Practice Tip of the Week | Taking Action to the Next Level for Transgender People

By  Damon B. Cottrell, PhD, DNP, APRN, FNP-C, CCNS, ACNS-BC; Phillip T. Atchison, PharmD;  and Darian Poe

Transgender is a term used to describe those who have a gender identity different from their sex assigned at birth. Recent data suggest 5.6% of the United States population identifies as transgender. Transgender people have become more visible in the last decade; a 2014 article in Time Magazine described that juncture as a pivotal time where visibility, particularly in the media, reached a high point.  There was inference to further societal change with much work to be done and suggestion of same-sex marriage playing a role in the increased visibility.  The work to be done certainly continues. 

From a societal perspective, transgender people experience issues within educational settings, employment discrimination, barriers within immigration and asylum needs, and even significant barriers to legal identification of gender. Transgender individuals often desire to change their names or genders on a legal document such as a birth certificate or driver’s license. The processes and barriers to accomplishing this vary by state.  As you might expect, Texas rates an F on a traditional academic scale for friendliness of changing a gender marker on a drivers license. Eight states and two territories fall into this classification due to the requirements of a court order, an amended birth certificate and proof of surgery.  Requiring a court order to change gender on a birth certificate in Texas, for example, leaves the decision to a Judge or a policy official.

The policy arena is filled with problematic legislation. Several attempts at untoward legislative action for transgender youth were at play at the last Texas legislative session, such as attempts in banning transgender youth from participating in sports and punishing providers for providing guideline-driven and appropriate care.  Fortunately, most attempts have been defeated. Senate Bill 3, another attempt at banning transgender youth in sports, has passed in the Senate and is pending review by the House Public Education Committee. 

Take a moment to consider being in a population that is four-times more likely to experience violent crime. This is the reality for transgender individuals as reported in a recent press release of the University of California Los Angeles’ Williams Institute. This report found 75% percent of transwomen believed their incident to be a hate crime. Many of these crimes end in death. The Center for American Progress released data that showed 37 transgender or gender-nonconforming people were killed in 2020, with transgender women of color being most vulnerable. Again, it appears Texas is highly stricken with involvement in such statistics and in 2019 led the nation in rates of such violence. 

In current literature, understanding of transgender individuals’ experiences is often situated within findings salient to the broad categorization of an LGBT+ identity. However, there are clear reports of disparities in mental health, including having a four-fold likelihood of at least one suicide attempt during their life compared to heterosexual people, failures to obtain  preventative care, experiences in poverty and homelessness, and intimate partner violence.

Merriam-Webster defines next-level as “surpassing others: uncommonly good or impressive.” This highly vulnerable population is in need of advocacy and support at unprecedented levels. The data are extremely worrisome and our actions as members of health disciplines should closely align in mitigating the challenges.  As people, we can all engage in various strategies or activities to promote transgender equality. GLAAD has a published list of tips that we can all consider engaging in. More specifically, for healthcare and nursing, we can learn and inform ourselves about the population and the additional challenges they may face. It is imperative to become an active advocate for equality, speak up when disparaging comments are heard or read, and engage in our organizations, such as TNA, in order to assure that all patients are at the center of our decision making. We must all get to that “next-level” and create change.