Misgendering in Health Care and How to Improve – Pager Publications, Inc.

In the first episode of the YouTube series These Thems, the main character Vero, a non-binary dog walker, anxiously goes to their gynecology appointment. Their gynecologist notices that they mark their gender as transgender on the intake form. The gynecologist explains she thinks people should use the bathrooms of their choosing, especially guys like Vero. Vero cringes slightly before correcting her stating that they are non-binary and use they/them pronouns. The gynecologist smiles and remarks oh lucky me! I thought I was only seeing one patient today! Despite its light hearted tone, this scene accurately portrays a common occurance in the life of transgender and non-binary individuals: being misgendered.

Misgendering occurs when someone refers to you as a different gender than the one you are. Often, it takes the form of using the wrong pronouns. For example, saying That belongs to her in reference to a man is misgendering. As a non-binary individual, I use they/them pronouns. When someone refers to me with she or her, they are misgendering me. While often unintentional, misgendering has consequences. Misgendering has been shown to increase feelings of stigmatization in transgender individuals and young adults whose pronouns are respected report attempting suicide at half the rate compared to those whose pronouns are not respected.

Some scholars have considered misgendering a microaggression. Though the term microaggression was coined to capture the verbal/non-verbal negative slights toward Black individuals, it has been more broadly applied to slights towards members of minority and marginalized populations. Microaggressions take a toll on the psychological well-being of a marginalized population that experiences repeated microaggressions. These effects are magnified on those who are a part of multiple minority groups such as LGBTQI+ people of color.

It is not uncommon for transgender and gender-nonbinary individuals (TGNB) to be misgendered by healthcare providers or in the healthcare setting. This negatively affects their health and their relationship with their providers. Leaders in the field of transgender and non-binary healthcare recommend asking about a persons pronouns and integrating pronoun introductions into the clinical setting. They have emphasized that correct pronoun use is a crucial part of gender affirming care. The World Proffesional Association for Transgender Health has recommended that electronic medical records include preffered name, gender identity and pronouns for each patients, and patients report wanting this information documented in their health record.

While cis-gender people can be misgendered, it occurs more often to transgender, non-binary and gender nonconforming individuals. One major reason for this is that not all transgender people want to, decide to or can recieve the gender affirming treatments such as hormonal or surgical treatment that would align their appearance to the stereotypes of their gender. Another is that appearance and gender identity are not related, despite social norms that support assuming an individuals pronouns instead of inquiring about and sharing them. Finally, in the case of gender neutral pronouns, many individuals report frank discomfort with using gender neutral pronouns such as they/them. Clearly, this was the case with the gynecologist in the These Thems episode.

As someone who uses the gender neutral pronouns they/them, I come face-to-face with this discomfort every day when I introduce myself to others. More often than not, our interaction starts with the individual using the wrong pronouns and misgendering me. After I correct them, I am met with a variety of reactions ranging from blatant doubling down of discriminatory ideology to sincere and profuse apologies. For the latter, and those who want to know what to do when you slip up, I have the following advice:

Step 1: Read the Room

Start with gauging the situation. You may not be in the most ideal setting to discuss your transgression right away, but make a note to address it later when you are in a more appropriate setting. I recommend physically making a note so you can personally message that individual before too much time has passed.

Step 2: Apologize

Generally, the best initial reaction is to start with a good and simple apology. There are many elements to a successful apology but a few are particularly applicable after an act of misgendering someone in conversation. Sincerity and remorse are key components of a successful apology that increase the likelihood of forgiveness. Mention that you are truly sorry and know it may have made that individual uncomfortable. Do not invalidate or minimize what occurred. You should also make sure to keep the focus on the person you misgendered, avoiding dramatic expressions of your guilt that shift the conversation to you and your emotional state.

Step 3: Gratitude

If you were corrected for misgendering someone, make an attempt at gratitude for the correction. This shows you have a genuine desire to be using the right name and/or pronouns for someone and appreciate being told you were wrong. Finally, say the same sentence again with the correct pronouns.

Here is an example of what this looks like in practice:

The slip up: Hello everyone, this is Nat. She is our new medical student.

The correction: Actually, I use they/them pronouns.

The apology: Oh, Im sorry for misgendering you. I should not have assumed your pronouns. Thank you for the correction.

The restatement: Everyone please meet Nat. They are our new medical student.

The follow up: Nat, I am sorry for any discomfort I might have caused when I misgendered you earlier. I will practice your pronouns to help get them right in the future. I will make sure your new coworkers are aware as well.

Step 4: Continued Work

Though the immediate transgression is often the most emotionally distressing, the real work of preventing further misgendering occurs after that encounter. Specific to the gender neutral pronouns they/them, many people have told me that the singular use of these pronouns is difficult and unnatural. Language and grammar are ever evolving and it makes sense that more widespread use of the singular they is awkward at first, or that you are unfamiliar with someones pronouns. Recognize that this discomfort is not an excuse to avoid adopting these pronouns. Practice using the individuals pronouns and correct yourself and others when they slip-up. Once, a friend of mine told me a story of how her and another peer spent a long car ride just practicing talking about me using they/them pronouns to get better at it. To advance your allyship further, include your own pronouns in your introduction to normalize the process of sharing (rather than assuming) pronouns.

This guidance is not meant to address every situation of misgendering you face, but it is meant to guide those who feel stuck in moments when they do misgender someone. There is still plenty of push back and mockery of gender-neutral pronouns. For every receptive and apologetic individual that misgenders someone I know there are five more who do not care to learn how to properly address transgender and non-binary individuals. Personally, if someone does not care to learn this basic introductory information about me, I usually feel safe in concluding that they do not care much about me at all. For those who do care, I appreciate you and your efforts. Keep up the good work!

Image Credit: Photograph provided by Nat Mulkey

Writer-in-Training

Boston University School of Medicine

Nat is a fourth-year medical student at Boston University School of Medicine in Boston Massachusetts, class of 2021. In 2017 they graduated from Hendrix College with a Bachelor of Arts in psychology. They will be applying into psychiatry this year and are currently interested in becoming a child and adolescent psychiatrist. Besides writing, in their free time they enjoy skateboarding, traveling, and trail running.

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Misgendering in Health Care and How to Improve - Pager Publications, Inc.

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