Gender identity is complex, and people describe their gender in a lot of different ways. As with all identities, it is important to validate the gender identities of transgender clients. One way of doing this is to ask your clients how they identify their gender, and what pronouns they use. In some cases, transgender Veterans will use different pronouns and names than what is written on their legal documents, which means that medical records, especially electronic medical records, can be difficult to amend to reflect a client’s identity appropriately.
It is important to work with your clients, and with the system in which you are practicing, to navigate any barriers that might arise in charting and other documentation. Consider using paperwork that asks clients to identify their sex assigned at birth and gender identity, as well as paperwork which either allows people to write in their gender identity or lists multiple gender identities that a person can choose from when completing necessary forms.
Names and pronouns are just one part of creating a welcoming environment. A lot of what we do in our day to day lives and practice is gendered. Wherever something in your clinical practice is gendered, consider how you can be inclusive of all gender identities. For some helpful tips, visit the links below.
“Commonly refers to the ability to withstand or overcome significant stress or adversity,” though there is no one, widely agreed upon definition that identifies exactly what fosters resilience in transgender and other minority populations.1 Some potential resilience factors that have been more widely studied include family support, peer support, and identity pride.1 Research suggests that high social support may foster resilience, while low social support increases minority stress. Both concepts can be interrelated with ‘coming out’ for the first time as transgender.1, 2 Pride in one’s identity/identities may also be a mediating factor, with important implications for multiple intersecting identities that may place someone at higher risk for stigma and discrimination, such as transgender women of color.3
The idea that personal growth can occur through adversity, or trauma, depending upon how adversities and the ability to overcome adversities are perceived. When applied to LGBTQ communities, stress-related growth often takes into account resilience factors such as community support and connectedness of individuals to communities.4 Similar to resilience, there are important implications for intersectional identities, with several research studies focusing on the interaction between gender identity, religion, and stress-related growth.5, 6
With the aforementioned importance of community connectedness and community pride, it may be important for clinicians working with transgender Veterans to consider ways of fostering pride during the coming out process, as well as during times of increased identity distress. One way of doing this is to help transgender Veterans connect with one another through VA and community groups. It may also be helpful to identify influential figures that Veterans can relate to who have publicly displayed resilience and/or stress-related growth. See a list of notable transgender Veterans.
Transgender Veterans face a number of physical and mental health disparities. They are also more likely than non-transgender Veterans to have experienced military sexual trauma (MST), as well as non-sexual harassment and assaults. Some may even have been dishonorably discharged. Despite these barriers, transgender Veterans have serviced honorably for decades, with higher rates of service connected disability than among non-transgender Veterans.1
While it is sometimes possible to have dishonorable discharges related to sexuality and gender amended through Vet Centers and other legal services, the complicated history of transgender military service and VA care may leave transgender people feeling uncertain about the safety of seeking important medical services both in and out of the VA. Studies have found that transgender Veterans may fear disclosing their identity to providers 8,9. Increased understanding of the unique needs of transgender Veterans can positively impact treatment planning and delivery. VA is working hard to create a welcoming environment for transgender Veterans including having visible signs that help dispel understandable fears that they are not welcome at VA.
Transgender Veterans’ racial and ethnic identities, socioeconomic status, religious or spiritual affiliation, age cohort, disability status, and era of service, among other characteristics, are all important aspects of identity that impact each Veteran’s experience, worldview, and treatment. Providers should integrate all of these factors into treatment.26 Below is other important information to consider when working with transgender Veterans.
Important Considerations/Health Disparities