Exploring Interactions Between Transgender,Gender-Diverse,and Nonbinary Individuals and Allied Health Professionals in Clinical Practice: A Scoping Review
Restricted accessReview articleFirst published online February, 2025
Exploring Interactions Between Transgender,Gender-Diverse,and Nonbinary Individuals and Allied Health Professionals in Clinical Practice: A Scoping Review
Transgender, gender diverse, and nonbinary (TGDNB) individuals access allied health care services for various reasons; however, barriers such as fear of discrimination and stigmatization exist. Little is known about the positive or negative features of health care encounters between allied health professionals and TGDNB individuals. This scoping review sought to (1) summarize current evidence describing health care encounters between allied health professionals and TGDNB individuals; (2) identify the extent of clinical practice guidance specific for allied health professionals; and (3) identify recommendations for improving allied health care for TGDNB individuals. A comprehensive search of four electronic databases and two grey literature sources was conducted from January 1, 2000 to September 26, 2021. Relevant data were extracted and summarized narratively, and recommendations were summarized via table. Thirty-five articles were included in this review. Barriers faced by TGDNB individuals in accessing allied health services included previous negative experiences, lack of clinician competence, financial barriers, travel times, lack of understanding of allied health scope and fear of stigmatization, and discrimination. No clinical guidelines were identified specific to allied health; however, eight key recommendations emerged from the synthesis: a need for TGDNB-specific referrals, resources and advocacy, clinician education, awareness and use of patient pronouns, gender neutral environments, inclusive and welcoming environments, gender-inclusive intake forms, confidentiality and privacy, and reduction of stigma and discrimination. Findings suggest that improvements to optimize allied health care experiences of TGDNB individuals are indicated and feasible. Significant scope remains for patient-centered research to improve health care experiences for TGDNB individuals.
Get full access to this article
View all access options for this article.
References
1.
BonviciniKA. LGBT healthcare disparities: What progress have we made?. Patient Educ Couns, 2017; 100(12):2357–2361; doi: 10.1016/j.pec.2017.06.003
2.
KleinDA, MalcolmNM, Berry-BibeeEN, et al.Quality primary care and family planning services for LGBT clients: A comprehensive review of clinical guidelines. LGBT Health, 2018; 5(3):153–170; doi: 10.1089/lgbt.2017.0213
3.
ShettyG, SanchezJA, LancasterJM, et al.Oncology healthcare providers' knowledge, attitudes, and practice behaviors regarding LGBT health. Patient Educ Couns, 2016; 99(10):1676–1684; doi: 10.1016/j.pec.2016.05.004
4.
StewartK, O'ReillyP. Exploring the attitudes, knowledge and beliefs of nurses and midwives of the healthcare needs of the LGBTQ population: An integrative review. Nurse Educ Today, 2017; 53:67–77; doi: 10.1016/j.nedt.2017.04.008
5.
White HughtoJM, ReisnerSL, PachankisJE. Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med, 2015; 147:222–231; doi: 10.1016/j.socscimed.2015.11.010
6.
HatzenbuehlerML, PhelanJC, LinkBG. Stigma as a fundamental cause of population health inequalities. Am J Public Health, 2013; 103(5):813–821; doi: 10.2105/AJPH.2012.301069
7.
NybladeL, StocktonMA, GigerK, et al.Stigma in health facilities: Why it matters and how we can change it. BMC Med, 2019; 17(1):25; doi: 10.1186/s12916-019-1256-2
8.
ÅlgarsM, AlankoK, SanttilaP, et al.Disordered eating and gender identity disorder: A qualitative study. Eat Disord, 2012; 20(4):300–311; doi: 10.1080/10640266.2012.668482
9.
TebbeEA, MoradiB. Suicide risk in trans populations: An application of minority stress theory. J Couns Psychol, 2016; 63(5):520–533; doi: 10.1037/cou0000152
10.
TestaRJ, RiderGN, HaugNA, et al.Gender confirming medical interventions and eating disorder symptoms among transgender individuals. Health Psychol, 2017; 36(10):927–936; doi: 10.1037/hea0000497
11.
ValentineSE, ShipherdJC. A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev, 2018; 66:24–38; doi: 10.1016/j.cpr.2018.03.003
12.
