With a rise in Americans identifying as transgender, dentists need to consider ways to better welcome and serve transgender patients if they want their practice to grow.
The percentage of people in the United States who self-identify as lesbian, gay, bisexual, and transgender (LGBT) has more than doubled in the past decade. Today, 8 percent of Americans aged 18 and older identify as LGBT, according to a November 2021 U.S. Census Bureau Household Pulse Survey. That puts the United States LGBT adult population at over 20 million people. (The acronym LGBT, also referred to as LGBTQ+, includes queer or questioning individuals.)
The same survey also found 0.6 percent of Americans, or about 1.5 million, self-identify as transgender, people whose gender identity differs from the sex they were assigned at birth. Trends from Gallup indicate the number of adults who identify as transgender will grow as young adults come of age at a time when Americans increasingly accept transgender people.
“With the rise in LGBTQ+ acceptance and freedom, we will surely see more trans people seeking out dental care and may even see many of our long-time patients who may have a change in their gender identity or expression,” said Dr. Alex Barrera, a founding member and current president of the Houston Equality Dental Network (HEDN), a nonprofit dental organization for LGBTQ+ dental professionals in the Greater Houston area.
“This means dentists need to be versed in the many facets of the LGBTQ+ community to better treat these individuals and to create an accepting and safe environment in our practice to welcome all individuals seeking care.”
“As dentists, we tend to build very personal connections with our patients. It's our ethical duty to not only serve the patients who come through our door but to continue to evolve and learn as the world around us changes.” — Dr. Alex Barrera
Understanding Your Patient
Understanding how a trans patient transitions, the medications they take, and their past experiences with healthcare may influence the dental care a dentist provides.
Many transgender individuals are prescribed hormone therapy or undergo surgery to align their bodies with their gender identity, but some do not. Any questions about their medical history should be relevant to their current dental treatment.
“It's also important that these patients feel confident with our knowledge of exogenous hormones and hormone blockers they may be taking so they can comfortably share their medical history with us so we in turn can safely treat the patient,” Dr. Barrera said.
“We must understand the unique behavioral and health challenges faced by the transgender community. For decades, trans and gender-queer individuals have battled discrimination in healthcare leading to a lifetime of disparities. These individuals are much less likely to have regular medical care and are much more likely to struggle with anxiety, depression, drug abuse, alcoholism, and self-harm.
“Those in the LGBTQ+ community are much more likely to have higher rates of HIV and STIs and may have more complex medical histories. With this, it is important that dentists acknowledge these hardships but also commit to the golden rule and treat these patients the way they would treat any other patient,” Dr. Barrera said.
A History of Fear and Discrimination
Based on recent surveys, the National Center for Transgender Equality reports 33 percent of transgender patients who saw a health care provider in the past year reported having at least one negative experience related to being transgender, such as verbal harassment, refusal of treatment, or having to teach the health care provider about transgender people to receive appropriate care.
As a result, 23 percent of transgender patients did not see a doctor when they needed to because of fear of being mistreated, according to the 2015 U.S. Transgender Survey, the largest survey examining the experiences of transgender people in the United States.
“A patient who is transgender will already present with a history of fear and discrimination, so doing small things like respecting their name and pronouns, and sharing our pronouns can make a huge impact,” Dr. Barrera said.
As a result of this negative treatment, many transgender people rely on their personal social networks for healthcare referrals. By providing dental care that is welcoming and sensitive to LGBTQ+ patients, there is a great opportunity for word-of-mouth marketing within your community to drive referrals. This presents an opportunity to distinguish your practice and expand into a previously underserved segment of the community.
Dr. Barrera agrees — “Recent surveys have shown that patients tend to do more 'shopping around' when looking for a dental office. LGBTQ+ people tend to do even more research when searching for a new dental home to assure they find a practice where they can feel safe and not be discriminated against.”
Ways to Make Your Practice More Inclusive
- Learn. Educate yourself and your entire practice team on appropriate ways to interact with transgender patients and about the specific health issues facing LGBTQ+ people.
- Be Sensitive. Make sure the entire practice team knows which pronouns are appropriate to use when referring to a transgender patient or same-sex couple.
- Revise Patient Forms. On patient intake forms, allow patients to indicate their gender identity via a two-step process by asking about their gender identity AND sex assigned at birth. Use neutral terms like “partner” or “spouse.” Use “parent 1” and “parent 2” to include same-sex couples raising children.
- Do Not Assume. Avoid making assumptions about a patient based on their appearance. Avoid gendered language (sir or ma'am) when greeting patients.
- Listen Attentively. Be sensitive to the fact that disclosing their gender identity or medical history may be difficult for a patient.
- Make Changes to Your Office.
- Post a rainbow or other equality symbol (Human Rights Campaign equal sign) on your door indicating that LGBTQ+ patients are welcome.
- If practice décor includes photos of families, include photos of LGBTQ+ people and families.
- Include at least one publication designed for LGBT readers with periodicals for patients to read in the practice lobby.
- Add books about LGBT families to the children's book selection in the lobby.
- Add signage to single-stall bathrooms to mark them as gender-neutral (unisex).
- Develop a patient nondiscrimination policy that includes sexual orientation and gender identity and post it in the lobby.
- Promote your dental office as a safe practice on your Google Business Page.
- Use Tools and Resources for LGBTQ-Friendly Businesses from Google for Small Business.
Treating Transgender Patients in Your Dental Practice
Creating a welcoming patient experience encourages LGBTQ+ patients to seek care. It may also increase their post-treatment compliance and the likelihood that they will return for follow-up appointments, according to University of California San Francisco Gender Affirming Health Program.
“My health center holds annual training sessions for practice staff, which include things like LGBTQ+ competency and sensitivity,” said Dr. Barrera. “I try to remind my staff that these patients live difficult lives outside of our clinic, and any minor thing we can do can have a big impact on their experience.
“Additionally, language and vocabulary count. So, I make sure we are all versed with the most updated knowledge and terms when it comes to addressing transgender patients. For example, it is important to use the word transgender as an adjective. A person is not 'a transgender,' but a 'transgender person',” he said.
Regular LGBTQ+ competency training should be a standard part of each dental office's growth plan, according to Dr. Barrera.
LGBTQ+ patients struggle daily with the expectations from others. It is important to recognize this and approach each patient as an individual, without any preconceptions. It requires eliminating judgment or editorializing about the patient's appearance, gender identity, or lifestyle.
Many transgender patients educate people around them daily about the realities of being transgender or transitioning. They should not be expected to have to educate their health care providers as well.