“Mom, when I walk in the room, all they see is a deviant Black man.”

Those were the words my transgender daughter said to me after a recent visit with her primary care physician. She felt like everyone was judging her, and the doctor acted like she had a contagious disease. He was also preoccupied with her name choice and whether she would be getting a “sex change” surgery, and he didn’t once make proper eye contact.

All this was during what was supposed to be a routine well-child/sports physical.

Naturally, we would like to assume that this sort of thing does not happen often, or rather, should never happen. My child later lamented to her siblings, “Just a year ago, I was treated like any other patient. What a difference a year of transitioning makes.” The good news is that many physicians want to know how to interact with their LGBTQ+ patients, and I can help.

Understanding LGBTQ+ terminology and identities

I am a proudly Bi+ pediatrician and mom of a transgender young adult. I attended medical school in the ’80s in Nigeria and residency in the ’90s in the United States. I had no idea what being transgender was until my child came out. In medical school, we weren’t taught much about the LGBTQ+ community besides that it is a form of mental illness.

Back then, we used terms like “transsexual,” “transvestite,” and “hermaphrodite” broadly in reference to the transgender community. These terms are extinct today. The word “queer,” once deemed a derogatory term, has now been reclaimed by the community, and many of the younger generation prefer to use it.

As of today, the commonly used alphabets in the community are as follows: LGBTQQIAAPPIO2S.

• L, for Lesbian: Persons who identify as women and are attracted to other women.
• G, for Gay: Persons who identify as men and are attracted to other men.
• B, for Bisexual: Persons who are attracted to both men and women. The majority of US adult LGBTQ+ persons are in this category.
• T, for Transgender: Persons whose gender identity is incongruent/misaligned with their assigned gender at birth.
• Q, for Queer: Reclaimed and considered a safe umbrella term for and by the community.
• Q, for Questioning: A term used by many in the community who are still searching for their perfect identity fit. The majority of US LGBTQ+ youth are in this category.
• I, for Intersex: Persons with external genitals, chromosomes, or reproductive organs that do not fit into a male or female binary.
• A, for Asexual, a.k.a. Ace or Aces: Persons who need a strong emotional connection before sexual attraction or have little interest in having sexual relations.
• A, for Ally: Someone who sees your fight, fights for you, and fights with you.
• P, for Pansexual: Persons who are attracted to other people regardless of their gender.
• P, for Polyamory: Multiple consenting adults in a committed romantic relationship.
• O, for Omnisexual: Persons attracted to other people, but the gender of the person matters.
• 2S, for Two Spirit: Indigenous persons believed to have both masculine and feminine spirits. They were the leaders, sages, and teachers before colonialism destroyed them. They are now being welcomed back to the community.

ENBY, or non-binary, refers to persons whose gender identities exist outside the more commonly accepted binary of male or female. A cisgender person sees themselves as a binary male or female. Cisgender is, therefore, not the opposite of transgender; nonbinary is the opposite of cisgender.

I’ll add that gender is different from sexuality. Gender comprises identity (a deep internal sense of self, aka who I say I am and how I see myself: transgender, nonbinary, binary, agender, bigender, etc.) and expression (how I showcase my gender identity; haircut, pronouns, dress sense, outward appearance, a.k.a. how people see me).

Sexuality, on the other hand, refers to romantic, physical, sexual, or emotional attraction to others: gay, lesbian, bisexual, etc. Both sexuality and gender are generally now accepted as fluid, meaning your patient might be gender fluid/genderqueer or sexually fluid and can be both or any combination.

Health disparities

Health disparities are preventable health conditions that affect socially disadvantaged members of the community. They usually parallel the five social determinants of health, which include access to quality and affordable health care, which is where you and I come in.

Recently, another Nigerian colleague was concerned about her “morals and belief systems” when it comes to caring for the Q+ community. I had to remind her of her oath to first do no harm (non-maleficence), to treat everyone equally (justice), to practice medicine that benefits everyone (beneficence), and to recognize our patients as whole and able to make decisions for themselves (autonomy). And lastly, to “do no further harm.”

This last point is critical because members of the LGBTQ+ community are already traumatized and untrusting of health care systems. They need us to step in as allies and not add any more trauma. I cannot over-emphasize the importance of allyship from the medical community.

Many patients, like my own child, who only has a handful of family members who affirm her, depend heavily on the outside world for support. As their health care providers and part of the village it takes to raise and save them, we must support them. Gender/sexuality-affirming care is, therefore, trauma-informed care.

Practical tips for allyship

The first thing to remember is that the LGBTQ+ patient’s experience with your office begins way before they walk through your doors. It begins at their previous doctor’s office, at home, at the bus stop, and at the playground—anywhere they are potentially exposed to traumatic experiences. Your practice should, therefore, be a sanctuary.

So, train your front office staff, midlevel practitioners, medical students, coworkers, and everyone who encounters them. Many have been betrayed by the health care system, and it is our duty to correct that notion.

I understand the current dilemma of many physicians who might want to be effective allies, but the anti-LGBTQ+ legislation and individual upbringing make it difficult. I get it. That said, I am also a mother of a transgender child, so my loyalty first lies with my child, but I am happy to help. There are many easily implementable practical tips and strategies to become better allies in your practice.

1. Use inclusive language (think: “everyone” rather than “ladies and gentlemen”). Respecting pronouns (introduce yourself using your own pronouns, ask them for theirs). Create a welcoming environment in your practice (all staff to learn terminologies and use their appropriate names and pronouns). Utilize inclusive images on wall decor, pride flags, pronoun pins, and gender-neutral/single-stall restrooms, and display and implement nondiscrimination policies.

2. Include spaces for pronouns on electronic medical records and update their medical information on forms and health records. Ask about positive as well as negative influences in their lives. Check with patients before sharing information with any family members/companions. Ask them for the words for/names of body parts and use the language offered.

3. When it comes to informing parents, read the room. Ask your patient first, then proceed with caution. If the parents are un-affirming, do not share any information except if it is life-threatening. If parents are affirming, then include them in necessary conversations as you would any other patient/adolescent.

4. Do not assume the gender identity or sexual orientation of any patient based solely on looks. Always ask first at each visit. Remember that affirmation begins with little things: names, pronouns, affirming language, and verbal and nonverbal cues. Also, just because the patient is transgender does not mean they are being seen for something related to their gender identity.

5. I cannot over-emphasize the need to understand intersectionality when it comes to Black and Brown patients who are gender or sexual minorities. Also, remember that neurodiversity co-exists with gender diversity in many children, and many parents feel guilt, shame, and fear and are overwhelmed by the concept of an LGBTQ+ child. So, be compassionate towards both the child and their parents.

6. Every member of your team must be continuously educated on culturally compassionate care. This applies to all medical care, particularly to the LGBTQ+ community and transgender people. One of the best places to obtain resources for your patients is the GLMA, or Gay and Lesbian Medical Association. However, my practice also offers bespoke training for offices and health care organizations.

7. Lastly, I implore you to exercise your civic duties by voting. Support LGBTQ+-friendly organizations and learn as much as possible about what gender-affirming care really means to each patient. Realize that your patient today could literally be your family member, your child, or your significant other tomorrow.

The best part of being LGBTQ+ allies is that it not only benefits our patients but also benefits our employees and coworkers.

Uchenna Umeh is a pediatrician.