How to build trust with a trans young person

Jesse Ashman, a volunteer for Gendered Intelligence, has some advice for nurses treating a trans young person to help them build a trusting relationship

Jesse Ashman, a volunteer for Gendered Intelligence, has some advice for nurses treating a trans young person to help them build a trusting relationship

Picture: Science Photo Library

It’s often been said to me by cisgender people (people whose gender identity matches their assigned gender at birth) that talking to trans people can be very stressful. They worry that they might inadvertently offend me by saying the wrong thing, using the wrong terminology or by asking inappropriate questions.


I usually reply by saying that so long as they are polite, they aren’t likely to offend me. However, this often isn’t enough guidance for people – and certainly is not enough in a medical context where it may be necessary to ask questions that would be inappropriate in a conversational setting and where the patient might be in an emergency situation.

The first place this comes up is when medical professionals are required to ask a patient for information about body parts that are usually gendered. For example, you might need to know if a young person has a cervix or not.

When I was at school I had the HPV jab because I am at risk of cervical cancer, however I know trans people my age who found it too stressful to go to the nurse for what they saw as a gendered procedure. This anxiety comes partly from the language nurses may use to refer to them and their bodies.

Stepping stones

The first step to making young trans people more comfortable seeing a nurse would be if the nurse asked, ‘what pronouns do you use?’ at the beginning of the consultation. This is a polite question and can be asked in conversational settings.

The next step is not to assume that the person is going to reply with either he/male pronouns or she/female pronouns – there’s a huge array of other pronoun choices. A few common pronouns other than he/she are they/them or ze/hir.  Similarly there are a huge amount of different genders aside from male and female – for example a young person may identify as genderless, genderfluid or non-binary gendered.

Other than pronouns, it is useful to avoid unnecessarily gendered language, so for example use phrases ‘this young person’ instead of ‘this young woman’. It may also be the case that a young person’s name on school or medical records is not the name they usually go by. For a trans person this is more important than simply a nickname they prefer – being referred to their legal name can be extremely stressful and in some cases induce panic attacks.

For this reason it is advisable to instead ask the person what name they want to use and to make them aware that this does not have to match the name on their school records. This is all part of allowing a person to be in charge of the language and names used to refer to them – something that is often not afforded to trans people but can make a huge different to comfort levels in any situation.

If it is going to be necessary to talk about gendered body parts, for instance reproductive organs/genitals/chest then it is useful to ask the young person if there are certain ways they would prefer you to refer to their bodies and to make them aware that they can tell you if you use a word they are not comfortable with.

Useful suggestions

When it is absolutely necessary to use gendered medical terminology, nurses should be conscious of how difficult this may be for a trans person and to warn the young person that you are going to need to use such terminology. For instance, my own GP uses the term ‘front passage’ for my vagina which, while strange, is considerate since he is clearly trying to avoid gendered terminology. However, ideally he would have asked me what terms I would prefer.

It is also useful to be aware that when it is necessary to examine a young person physically that this may be more stressful for a transgender person than a cisgender person so putting them at ease and making sure they are mentally ready and calm beforehand is a good precaution.

These are just a few tips that would have improved the care that I have had but it is by no means an exhaustive list. The most important things to remember are be polite, be aware, communicate and if you make a mistake – apologise and move on.

If you’d like to know more about trans issues in professional settings, Gendered Intelligence offers transgender awareness training

Jesse Ashman is a volunteer for Gendered Intelligence, a support organisation for trans young people

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