Lippincott Nursing Pocket Card - June 2022

Affirming Care for LGBTQ+ Patients



A 2021 Gallup update on lesbian, gay, bisexual or transgender (LGBT) identification found 5.6% of U.S. adults identify as LGBT (Jones, 2021). This population has complex health needs and experience health disparities such as higher rates of substance abuse, psychiatric disorders, suicide, alcohol and drug abuse, smoking, cardiovascular disease, and interpersonal violence (Margolies & Brown, 2019). Affirming care recognizes the significant impact of sexual and gender minority (SGM) status on a person’s health and is critical to ensuring SGM patients receive culturally competent and clinically appropriate care (McElwain & Carr, 2021; Cottrell, 2019).



Providing affirming care requires an understanding of terms that are unique to the SGM population. In addition to lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+), here are additional key terms you should know. Please note this list of terminology is not exhaustive and is ever-changing.
  • Sex assigned at birth: listed as male or female based on biological status (sex chromosomes), reproductive organs (penis or vagina), or the appearance of external genitalia present at birth.
    • Assigned male at birth (AMAB)
    • Assigned female at birth (AFAB)
  • Gender: a social construct that identifies the traditional view of two sexes, male and female; indicates traits and behaviors considered to be masculine or feminine (Cottrell, 2019).
  • Gender Identity: describes an individual’s internal sense of maleness or femaleness; it refers to one’s chosen identity and can exist on a spectrum.
    • Cisgender: individual whose gender identity matches the sex they were assigned at birth.
    • Agender: individual who doesn’t identify with any gender.
    • Gender dysphoria: psychological stress related to having a gender that differs from one’s assigned sex at birth.
    • Gender fluid: individual whose doesn’t identify with a fixed gender.
    • Multigender: individual who has more than one gender.
    • Nonbinary: individual that identifies as neither male nor female and sees themselves outside the gender binary; some may use the term “gender nonconforming.”
    • Transgender: individual whose gender differs from the biological sex they were assigned at birth. Transgender individuals may identify as heterosexual, homosexual, bisexual, nonbinary, or other term.
      • Transgender man: individual whose assigned sex at birth was female but now lives as a man.
      • Transgender woman: individual whose assigned sex at birth was male but now lives as a woman.
  • Sexual orientation: identifies whom the person is romantically and sexually attracted to and may exist on a spectrum.
    • Asexual: individual who experiences little to no sexual attraction.
    • Bisexual: individual who is emotionally and sexually attracted to others of the same or different gender.  
    • Gay: individual who has or desires to have a relationship with a person of the same gender; this term often refers to men who are emotionally and sexually attracted to other men and may partner exclusively with men.
    • Heterosexual: individual who is attracted to the opposite gender.
    • Lesbian: woman who is emotionally and sexually attracted to other women and may partner exclusively with women.
    • Pansexual: individual who is attracted to people of any gender; someone who is attracted to a person’s qualities regardless of their gender.
    • Questioning: individual who is uncertain or exploring their sexual orientation or gender.
    • Queer: an all-encompassing term that is not gender- or sex-specific.
    • “+”: indicates anyone not included in the other terms; everything on the gender and sexuality spectrum that letters and words don’t yet describe.


Addressing an individual using correct personal pronouns shows respect and creates an inclusive environment. A person could be a man or a woman or both or neither and choose any set of pronouns to use, and no pronoun choice is wrong. Identified pronouns may not necessarily be indicative of their gender.
  • Cisfemale: She/Her/Hers
  • Cismale: He/Him/His
  • Transgender male: he/him/himself
  • Transgender female: she/her/herself
  • Gender nonconforming (non-binary): They/Their/Theirs/them/themselves
  • Gender neutral: Ze/Hir/zhe/zhim/zher/zhimself/zherself

Transgender Care (Rowe, Ng & O’Keefe, 2019)

Patients who are transgender require special consideration as they face barriers to care due to stigmatization, discrimination in insurance coverage, and healthcare professional knowledge gaps. For patients experiencing gender dysphoria, gonadotrophin-releasing hormone (GnRH) therapy helps suppress puberty hormones and may improve self-esteem and the ability to cope with stress.
Individuals who are transgender may seek to align their bodies with their gender identity (“transition”) and may explore Cross-Sex Hormone Therapy (CSHT) or surgical procedures. For transgender women, CSHT includes estradiol for feminization therapy and antiandrogens for androgen deprivation (lower testosterone levels). This will cause a decrease in size of male genitalia, development of fat around the hips, increase in size of breasts and a reduction in facial and body hair. CSHT for transgender men includes testosterone for masculinization therapy. This will increase facial and body hair, increase muscle development, and stop menstruation. Surgical procedures for male to female transition include breast augmentation, orchiectomy, penectomy, vaginoplasty, vulvoplasty, and trachial cartilage shaving. For female to male transition, procedures include masculinizing chest surgery, hysterectomy, metoidioplasty, testicular implants, and phalloplasty. To legally transition from one gender to another requires a legal name change, changing the sex designation on your birth certificate, Social Security card, driver’s license, and passport.

