Don’t Expect Transgender Patients to ‘Out’ Themselves

Get Permission

Although more transgender patients are presenting to breast centers for imaging, many “report significant social stigma when seeking care,” according to a study in the Journal of Breast Imaging.1 Reported verbal abuse and other forms of harassment “can lead to transgender patients concealing their gender identity due to prior uncomfortable experiences, which impedes the health-care provider’s ability to counsel them appropriately,” the authors wrote.

A survey found “only 28% of transgender individuals surveyed were ‘out’ to all of their health-care providers; 18% were out to ‘most’ of them; 33% were out to ‘some or a few’; and 21% were not out to any of their health-care providers,” the authors reported. “Having only a quarter of transgender patients feeling comfortable to disclose their status to providers implies a need for the medical community to improve how transgender patients are treated in the medical setting.”

Sensitivity and Training Programs

“It is infrequent for individuals presenting for breast imaging to identify themselves as transgender,” the study’s senior author, Miriam David, MD, told The ASCO Post. Dr. David is Director of Breast Imaging Services, Advanced Imaging at Westchester Medical Center, and Clinical Associate Professor of Radiology at New York Medical College, Valhalla, New York.

Asked what radiologists can do to ensure patients are comfortable enough to “out” themselves, Dr. David stressed that “training and sensitivity courses for all employees are important.” They may include “specific programs designed for comfort with different community subgroups and in particular transgender patients,” Dr. David added. She noted that a “leader” in the field of designing sensitivity and training programs is Asa Radix, MD, PhD, MPH, FACP, Senior Director of Research and Education at the Callen-Lorde Community Health Center and Clinical Associate Professor of Medicine at New York University.

Intake Forms

An appropriate and respectful way to inquire about a patient’s gender identity is through patient intake forms. They allow patients to inform medical staff about preferred first and last names and personal pronouns, and they can submit the information either electronically ahead of their appointment or to the person at the office front desk on the day of their appointment. The staff person then knows what name or names to use to call patients in for their appointments. Dr. David noted that a small transgender symbol on a practice website can reassure patients they will have a positive experience.

Proprietary mammography companies are designing online gender-neutral intake forms that radiology practices can then modify to suit their own needs, an approach she is seeking at Advanced Imaging at Westchester Medical Center.

“We believe that transgender patients will be reassured to learn that radiologists are working to address their needs,” Dr. ­David said. “Our team expects that, with awareness, will come the delivery of care to transgender patients in more comfortable and inclusive environments.” 

DISCLOSURE: Dr. David reported no conflicts of interest.


1. Huang SY, Zhang M, David M: Radiology’s engagement with transgender breast imaging: Review of radiology practice websites and publications. Journal of Breast Imaging. January 30, 2020 (early release online).


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