Table 3.

Specific Recommendations for Community-identified LGBTQI Competencies

Competency	Specific Recommendations
Be comfortable with LGBTQI patients	Avoid behaviors and language, which could be perceived as disrespectful or stigmatizing.
	Avoid body language or tone that conveys disgust
	Use the preferred name and pronoun for patients.
	Use words for anatomy that patients prefer. Avoid using words for anatomy that may be perceived as assigning the incorrect gender to patients.
	Do not avoid touching patients.
	Avoid denials of care.
	Do not demonstrate a comfort that is disingenuous
Share medical decision-making with patients	Use shared decision-making for all medical decisions
	Avoid so-called gatekeeping or presenting obstacles to hormone therapy and surgeries for transgender patients.
Avoid assumptions about sexual orientation, gender identity, behavior, or anatomy	Avoid assumptions of cisgender and heterosexuality
	Avoid assumptions connecting gay men and transgender people with HIV
	Avoid assumptions about anatomy
	Avoid assumptions connecting identity and behavior
	Avoid assumptions about lack of sexually transmitted infection and other disease risk factors for women who have sex with women.
Apply knowledge of LGBTQI identities, anatomy, and common sexual practices	Apply knowledge of transgender health care, including need for routine health maintenance
	Apply knowledge of common sexual practices of LGBTQI people.
Acknowledge and address the social context of health disparities	Advocate for patients
	Create resources to fill gaps in care
	Improve language access by learning languages
	Provide health care to undocumented people
	Understand the histories of stigma that transgender and other LGBTQI patients experience and do not stigmatize patients.
	Avoid assumptions that health concerns of LGBTQI people are the result of psychiatric pathology
	Understand and address the sequelae of lack of health care access.
	Provide health care to address stigmatized experiences including sex work, use of hormones obtained without a prescription, intravenous drug use, immigration, incarceration, poverty, and silicone injection.