  Transgender Woman Transgender Man
Cross-Sex Hormone Therapy (CSHT)
  • Estradiol for feminization
  • Antiandrogen (lower testosterone levels)
  • Decreases size of male genitalia, increases development of fat around the hips, increase in size of breasts, reduces facial and body hair
  • Testosterone for masculinization therapy
  • Increases facial and body hair, increases muscle development, and stops menstruation
Surgical procedures
  • Breast augmentation
  • Orchiectomy
  • Penectomy
  • Vaginoplasty
  • Vulvoplasty
  • Tracheal cartilage shaving
  • Masculinizing chest surgery
  • Hysterectomy
  • Metoidioplasty
  • Testicular implants
  • Phalloplasty

Patients who are transgender experience higher rates of discrimination, stigmatization, mental health issues, suicide, alcohol, drug use, smoking and sexually transmitted diseases. According to the Centers for Disease Control and Prevention (2021), adults and adolescents who are transgender made up 2% of new HIV diagnoses in the US in 2018. It is important for nurses to promote HIV testing with their transgender patients and to discuss pre-exposure prophylaxis (PrEP) medications that can be taken to prevent getting HIV from sex or injection drug use. Mental health care and substance use disorder counseling are critical services that should be provided to the transgender community.

Collecting Sexual Orientation and Gender Identity (SOGI) Data

It is important for nurses to appropriately communicate and assess patients based on their sexual orientation and gender identity (SOGI). Collecting SOGI data improves health screening, detection, and prevention of conditions more common in SGM groups. Use open-ended questions with an unbiased attitude and allow patients to describe their bodies, pronouns, and relationship partners in their own words.

  • “How would you like to be addressed and what are your pronouns?”
  • “To eliminate discrepancies in billing, or errors in the medical record, what name is noted on your health insurance card and driver’s license?”
  • “Can you tell me your assigned sex at birth? Is this your gender?”
  • “Have you had any surgical procedures or taken any medications to change your body to align with your gender?”
    • “Do you have the organs that were present at birth? It is important that we know what organs are present so we can conduct appropriate health screenings.”
  • “Are you attracted to males, females, both, or neither?”
  • “Are you in a relationship and, if so, how do you express physical intimacy?”
  • “Who are the important people in your life?” or “Who is family to you?”
  • “Is it ok to document this information in your medical record?”

Creating a Gender-Affirming Environment (McElwain & Carr, 2021; Rowe, Ng & O’Keefe, 2019):

Tips for creating a welcoming and gender-affirming environment include:
  • Integrate SGM/LGBTQ+ education into nursing curriculums.
  • Develop educational brochures for hospital staff.
  • Use appropriate terminology and a normalizing assessment of SOGI to decrease stress, build rapport, and increase patients’ feeling of safety.
  • Institute non-discriminative policies that prevent discrimination against a patient because of sexual orientation or gender.
  • Maintain an open, reflective, and individualized approach to each patient.
    • Avoid assumptions about sexual orientation and gender based on appearance
  • Institute nondiscriminatory policies:
    • Ensure all staff address patients using their preferred names and pronouns.
    • Revise intake forms to include more sexual orientations, genders, and neutral terms such as “partner” rather than “husband” or “wife.”
    • Display an organizational nondiscriminatory statement in waiting rooms specifically mentioning sexual orientation and gender.
  • Create multidisciplinary teams comprised of specialists such as endocrinologists and mental health professionals.
  • Develop patient education materials that reflect and include a diverse patient population.
  • Designate bathrooms with unisex signs and other SGM-friendly symbols.
American Nurses Association (ANA): Nursing Advocacy for LGBTQ+ Populations.
Centers for Disease Control and Prevention (CDC): Lesbian, Gay, Bisexual, and Transgender Health
Health Professionals Advancing LBGTQ Equality. Cultural Competence Webinar Series:
The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community
U.S. Department of Health and Human Services (HHS). LGBTQ+ Communities and Resources.

American Nurses Association (2018). Nursing Advocacy for LBGTQ+ Populations, Position Statement.
Centers for Disease Control and Prevention (2021, April 15). Transgender Persons.
Cottrell D. B. (2019). Fostering sexual and gender minority status disclosure in patients. The Nurse practitioner44(7), 43–49.
Jones, J. (2021). LGBT Identification Rises to 5.6% in Latest U.S. Estimate. Gallop.
Margolies, L., & Brown, C. G. (2019). Increasing cultural competence with LGBTQ patients. Nursing49(6), 34–40.

McElwain, S.D. & Carr, K.L. (2021). Providing affirming care for LGBTQ patients. Nursing Made Incredibly Easy!, 19(3), 36-43.
Rowe, D., Ng, Y. C., & OʼKeefe, L. C. (2019). Addressing transgender patients' barriers to access care. The Nurse practitioner44(6), 30–38.