Caring For Transgender Clients

Public awareness about diverse gender identities and expressions have become more commonplace over the past decade as there is increased visibility of transgender people, both in our communities and in the mainstream media. Despite increased visibility, transgender people still face widespread transphobia, which includes fear, dislike and/or prejudice, as well as harassment and abuse. To support your learning in this area, we wanted to share some key terms and highlight gender-related challenges to assist you in offering the best care possible to transgender clients.


  • Gender Expression: Gender expression refers to the various ways in which people choose to express their gender identity, for example, clothes, voice, hair, make-up, etc. A person’s gender expression may or may not align with societal expectations of gender. It is therefore not a reliable indicator of a person’s gender identity.
  • Gender Identity: Internal and deeply felt sense of being a man or woman, both, or neither. A person’s gender identity may or may not align with the gender typically associated with their sex. It may change over the course of one’s lifetime.
  • Sexual Orientation: Romantic and sexual attraction for people of the same or another sex or gender.
  • Cisgender: A person who identifies with the sex they were assigned at birth.
  • Transgender: (Also ‘trans’). A person whose gender identity differs from what is typically associated with the sex they were assigned at birth.
  • Transphobia: The fear, hatred, or aversion of people whose gender identities differ from the sex they were assigned at birth.
  • Two-Spirit: (also Two Spirit or Two-Spirited). An English term used to portray concepts traditional to many Indigenous cultures. It is a culturally specific identity used by some Indigenous peoples to indicate a person whose gender identity, spiritual identity and/or sexual orientation comprises both male and female spirits. The term is also a form of resistance to binary, colonial understandings of gender.

(With some modifications, above definitions from: Government of Canada LGBTQ2 Glossary)

A person’s sex refers to one’s body chemistry (e.g., hormones like testosterone or estrogen) which is generally considered to determine one’s sex. The five indicators of sex are:

  1. Genitals
  2. Internal gonads
  3. Chromosomes
  4. Hormones
  5. Bodily changes caused by hormones like puberty, menopause

While sex is often thought about in a binary way (male or female) there are, in fact, a spectrum of possibilities based on variations in any of the above five factors. The term intersex describes a person born with a blend of sexual characteristics.

(Source: Ambit Gender Diversity Consulting)

While experiences and needs are different for each transgender person, some may choose to transition, or take a step or steps to find congruence in their gender. They may choose to change outward social identifiers like clothing, hair or makeup; seek hormone treatment to promote physical, mental and emotional alignment; surgical treatment to change gender-related physical traits; spiritual measures such as the use of sweat lodges; as well as legal measures like changing a birth certificate or driver’s licence.

Health care challenges for transgender clients

While facing all the same health risks that cisgender people do, transgender people can experience additional health challenges that include:

  • Discrimination and lack of transgender competence among health care practitioners due to a lack of training and education in this area
  • Higher rates of anxiety and depression due to transphobia of family, friends, employers, and society1
  • Higher rates of alcohol and substance abuse as a way of coping with transphobia1
  • Greater risk of sexually transmitted infections1 (and potentially related oral lesions)

Your role

Dental hygienists can help create a supportive, trans-competent environment in which transgender individuals are comfortable seeking oral health care.

As a starting point, one should not assume a client is transgender unless a client discloses this. Trans Care BC’s Gender Inclusive Language document is a great resource for building relationships with new clients when you are not sure of the client’s gender identity.

If an individual has disclosed that they are transgender, there is an opportunity to provide treatment in a trans-competent way. It is important to understand that transgender people are often asked personal questions about their health, bodies, and histories in moments where those questions are irrelevant, invasive, or humiliating or make them feel vulnerable.

So, before inquiring about a transgender client’s medical history, explain why you are asking. This can include sharing with them the importance of having a complete medical history to identify issues that may be relevant to their care. As an example, individuals taking estradiol therapy for gender transitioning purposes may be at increased risk for gingival inflammation 2. It may be helpful to explain that having an accurate pharmaceutical history helps you offer your clients the best care and guidance.

By being sensitive to the needs and challenges of transgender clients, you can help reduce the inequities transgender people experience in seeking health care by creating a welcoming, inclusive and trans-competent environment.

Learn more

To continue your learning*, TransCareBC offers free online courses about gender diversity and creating gender-affirming environments, which are offered through the Provincial Health Service Authority’s LearningHub.

*Note: The above courses are eligible for hour-for-hour Continuing Competency (CC) credits as they contribute to registrants’ practice by enhancing understanding and client-professional relations. They align with the Quality Assurance Program’s content category B1: Psychology/Sociology.


1. Macri D, Wolfe K. My preferred pronoun is she: understanding transgender identity and oral health care needs. Can J Dent Hyg 2019:53(2):110-117.
2. Jeske A. Mosby’s dental drug reference. 13th ed. St. Louis, Missouri: Elsevier; 2021.