Taking Care of Your Transgender and Nonbinary Clients

By Amber Briggle, August 1, 2024

According to UCLA’s School of Law Williams Institute, nearly 14 million Americans—5.5% of the adult population in this country—identify as LGBTQ, and 1.6 million people ages 13+ in the U.S. are transgender.

With so many of our neighbors, loved ones, relatives and friends part of this vibrant, diverse, resilient—and often marginalized and vulnerable—community, odds are at least one of your clients or coworkers is LGBTQ, even if they aren’t “out” to you.

Educating yourself on proper language and best-practices when working with transgender and nonbinary people will not only benefit your clients and colleagues, but will benefit your practice, too.

Here are four common questions you might be thinking to yourself but are afraid to ask, as well as answers that will help you do your best by your trans and nonbinary clients.

1. What Does “Transgender” Mean?

The word “trans” is a Latin prefix meaning “across” or “other side of.” So, a person who is transgender (or trans for short) has a gender identity that is different from the one that was assigned to them at birth (“It’s a boy!” or “It’s a girl!”).

The opposite of transgender is cisgender, which means that a person (like myself) identifies as the gender they were presumed to be at birth. Cis- is another Latin prefix that means “on the same side as.” If you’ve never had to think about your gender identity, you’re probably cisgender.

It’s important to note that gender isn’t binary, and over 1 million Americans between the ages of 18–60 identify as nonbinary. Nonbinary individuals’ experiences are diverse: some identify as both male and female, whereas some people identify as neither, with a whole rainbow of experiences in between.

“Nonbinary” is the most commonly used term, but words like genderqueer, agender, bigender and genderfluid may be preferred by some individuals. Being nonbinary is not the same as being intersex.

Gender identity is innate, and even young children (including my son) know exactly who they are at very early ages. This is true for everyone, including you!

2. How Should I Address a Transgender Person in My Practice?

Your intake forms already have a place for your clients’ names, but there is still more you can do to create a more inclusive practice.

First, make sure you include additional space for a client’s preferred name or nickname. Out of habit, many clients will put their legal name on a document, even when insurance isn’t involved. By including a space for a preferred name, you can be sure that you’re addressing your client with care and respect every time they visit your practice.

Additionally, including a space on your intake form for pronouns (she/her, he/him and they/them are common) might seem unnecessary if you personally have never had to worry about the way someone refers to you. But, you can’t always correctly guess a person’s pronouns based on how they look or what their voice sounds like over the phone.

Using the correct name and pronouns for our clients and colleagues can lower rates of depression and go a long way toward raising our clients’ self-esteem and overall sense of well-being.

Be sure to make a note of their chosen name and correct pronouns in your scheduling and billing software, too, so everyone from your practice who may interact with your LGBTQ clients can be using the name and pronouns that make these clients feel their best.

3. Can I Ask a Trans Client about any Gender Affirming Surgeries or Hormone Therapies?

In some circumstances, gender affirming procedures may be relevant information. Examples might include a transgender man or nonbinary client who recently had “top surgery” to have breast tissue removed, or a transgender woman who underwent breast enhancement surgery to feel more comfortable in her body.

(Remember, cisgender people receive these types of surgeries too—such as breast enhancement, rhinoplasty and liposuction, for example, to feel better in their bodies—which shows that gender affirming procedures aren’t only for the trans community).

In both cases, your clients may need extra upper body work to relieve tight musculature as a result of the surgery. Treat these clients the same as you would a client who underwent a double mastectomy after a breast cancer diagnosis, or a cisgender woman who recently had breast augmentation: comfortable bolstering, lymphatic drainage if appropriate and, most of all, with respect and privacy.

Unless a previous surgery or hormone therapy is necessary information for you to know prior to their massage (it’s usually not), then it’s usually not OK to ask a transgender person about any gender-affirming medical procedures they may have had. If you wouldn’t ask a cisgender woman about her estrogen supplements or surgery from 10 years ago, then it’s not necessary for you to ask these questions of your transgender and nonbinary clients either.

4. Are There Words or Phrases I Should Avoid Using?

Language around this subject changes with every generation. “Transsexual” used to be the common nomenclature—and may still be used by some trans elders, to be sure—but the term has largely been replaced by the word “transgender” today.

The same can be true of other words and phrases. “Born in the wrong body” isn’t necessarily appropriate because trans people’s bodies are perfect the way they are, regardless of whether they feel the need (or have the financial means or social support) to medically transition via hormones and surgery.

“Male-to-female” or “female-to-male” also assumes that gender is a binary (it’s not) and that a person can simply be a boy one day and—viola!—a girl the next. (Also not true.)

