June 2015, Volume 101, No.
6 Letters to the Editor
Communicating With a Transgender Patient
I would like to provide clarication and information in sup-
port of the Terminology for the transgender community
question and answer in Clinical IssuesdFebruary 2015
(February 2015, Vol 101, No 2) written by Byron L.
Burlingame, MS, BSN, RN, CNOR. The answer provided
guidance in response to a question about the correct termi-
nology to use when providing care for a transgender patient.
Nurses need to understand how to respectfully communicate with
a transgender patient undergoing surgery. Transgender is the
appropriate term commonly accepted in the transgender com-
munity. Terms such as gender nonconforming, genderqueer, and
transsexual do not provide the nurse with good communication
approaches to transgender care. Transgender persons wish to be
acknowledged according to the name and pronoun that corre-
sponds to their gender identity. Use he for a female-to-male
transgender individual and she for a male-to-female trans-
gender individual.
During registration, a transgender patient should be asked
for his or her preferred name, which may be different from
his or her legal name. A female-to-male transgender patients
legal name on the medical insurance card may be Michelle,
but his preferred name may be Mike. The nurse can ask the
patient, What is your preferred name? The nurse then
documents the preferred name and uses it when speaking to
the patient.
Several comments by the author are not supported in the
literature or require clarication.
1. The process of transitioning from the assigned gender
role to another begins when a person decides to live
openly as the gender he or she identies with rather than
the gender assigned at birth.
Gender roles are established at birth. When a person rejects a
traditional role and establishes a new gender identity, he or she
does not automatically decide to live openly. Living openly
would most likely invite discrimination. A person desiring to
embrace a new gender identity often fears the possibility of
being outed and keeps the decision a secret. When the
transgender person is emotionally prepared to come out, he
or she will publically express the change.
2. The transition may or may not include medical treat-
ment (eg, taking hormones, sexual reassignment surgery)
or legal changes (eg, changes to the drivers license, Social
Security record) to reect the new gender identity.
www.aornjournal.org
Transgender individuals routinely take hormones during
transition. Unsupervised hormone use has been docu-
mented in 58% of male-to-female transgender individuals.1
Studies have documented transgender success rates for
changing drivers licenses at 59% and social security cards
at 49%.2 Changes in identication are a familiar
occurrence during transition.
3. The medical record should contain the current name of
the patient; however, the name on the previous medical
records may be different from the patients current name.
If a discrepancy exists, the patient should be asked to state
his or her current name and previous name to conrm
the identity of the patient.
Asking a transgender patient to state his or her current name
and previous name is outing the patient. When a transgender
individual comes to surgery, the nurse may see different names
on different documents. Here is a ctional example. The name
on the patients chart and medical insurance card is Michelle
Smith, while the name and signature on the consent and the
drivers license is Michael Smith. The name on the wristband
is Michelle Smith. The nurse identies the patient by asking
his or her name and date of birth. The name and date of birth
are conrmed according to the patients chart.
I believe the Clinical Issues author had good intentions, but
subjects such as transgender care are complex, and a one-page
explanation cannot completely address the subject. Nursing
questions on subjects such as transgender care should not be
addressed in a Clinical Issues format. My manuscript,
Transgender Care in Surgery and Beyond, provisionally
accepted for publication in the AORN Journal, will provide