SeelmanKL, Colón-DiazMJP, LeCroixRH, et al.Transgender noninclusive healthcare and delaying care because of fear: Connections to general health and mental health among transgender adults. Transgend Health, 2017; 2(1):17–28; doi: 10.1089/trgh.2016.0024
13.
DhillonN, OliffeJL, KellyMT, et al.Bridging barriers to cervical cancer screening in transgender men: A scoping review. Am J Mens Health, 2020; 14(3):1557988320925691; doi: 10.1177/1557988320925691
14.
WeyersS, GarlandSM, CruickshankM, et al.Cervical cancer prevention in transgender men: A review. BJOG, 2020; 128(5):822–826; doi: 10.1111/1471-0528.16503
15.
dickeyLM, BudgeSL, Katz-WiseSL, et al.Health disparities in the transgender community: Exploring differences in insurance coverage. Psychol Sex Orientat Gend Divers, 2016; 3(3):275–282; doi: 10.1037/sgd0000169
16.
SaferJD. Hurdles to health care access for transgender individuals. Nat Hum Behav, 2019; 3(11):1132–1133; doi: 10.1038/s41562-019-0693-4
17.
SaferJD, ColemanE, FeldmanJ, et al.Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes, 2016; 23(2):168–171; doi: 10.1097/MED.0000000000000227
18.
ColemanE, RadixAE, BoumanWP, et al.Standards of care for the health of transgender and gender diverse people, Version 8. Int J Transgend Health, 2022; 23(Suppl 1):S1–S259; doi: 10.1080/26895269.2022.2100644
19.
TetiM, KerrS, BauerbandLA, et al.A qualitative scoping review of transgender and gender non-conforming people's physical healthcare experiences and needs. Front Public Health, 2021; 9:598455; doi: 10.3389/fpubh.2021.598455
20.
CiceroEC, ReisnerSL, SilvaSG, et al.Health care experiences of transgender adults. Adv Nurs Sci, 2019; 42(2):123–138; doi: 10.1097/ans.0000000000000256
21.
JiangDD, GallagherS, BurchillL, et al.Implementation of a pelvic floor physical therapy program for transgender women undergoing gender-affirming vaginoplasty. BJOG, 2019; 133(5):1003–1011; doi: 10.1097/aog.0000000000003236
22.
KimH-T. Vocal feminization for transgender women: Current strategies and patient perspectives. Int J Gen Med, 2020; 13:43–52; doi: 10.2147/IJGM.S205102
23.
De VriesE, KathardH, MüllerA. Debate: Why should gender-affirming health care be included in health science curricula?. BMC Med Educ, 2020; 20(1):51; doi: 10.1186/s12909-020-1963-6
24.
NowaskieDZ, PatelAU. How much is needed? Patient exposure and curricular education on medical students' LGBT cultural competency. BMC Med Educ, 2020; 20(1):490; doi: 10.1186/s12909-020-02381-1
25.
American Psychological Association. Guidelines for psychological practice with transgender and gender nonconforming people. Am Psychol, 2015; 70(9):832–864; doi: 10.1037/a0039906
KattariSK, BakkoM, HechtHK, et al.Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. SSM Popul Health, 2019; 10:100525; doi: 10.1016/j.ssmph.2019.100525
28.
RosaDF, CarvalhoMVdF, PereiraNR, et al.Nursing care for the transgender population: Genders from the perspective of professional practice. Rev Bras Enferm, 2019; 72(suppl 1):299–306; doi: 10.1590/0034-7167-2017-0644
29.
StantonAM, BatchelderAW, KirakosianN, et al.Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center. PLoS One, 2021; 16(1):e0245872; doi: 10.1371/journal.pone.0245872
30.
MunnZ, PetersMDJ, SternC, et al.Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol, 2018; 18(1):143; doi: 10.1186/s12874-018-0611-x
31.
ArkseyH, O'MalleyL. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol, 2005; 8(1):19–32; doi: 10.1080/1364557032000119616
32.
PetersMDJ, MarnieC, TriccoAC, et al.Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth, 2020; 18(10):2119–2126; doi: 10.11124/jbies-20-00167
33.
