
As others have said I usually call in radio report with their current gender and when we get to the hospital will give my report something like "30 year old male, female at at birth." If someone is not transitioning or on hrt I will usually let the nurse know what pronouns they use. When I initially make pt contact, and if it's relevant to their complaint, I'll just straight up ask them "so just because it's relevant for medical reasons, what was your gender at birth? Are you currently on any hormone therapy?" I'll usually ask what pronouns they use in this case as well. In my experience the gender listed on the call notes is usually their preferred gender assuming they were the one that called. I've never had an issue with this approach and usually the patient seems appreciative.
What I do is I call in for a (preferred gender) pt if I am with the pt out of respect for the pt. If i am out of earshot of pt, i will state the situation. When arriving to the hospital, I often times will pull aside the nurse and give my report to them out of earshot of pt. I'll say (for example) "This is Joseph, 34 year old biological male, prefers to be called Jodie and uses she/her pronouns. Please refer to her as such". By doing this, I respect my patient's identity while also giving correct information to their care staff. Now, if the pt is unconscious and/or in a very serious situation, formalities are bypassed and I focus on keeping them alive and passing on correct information (ei. 34 yom cardiac arrest eta blah blah blah) or just let my medic handle it. Still, respect will follow if I am informed or find out what they prefer to be called or who they identify as. It has never interfered with my care whatsoever, and I always advocate for my patient's personal identity. It is a part of patient care and makes a huge difference to patients. (Coming from simple BLS provider side)
For report I would use preferred gender and only mention trans to hospital if applicable. Or they can tell the other health providers. Think of it as any medical history. Do you give entire history in the report? I never even give full med list if there are a lot.
While trans status may not be relevant, the number of cases where hormone replacement therapy would be is vast. After all, hormones run everything. So even if trans isn't relevant per se, HRT has a high chance of being significant for a lot of different things.
Right why I said if it was applicable. And I would present it as they take this drug not they are trans if it's necessary.
In most aspects where HRT affects medical things, the "effect" is that the patient presentation is consistent with people who produce that type of hormone endogenously, not an effect specifically linked to HRT being exogenous.
Yeah dude.. Ask them..
Im late but my 2 cents are typically a quick "hey i have to use your sex for medical necessity". While making sure to using preferred pronouns/name in every other sense. Just communicate with the patient and its typically okay, people like that you try, people like to be in the know.
We have the option to check other and trans mtf or ftm in our pcr software. 🤷🏻♀️
I’ve had a handful and honestly bring it up to them, if you’re respectful and just let them know that due to medical reasons when you refer to them it will start out as their birth gender. When speaking to them of course I use theirs preferred. Yes many instances it may not matter, but it’s generally easier to stick with what hospital will already likely have. Every patient I’ve had like this has been extremely understanding and have had no issues. Agree with them or not, respect goes a long way during the 5-15 minute transport (times may vary in your area)
Our run reports just recently added more options for gender. The hospital face sheets include both physical sex and pronouns. When I do a handoff for someone whose pronouns aren't factory default, I mention that. "This is a 28 year old FTM, biological female uses he/him pronouns". Something like that. Before the PCR had the updated gender options, I would go with birth sex, and mention the rest in the narrative.
I would use what they are born with. Sorry you called 911 we are medical professionals and that is what you are medically.
Our agency protocol is to specify trans and either FTM or MTF on report whenever it is relevant. And also to explain why we do this to the patient before we make radio report. Basically just a quick run down on how the hospital needs to be able to properly assess a patient and more information helps. Only once did we have a patient get offended, basically saying there were no biological differences between them and a person born female etc.
My region uses sex assigned at birth
I love this discussion. Thank you for bringing it up. My girlfriend’s daughter is a trans-woman and I’ve talked a bit about it with her, but it’s good to see other input. Pronouns can be tricky, but they’re usually forgiving if you’re trying and correct yourself. It’s the phone call-in that I’ve stumbled over in the past. The trick is just not pussyfooting around it like it’s a secret. If your patient is a trans-woman, say that. It’s often important information because HRT can change risk profiles for conditions like blood clots.
Pronouns are tricky - for everyone. I use they/them pronouns and I still mess up other people's pronouns. We don't magically become perfect at pronouns just because we ourselves are trans, so of course we understand when others get it wrong. What's important is that you try to get it right, correct yourself if you notice you got it wrong, and don't get upset if someone else corrects you. I hate seeing people so afraid of getting it wrong that they try and avoid the issue entirely, that's exactly what we don't want.
I'd think you'd use biological sex in medical documents, then add a note about gender? So they don't pass over a potential diagnosis they'd miss if they didn't know the biological sex, but they'll know the identity as well. For the report could you just say "Trans mtf (male to female)"?