nurses with the education they need to care for the trans-
gender patient.
Francis Duval Smith, MSN, RN, CNOR
AVP Nursing Services
Surgical Suite
Geisinger Health System
Danville, PA
http://dx.doi.org/10.1016/j.aorn.2015.04.007
References
1. Xavier JM, Simmons R. The Washington Transgender Needs
Assessment Survey. Gay and Lesbian Activists Alliance. http://www
.glaa.org/archive/2000/tgneedsassessment1112.shtml. Accessed
April 6, 2015.
AORN Journal j 603
Letters to the Editor
2. Grant JM, Mottet LA, Tanis J. Injustice at every turn: a report of
the National Transgender Discrimination Survey. National Center
for Transgender Equality. http://www.transequality.org/sites/
default/les/docs/resources/NTDS_Report.pdf. Accessed April
6, 2015.
Author response
I thank Mr Smith for his letter. I agree that the subject
of transgender care is complex, but for complex topics
to be digested, at times they must be broken down into smaller
pieces, such as a Clinical Issues column. I am happy that
another perioperative nurse has taken the initiative to author
an article on this complex and sensitive topic because each
opportunity to educate perioperative professionals about this
topic can increase understanding of how to address and pro-
vide care for transgender individuals.
I agree with Mr Smith that the transgender person should be
addressed as he or she, as that person prefers. The terms
gender nonconforming and genderqueer were included as
educational information to assist the nurse who has a patient
who identies with one of those terms. They were not
intended to be conveyed as ways to address a transgender
person. Transsexual was included because it is a term with
Correction
February 2015, VOL 101, NO 2, pages 178-179. The Special Thanks to the 2014 AORN Journal Authors
incorrectly omitted David L. Taylor III, MSN, RN, CNOR, from the list of authors. AORN is proud to recognize
Mr Taylor as one of the talented authors who make the AORN Journal a respected source of quality information
for perioperative nurses, educators, managers, and leaders.
604 j AORN Journal
June 2015, Volume 101, No. 6
which the nurse may be familiar, although this term should
no longer be used.
In response to the comment that the establishment of a new
gender identity does not necessarily occur in tandem with
living openly, the description of the transition process I used is
a paraphrase of information found in references cited within the
article. This description appears to be more restrictive than Mr
Smiths description and begins at a different time frame.
In response to the assertion that asking a transgender patient to
state his or her name and previous name is outing the patient,
the patient is already out in the medical setting where this
conversation takes place. This conversation should take place in
private. This is the same type of conversation that should take
place with any person who has changed his or her name, such as
the woman who has recently been married and has taken her

husbands surname or a man who has married another man and
may now have a hyphenated surname.
Byron L. Burlingame, MS, BSN, RN, CNOR
Perioperative Nursing Specialist
AORN, Inc
Denver, CO
http://dx.doi.org/10.1016/j.aorn.2015.04.006
www.aornjournal.org
Letters to the Editor
2. Grant JM, Mottet LA, Tanis J. Injustice at every turn: a report of
the National Transgender Discrimination Survey. National Center
for Transgender Equality. http://www.transequality.org/sites/
default/les/docs/resources/NTDS_Report.pdf. Accessed April
6, 2015.
Author response
I thank Mr Smith for his letter. I agree that the subject
of transgender care is complex, but for complex topics
to be digested, at times they must be broken down into smaller
pieces, such as a Clinical Issues column. I am happy that
another perioperative nurse has taken the initiative to author
an article on this complex and sensitive topic because each
opportunity to educate perioperative professionals about this
topic can increase understanding of how to address and pro-
vide care for transgender individuals.
I agree with Mr Smith that the transgender person should be
addressed as he or she, as that person prefers. The terms
gender nonconforming and genderqueer were included as
educational information to assist the nurse who has a patient
who identies with one of those terms. They were not
intended to be conveyed as ways to address a transgender
person. Transsexual was included because it is a term with
Correction
February 2015, VOL 101, NO 2, pages 178-179. The Special Thanks to the 2014 AORN Journal Authors
incorrectly omitted David L. Taylor III, MSN, RN, CNOR, from the list of authors. AORN is proud to recognize
Mr Taylor as one of the talented authors who make the AORN Journal a respected source of quality information
for perioperative nurses, educators, managers, and leaders.
604 j AORN Journal
June 2015, Volume 101, No. 6
which the nurse may be familiar, although this term should
no longer be used.
In response to the comment that the establishment of a new
gender identity does not necessarily occur in tandem with
living openly, the description of the transition process I used is
a paraphrase of information found in references cited within the
article. This description appears to be more restrictive than Mr
Smiths description and begins at a different time frame.
In response to the assertion that asking a transgender patient to
state his or her name and previous name is outing the patient,
the patient is already out in the medical setting where this
conversation takes place. This conversation should take place in
private. This is the same type of conversation that should take
place with any person who has changed his or her name, such as
the woman who has recently been married and has taken her

husbands surname or a man who has married another man and
may now have a hyphenated surname.
Byron L. Burlingame, MS, BSN, RN, CNOR
Perioperative Nursing Specialist
AORN, Inc
Denver, CO
http://dx.doi.org/10.1016/j.aorn.2015.04.006
www.aornjournal.org