Unicorns, gender and belonging

Aaron is an RN working in at the RBWH ED who loves his job in addition to living with 3 great – and rather opinionated – kids, a dog and 3 noisy parrots.

1.  I heard about The Gender Unicorn for the first time at your talk at the ACEM Autumn Symposium. Can you tell us a bit more about that concept?

The gender unicorn is a great device, developed by Trans Student Educational Resources, that illustrates the differences between sex assigned at birth, gender identity, gender expression and sexual orientation. In a light-hearted way, it enables you to explain that all of these things exist on a spectrum and are independent from each other. So, for instance, a transgender man would have been assigned the female sex at birth yet have a male gender identity, making them transgender. They could have a gender expression that may be either masculine or feminine, or mixed, and could be attracted to people of the same gender or of a different gender to themselves. 

Most people are what are called cisgender, which simply means that their gender identity is the same as the sex they were assigned at birth. As there is no conflict, most people will never have a need to think about it.

The other term I’d like to mention here is non-binary. This is a concept I find a lot of folks struggle with. Essentially, it’s a term used to describe someone who doesn’t feel completely male or female but somewhere in-between or neither. 

But I guess the take home message is that we all have a gender identity that may or may not match our sex, and that people’s sense of it is broader than the binary of male and female.

2. A safe ED that provides a sense of connection and belonging is the best kind of ED to work in. How can we help the people who work in our EDs, with a gender diverse background, feel safe and that they belong?

Respect them! You can do this by using the name and pronouns they use for themselves and by respecting their privacy. This is a big one. Most gender diverse people (meaning transgender or non-binary) would not want questions asked about what their name used to be, what they used to look like, what surgeries they may or may not have had. Facebook, and other social media, can cause a particular problem in this area where photos pre-transition may appear. Please don’t go looking for this, and if you do happen to see any, don’t spread it around to others. Remember your colleague isn’t a source of curiosity or of information; they’re just a regular person who wants to be treated like anyone else.

If you do find you have questions about transitioning or gender diverse people your first point of call should be the internet where, if you know where to look, there are some great trustworthy resources [see Q5]. On the other hand, if your colleague has made it clear that they’re happy for you to ask them anything, then go for it, and make good use of their knowledge and experience. 

3. Those who attend the ED are often having one of the worst days of their life – whether it’s a broken toe or a STEMI. In you talk, you outlined how this can be an even worse time for those with gender dysphoria. What can we do to limit this extra layer of discomfort as a department and health service?

As before, respect the patient’s names, pronouns and their privacy. If you’re not sure which pronouns to use, go gender neutral until you find out. You can find out by privately asking, ‘Would you mind me asking which pronouns you use?’. If you’re comfortable with it you could also introduce yourself with your own pronouns. For example, ‘Hi I’m Simone, I use she and her pronouns.’ 

Names and pronouns can be especially difficult in the hospital setting where someone’s Medicare name may not match the name they use. Imagine a transgender woman who in every way looks female but who is on the hospital system as, say, Robert with a male gender. Their armband and labels will reflect an incorrect name and gender for them and they will be repeatedly correcting staff. This is not only frustrating, and even traumatising for the patient, but also incredibly unsafe. Violence, both physical and verbal, is still very much a reality for gender diverse people so privacy and confidentiality in this area is extremely important. 

Non-binary people can have an especially hard time in this area as most hospital systems do not allow a gender marker other than male or female. 

The other area I’d want to mention is gender dysphoria and the physical exam. Some people who are gender diverse may experience significant distress around parts of their anatomy that they were born with. As such they may find a physical exam in these areas very distressing. Take the time to explain what you are going to do and why it is important. Some people may have made up a different name to describe this part of their anatomy so you may want to find out if this is the case. For example, a lot of transgender men who have not had surgery will call their breasts, their chest. I can tell you, from doing this for trans patients myself, that these steps make a big difference to your patient’s well-being as well as increase their trust in you.

4. Many clinicians are worried about saying the wrong thing at the wrong time to our patients and our colleagues who are gender or trans diverse, despite their best intentions. What advice would you have for our colleagues when we think we’ve said the ‘wrong thing’?

Mistakes happen. I should know, I’m trans and I’ve made mistakes! So if you misgender someone (that is, call a gender diverse person by the incorrect gender) briefly apologise, don’t make a big deal out of it, move on and try not to do it again. The truth is we’re conditioned to respond to a certain body type or tone of voice with a certain gender. So if needed, especially for colleagues who you’re likely to see on a regular basis, take the time to practice prior to seeing them. 

When I first started at my workplace I’d only just started transitioning so unfortunately received a fair share of unintentional misgendering. I can tell you that it makes a big difference to your well-being to be gendered correctly.

5. What would be your top three recommended reading/websites for our readers in this area of health?

The top three sites I’d recommend would have to be:

Transhub – www.transhub.org.au

This is a great resource for all things trans and gender diverse. It’s developed by the NSW based ACON, so has more resources specific to NSW. But the section for clinicians has an excellent overview and has been endorsed by AusPATH.

AusPATH – www.auspath.org

AusPATH stands for Australian Professional Association for Trans Health and is the peak body for professionals who are involved in the health, rights and well-being of trans and gender diverse people. In addition to a list of service providers in Australia it also has educational resources.

Trans and Gender Diverse Connections –  www.tgdconnections.org

This is my own website. I popped this one in simply because in the contact section I’ve included a list (with links) of sites I consider reputable and trustworthy. Although not containing all groups out there, many of which are private community groups, it is a good start for finding further support and information.