Understanding Gender-Affirming Nutrition Care: How I Support My LGBTQIA2S+ Clients as a Dietitian

Happy Pride!!! Why is Gender-Affirming Care Important?

LGBTQ Pride Month (colloquially referred to as "Pride"), is celebrated every year during the Month of June to honor the 1969 Stonewall Uprising in Manhattan. Since then, it has become a deeply important part of the LGBTQIA2S+ community as we continue to fight for equal justice, equal opportunity, equal human rights, affirming healthcare, mental health support and so much more. Pride month is both about celebration and joy, and also about continuing to protest, fight and stand up for the rights of the queer community.

The Stonewall Uprising began on June 28th, 1969 and involved police raids on a gay bar called Stonewall, with the queer community subsequently fighting back. Police raiding a gay bar wasn't new, and neither was this type of activism. However, it was the first time that it garnered significantly more attention and radically changed the way we think about LGBTQ rights in the United States. It is important to acknowledge that the queer community has been living with this reality for hundreds of years prior to the uprising. This shift specifically brought it to the attention of cis-gender folks who then joined the movement, when perhaps they had less awareness before.

Gender Affirming-Care

The World Health Organization defines gender-affirming care as a model that includes Interventions encompassing social, psychological, behavioral, and medical support. Gender- affirming care is specifically designed to affirm the gender identity of the patient, even if it conflicts with their assigned gender at birth. These care modalities allow transgender people to exist in their true self, without having to mask, hide, pretend, or live in fear and anxiety constantly. It allows for emotional, interpersonal, physical, spiritual, and biological integration to their truest sense of self.

Gender-affirming interventions range from providing hormone therapy to recognizing and acknowledging a patient's pronouns. The goal of providing gender-affirming care is to listen, build trust, create a safe environment, provide space for curiosity and questions, and to provide respectful care.

Most of us probably (hopefully!) believe that ALL people should be treated with dignity and respect; that it is a given. But, reality tells us a very different story. Transgender folks face harassment, discrimination, and hate crimes. Systemic discrimination happens in schools, healthcare settings, churches and workplaces. Transphobia is the expression of fear, hatred and disrespect toward folks who are transgender, nonbinary or gender nonconforming.

When transgender folks experience continued discrimination, it deeply impacts their mental, emotional and physical health. Feelings of anxiety, hopelessness, confusion, isolation, and even suicidal ideation are common. Often, transgender folks will not pursue medical care out of fear that they will be outed, verbally abused, or denied help.

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How I provide Gender Affirming Care

1. I affirm my clients gender from the beginning. In my intake forms, my clients are given the opportunity to share their gender identity and pronouns. They are also given a "free text" option to write in whatever their gender identity and pronouns are. If I am engaging with the family member of a client, I first check with them to make sure I use the correct pronoun and name in front of their family.

2. I practice individual nutrition counseling that factors in any metabolic changes my client might be experiencing as a result of hormone replacement therapy. I also provide pre and post-surgery nutrition to ensure their bodies are adequately nourished for proper healing.

3. I validate the deeply distressing experience of gender dysphoria when working on body image support. I make sure that I am identifying if the eating disorder part of self is in charge of distorted or unhelpful thinking patterns, or if my client is experiencing discomfort as they explore their relationship to their body. I do not minimize this experience, or enmesh it with body dysmorphia.

4. I provide referrals so they can build their care team and have more gender-affirming medical providers on their side. I am constantly networking, researching, and vetting local health care providers to ensure that if I refer my client, they will feel safe and heard.

5. I treat the whole person. When a transgender or non-binary client comes to me for support, I acknowledge that they are a whole lot more then their gender identity. I focus on the same important markers that I work on with every client: sleep, digestion, stress, nutrition, social and cultural engagement, etc.

6. If I mess up, I own it. There is a learning curve to being a healthcare provider in general. It is important to be humble and acknowledge when I make a mistake. Healthcare providers are systemically in a place of privilege and power. With that information in mind, It is my responsibility to acknowledge if I accidentally misgender someone and work to rebuild trust if necessary

7. I engage in continuing education. As a dietitian, I am expected to pursue 75 hours of continuing education in a five year cycle. When I am choosing continuing education, I look for options that will help me to continue providing gender-affirming care, gender informed care, evidence based practices, and to support me in continuing to be an ally, and to provide a space where my clients feel more seen and heard than they would otherwise.