Experiences of Transgender and Gender Nonbinary Patients in the Emergency Department and Recommendations for Health Care Policy, Education, and Practice



      Transgender and gender nonbinary (trans/NB) individuals face many barriers to accessing health care in the United States due to systemic and clinician discrimination. Such experiences can lead to avoidance or delays in seeking care. These issues are relevant for emergency department (ED) clinicians and staff because trans/NB patients may use the ED in times of crisis.


      The purpose of this study was to qualitatively explore experiences of trans/NB individuals accessing health care in the ED and provide recommendations for improvements.


      This study involved semi-structured qualitative interviews with nine trans/NB individuals living in Arkansas about their experiences when visiting local EDs.


      Interviews revealed four main themes: 1) system and structural issues; 2) interactions with clinicians/staff influence care received; 3) perceptions of clinician knowledge and education about trans/NB health; and 4) impact on future health and health care access. Participants recommended education for current and future ED clinicians and staff to improve knowledge of best practices for trans/NB health care. Recommendations were also made to improve ED policy for inclusive and affirming intake processes, intake forms, and electronic health record (EHR) documentation, including documentation and use of patients’ chosen name and pronouns.


      The negative experiences and discrimination reported by trans/NB patients in ED visits underscores the importance of improving ED clinician knowledge of gender-affirming care practices, ED intake policies and practices, and EHR documentation in EDs.


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      1. Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States? 2016. Available at: Accessed 17 May 2021.

      2. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The Report of the 2015 U.S. Transgender Survey. Washington, DC; 2016. Available at: Accessed 7 July 2020.

      3. Centers for Disease Control and Prevention. FastStats – Emergency Department Visits. Available at: 2017. Accessed 8 December 2020.

        • Bauer GR
        • Scheim AI
        • Deutsch MB
        • Massarella C.
        Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey.
        Ann Emerg Med. 2014; 63 (e1): 713-720
        • Brown JF
        • Fu J.
        Emergency department avoidance by transgender persons: another broken thread in the “safety net” of emergency medicine care.
        Ann Emerg Med. 2014; 63: 721-722
        • Samuels EA
        • Tape C
        • Garber N
        • Bowman S
        • Choo EK.
        Sometimes you feel like the freak show”: a qualitative assessment of emergency vare experiences among transgender and gender-nonconforming patients.
        Ann Emerg Med. 2018; 71 (e1): 170-182
        • Romanelli M
        • Lu W
        • Lindsey MA.
        Examining mechanisms and moderators of the relationship between discriminatory health care encounters and attempted suicide among U.S. transgender help-seekers.
        Adm Policy Ment Health. 2018; 45: 831-849
        • Korpaisarn S
        • Safer JD.
        Gaps in transgender medical education among healthcare providers: a major barrier to care for transgender persons.
        Rev Endocr Metab Disord. 2018; 19: 271-275
        • Chisolm-Straker M
        • Willging C
        • Daul AD
        • et al.
        Transgender and gender-nonconforming patients in the emergency department: what physicians know, think, and do.
        Ann Emerg Med. 2018; 71 (e1): 183-188
        • Stewart MK
        • Archie DS
        • Marshall SA
        • Allison MK
        • Robinson C.
        Transform Health Arkansas: a transgender-led partnership engaging transgender/non-binary arkansans in defining health research priorities.
        Prog Community Health Partnersh. 2017; 11: 427-439
        • Marshall SA
        • Allison MK
        • Stewart MK
        • Thompson ND
        • Archie DS.
        Highest priority health and health care concerns of transgender and nonbinary individuals in a Southern state.
        Transgend Health. 2018; 3: 190-200
        • Allison MK
        • Marshall SA
        • Archie DS
        • et al.
        Community-engaged development, implementation, and evaluation of an interprofessional education workshop on gender-affirming care.
        Transgend Health. 2019; 4: 280-286
      4. Pew Research Center. Adults in Arkansas - Religion in America: U.S. religious data, demographics and statistics. Available at: Accessed 16 March 2021.

      5. Lipka M, Wormald B. Pew Research Center. How religious is your state? February 2016. Available at: Accessed 16 March 2021.

      6. Smith GA. Pew Research Center. Views of transgender issues divide along religious lines. 2017. Available at: Accessed 8 December 2020.

        • Kanamori Y
        • Cornelius-White JHD
        • Pegors TK
        • Daniel T
        • Hulgus J.
        Development and validation of the Transgender Attitudes and Beliefs Scale.
        Arch Sex Behav. 2017; 46: 1503-1515
        • Gorton RN
        • Berdahl CT.
        Improving the quality of emergency care for transgender patients.
        Ann Emerg Med. 2018; 71 (.e1): 189-192
        • Cahill S
        • Baker K
        • Makadan H.
        Do Ask, Do Tell: a toolkit for collecting data on sexual orientation and gender identity in clinical settings.
        The Fenway Institute, 2015 (Available at:)
        Date accessed: December 1, 2020
      7. National LGBT Health Education Center. Affirmative care for transgender and gender non-conforming people: best practices for front-line health care staff; 2016. Available at: Accessed 17 May 2021.

        • Bradford J
        • Reisner SL
        • Honnold JA
        • Xavier J.
        Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.
        Am J Public Health. 2013; 103: 1820-1829
        • Chisolm-Straker M
        • Jardine L
        • Bennouna C
        • et al.
        Transgender and gender nonconforming in emergency departments: a qualitative report of patient experiences.
        Transgend Health. 2017; 2: 8-16
        • Kattari SK
        • Bakko M
        • Hecht HK
        • Kattari L.
        Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults.
        SSM Popul Health. 2020; 10100525
        • Seelman KL
        • Colón-Diaz MJP
        • Lecroix RH
        • Xavier-Brier M
        • Kattari L.
        Transgender noninclusive healthcare and delaying care because of fear: connections to general health and mental health among transgender adults.
        Transgend Health. 2017; 2: 17-28
        • Bazzi AR
        • Whorms DS
        • King DS
        • Potter J.
        Adherence to mammography screening guidelines among transgender persons and sexual minority women.
        Am J Public Health. 2015; 105: 2356-2358
        • Brown GR.
        Breast cancer in transgender veterans: 1 ten-case series.
        LGBT Health. 2015; 2: 77-80
        • Lelutiu-Weinberger C
        • Pollard-Thomas P
        • Pagano W
        • et al.
        Implementation and evaluation of a pilot training to improve transgender competency among medical staff in an urban clinic.
        Transgend Health. 2016; 1: 45-53
        • Braun HM
        • Garcia-Grossman IR
        • Quiñones-Rivera A
        • Deutsch MB.
        Outcome and impact evaluation of a transgender health course for health profession students.
        LGBT Health. 2017; 4: 55-61
        • Ostroff JL
        • Ostroff ML
        • Billings S
        • Nemec 2nd, EC
        Integration of transgender care into a pharmacy therapeutics curriculum.
        Curr Pharm Teach Learn. 2018; 10: 463-468
        • Click IA
        • Mann AK
        • Buda M
        • et al.
        Transgender health education for medical students.
        Clin Teach. 2020; 17: 190-194
        • McCave EL
        • Aptaker D
        • Hartmann KD
        • Zucconi R.
        Promoting affirmative transgender health care practice within hospitals: an IPE standardized patient simulation for graduate health care learners.
        MedEdPORTAL. 2019; 15: 10861
        • Strong KL
        • Folse VN.
        Assessing undergraduate nursing students'knowledge, attitudes, and cultural competence in caring for lesbian, gay, bisexual, andtransgender patients.
        J Nurs Educ. 2015; 54: 45-49