Chapter 68: Concepts of Care for Transgender Patients

Central to competent care is the consistent use of patient-preferred names and pronouns in all clinical documentation and communication, regardless of what appears in medical records or natal sex designation. The chapter explains the physiological effects and nursing considerations for both masculinizing and feminizing hormone therapies. Masculinizing therapy administered to transmasculine patients produces predictable changes including voice deepening, increased body and facial hair growth, enhanced muscle development, and cessation of menstruation, while feminizing therapy for transfeminine patients produces corresponding feminizing physical changes. A critical nursing responsibility involves comprehensive counseling about how hormone therapy and gender-affirming surgical procedures affect reproductive capacity and future fertility options. Nurses must educate patients about fertility preservation strategies including sperm cryopreservation for transmasculine individuals and oocyte or embryo freezing for transfeminine individuals, presenting these options before transition begins to support informed decision-making. The chapter emphasizes identifying major psychosocial stressors specific to transgender populations and connecting patients with appropriate support resources, including organizations like WPATH that provide evidence-based guidelines and community networks. Successful transgender healthcare requires that nurses develop competency in terminology, demonstrate respect for gender identity, advocate for equitable access to care, and recognize how systemic barriers and discrimination contribute to health disparities. The interprofessional team approach integrates nursing, medical, mental health, and surgical specialists to address the complex biopsychosocial needs of transgender patients throughout their transition journey.