Authors: Nicole Bell, Rhea Manohar, MPH; Ariela L. Marshall, MD on behalf of the Gender Equity Task Force
A patient sits quietly in an exam room, pretending to listen to their doctor while rehearsing a correction in their head. Finally, the phrase “I use they/them pronouns” is quietly uttered after the doctor addresses them as “her” four times already. The doctor apologizes, nods quickly, and moves on, but the moment lingers. For many non-cisgendered individuals, an interaction such as this is not a fleeting moment or brief social exchange, but rather serves as a signal about whether or not that healthcare environment is safe and trustworthy for patients like themselves.
Language in medicine can often be dismissed as “just semantics,” yet qualitative studies consistently show that gender-affirming communication shapes trust, safety, and enhances care quality (Speechley et. al., 2024). While existing literature on transgender health relies on qualitative studies and patient experiences, additional quantitative research is needed to accurately assess the healthcare disparities. As we recognize Pride month, we examine how language in the clinic directly impacts those we deliver care to.
Transgender is an umbrella term used to describe an individual whose gender identity does not align with their gender assigned at birth. The transgender population includes, but is not limited to, gender fluid, agender, nonbinary, and genderqueer people (Coventry et. al., 2025). For these reasons, the transgender community is not a monolithic population, but rather an amalgamation of different individuals’ preferences and lived experience. Up to 0.7% of the United States population identifies as transgender, while in other countries like Brazil and Australia, it is estimated to be 1.2% and 2.3%, respectively (Bhatt et. al., 2025; Coventry et. al., 2025). Using gender-affirming language recognizes this diversity and reinforces that an environment is safe and trustworthy for a patient; therefore, it is a core component of delivering patient-centered care.
Adherence to stereotypical beliefs about gender identity represents a barrier to delivering care, similar to those regarding race, ethnicity, cultural beliefs, and language (Speechley et. al, 2024). In practice, this involves centering the conversation around the experiences shared by the patient and asking open-ended questions that allows the patient to feel comfortable sharing, instead of relying on assumptions. When introducing themself to a patient, doctors should state their name and preferred pronouns first and then ask “what name and pronouns do you use?”. For the patient, normalizing the use of preferred name and pronoun in every encounter disarms the patient and alleviates worries about being “dead named” or “misgendered” by a clinician (Bhatt et. al, 2022). For providers it becomes second-nature and avoids the potential harm caused by unconscious biases and stereotypes on who is transgender or not based on their appearances. Notably, clinicians should recognize that gender-affirming language extends beyond a patient’s name and pronouns to include their community. Simple changes to gender-neutral terms, such as “partner” instead of girlfriend or boyfriend, and “parent” instead of mother or father can improve communication and trust with the patient. There is no “one-size-fits-all” approach to the transgender community, as every person’s sexual preferences and behaviors, anatomy, and self expression significantly vary. Therefore, keeping an open mind, staying curious, and asking questions is key to building patient-provider trust.
Non-affirming language negatively affects the physical and psychological health outcomes of transgender patients. At baseline, transgender people are more likely to experience depression, anxiety, eating disorders, and suicidality compared to their cisgendered counterparts (Coventry et. al, 2025). According to a 2022 survey, 80% of transgender respondents experienced frequent depressive symptoms, which far exceeded the cisgender population at 57%, while 25% reported a previous suicide attempt (Guduri et. al., 2025). Misgendering, especially in a clinical setting, is a delegitimisation of a patient’s identity and reinforces the stigma and marginalization they may already face (Speechley et. al, 2024). The invalidation, loss of dignity, and feelings of anxiety leads to transgender people avoiding essential healthcare, such as screening for breast and cervical cancer (Coventry et. al, 2025). In one study, results showed that only 31% of sexually active transgender men received a pap smear within the past year (Bhatt et. al., 2022). Additionally, 24% of transgender patients reported avoiding healthcare in general out of fear of being mistreated by their healthcare provider (Bhatt et. al., 2022). This finding underscores the adversities that gender diverse populations face, ultimately resulting in a lack of preventative care. However, when gender-affirming language is put into practice, studies have shown that transgender and non-binary youth are 32% less likely to attempt suicide (Price & Green, 2023). These results highlight the meaningful role inclusive language plays, and how something so simple could greatly benefit the mental health of an entire community.
