Inclusion in Your TCM Practice
Why should you take steps to make your acupuncture practice LGBTQI inclusive? We all want to be welcoming to each patient who walks in the door, but why focus on one specific population? A great starting point for any practitioner is to listen to each patient's concerns and treat everyone with basic respect, and sometimes we need to go even beyond this to make our practices inclusive and welcoming to specific populations. Because LGBTQI patients are more likely to have had a negative experience with a previous healthcare provider, anything from the patient being called by the wrong name to refusing them care unless they stop taking gender-affirming hormones, you can help repair your patients’ trust in their healthcare providers by building a more inclusive practice.
Of course, we all want to build reputations as caring, competent practitioners. Going beyond being routinely respectful to specific populations encourages patient openness and honesty. This provides the crucial personal details that we need from our patients to treat them expertly and safely. Creating a respectful intake process can help us achieve this and will benefit our treatment outcomes. We don’t always need to know the latest gender theory term to work with our patients. Just listen to your patient’s primary reasons for seeking care and address it, regardless of what you have learned about their history during the interview. You won’t engender your patient’s trust if you treat what you have decided is important, rather than listening to what is most important to them.
Remember that neither gender identity or physical sex are black and white. Your legal sexual designation is decided based on what your genitals look like when you’re born. However, this may not match your chromosomes (e.g., androgen insufficiency syndrome), your internal reproductive organs (e.g., vaginal agenesis), or your hormones or secondary sexual characteristics (e.g., Klinefelter's syndrome). Being LGBTQI inclusive is not just about respecting identity, but actually about understanding the wide variation of human sexual physiology.
There is a misconception that Chinese Medicine is inherently binary because Yin and Yang are associated with female and male energy, but the basic principles of Yin Yang Theory state that while Yin and Yang are opposites, they are also interdependent and in a constant state of transformation of one into the other. The great thing about Chinese Medicine is that we always work from a constitutional root. For example, this does not in any way counteract a Trans patient’s medical transition, it balances and keeps them aligned with their constitutions. Chinese herbal medicine and acupuncture have thousands of years of experience in dealing with hot flashes, vaginal dryness, menstrual spotting, and hair loss. Many of these treatments can also be applied to transgender care to ease side effects of hormone therapy, and to reduce recovery time and scarring after surgery.
It is also important to remember that there are no specific ‘LGBTQI disorders.’ LGBTQI patients come in for the same things other patients come in for: pain, sleep, mental health, digestion, hormonal support. However, they are often more likely than the general population to experience mental health symptoms like stress, anxiety, depression, and PTSD, but we treat those conditions the same way we would for all our patients. The last thing we want is to act as if those symptoms are ‘caused’ by their identity. We can treat these based on our patients’ constitutions, without even knowing about their LGBTQI identity.
Many practitioners are concerned about the safety of hormone medications or increased risk of suicide or substance addiction. Every medication has potential side effects, and every population is at risk for self-harm. These factors should be documented and are important considerations, but they should not be our primary focus while working with LGBTQI patients. Fighting to be who we are despite opposition, hatred, and violence, the amazing courage of our queer elders coming out and supporting each other at a time when it was unsafe to be gay, the tenacity of visibly gender non-conforming people everywhere, the grit of queer folks who lost the support of their families by coming out... these are the things that should be informing practitioners about this population, not just the red flags and health disparities.
So, when asking about sensitive subjects, consider your diagnostic goals. Do you need to know a patient’s sex-related medical history for your treatment? Do you need to know their preferred name and pronouns to develop practitioner-patient rapport? This can help you decide how and what to ask. It is appropriate to ask what hormones they are taking and what gender affirming surgeries they’ve had, just like we ask about other medications and surgical history. It is appropriate to ask whether they have a uterus or ovaries if they are presenting with pelvic pain. Use your patient’s time only to gather information relevant to their health goals.
I would like to provide one clear manner by which we can affirm our patients and provide welcoming spaces, which is to provide gender neutral bathrooms. When a bathroom is gender neutral, everyone can use it without risking harassment, and it also can help to prevent UTIs caused by “holding it” until a safer restroom is available. Even if you only have one bathroom, changing the sign from the ‘male/female’ symbol to ‘restroom’ or a picture of a toilet is more inclusive. If you have a shared space with multi-stall single gender restrooms, a simple way to work around this is to post a sign saying that everyone is welcome to use the restroom that fits their gender identity. This can also be a useful office policy if another patient complains about someone being in the ‘wrong’ restroom.
Even those of us who are part of the LGBTQI community have a lot to learn about being inclusive practitioners. A lot of us start out thinking that we know what our community needs because we’re a part of it. However, you can fall into a trap of only serving people like you with this thinking. This has been especially important for me as a cisgender person focusing on working with Trans folks. I can’t know from personal experience how best to serve that community, so I have to remain open to suggestions and criticism in order to be an effective provider. By remaining open we can serve people who need our services the most. To summarize: carefully listen to your patients’ concerns, consider your intentions before you ask, don’t pathologize LGBTQI patients’ health concerns, and be open to something you haven’t considered before. This will make a more welcoming and effective healthcare experience for all.
About the Author
Katrina Hanson L.Ac. is a former Professor at the Academy of Chinese Culture and Health Sciences, Oakland, CA. She studied Public Health at The Evergreen State College and trained as a health educator before completing the Acupuncture and Integrative Medicine College (AIMC)’s Master of Science program, including an internship at UCSF Benioff’s Mission Bay Children’s Hospital and the San Francisco Homeless Prenatal Program. She specializes in LGBTQI+ wellness, surgical recovery, endometriosis and pelvic pain, sexual wellness, and hormone regulation. She consults with a variety of alternative medicine colleges on transgender medicine and LGBT-inclusive schools. She published First Steps Towards Making Your Clinic Trans-Inclusive in the California Journal of Oriental Medicine, Fall 2015.
