Gender Affirming Care Q&A

Q1: I would like to become familiar with some common terms that are used in the 2SLGBTQIA+ community. How can I get started?

Language changes. Some of the terms now in common usage are different from those used in the past to describe similar ideas, identities and experiences. Some people may continue to use terms that are less commonly used now to describe themselves, and some people may use different terms entirely. What’s important is recognizing and respecting people as individuals.” (1)

For the purposes of this Q&A, the definitions are provided from “A Guide to Understanding Gender Identity and Pronouns : NPR” and “What is cross-sex hormone therapy? – ISSM” to help with context and understanding. This is with the recognition that different organizations and publications will vary in their definitions, and these definitions will change over time. You are encouraged to access these resources and any other reputable resources (a starting list is in Q5) that will define common terms used in this community.

Gender Identity: “one’s own internal sense of self and their gender, whether that is man, woman, neither or both. Unlike gender expression, gender identity is not outwardly visible to others.”(1)

Cisgender/Cis:an adjective that describes a person whose gender identity aligns with the sex they were assigned at birth” (1).

Transgender/Trans: “an adjective used to describe someone whose gender identity differs from the sex assigned at birth. A transgender man, for example, is someone who was listed as female at birth but whose gender identity is male”(1).

Cross-Sex hormones: “treatment used to help people with gender dysphoria transition from their biological gender to their desired gender.” Examples include testosterone (used in female to male transition) and estrogens (used in male to female transitions) (2).

Correctly used pronouns are critically important for gender-affirming care and can help convey acceptance and genuine care (1).

References:

  1. A Guide to Understanding Gender Identity and Pronouns : NPR
  2. What is cross-sex hormone therapy? – ISSM
Q2: What is gender-affirming care?

Gender-affirming care (GAC) is a holistic approach to caring for the way that individuals express their and ensuring optimal care for clients so they feel happy, healthy, and safe (1).

There has been an ongoing stigma around transgender and gender-diverse individuals accessing healthcare services (2). This may look like misusing someone’s pronouns, assumptions of cisnormativity, and having barriers to, or being denied healthcare services.

Due to these stigmas, as well as historical trauma associated with stigma, many people are avoiding medical care and are not receiving the mental and physical support they may need. It is important for dietitians and other healthcare professionals to practice gender-affirming care, as it can reduce the stress and negative feelings an individual may experience with gender dysphoria and social stigma (3).

Refer to the Trauma Informed Practice Q&A for more information.

 

References:

  1. Everything You Need to Know About Gender Affirming Care. Healthline.
  2. Food, Nutrition, and Eating Issues of Transgender and Gender-Diverse Individuals Background. PEN Global Resource for Nutrition Practice.
  3. Gender Affirming Care: What it Means and Why its in the News. CBC Kids.
Q3: How does gender-affirming care apply to dietetic practice?

The current healthcare system is built upon cisgender-based standards and heteronormative practice (1). More noticeably, the language that is being used often does not capture gender inclusivity. When it comes to nutrition care, gender dysphoria and body dysphoria are the leading causes of eating disorders and disordered eating for transgender and gender-diverse individuals (2). Although there may still be many challenges and barriers the healthcare system needs to overcome, these are ways that dietitians can work towards ensuring gender-affirming care (1,3,4):

  • Understand how to access a client’s preferred pronouns in a thoughtful way. Use these appropriate pronouns and apologize to your client if you accidentally use incorrect pronouns. Actively use your client’s preferred pronouns if you hear your colleagues/team misusing them.
  • Proactively learn about gender diversity and transitioning and educate those around you.
  • Recognize the difference between gender identity and gender expression; they may not align with each other. Adapt your nutrition care plan so it is specific to your client and not necessarily specific to gender identity. Nutrition recommendations should be tailored to biological sex, with considerations for clients who may be accessing cross-sex hormones. A good example is iron recommendations. These should be based on whether a person menstruates and not on whether your patient identifies as female.
  • Recognize that there is no “one size fits all” approach.
  • Display visuals that convey one’s alliance (ex. flags, pins, stickers) and that the counselling space is a safer one. Some workplaces have campaigns that will supply employees with pronoun pins.
  • Advocate for gender-inclusive spaces such as change rooms and washrooms.