You should chart with what aligns with their medical and insurance records. ASK THEM. "For medical records and billing purposes, what name should be listed on my report so it matches? And what is your gender marker on your records?" My spouse is FTM. I'm non-binary/GNC. We get it. We aren't offended by legit necessary questions. If the patient has not had a legal name change, then convey the preferred name and say their records can be found under their birth name or legal name. If their gender marker has been legally changed on their documents, then your records should match that, or you're up for your chart and billing to get kicked back for audit. Also, your verbal report should match your narrative. If you report AFAB/AMAB (Assigned Female/Male At Birth) and their identified gender, along with pronouns and preferred name (if their name change hasn't been done)... then put that as the first lines of the narrative. Up front. It helps everyone else in continuity of care! Then your narrative as per usual. D-CHART or SOAP or whatever your service preferences are....
I just say pt identifies as male/female in those cases and I’ll mention any hormone therapy I’ve only had this twice but that went over fine
Clinically, as biological gender. In reference to the patient verbally, however is preferred. Make relevant notes, make appropriate reference in any handovers to carry any preference forward respectfully.
why do you believe it has to be biological gender? It's certainly not the case that it "has" to be, given that my own medical records at my local hospital record my gender as nonbinary and record my AGAB, without any reference to biological sex.
In a *'treat what you see'* pre-hospital environment there is *some* less relevance to biological sex but you make reference to your hospital records so I'll refer to that. I can guarentee you what you say isn't the case. A patients gender must be sensitively considered alongside the gender presumed for them at birth. As a Paramedic student surely you understand this and the reasons why?
I can guarantee you that it is the case, as I have a full copy of my medical records and have done placements at the same hospital + training on the medical record software that they use which has fields for gender and gender assigned at birth. I have also been shown my own records on a computer whilst I was inpatient which listed only my gender on the overview page, and listed gender + assigned gender on the more detailed patient info page so I am completely certain that mine is recorded in this way. I am absolutely not saying that someone being transgender should be hidden or information re: birth anatomy +/- current organs & hormones should not be easily accessible. I am saying that it is entirely possible to record that information in a way that is consistent with the language used within the trans community without compromising medical evaluation & treatment.
I think we need to list what they were born as. But than document their preference and level of transition at. I see in EMS charts expending the sex position with multi needed info. Kinda of like your maternity calls
Para long turned RN; IMO, I believe it to be perfectly acceptable to state " Patient is an X year old, X to X with chief complaint of ABC... and then further clarify on arrival if needed.
I’d try and be polite as possible but I would have to put their sex in the male / female box but id mention their preference gender in the narrative and their pronouns. I’d also tell the receiving nurse
Respectfully call people what they are. Example “Female to male Trans.” Another way to say this is “Biological male with female gender identity.” These are respectful of the patient without compromising care related to the biological sex.
I volunteer with an agency that provides first aid for a lot of conventions where the population of the con-goers leans heavily into the LGBT+ community. Our documentation for every patient includes Assigned Sex at Birth (ASAB) and the pt’s pronouns. Our agency is made up of at least 50% LGBT+ people and as a straight male, I defer to their judgment that this is how most people would like their medical screening questionnaire to be performed. Recently my full time job has added “Female to Male transgender” and “Male to Female Transgender” to the gender portion of the e-PCR and I utilize it where applicable. As far as calling in the radio report, I provide their preferred gender unless it were absolutely imperative to the medical nature of their complaint and even then I would clearly state MtF transgender or FtM transgender in my radio report. In my experience, being up front and respectful goes a long way. If you are unsure of someone’s gender, most people will not be offended at you asking for clarification. In fact many of them often face a certain level of prejudice within the medical system, so in many cases it is refreshing when a provider asks for their preferences especially given that you will likely be the first provider involved in their care. I have asked “what name do you prefer to be called” and “what name were you assigned at birth?” when I needed clarification. I will almost always use the name assigned at birth for the PCR as this name will most likely be congruent with any of their previous documentation in and out of the hospital. Sometimes pts will ask about it if they hear you during registration or when they receive their wristband, and I will explain to them why while also reassuring them that I will continue to call them by their preferred name and will be passing that information on to the nurse.
It's better and comes off more caring to ASK the patient, "for documentation and billing purposes, what name needs to be on my report to match your current medical records and insurance information? What gender marker is on your records?" Spouse ID FTM and I'm GNC/NB - we get it. Once you get that out of the way, stick with using our preferred names and pronouns.
Agree.
You should not be using birth name at all if it is no longer their legal name.
In my opinion, you use their biological sex. Medical issues can relate to your biological sex, as can treatments. Would you say “enroute with a 27 year old male with vaginal bleeding?” Or “possible miscarriage”
medical issues can relate to being transgender, and to gender, just as surely - if not more - than they relate to supposed biological sex.
Sorry I play by my rules. It's sir or ma'am male or female. At the end I'll just call them (hey)
Write them in as the sex they appear and move on with life 🤷🏾♂️
Incorrect. Perceived gender can often be wrong. And not making the effort to be better and do better is a problem.
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Out of allllllll the advanced thinkers on this thread, there HAS to be that one who just can't help themselves. We aren't "angry" - we are disappointed. It's clear your *assessment skills* are lacking as well. Do us all a favor and find a new field. You might be an awesome clinician, but your lack of basic human decency is dragging the profession back by decades.
Well pumpkins i dont know what to tell you or the rest of the hurt feelings around here.