Caring for Transgender and Gender-Diverse Patients in the Urgent Care Setting

How can urgent care clinicians support disclosure of clinically relevant information?

Use neutral language, confirm the patient’s name and pronouns, explain why sensitive questions are medically relevant, and provide privacy whenever possible. A welcoming environment and nonjudgmental approach can improve trust and diagnostic accuracy.

When should anatomy and pregnancy potential be discussed?

Anatomy should be clarified only when it affects the differential diagnosis, testing, imaging, or treatment. Current anatomy and pregnancy potential should not be inferred from appearance, identity, name, or the electronic health record.

What health concerns may require particular attention in transgender and gender-diverse patients?

Transgender and gender-diverse patients have elevated risks related to mental health, self-harm, suicidality, domestic violence, social instability, and delayed care. Assessment should remain individualized and grounded in the presenting concern.

How can examinations and diagnostic testing be made more patient-centered?

Explain the clinical need, obtain consent, ask about preferred terminology for body parts, and offer a chaperone when appropriate. Alternative testing approaches may improve comfort in selected situations.

What should clinicians consider when gender-affirming care may be relevant?

Review medications, surgeries, and self-managed practices without assuming they caused the current problem. Awareness of potential complications and access barriers can inform evaluation, counseling, referral, and follow-up.

CASE 1 — Syncope, Dyspnea, and Weight Loss: An 18-year-old transgender girl presents after fainting at school, with dyspnea, substantial recent weight loss, bullying, and reluctance to discuss her symptoms. The case highlights the importance of privacy, supportive communication, and awareness of health concerns that may be more prevalent among gender-diverse youth.

CASE 2 — Sudden Abdominal Pain With Unclear Anatomy: A 21-year-old patient with masculine gender expression presents with severe left-sided abdominal pain, while the chart does not clarify gender identity or current anatomy. The case underscores the diagnostic risk of making anatomy-based assumptions and the value of clinically relevant, respectful questions.

CASE 3 — Traumatic Arm Injury and Signs of Self-Harm: A 14-year-old nonbinary adolescent presents after an ATV fall with arm pain, and the examination also reveals wounds suggestive of self-harm. The case focuses on integrating injury evaluation with private, nonjudgmental mental health and safety assessment.

• Recommendations for creating a welcoming clinical environment, using inclusive communication, avoiding anatomy-based assumptions, and connecting patients with support resources.
• Terminology guide covering gender identity, sexual orientation, transgender and gender-diverse identities, nonbinary identities, LGBTQIA+ terminology, names, and pronouns.
• Summary of high-priority concerns, including suicidality, violence, missed diagnoses, and complications of gender-affirming interventions.
• Strategies for inclusive urgent care spaces, including patient-facing materials, staff language, visible symbols, and restroom considerations.
• Evaluation considerations for pelvic and genital examinations, pregnancy testing, imaging, postsurgical sites, and prior silicone injections.
• Directory of national family, mental health, community support, advocacy, and educational resources.
• Overview of gender-affirming medication classes, administration routes, and potential complications.

• Assuming anatomy from gender identity or appearance and narrowing the differential diagnosis prematurely.
• Failing to acknowledge and correct mistakes involving a patient’s name or pronouns.
• Using anatomical terminology without asking what language the patient prefers for their body.
• Overlooking pregnancy potential in a patient with masculine presentation or a male gender marker.
• Attributing unrelated symptoms to gender-affirming hormone therapy without considering other likely causes.