Gender Pronouns: A Provider’s Guide to Referring to Transgender Patients

Being unsure of how to refer to one’s transgender, gender-expansive, and intersex patients can be anxiety-inducing. The fact is, many transgender people delay or decline to seek care due to discrimination in health care settings, and those patients who have had to teach their providers about transgender people are far more likely to delay seeking care.¹Jaffee K, Shires D, Stroumsa D. Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery. Medical Care. 2016;54(11):1010-1016. This has clear implications for these patients’ health outcomes, and providers appropriately referring to their transgender and intersex patients is a critical first step in making them feel comfortable and welcome in the clinic.

What are gender pronouns?

Gender pronouns are the words we use to refer to a person when not using their name. For example, “Kevin’s vitals were just recorded. He is febrile, according to his chart.” The most common gender pronouns are: he/him/his, she/her/hers, and they/them/their. The following chart details some typical gender pronouns, though others exist as well.

	Subject	Object	Possessive	Possessive Pronoun	Reflexive
Male/Masculine	he	him	his	his	himself
Female/Feminine	she	her	her	hers	herself
Gender Neutral	they	them	their	theirs	theirself
Gender Neutral	ze	hir	hir	hirs	hirself

Trans-feminine and female-presenting patients will typically use female pronouns. The same is true for trans-masculine and male-presenting patients with male pronouns. Those patients who identify as nonbinary, genderqueer, or another gender identity that is not entirely male or female will often use gender neutral pronouns. (Not sure what some of these terms mean? Check out our post on the ABCs of LGBT.)

Using the appropriate pronouns both accurately reflects a patient’s gender identity and indicates to the patient that their true gender is acknowledged and respected.

Breaking the ice: how to bring up pronouns

Until a patient’s gender pronouns are known, it’s best to refer to that patient by name. Thankfully, knowing the right gender pronouns for any patient is as simple as asking them.

Upon first meeting a patient, it’s easiest to begin a discussion of pronouns by first offering one’s own. For example, “Hello, I’m Dr. Quigley. My pronouns are he/him. How would you like to be addressed?”

This introduction can feel awkward if not practiced regularly. To make conversations regarding pronouns more routine, and to ensure that the wrong pronouns are not mistakenly used with one’s patients, it’s not a bad idea to incorporate a quick mention of pronouns at the beginning of all new patient visits.

One way of facilitating a discussion about pronouns is for staff to prominently display their own pronouns. Pronoun pins or buttons are a great way to do this, as is including one’s pronouns in an email signature, like the example below.

Glenda Jones, MD (she/her)
Resident Physician, Internal Medicine
Green Acres Medical Center

Frequently asked questions

What if I or another team member make a mistake?
Mistakes happen, and patients generally understand this. If the mistake occurs when nearby the patient, a short apology and a correction to the proper pronouns is typically all that’s necessary. If a mistake is made while discussing a patient with staff members, a quick correction to the patient’s authentic pronouns helps prevent future slips.

Is it grammatically correct to use they/them/their pronouns to refer to one person?
Yes. Using they/them as a singular pronoun dates back to Shakespearean times. Imagine this common usage when a person’s gender is unknown: “Look, someone must have lost their wallet. I’ll take it to the lost and found for them.”

What if my patient doesn’t use gender pronouns?
This is possible! Some people prefer to be referred to by their name instead of by pronouns. For example, “Lynda is in exam room two. Lynda does not use gender pronouns.” Just as it is important to be open to the possibility of using they/them or other gender pronouns with patients, it is also important to elicit from patients if they prefer not to use pronouns at all and to reflect that preference during future interactions.

Did we miss anything? Leave any questions about gender pronouns in the comments below, and we will update this article as needed.