Microaggressions & Culturally Competent Healthcare

As healthcare providers for transgender, gender non-conforming or gender non-binary people, it is extremely important to continue learning about the population you treat because terminology and other things are changing constantly.  It isn’t necessary to be perfect or never make mistakes, but it is important to be understanding of the multitude of microaggressions that people use toward transgender, GNC, and GNB individuals (often without knowing they are doing it).

On occasion we will all make mistakes.  We may inadvertently insult someone or use incorrect words at times.  One way to try and avoid this is to learn what many people have experienced as microaggressions.

Please note, this information is not as comprehensive as I would hope.  It mainly focuses on transgender, not so much on gender non-binary or gender non-conforming individuals.

The most inclusive list I have found to date is through The Body is Not an Apology Website.


In a nutshell, based on this article and my clinical experience, here is a list of microaggressions that seem to occur most often to date (not an exhaustive list):

Asking for a “real” name or “preferred” pronouns, just ask for their pronouns

  • We could all learn to provide our pronouns and then transgender, GNC and GNB individuals aren’t separated out and made to feel “other.”

Using words like “regular” or “normal” as synonymous for heterosexual or cisgender

  • Recognize that we live in a cisgender- and heterosexual-normative world

Showing intrusive curiosity or expressing assumptions about sex and bodies

  • We really don’t need to know about surgeries or others’ “body bits” unless this is pertinent to their treatment. Recognize the difference between your own curiosity and clinical necessity.

Focusing on gender and sexuality when that’s not an issue in treatment

  • Often clients will come into therapy with issues around trauma, social anxiety, etc. and a therapist will continue to refocus them on being transgender, GNB or GNC when this isn’t really the presenting issue at all.

Expressing cis-normative assumptions about trans people’s goals for transition

  • Gender is not a binary where people’s only choices are “man” and “woman.” Providers shouldn’t force their patients into this binary, and may do so without realizing it. All people have different goals for their transition.

Expressing assumptions about transgender narratives

  • e. Assuming a “born in the wrong body” narrative
  • e. Everyone goes through the same journey – this just is not true. Let your client tell you their Gender Journey and don’t question their gender based on them not fitting some kind of standard narrative that you have for them.

Assuming who someone dates

  • Gender and sexuality are separate, so providers should never assume the gender(s) to whom a person is attracted.

Communication & Culturally Competent Care

Lastly, learn to use non-gendered or gender-inclusive terms.  This takes a little getting used to, but helps tremendously in healthcare in order to avoid mistakenly mis-gendering someone.

Here are some examples:

Rather than using terms like:


Simply use: the chosen name of the person, patient, or the terms birth.non-birth parent


Rather than using terms like:


Simply use: Partner, Parent, Spouse, Significant Other, Co-Parent(s)


Rather than using pronouns, such as:

He/Him/His or She/Her/Hers

Simply ask patients/clients for their gender pronouns

There are many possibilities:  They/Them/Theirs Ze/Hir/Hirs/Ze/Zir/Zirs, as well as the more standard He/Him/His or She/Her/Hers


This is the final blog in the series, “Gender and Healthcare.”  If you have any questions or would like to discuss this topic further, please feel free to reach out.

Kimberly Atwood is a licensed psychotherapist and certified sex therapist working in private practice in Princeton, NJ.  She also provides online therapy with clients living in Indiana, New Jersey, New York, Massachusetts, and Pennsylvania.  She specializes in sexual health, intimacy and relationship issues.  For more information, please check out her website.