Table 2.

Recommendations for Gender-Affirming Practices with Nonbinary Patients

Health care level	Recommendation	Supporting quote
Provider-level	Elicit every patient's gender identity and pronouns	“What would build that sense of safety is the onus not being on me or not being on the patient, where I'm already shown that this is a trans and nonbinary friendly atmosphere and to be shown that the provider takes the first step and then me as a patient would feel comfortable taking the second step.”—Madlyn, age 43, White, Focus Group 3
	Confirm the name and pronouns of every patient	“I have a primary care physician and he comes in the door and always says my name and then asks if I'm still going by that name. I've always felt that's a really positive experience. Even if I haven't seen him very recently, he just does a good job of checking back up and not making assumptions about where I am in my life.”—T, age 29, White, Focus Group 1
	Use patient's correct name and pronouns and describe anatomy without gendered language	“Using the right pronouns, de-gendering like body parts—I do not need someone specialized in like Transgender Health to do that, and it would make my life a lot easier.”—Andre, age 18, Hong Kongese/Middle Eastern/White, Focus Group 1
	Be open to correction	“I froze my eggs last summer and the reproductive endocrinologist was explaining something, and they said the word ‘women’, and I said ‘people’, and she was like, ‘You're right, thank you.’ And then she moved on. And that was really wonderful.”—Jin, age 20, Chinese, Focus Group 1
	Advocate within existing system for documentation to be more inclusive	“Something that made me feel supported was that when I decided to exclusively use they/them pronouns, my psychiatrist immediately was like, ‘I don't know how easy it will be but I can help with trying to change all your medical records within the system to reflect that change.’”—Max, age 22, Japanese/Brazilian, Focus Group 2
Health systems-level	Include curriculum on the needs of nonbinary patients in health professions education	“Medical education needs to include education about trans people and nonbinary people.”—Charlie, age 33, White/Multiracial, Focus Group 2
	Be intentional about alliance signaling	“I think something that's been really uncomfortable for me is when I'm in a clinic that says it's mindful of these things. And I'll be upfront about what pronouns I use and then get misgendered throughout the entire session. It's like I came in with this expectation and it was pretty much immediately ignored.”—Rasa, age 18, Black/North African, Focus Group 2
	Create intake forms and electronic systems with standardized and nonpathologizing documentation of gender identity	“Something that's really easy would be to have better intake forms and to have a patient portal where you can put your pronouns and gender identity without having to get diagnosed with Gender Identity Disorder or other psych conditions.”—Honey, age 20, Black, Focus Group 1
	Diversify provider pool to include more nonbinary providers, especially BIPOC providers	“Having more trans—particularly trans practitioners of color—I think would also, make a huge difference because then there's like that mutual understanding of shared experiences that a cis[gender] practitioner might not necessarily have”—Rasa, age 18, Black/North African, Focus Group 2

BIPOC, black, indigenous, or people of color.