Culturally sensitive care of transgender and other gender or sexual identities within Chiropractic

treatment.

Identify a central concern

(Maiers et al., 2017) outlines how Transgender individuals often times experience barriers when
trying to access quality healthcare, due to certain challenges and or discrimination when finding
appropriate healthcare for their musculoskeletal complaints. Gender and sexual identities such as
transgenderism are to exclusive to race, age, sex, religion, or cultural background and therefore
appropriate attention to epidemiology and patient care should be made to elicit a welcoming
practice environment. Health care has generally used the societal gender binary concept of ‘male’ or
‘female’ without acknowledging non-binary gender identities which often get grouped the term
‘transgender’.

Research a strategy to access central concern

Very little LGBTIQIA+ literature in relation to chiropractic exists, therefore chiropractors who wish to
gain more understanding about how to treat the LGBTQIA+ community should emulate colleagues in
similar fields that have stronger research surrounding these topics. The journal by (Lady & Burnham,
2019) offers some tables with definitions of various sexual and gender identities and even goes as far
as offering a check list (Fig. 1) that can be used to self-evaluate health care environments as well as
the health care providers.

(Fig. 1) Sourced from (Lady & Burnham, 2019).

Implement change strategy to address central concern

As shown in (Lady & Burnham, 2019), a great first step in making a positive change to clinical
environments focused towards gender spectrum minorities would be to learn the terminology that
individuals might use to self-identify. This may vary from patient to patient but there is no harm in
asking the patient what pronouns they are comfortable using in order to create an inclusive and
supportive doctor-patient understanding based around communication. Before a doctor-patient
relationship Is established, the use of pronouns and prefixes such as he/ she and Mr/Mrs should be
avoided. It is also equally important to use a preferred name over a legal name for patients
especially nonbinary persons to limit patient stress. Within the chiropractic clinic chiropractors
should be aware of social and advocacy and health care resources for such patients that may require
additional supportive resources. The use of non-gendered bathrooms and washrooms will also help
to ensure that LGBTQIA+ patients feel safe, included, and cared for.

Another useful change to clinic can be to redesign patient history forms. These forms should provide
patients with the option to express their preferred gender identity. A well-designed intake form
should provide addition space for the patient to describe any preferred names, pronouns, prefixes,
and allow for multiple gender and sexual identities as well as gender expression. All this can help the
chiropractor isolate what type of care and attention to provide for each individual regardless of
gender. Note should be made that it it not a patient’s responsibility to educate the doctor about
such topics but some may choose to share their experiences with their chiropractor. All appropriate
standards of care should still be implemented when managing care for the LGBTQIA+ community;
chiropractors should respectfully ask what reproductive organs the patient currently possesses on
the intake form. This is to ensure that proper treatment and screening evaluations can be provided
such as breast exams/ prostate exam. Chiropractors should also take accurate histories covering any
transitions a transgender person may have undergone as certain diseases can be often associated
with patients using hormone replacement therapy (HRT). A few of the diseases associated with
people that were assigned male at birth and taking estrogen have in increased risk of osteoporosis,
cardiovascular disease, and venous thromboembolism. For patients assigned female at birth and
taking testosterone pose a higher risk to develop a loss of bone mineral density, ovarian cancer, and
particular liver enzymes. Aside from physical health risks, depression is very prevalent among
LGBTQIA+ youth and when compared to heterosexual youth are twice as likely to feel suicidal and
four times as likely to attempt suicide as shown in (Kann et al., 2016).

Using the checklist from (Fig. 1), if any sections are not marked ‘yes’ chiropractors should consider
creating a plan to educate healthcare providers within their clinic to create a supportive experience
and understanding patient-centred treatments.

Reassess if strategy has been successful

With an increasing amount of people each year identifying with various sexual and gender identities
small appropriate changes have to be made to clinical environments based around language used
and treatments provided for these communities in on often heteronormative healthcare system.
More studies also needs to be made to provide more understating surrounding the various
LGBTQIA+ communities in an ever changing society as it pertains to health care.

Lady, S. D., & Burnham, K. D. (2019). Sexual Orientation and Gender Identity in Patients: How to

Navigate Terminology in Patient Care. Journal of Chiropractic Humanities, 26, 53–59.

https://doi.org/10.1016/j.echu.2019.08.005
‌Kann, L., Olsen, E. O., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R.,

Chyen, D., Whittle, L., Thornton, J., Lim, C., Yamakawa, Y., Brener, N., & Zaza, S. (2016). Sexual

Identity, Sex of Sexual Contacts, and HealthRelated Behaviors Among Students in Grades 9–12

— United States and Selected Sites, 2015. Morbidity and Mortality Weekly Report:

Surveillance Summaries, 65(9), 1–202. JSTOR. https://doi.org/10.2307/24805814

Maiers, M. J., Foshee, W. K., & Henson Dunlap, H. (2017). Culturally Sensitive Chiropractic Care of

the Transgender Community: A Narrative Review of the Literature. Journal of Chiropractic

Humanities, 24(1), 24–30. https://doi.org/10.1016/j.echu.2017.05.001