In the United States, transgender people are also less likely to have a PCP or health insurance than cisgendered people (Coventry et. al, 2025). Studies have shown that despite a clinicians’ positive and affirming attitude towards transgender patients, non-inclusive language still hinders the quality of care a patient receives (Speechley et. al, 2025). These findings suggest that the words used in the clinic hold weight and can affect the clinical experience, regardless of if linguistic missteps had malicious intent. The language we use sets the tone for the entire patient-clinician relationship and signals whether or not the space is safe. After building trust and establishing rapport, clinicians can focus on the chief complaint and deliver optimized healthcare, regardless of their patient’s gender.
Beyond introductions, inclusive communication can be integrated into many other aspects of patient communication. When gender-affirming language is used, transgender patients are more likely to provide an accurate and fully-inclusive history (Speechley et. al, 2024). This leads to more accurate and unbiased diagnoses, increases patient adherence to care, and builds the foundation for shared decision-making. These are essential pillars in providing high-quality patient-centered care and should be considered by all clinicians.
Creating a safe space for all gender diverse patients doesn’t stop at learning terminology. Every person has their limitations, and not all introductions and discussions will go well no matter how well-meaning the physician may be. When mistakes and miscommunications do occur, it is important to acknowledge and correct them briefly and transparently. However, clinicians should be also wary about over-apologizing, as it shifts the focus away from the patient and towards the provider. In order to maintain a patient-centered atmosphere, apologies should be brief yet meaningful, and the provider should take the necessary steps forward to ensure a mistake like that does not happen again.
Additionally, proper structuring of the clinic is a powerful tool that can aid in maintaining a gender-inclusive environment. Intake forms should have distinct blank sections for a person’s legal name, chosen name, pronouns, gender, and sex. These should be documented in the system’s electronic medical records (EMR) and charts and passed on to the physician to ensure consistency and prevent misnaming and misgendering. Additionally, there should be non-gendered restrooms and changing areas to ensure comfortability for all patients. Gender self-identification and freedom of restroom use was protected under law until 2024, when Executive Order 14168 defined gender solely as a person’s biological sex defined at birth; thereby eradicating recognition of transgener, non-binary, and intersex individuals (Guduri et. al., 2025). This executive order prohibits both self-identification on federal records and use of single-sex facilities that align with personal gender (Guduri et. al., 2025). Protections for transgender individuals are actively being stripped away, so as healthcare professionals it is our responsibility to mitigate these effects as much as possible. Therefore, implementation of non-gendered intake forms and restrooms creates a safer environment, irrespective of gender identity, before patients step foot in the room.
While the principles stated above are conceptually straightforward, consistent implementation may prove to be challenging. The checklist below highlights several key components necessary for ensuring inclusive and respectful healthcare:
Before the Visit
- Review chart for:
- Chosen name
- Pronouns
- Ensure forms are inclusive (ex: blank spot for gender instead of circling M or F)
During the Encounter
- Introduce yourself with your own pronouns
- Ask open-ended, non-assumptive questions
- Mirror the patient’s language
- Apologize briefly and correct yourself if you make a mistake
After the Visit
- Document appropriately
- Communicate updates with the care team
- Reflect on areas for improvement
Common Pitfalls to Avoid
- Assuming gender, sexuality, and anatomy based on appearance
- Over-apologizing in a way that shifts focus to the provider
- Treating gender identity as irrelevant when it may impact care
- Tokenizing or overemphasizing identity unnecessarily
These suggestions provide a concise framework for aiding physicians in incorporating gender-affirming language into daily practice. While a checklist cannot replace empathy, inclusivity, and humility, it can serve as a starting point for creating a respectful, safe environment for gender diverse patient populations.
In healthcare, language cannot be boiled down to “just words.” The names and pronouns used as well as attitudes and beliefs conveyed communicate a respectful, safe environment that opens the door to high quality healthcare. Gender-affirming language is a clinical skill that should be utilized by all healthcare professionals; it is not optional and it is certainly not a courtesy. Inclusive language improves trust, accuracy, and health outcomes amongst gender diverse individuals (Coventry et. al, 2025).
