Understanding Terminology for Sex, Gender Identity is Critical in Patient Care Today

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Even the terms themselves, “sex” and “gender,” are often misused and misunderstood by US society and medical professionals alike.

The terms “sex” and “gender” are often misused in US society and in medical communities, explained Kelsea Aragon, PharmD, PhC, BCACP, CDCES, during her presentation at the APhA 2023 Annual Meeting & Exposition. In relation to sex and gender, the term “sex” refers only to a person’s external genitalia; however, medical literature commonly does not make this distinction. For example, in US society, the trend of “gender reveal parties” is in fact misusing the term gender.

“When people do gender reveal parties, they're just saying, ‘Congratulations, the external genitalia on your baby is going to be a penis.’ Gender, however, is based off your internal sense of self and how you fit into society,” Aragon said. “Gender could be binary—so male/female—or could be non-binary, [meaning] maybe your gender doesn't fit a male or female umbrella.”

Additionally, some medical professionals are not yet acquainted with the difference between trans versus cis, according to Aragon. She explained further that it can be helpful to think of organic chemistry to understand the difference between each term.

“So trans, we think about opposite, and cis the same. And so trans people have a gender that is different than the external genitalia that they were assigned at birth. And cis people have the same genitalia [that they were assigned at birth]—it has nothing to do with your sexuality,” Aragon said. “Currently, the DSM-5 diagnosis is gender dysphoria. And so this is what it is, it is absolutely treatable. And there are absolutely lifesaving interventions that may or may not have to do with medications, and have a lot to do with culture.”

Aragon explained further that gender has nothing to do with who a person is attracted to emotionally, romantically, or physically. Instead, gender identity is deeply felt identification, while gender expression is how a person decides to present in the world. Sexual orientation, on the other hand, refers to how people are physically, emotionally, or romantically attracted to someone.

Aragon noted that in her practice, she is a pharmacist clinician with prescriptive authority in an ambulatory care setting at a Ryan White clinic. In her work, she cares for patients who are looking to prevent HIV, manage their disease, or pursue hormone therapy.

“I prescribe and monitor hormone therapy, and we see ages 13 and up—and that is newer for us as of the last year and a half,” Aragon said. “In the state of New Mexico, we need at least one parent to provide informed consent for their child. Ideally, we always try to get both parents on board if that is possible.”

Aragon explained further that for the patients who come in to seek hormone therapy, they often have a clear understanding about who they are in relation to their gender identity. However, it is often the parents who lack some of that knowledge and would benefit from further education from a third party who can help explain those details.

“Oftentimes, that person who's coming in who's the patient, they know who they are for sure. So what we're trying to do is help involve the parent and help educate the parent to kind of understand their child as the child is, versus the child that that parent had in their vision when they had that sex reveal party and they say, ‘Congratulations, your child has a penis,’ and they immediately envision their child's life in a very binary way,” Aragon said. “Now, we're having to break that down and have those conversations.”

Additionally, Aragon explained that for all of the terminology associated with sexual orientation, that it is not appropriate to assume and then use any of those terms to describe someone unless that's the term that they use to describe themselves. Even for the term “queer,” which has gained popularity due to its presence in popular culture, such as in the show “Queer Eye.”

“But again, it's not something that you would ever assign to someone else unless they identify themselves as queer. Just like you wouldn't identify or assign any of these things to someone,” Aragon said. “I think it is just nice to pause and to think about your own gender. So how would it feel like if you woke up tomorrow with a body that's associated with a different person that’s a man? What would it be like if everyone told you that that gender that you've always known yourself to be was wrong—your doctor, your pharmacist, your significant other, your family members? And what would you do if everyone believed you are a man and expected you to act like a man, even though you know you're a woman, or vice versa?”

Aragon said that it can be easy for people without this experience to have very strong opinions about the gender identities of others based on the political and cultural climate around these topics today. However, she noted that there remains value in sitting down and reflecting on one’s own gender identity, and how that feels for them.

However, despite the current climate around the subject of gender identity in US society, Merriam Webster had “they” as the single pronoun as word of the year in 2019.

“That was a really cool moment to see that being acknowledged,” Aragon said. “There have been trans people and gender non-conforming people forever—let's just make that very clear. But the attack on them has really ramped up, so this was a very nice step. I thought, at the time, when things weren't as sensationalized, that this was a very affirming thing, and very exciting [because] pronouns are extremely, extremely important.”

Aragon explained that there are data to suggest that for gender non-conforming individuals, if they have family members and health care providers who start using the correct pronoun for them, this can decrease the risk of suicide and depression by more than 60%. In this way, this single interview intervention of using the appropriate name and appropriate pronouns of a patient can have a significant impact on their life.

“That's a form of gender-affirming care,” Aragon said. “[Also] patients may identify as one gender, but they might not be ready to use a pronoun. So these pronouns are sacred to people, and this might not be something that you've ever thought about. If any of you have been misgendered, or had those incorrect pronouns used before, think about how that felt, and then think about if you had to have that feeling often or all of the time—how that would feel.”

Because of this, Aragon said it is important to periodically check in with patients to confirm that their recorded pronouns are still the correct ones to use, as pronouns can change.

“So introducing myself with my pronouns is a way to start a conversation about pronouns without starting a conversation about pronouns: ‘So my name is Kelsey, she/her/hers, I'm going to be your pharmacist today, can you tell me a little bit about yourself.’ You're having a conversation without being like, ‘We're going to talk about your pronouns now.’ So try to make it just more of a natural thing.”

Aragon explained that checking in on patients’ pronouns can also allow health care providers to not need to rely on electronic medical records (EMRs) as a reliable source of information in this area, because EMRs are often quite difficult to update and are not quite yet made to facilitate more flexible gender identities of patients.

“Have you ever tried to change sex or gender for someone in an EMR? And how many of you have done that, and then had an insurance claims kick back? So our EMRs are not great at that,” Aragon said. “It is also important to have the genitalia assigned at birth on their charts, as that's usually what triggers our health maintenance to say they're due for a prostate screening [or] a mammography. So we need to be able to collect both gender identity and sex assigned at birth in order to be able to appropriately care for people.”

Reference

Aragon K. Make it Personal: LGBTQIA+. Presented at: APhA 2023 Annual Meeting & Exposition in Phoenix, AZ; March 24, 2023.

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