Allied Health Professions Australia. Allied Health Professions. Healthdirect: Australia; 2021. Available from: https://ahpa.com.au/allied-health-professions [Last accessed: July19, 2021].
34.
RethlefsenML, KirtleyS, WaffenschmidtS, et al.PRISMA-S: An extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev, 2021; 10(1):39; doi: 10.1186/s13643-020-01542-z
35.
TriccoAC, LillieE, ZarinW, et al.A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol, 2016; 16:15; doi: 10.1186/s12874-016-0116-4
36.
AdlerRK. The SLP as counselor for the transgender client. Perspect ASHA Spec Interest Groups, 2017; 2(10):92–101; doi: 10.1044/persp2.sig10.92
37.
AntoniC. Service delivery and the challenges of providing service to people who are transgender. Perspect Voice Voice Disord, 2015; 25(2):59–65; doi: 10.1044/vvd25.2.59
38.
BeaumontSL. Art therapy for gender-variant individuals: A compassion-oriented approach. Can Art Ther Assoc J, 2012; 25(2):1–6; doi: 10.1080/08322473.2012.11415565
39.
BoozJ, DormanK, WaldenP. First-person narratives by transgender individuals on voice and communication. Perspect ASHA Spec Interest Groups, 2017; 2(10):60–63; doi: 10.1044/persp2.sig10.60
40.
CollazoA, AustinA, CraigSL. Facilitating transition among transgender clients: Components of effective clinical practice. Clin Soc Work J, 2013; 41(3):228–237; doi: 10.1007/s10615-013-0436-3
41.
DaviesS, PappVG, AntoniC. Voice and communication change for gender nonconforming individuals: Giving voice to the person inside. Int J Transgenderism, 2015; 16(3):117–159; doi: 10.1080/15532739.2015.1075931
42.
FergussonP, GreenspanN, MaitlandL, et al.Towards providing culturally aware nutritional care for transgender people: Key issues and considerations. Can J Diet Pract Res, 2018; 79(2):74–79; doi: 10.3148/cjdpr-2018-001
43.
FloydMJ, MartinO, EckloffKJ. A qualitative study of transgender individuals' experiences of healthcare including radiology. Radiography, 2020; 26(2):e38–e44; doi: 10.1016/j.radi.2019.10.008
44.
GoldbergAC. Our transgender language choices make all the difference. ASHA Leader, 2019; 24(4):6–7; doi: 10.1044/leader.fmp.24042019.6
45.
GunjawateDR, B KumarR, RaviR, et al.Knowledge and attitudes toward transgender community among speech-language pathologists in India: A questionnaire-based exploration. Int J Transgend Health, 2020; 21(4):455–462; doi: 10.1080/26895269.2020.1753135
46.
HancockA, HaskinG. Speech-language pathologists' knowledge and attitudes regarding lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations. Am J Speech Lang Pathol, 2015; 24(2):206–221; doi: 10.1044/2015_ajslp-14-0095
47.
HancockAB. The role of cultural competence in serving transgender populations. Perspect Voice Voice Disord, 2015; 25(1):37–42; doi: 10.1044/vvd25.1.37
48.
HancockAB, GarabedianLM. Transgender voice and communication treatment: A retrospective chart review of 25 cases. Int J Lang Commun Disord, 2013; 48(1):54–65; doi: 10.1111/j.1460-6984.2012.00185.x
49.
HelouL. Crafting the dialogue: Meta-therapy in transgender voice and communication training. Perspect ASHA Spec Interest Groups, 2017; 2(10):83–91; doi: 10.1044/persp2.sig10.83
50.
HirschS. Combining voice, speech science and art approaches to resonant challenges in transgender voice and communication training. Perspect ASHA Spec Interest Groups, 2017; 2(10):74–82; doi: 10.1044/persp2.sig10.74
51.
LewisCP. The road to trans-inclusive health care: Policy implications and the critical role of social work. Health Soc Work, 2016; 42(1):60–62; doi: 10.1093/hsw/hlw056
52.
LitosselitiL, GeorgiadouI. Taiwanese speech-language therapists' awareness and experiences of service provision to transgender clients. Int J Transgend, 2019; 20(1):87–97; doi: 10.1080/15532739.2018.1553693
53.