A more accurate way to describe this is by using the terms “assigned female at birth” or “assigned male at birth” (abbreviated as AFAB or AMAB), since that’s what happened: a transgender person was assigned a gender at birth before they could speak and let the world know who they truly are!

Additionally, when talking about someone you knew from before they transitioned, it’s best not to disclose their previous names or pronouns. “Oh, I have a transgender friend! She used to go by Steve before he—I mean, she—transitioned, but now she’s Hannah at work!”

Now, you’ve not only deadnamed and misgendered Hannah, you’ve also outed her without her consent. Keep her private information private to keep her safe.

When your heart is in the right place, people will understand if you make the occasional mistake, especially when you hold yourself accountable in a simple and straightforward way: “Oh, I’m sorry I got your pronouns wrong just now. Let me try this again.” Do your best, apologize when you make mistakes, correct yourself, do better, and move on. Eventually practice makes perfect!

Knowing the Difference: Gender Identity, Gender Expression and Sexual Orientation

Gender identity, gender expression and sexual orientation are three distinct things, and knowing the difference will help you better understand how you can provide a welcoming environment to your LGBTQ clients.

The Power of Personal Stories

In addition to being a massage therapist and owner of Soma Massage Therapy in the Dallas, TX, area, I’m also the mother of a transgender 16 year old.

My son “came out” to me almost as soon as he could speak, but it took years to understand what he was trying to tell me. I finally—and fortunately—understood him when he was in 1st grade, which is when his dad and I gave him the space to socially transition: changing his name, cutting his hair, wearing more traditionally masculine-aligned clothing, and using male pronouns (he/him/his).

Almost overnight, my moody and withdrawn child exuded a light and a joy that we as his parents hadn’t seen in years. He no longer had to pretend to be someone he wasn’t, and because our love and acceptance of him had not changed, he felt safe to live as his authentic self both at home and in public.

I saw in real time how affirming him in his gender identity was literally saving his life, and I vowed that I would rather change the entire world than have the world try to change my perfect son.

Since then, I’ve made it my mission to educate others on the importance of allyship and being an “up-stander” to protect and advance the rights of nonbinary and transgender people like my precious son everywhere.

What I’ve learned in the past decade is that there are a lot of people out there (you’re probably one of them!) who want to do the right thing and stand on the side of justice, love and equality, but just don’t know how or where to begin when it comes to trans rights.

We as massage therapists are obligated to value our clients’ individuality. As our AMTA Code of Ethics states, we must: “Acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudicial manner with clients and/or colleagues.”

5 Quick Ways to Build a More Inclusive Community

No matter if you have several LGBTQ clients, have no idea if any of your clients are LGBTQ or are just beginning to think more deeply about inclusive practice, there are small, meaningful steps you can take to ensure your practice is welcoming to everyone, especially vulnerable and marginalized communities.

1. Donate a massage gift certificate to a local LGBTQ organization to help with a fundraiser. Or, consider sponsoring a local event!
   
   
2. Start or join an Employee Resource Group at your practice that focuses on LGBTQ issues to make sure you and your staff are staying updated on inclusive practice.
   
   
3. If you can, consider offering sliding scale pricing to LGBTQ clients who might not be in a position to pay full price for regular massage therapy.
   
   
4. Make sure your LGBTQ clients have visible reminders they are in safe space, whether that’s gender neutral restrooms, staff that asks for pronouns and offer their own, pride flags or anything else that feels right for you and your practice.
   
   
5. Commit to continually educating yourself and others when you can so you can continue to build on the inclusive environment you’ve started. Also, doing that personal work means your LGBTQ clients don’t have to spend their own energy educating people.
   
   Our clients put their trust in us to care for them week after week, month after month, sometimes for years at a time. We owe it to them to extend that care to all aspects of their lives. Doing so will positively impact their health and well-being, and will create a more just environment for us all.

This sentiment should absolutely include our LGBTQ clients.

Where Can I Learn More?

When my son told me he was a boy over 14 years ago, I had no idea what that meant or where to find more information to help me guide him to become the sensitive, articulate, intelligent, helpful, talented, goofy young man that he is today.

Fortunately, there are more resources available today to help everyone better understand LGBTQ people and how to be inclusive when serving your LGBTQ clients.

Some organizations you might consider to learn more about creating inclusive practice include:

• The National Center for Transgender Equality
  
  
• GLAAD
  
  
• PFLAG
  
  
• The GenderCool Project
  
  
• The Trevor Project

All of these organizations are focused on lifting up the voices of LGBTQ people and encouraging and educating the rest of us on how to manifest a safer and more supportive world—and practice space—for vulnerable populations.