Primary Care Providers and Physicians

Key Tips for Service Providers

• Ensure that your services are accessible to trans/nonbinary survivors (including disability access)
• Honor patients’ autonomy
• Treat the patient for what they are seeking care for
• Use harm reduction frameworks to care
• Understand the barriers trans/nonbinary survivors face to accessing healthcare and trusting healthcare providers

Practices that make healthcare more trans-affirming

Healthcare providers can reduce these harms by creating visibly trans-affirming environments, making care accessible, respecting survivor autonomy, and responding to the concern the patient brings in rather than centering their transness unnecessarily.

Accessibility

In a 2024 survey, conducted by FORGE, 71% of trans and nonbinary participants shared that they had one or more disabilities. On average, participants reported having 3.3 different disabilities.[vii] These might include physical disabilities, chronic health conditions, mental health conditions, developmental disabilities, neurodivergence, or other disabilities. Healthcare services for trans and nonbinary survivors need to be accessible to people with disabilities as part of providing affirming, trauma-informed care.

Trans/nonbinary people are also more likely than the general population to be impacted by COVID-19, including higher rates of infection and long COVID. These disparities are likely shapted by intersecting factors that affect risk and access to care, including underlying health conditions, poverty, and other barriers.  For providers, this means that COVID precautions are part of making healthcare accessible, affirming, and trauma-informed for trans clients.

he COVID-19 pandemic is still ongoing, and measures like wearing high-quality masks reduce the risk of infection. Most health systems have removed mask mandates, and some states are even moving to ban masks in certain settings. In this context, providers can still reduce risk by masking around patients, supporting patients who choose to mask, and reviewing clinic policies that may discourage or prevent mask use.

Part of providing accessible healthcare to trans and nonbinary survivors is reducing the risk that they will be harmed while seeking care. That includes reducing the chance of discrimination and avoiding exposure to serious or disabling infections. Wearing a high-quality mask around patients and revisiting masking policies in a clinic or practice are concrete steps providers can take to reduce that risk.

Harm reduction frameworks:

In response to violence and trauma, many trans and nonbinary survivors turn to coping methods that might not support their health in the long-term. At the same time, these coping methods might be keeping someone alive in the meantime. Using a harm reduction approach to care means understanding the risks in someone’s life, respecting the function their coping strategies serve, and working with them to reduce risks without taking away supports they rely on.

Some trans and nonbinary people may use survival strategies such as sex work, drugs or alcohol, or obtaining hormones outside formal medical systems(on the black/gray market). These strategies can meet urgent needs and may also carry health risks. Rather than withdrawing support or requiring someone to stop before receiving care, providers can offer care that responds to those risks, such as STI testing, safer-use supplies or counseling, hormone-level monitoring, or referrals to affirming mental health support.

This underscores the importance of individualized care. Providers using a harm reduction framework can recognize the strategies that help someone survive, reduce immediate risks, and work with the patient toward safer or healthier options when the patient is ready.

Treating the patient for what they’re seeking care for:

Sometimes trans and nonbinary people are not treated for the concern that brought them in. A patient seeking care for injuries after an assault should not be redirected simply because they are trans. A patient with an existing HIV diagnosis who needs STI testing should not be sent elsewhere when their primary care provider can provide that testing. Providers should address the patient’s stated concern first, then make informed referrals only when the requested care truly falls outside their scope.

Informed referrals can be helpful, but they should not replace listening to what the patient is actually asking for. Providers should first respond to the concern the patient identifies, then decide with the patient whether a referral is needed. One trans man who also does sex work shared:

“I wish that just healthcare providers, or even just the system itself, understood that, at the end of the day, when somebody’s coming to you and saying, ‘This is my problem,’ know that this is the problem… It’s not because I’m trans, it’s not because I’m poz, it’s not because I live in Detroit. It’s because I have a problem.”[viii]

Providers may also center someone’s transness unnecessarily, when the care they need does not revolve around being trans. In trans communities, sometimes this is referred to this as “trans broken arm syndrome.”

“You walk into a clinic or emergency room with a broken arm. But instead of having the presenting symptom be the focus of the visit (your broken arm), somehow the doctor’s attention seems to be on your gender. Is your broken arm at all related to your gender? Most likely not.”[ix]

Avoiding this means listening to the patient’s stated concerns, honoring their autonomy, and caring for the whole person rather than assuming every health need is about being trans. One participant in the Black trans women and girls listening session summarized this clearly:

“I am a trans woman who has not had bottom surgery, so there’s certain needs that I’m still going to need as a woman. I’m still going to need the prostate exams. I’m still going to need those types of things, along with, I have breasts now. So I’m going to need a mammogram check… You need to make sure that when you’re servicing the patient, you’re servicing the full patient when they come in asking those questions so that they can get the best healthcare.”[x]

For more on ways to talk with trans patients about what care they might need and collecting information on body parts, check out this resource on organ inventories.

Autonomy:

All survivors deserve to have their autonomy respected. In healthcare settings, this means treating the concern that brought the patient in, obtaining informed consent before exams or procedures, explaining what will happen next, and offering choices whenever possible. One nonbinary survivor described what would make them feel more comfortable in healthcare settings:

“If possible, ask consent before touching and narrate what you are going to do in an examination setting, how we want to refer to body parts, if applicable, and not invasive.”[xi]

Survivors should also have choices about how their care is documented. Some trans and nonbinary people may need healthcare records to include their legal sex so insurance will cover care. Others may not want their records to identify them as trans. Providers should explain what information is required, what is optional, who may be able to see it, and how it will be used before documenting sensitive information.

Because documentation and reporting requirements vary by setting and location, providers should explain confidentiality, mandatory reporting obligations, and documentation options before collecting sensitive details whenever possible. Clear information helps survivors make informed choices about what they share and how they receive care.

This can be especially complicated when a survivor is seeking treatment after a crime. Providers should explain the survivor’s treatment options, what may happen if they receive or decline care, and how documentation could affect future choices. For example, a healthcare provider pointed out in a listening session:

“Especially in the context of violence, if you ever want to report this to somebody, having medical record to say you have talked to somebody unfortunately legitimizes your report.”[xii]

Trans survivors may or may not want to press charges after experiencing a crime. Clear information about documentation and treatment options can preserve future choices rather than closing the door to possible legal proceedings.

Providers do not need to be experts in trans health care before offering better care. Small, consistent practices—using correct names and pronouns, explaining options clearly, reducing infection risk, making informed referrals, and treating the concern the patient brings in—can make healthcare more accessible and less harmful for trans and nonbinary survivors.

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