Due to differences in lean body composition between biological males and females, it's generally preferable to base nutrition recommendations on the patient's biological sex in order to meet energy and protein needs, in addition to other vitamins and nutrients.
Also be sure to ask if the patient is receiving crosssex hormones (such as androgens for female-sex patients and estrogen for male-sex patients), which may increase risks of certain conditions. For example, transwomen taking oral estrogens may be at increased risk of thromboembolic disease, while taking progesterone can cause weight gain.
Remember to address transgender patients by the gender pronouns (she/he, his/her) with which they identify, even while discussing physical conditions that align with birth-assigned sex.
Counseling with Compassion
In transgender care, use "sex" to refer to the birth-assigned or biological sex of an individual and "gender" for the person's expression or identity. According to "Injustice at Every Turn: A Report of the National Transgender Discrimination Survey," nearly one-fifth of the survey's 6,450 participants reported refusal of medical care due to transgender or gender non-conforming status, while 30 percent postponed care due to discrimination even when they were sick or injured.
To lay the groundwork for a trusting practitioner-patient relationship with transgender people:
• Consider adding a gender question to your patient-intake form. Giving patients the opportunity to declare gender, sex assigned at birth and preferred pronouns not only demonstrates inclusiveness, but prevents a potentially embarrassing first encounter with the practitioner.
• If your patient has a spouse or partner, encourage him or her to invite the partner to the next meeting. Ask who does the cooking and how often they eat out—these questions help you see how food and activity behaviors may affect your patient's wellness.
• Brush up on transgender vocabulary to communicate accurately and respectfully with your transgender patients. Unintentional slang or misused terms can be inappropriate at best, and offensive or discriminatory at worst.
Thanks to Theresa Garnero, APRN, BC-ADM, MSN, CDE; and the University of California – San Francisco Medical Center's Center of Excellence for Transgender Health (click on "Health care providers" for guidelines and best practices, a glossary of transgender terms and other cultural competency pointers for treating transgender patients).
