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GCC Values and Standards of Care for Non-Binary Patients

We believe the standards of healthcare for transgender and gender expansive patients are considerably lower than ideal, and the existing standards can be even lower for non-binary people. This content has been developed to help prospective patients understand that our surgeons perform non-binary chest reconstruction top surgery and we have processes in place at our practice that are aimed at creating a safe and gender affirming environment throughout the entire surgery experience.  

The introduction to non-binary top surgery gives a more in-depth definition of what non-binary is. Binary gender refers to “male” or “female,” whereas non-binary refers to persons who don’t identify exclusively as male or female.  Although it’s estimated that about 25-35% of the transgender population are non-binary, trans healthcare settings are largely binary and often don’t lend the space they could to those identifying outside of it. The goal of this content is to start a conversation between all of us about:

• People with non-binary identities seeking care and how we can best fit the needs of the nonbinary population
• Gender affirming surgeries exclusively categorized for binary transgender men and women when there are many other gender identities seeking these same services
• What a non-binary affirming healthcare experience can look like and the ways our surgeons are able to implement those practices

Non-binary Inclusive Healthcare Forms: Paper and Electronic

Any identifying forms (paper or electronic) the patient comes into contact at our office will have:

• Multiple gender identity options, as well as a space to write in a gender that may not be listed
• Differentiating language between legal name and the name currently used by the patient
• Gender neutral pronoun options (they, per, ve, xe, ze/zie, etc.), including space to input pronouns that may not be listed 

Non-binary Affirming Communication

Our office uses our patient’s chosen name and correct pronouns, as well as accurate gender in all written and verbal communication. Other requests, such as the patient not wanting to be referred to by any pronouns, can also be accommodated.

Non-binary Comprehensive Electronic Medical Records

An Electronic Medical Records (EMR) system is an electronic record of your health-related information that healthcare providers use. These programs are generally not set up for the transgender and nonbinary population. What would it look like if healthcare providers demanded that their EMR systems make concrete changes to be more trans and non-binary inclusive? Dr. Mosser did just that and was able to achieve the following changes in our EMR systems:

• Distinction between assigned sex (male, female, intersex) and gender identity (male, female, neutral/non-binary)
• Distinction between legal name and chosen name
• Pronouns (he/him, she/her, they/them, ze/hir, etc.)

As healthcare providers, it is our responsibility to demand change if the systems in place are not serving our patients. Institutional changes, such as the ones mentioned above, send a message that EMRs need to properly serve and capture information for transgender, nonbinary, and gender expansive patients.

Top Surgery Consultations

Our practice uses the informed consent model, which means that a letter from a therapist is not required unless the patient is seeking insurance approval. It is our hope that as time progresses, more surgeons will accommodate the needs of those seeking a variety of surgical outcomes, whether they are conventional or not. Regardless of the patient’s desired outcome, we strongly believe that it is the responsibility of the surgeon to:

• Ask the patient what their goals are
• Explain the different surgical techniques available
• Explain the advantages and disadvantages of each technique 
• Describe the limitations of each procedure to achieve the patient’s ideal outcome, given their body composition, skin type and medical history
• Discuss risks and possible complications of the various techniques as well as communicate their own complication rates for each procedure 

Asking the patient about their goals while actively listening and explaining the procedure types available is key. Surgeons who are unfamiliar with top surgery techniques that aim at achieving non-anatomical or less common results should remain informed on which surgeons do so they can provide a trusted referral.

In Conclusion:

• Standards of care should be established and upheld for the non-binary population.
• Documents and systems related to transgender and non-binary care should reflect the patient’s identity on their own terms (name, gender identity, pronouns, etc.)
• Providers can demand change from the systems in place that aren’t inclusive of trans and non-binary identities 
• Consultations should be shaped around the patient’s goals and should not be steered subjectively by the surgeon
• Providers caring for trans,non-binary, and gender diverse persons should stay informed on what the needs of community are