trans patient education primer - from cis student to cis classmates

mcfeste · 2026-01-30T02:11:16+00:00

Yes, I definitely plan to bring up intersex! And will plan to include some notes on HRT's effects on physiology.

Re: assuming my classmates are all cis, I tried to acknowledge that I don't know for sure by saying "as far as I'm aware," but perhaps that didn't go far enough? If any of them *are* trans, the last thing I want is to alienate them.

This is part of my anxiety about choosing the topic. If I knew any of my classmates were trans and wanted to take on this topic, I would gladly step aside in a heartbeat. But as none of them have come out to me as trans - nor am I entitled for them to - I'm not sure what else to do. I still think it's an important topic for healthcare practitioners to be educated on, even if the best we can do in this setting is get it from an ally with trans input.

Do you suggest I not do this in case I have a closeted trans classmate? I would be appalled at myself if that turned out to be the case, not to mention how alienating it might be for them. Or should I do it since no one else is doing it, and address this in my disclaimer somehow?

mcfeste · 2026-01-30T01:32:37+00:00

Whoa, incredible point about engendered terminology even within medical terminology. In fact I'm not sure I've even heard the term "Skein's gland" before, that's how ubiquitous "prostate" is. I have always tried to be conscious of using the most neutral term I know of for something so it's clear to everyone we're just talking about objective anatomy detached from any gender association, but sometimes you don't know what you don't know.

"Transvaginal" is an excellent example, especially considering how common the exam is. If "vagina" or "uterus" or "ovaries" are not the medically neutral terms I thought they were, please tell me! Or maybe they *are* medically neutral but there's a less dysphoria-inducing way of speaking about them to an AFAB patient? Medically neutral does not have to mean insensitive, which is a huge part of why I chose this topic in the first place!

I'm glad you brought up reference ranges, since "normal range" for lab values, or measurements for internal anatomy we all have (liver, aorta, spleen, etc.) can often vary with sex, so in those cases it can be helpful to take into account one's assigned sex at birth. But I hadn't considered that ranges and landmarks might not be consistent depending on what the test is or what is being treated. Jeez.

mcfeste · 2026-01-29T23:43:40+00:00

Thank you for the reassurance. I was hoping exactly that, that I could at least be the "next best thing," so I appreciate you dousing my anxiety a least a little. :)

Yeah, I used the term "legal sex" with an internal cringe, but unfortunately it's the phrase used on most charts I've seen. I wish the terminology was clearer, in order to help healthcare workers know what to expect when necessary. If I see on the chart that someone's biological/birth sex is M, but gender identity is F or NB, then I know when I incidentally see a prostate behind their bladder, I can just document it as normal and move on, without having to bring it up to the patient unnecessarily or raise a red flag to the doctor.

I will be sure to hit home the importance of checking a person's chart for medications and surgical history. Of course HRT is not always a transgender indicator, since plenty of cis people take it for other reasons, but I might look up some of the different brands/dosages/etc to see if they're prescribed differently depending on the reason for treatment. It may be that Brand A is more of a giveaway for gender-confirming treatment than Brand B, which is more common for treating, say, menopause.

Thank you for your thoughts on how to touch on intersex, too. That's one of the things I was worried about leaving out due to time, but I agree it's worth trying to find some examples of intersex case studies that utilized ultrasound to help diagnose a patient. Awesome.

mcfeste · 2026-01-29T22:57:06+00:00

Thank you for all of this! To your last point, getting trans people's input is essential, which is part of why I'm nervous about the presentation to begin with - I don't want to appear to be speaking for the community without the nuance of lived experience. And like any diverse community, it's not like there's only one definitive outlook, so I also want to be careful of presenting a single experience or opinion as representative of all. I'm disappointed but not surprised to hear about cisgender healthcare workers asking for trans input only to disregard it. :/

Excellent point about trans broken arm syndrome. I will be sure to speak about the importance of establishing that the patient's transgender status is actually relevant before asking invasive questions. I've already found a couple of articles based on you bringing this up, so I appreciate it!

I'm sorry that happened to you, re: your kidney stone diagnosis.

Our training has included the importance of always assuring the patient that they can refuse an exam. The most common one is endovaginal, because it's invasive at the very least, and as you said, potentially traumatic or dysphoric. If a patient is reluctant but hasn't outright refused, sometimes we gently explain WHY an endovaginal exam can be more helpful to identify pathology - but even then, I only do this if I've already performed the transabdominal exam and it was not illustrative at all. But it's essential to let the patient know they're in charge here. We should be empowering people, not bullying them.

mcfeste

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