References:

  1. Food, Nutrition, and Eating Issues of Transgender and Gender-Diverse Individuals Background. PEN Global Resource for Nutrition Practice.
  2. Parker, L.L., Harriger, J.A. (2020). Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. Journal of Eating Disorders. 
  3. A Guide to Understanding Gender Identity and Pronouns : NPR(3) Nutrition for Transgender Individuals (eatright.org)
  4. What is cross-sex hormone therapy? International Society for Sexual Medicine.
Q4: Which CDBC Standards of Practice apply to Gender Affirming Care?

3.3 A dietitian maintains competence in their practice area [by] determin[ing] new or anticipated areas of dietetic practice and acquir[ing] knowledge and/or skills needed to practice competently.

4.1 A dietitians acts ethically in their professional interactions and while providing professional services [by] apply[ing] the CDBC Code of Ethics… when providing services.

9.8 A dietitian communicates in a clear, concise and respectful manner [by] demonstrate[ing] cultural safety, humility and anti-racist practice.

10.1 A dietitian contributes to the provision of quality professional services as a member of the clients’ interprofessional team [by] contribut[ing] professional knowledge to discussions and interactions with team members using an open, collaborate approach.

12.1 – 12.6 A dietitian provides quality professional services that reflect the unique needs, goals, values, and circumstances of the client.

13.1-13.6 A dietitian seeks information and incorporates an evidence-informed approach to their practice.

14.1-14.10 A dietitian uses critical thinking to obtain assessment data, determine practice problems, plan, implement and evaluate professional services.

Q5: What are examples of resources that can enhance my knowledge about this topic?

Many healthcare professionals feel uncomfortable discussing gender identity due to a lack of knowledge, understanding, and overall open communication about the topic. Setting goals and learning about gender affirming care can be a great CCP goal to help develop your skills as a dietitian and to provide the best client care possible.

Consider the following questions:

  • How would I calculate energy needs in my transgender client?
  • How comfortable am I with discussing gender pronouns and their use?
  • What do I need to work on to improve my ability to provide gender-affirming care?
  • Where can I find background information so I can better formulate questions that can lead to learning goals?

Here are some helpful resources:

Everything You Need to Know About Gender Affirming Care. Healthline.

Food, Nutrition, and Eating Issues of Transgender and Gender-Diverse Individuals Background. PEN Global Resource for Nutrition Practice.

Gender and Sexual Diversity Reading List. College of Physicians and Surgeons of BC.

Gold, E. et al (2023). Nutrition Considerations in the transgender and gender-diverse patient. ASPEN Nutrition in Clinical Practice.

How to transition to using more gender-inclusive language. TransFocus Consulting Inc.

Indigenous gender diversity: creating culturally relevant and gender-affirming services. PHSA Learning Hub. Available to “people working in health care, mental health, and social service settings.” 

Linsenmeyer, W. et al. (2022). An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care process: Considerations for Nutrition and Dietetics Practitioners Working With Transgender and Gender-Diverse Clients (Open Access). Journal of the Academy of Nutrition and Dietetics.

Parker, L.L., Harriger, J.A. (2020). Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. Journal of Eating Disorders. 

The Role of Nutrition in Mental Health Promotion and Prevention (Open Access). Dietitians of Canada.

White, M. et al. (2023) Safe, Seen, and Supported: Navigating Eating Disorders Recovery in the 2SLGBTQ+ Communities. Canadian Journal of Dietetic Practice and Research.

Many thanks to Yu Jun (Jessica) Zou, LEAP Pharmacy student, for her input into this post.

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