What policies should hospitals implement to prevent misgendering of transgender and non-binary patients?

Hospital Policies to Prevent Misgendering of Transgender and Gender-Diverse Patients

Hospitals must implement comprehensive institutional policies that mandate staff training, modify electronic health records to capture gender identity and pronouns, and establish clinical governance pathways to monitor discrimination—as misgendering directly contributes to healthcare avoidance, delayed care, and worse health outcomes in this population. 1

Electronic Health Record and Documentation Systems

Medical records must be redesigned to separately capture and display sex assigned at birth, current gender identity, affirmed name, legal name, and pronouns in accessible fields visible to all staff. 1

• Implement a "two-step" gender identification process: (1) ask about sex assigned at birth, and (2) ask about current gender identity, with options that accommodate intersex, nonbinary, and agender individuals 1

• Create a "body organ checklist" or organ inventory system to identify relevant medical information without imposing gender identity or triggering gender dysphoria 1

• Ensure the patient's affirmed name (not "dead name") appears throughout all documentation and is used when calling patients from waiting rooms to prevent inadvertent "outing" 1

• Document pronouns before the first patient encounter and make this information immediately visible to all clinical and non-clinical staff 1

• Maintain strict confidentiality of transgender status, sharing only when necessary for safe care and with patient consent, as mandated by laws such as the UK Gender Recognition Act 1

Staff Training and Education Requirements

All hospital personnel—including receptionists, front desk staff, medical assistants, phlebotomists, nurses, and physicians—must complete mandatory training modules on transgender-inclusive care. 1

• Training should cover appropriate terminology (avoiding outdated terms like "transsexual," "biologically male/female," or "transgenderism"), correct pronoun usage, and recognition that "transgender" is an adjective, not a noun 1

• Implement regular implicit bias testing for all clinic staff using validated online tools (www.implicit.harvard.edu) 1

• Educate staff to use gender-neutral language universally: "they/them" when pronouns are unknown, avoiding "ma'am" and "sir" at first contact, and using terms like "partner" or "spouse" instead of "wife" or "husband" 1

• Train staff to introduce themselves with their own name and pronouns first (e.g., "Hello, my name is [name], and my pronouns are [pronouns]. What is your name, and what are your pronouns?") 1

• Ensure staff understand they should never make patients responsible for teaching them about appropriate terminology or transgender care 1

Pre-Visit and Intake Procedures

Intake forms and pre-visit paperwork must be redesigned to be gender-neutral with inclusive visual representation and language. 1

• Send nongendered forms that capture whether the patient's current name differs from their legal name, along with gender identity, sex assigned at birth, and sexual orientation 1

• Include questions about organ inventory applicable to care provision, allowing for tailored cancer screening and treatment recommendations 1

• Use open, non-gendered questions on checklists (e.g., "Is there any chance you could be pregnant?" rather than gender-specific language) 1

• Avoid terms like "male" and "female" when asking about pregnancy risk; instead ask about presence or absence of specific reproductive organs 1

Physical Environment Modifications

Create visibly inclusive clinical spaces that signal safety and affirmation before the first patient interaction. 1

• Display welcoming imagery and language such as "All are welcome here" posters with pictorial depictions of diversity 1

• Provide single-person, gender-neutral bathrooms as the optimal solution for patient comfort 1

• Consider using colors without strong binary gender associations in waiting areas and clinical spaces 1

• Implement departmental posters and staff pronoun badges to normalize gender diversity 1

• Ensure availability of gender-inclusive services (e.g., gender-inclusive midwives for obstetric care) 1

Clinical Governance and Accountability

Establish formal pathways for monitoring and addressing discrimination against transgender and gender-diverse patients and staff. 1

• Create clinical governance systems to review themes and trends of discrimination, victimization, or aggression against transgender individuals 1

• Develop clear non-discrimination policies that explicitly protect transgender and gender-diverse individuals 2

• Implement feedback mechanisms for patients to report experiences and identify areas for improvement 2

• Establish key performance indicators to measure the impact of inclusive policies on patient satisfaction and health outcomes 2

Critical Communication Protocols

Staff must be trained to handle misgendering incidents with immediate acknowledgment and repair. 1

• When a mistake occurs, staff should humbly state "it seems that I may have said something that hurt you," allow the patient to respond, apologize appropriately, and commit to discontinuing the harmful language 1

• Confirm the patient's preferred name and pronouns at every clinical encounter and communicate this information during surgical briefs and team handoffs 1

• Share transgender status only with the patient's consent and only when deemed important for safety of care, treating it with the same confidentiality as other sensitive personal information 1

Common Pitfalls to Avoid

The evidence reveals several critical errors that worsen patient experiences:

• Never make overly positive remarks about a patient's appearance, as this can feel objectifying despite good intentions 1

• Never use gendered terms when explaining cancer pathophysiology or treatment side effects (e.g., avoid "women diagnosed with breast cancer" in favor of "people with breast cancer") 1

• Never express opinions about the appropriateness or effectiveness of gender-affirming hormone therapy or classify gender-affirming surgery as anything other than medically necessary 1

• Never assume that masculinizing hormone therapy provides contraception—patients with functioning reproductive organs remain at risk for pregnancy 1

Evidence Context and Strength

The recommendations above are based primarily on 2024-2025 guidelines from Anaesthesia 1, CA: A Cancer Journal for Clinicians 1, and Mayo Clinic Proceedings 1. These represent the most recent, high-quality institutional guidance available. The evidence consistently demonstrates that misgendering and discrimination create substantial barriers to care: 30% of pregnant transgender patients in the UK avoided perinatal care entirely, and 30% of those who sought care reported being treated without respect or dignity 1. In the US, 23% of transgender individuals avoided medical care when needed due to fear of mistreatment 1. These policies directly impact mortality and morbidity by reducing healthcare avoidance and improving access to preventive and acute care.