While Pride Month encourages reflection and inclusivity, awareness is not enough. As clinicians, it is our responsibility to make meaningful change for marginalized communities. Meaningful change comes from consistent learning, striving for growth, and pushing forward despite minor setbacks. Language in medicine has more than just the power to communicate. It has the power to heal.
References
- Bhatt, N., Cannella, J., & Gentile, J. P. (2022). Gender-affirming Care for Transgender Patients. Innovations in clinical neuroscience, 19(4-6), 23–32. https://pmc.ncbi.nlm.nih.gov/articles/PMC9341318/#ref-list1
- Coventry J., Lane R., Osadnik C (2025). Exploring Interactions Between Transgender, Gender-Diverse, and Nonbinary Individuals and Allied Health Professionals in Clinical Practice: A Scoping Review. Transgender Health, 10(1), 22-34. https://doi.org/10.1089/trgh.2022.0222
- Guduri, S. P., Bindra, A. K., Chigullapally, N., & Beck Dallaghan, G. L. (2025). The Role of Medical Training in Ensuring Gender-Affirming Care Access in 2025 and Beyond. Journal of Medical Education and Curricular Development, 12. https://doi.org/10.1177/23821205251403022
- Price, M. N., & Green, A. E. (2023). Association of Gender Identity Acceptance with Fewer Suicide Attempts Among Transgender and Nonbinary Youth. Transgender health, 8(1), 56–63. https://doi.org/10.1089/trgh.2021.0079
- Speechley, M., Stuart, J., Scott, R.A., Barber, B.L., Zimmer-Gembeck, M.J. (2024). Provision of gender affirming care among medical and allied health practitioners: The influence of transnormative beliefs in working with gender diverse patients. Social Science & Medicine, 348. https://doi.org/10.1016/j.socscimed.2024.116876.
About the Authors
Nicole Bell, MS3
Nicole Bell is a third year medical student at St. George’s University School of Medicine. She has a bachelors in Health Sciences from Boston University. Nicole is passionate about inclusive healthcare and building long-lasting and trusting relationships with her community. She is an active member of the AMWA Gender Equity Task Force and the Justice, Equity, Diversity and Inclusion Committee. When she’s not studying medicine, Nicole enjoys surfing, rock climbing, hiking, and reading.
Rhea Manohar, MPH, MS3
Rhea Manohar is a third year medical student from St. George’s University. She has a Masters in Public Health with a concentration in Maternal and Child Health from George Washington University Milken Institute of Public Health and a Bachelors of Science in Microbiology & Immunology, and Public Health from the University of Miami. She served as Co-VP of OB/GYN Education for St. George’s University’s Women in Medicine chapter in St. George, Grenada where she developed hands-on workshops to further reproductive health issues and navigating challenging physician-patient communication scenarios. Prior to medical school, she was a Research Associate for Fors Marsh Group, where she led qualitative and quantitative public health research and campaign development for federal agencies (e.g., CDC, NIH, DHHS, CPSC). She is also Medical Student Co-Chair of the Gender Equity Task Force of the American Medical Women’s Association. When she is not pursuing medicine, you can find her reading, exploring artistic passions, and spending time connecting with friends and family.
Ariela Marshall, MD
Dr. Ariela Marshall is a Harvard-trained physician and an internationally renowned advocate, career development advisor, and mentor. Dr. Marshall specializes in bleeding and clotting disorders, especially as they relate to women’s health. She has worked at Mayo Clinic and the University of Pennsylvania and currently practices as a consultative hematologist at the University of Minnesota (UMN) and the Program Director of the UMN Hematology-Oncology Fellowship. In addition to her clinical work, Dr. Marshall is a highly respected leader, mentor, and speaker. She is an active leader with the American Society of Hematology (where she led efforts to found the Women in Hematology Working Group and currently holds seats on the Women in Heme Working Group, Committee on Communications and Media Experts Subcommittee) and American Medical Women’s Association (leading the Infertility Working Group and holding seats on the Gender Equity Task Force). She speaks regularly on a national and international scope to discuss her efforts to advance career development and mentorship for physicians, gender equity, fertility/infertility awareness, parental health and wellbeing, reproductive health and rights, and work-life integration.