MaiersMJ, FosheeWK, Henson DunlapH. Culturally sensitive chiropractic care of the transgender community: A narrative review of the literature. J Chiropr Humanit, 2017; 24(1):24–30; doi: 10.1016/j.echu.2017.05.001
54.
ManriqueOJ, AdabiK, HuangTC-T, et al.Assessment of pelvic floor anatomy for male-to-female vaginoplasty and the role of physical therapy on functional and patient-reported outcomes. Ann Plast Surg, 2019; 82(6):661–666; doi: 10.1097/sap.0000000000001680
55.
MarkmanER. Gender identity disorder, the gender binary, and transgender oppression: Implications for ethical social work. Smith Coll Stud Soc Work, 2011; 81(4):314–327; doi: 10.1080/00377317.2011.616839
56.
MoogD, Timmons SundL. Clinician and consumer perspectives on gender-affirming voice services. J Voice, 2021;S0892-1997(21)00175-2; [Epub ahead of print]; doi: 10.1016/j.jvoice.2021.05.009
57.
NeiraPM. Blowin’ in the wind—Another study reporting shortfalls in caring for our transgender patients. J Radiol Nurs, 2019; 38(1):42–43; doi: 10.1016/j.jradnu.2018.10.003
58.
Oğuz Ö, AyranB, YelkenK. Clinical considerations in speech and language therapy in Turkish transgender population. J Voice, 2021; 35(4):662.e9–e662.e13; doi: 10.1016/j.jvoice.2019.12.011
59.
PasternakK, FrancisDO. An update on treatment of voice-gender incongruence by otolaryngologists and speech-language pathologists. Curr Opin Otolaryngol Head Neck Surg, 2019; 27(6):475–481; doi: 10.1097/moo.0000000000000582
60.
PerryH, FangAJ, TsaiEM, et al.Imaging health and radiology care of transgender patients: A call to build evidence-based best practices. J Am Coll Radiol, 2021; 18(3):475–480; doi: 10.1016/j.jacr.2020.10.008
61.
RahmanR, LinsenmeyerWR. Caring for transgender patients and clients: Nutrition-related clinical and psychosocial considerations. J Acad Nutr Diet, 2019; 119(5):727–732; doi: 10.1016/j.jand.2018.03.006
62.
SendS. Nutrition management of the transgender patient. Support Line, 2020; 42(1):14–19.
63.
SiverskogA. “They just don't have a clue”: Transgender aging and implications for social work. J Gerontol Soc Work, 2014; 57(2–4):386–406; doi: 10.1080/01634372.2014.895472
64.
SmithCJ. Culturally competent care for transgender voice and communication intervention. Perspect ASHA Spec Interest Groups, 2020; 5(2):457–462; doi: 10.1044/2020_persp-19-00117
65.
SmolleS, EspvallM. Transgender competence in social work with older adults in Sweden. J Soc Serv Res, 2021; 47(4):522–536; doi: 10.1080/01488376.2020.1848968
66.
SonnenblickEB, ShahAD, GoldsteinZ, et al.Breast imaging of transgender individuals: A review. Curr Radiol Rep, 2018; 6(1):1; doi: 10.1007/s40134-018-0260-1
67.
SwensonR, AlldredP, NichollsL. Doing gender and being gendered through occupation: Transgender and non-binary experiences. Br J Occup Ther, 2021; 85(6):446–452; doi: 10.1177/03080226211034422
68.
TaylorET. Transmen's health care experiences: Ethical social work practice beyond the binary. J Gay Lesbian Soc Serv, 2013; 25(1):102–120; doi: 10.1080/10538720.2013.750575
69.
TrevorM, BoddyJ. Transgenderism and Australian social work: A Literature Review. Aust Soc Work, 2013; 66(4):555–570; doi: 10.1080/0312407x.2013.829112
70.
FisherC, MikolajczakG, EzerP, et al.Study Protocol: 6th National Survey of Australian secondary students and adolescent sexual health, 2018. Front Public Health, 2019; 7:217; doi: 10.3389/fpubh.2019.00217
71.
SpizzirriG, EufrásioR, LimaMCP, et al.Proportion of people identified as transgender and non-binary gender in Brazil. Sci Rep, 2021; 11(1):2240; doi: 10.1038/s41598-021-81411-4
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
