SO/GI questions exist that have been shown to be acceptable to patients from diverse backgrounds in real-world settings. In 2013, The Fenway Institute and the Center for American Progress conducted a study that asked 301 people in the waiting rooms of health centers in Chicago, Baltimore, Boston, and rural Beaufort County, South Carolina how they felt about answering questions about sexual orientation and gender identity. Most respondents were heterosexual and non-transgender; more than half were people of color, and 7 percent were over age 65. A majority of the patients surveyed were heterosexual or straight and not transgender, and a sizable minority were LGBT. Across all of these variables and regardless of geography, respondents overwhelmingly supported the collection of SO/GI data in health care encounters. Specifically, 73 percent agreed that sexual orientation data are important for providers to know, and 82 percent agreed with regard to gender identity data. Most LGBT respondents said that the questions allowed them to accurately reflect their SO/GI.
Based on this and other studies, such as research conducted by the Center of Excellence for Transgender Health at the University of California at San Francisco on how to ask about gender identity in clinical settings, (25) we recommend the following questions:
Do you think of yourself as:
- Lesbian, gay or homosexual
- Straight or heterosexual
- Something else (please specify): ___________
- Don’t know
With regard to gender identity, it is important to note that many transgender people do not identify as transgender. For example, a person who was assigned male at birth but whose current gender identity is female may choose “female” rather than “transgender.” Asking about sex assigned at birth as well as current gender identity provides better, more clinically relevant data and offers a clearer picture of the patient’s identity and clinical needs. As such, gender identity data collection should involve both of these concepts. Together, the questions below replace any existing “Sex: Male or Female?” questions on patient information forms and in EHRs.
Based on the 2013 Fenway/CAP study in four health centers, as well as prior research on how to ask about gender identity in clinical settings conducted by the Center of Excellence for Transgender Health at the University of California at San Francisco, (26) we recommend the following questions:
What is your current gender identity?
- Female-to-male (FTM)/Transgender Male/Trans Man
- Male-to-Female (MTF)/Transgender Female/Trans Woman
- Genderqueer, neither exclusively male nor female
- Additional Gender Category/(or Other), please specify:____________
- Decline to answer
What sex were you assigned at birth on your original birth certificate (Check one)
- Decline to answer
We also suggest asking questions to prevent misunderstandings that may occur for transgender people who do not have identification documents that accurately reflect their current name and gender identity:
Preferred gender pronoun:
Something else (Specify:_____________)
Preferred name or alias:
Preferred name and gender pronoun information has been shown to greatly facilitate patient-centered communication in clinical settings when coupled with appropriate staff training.