This article shares guidance on how to foster a gender-inclusive approach to practice, to offer safe and supportive healthcare for trans and non-binary patients.
Why is the right language important in herbal practice?
In healthcare settings, language is not just a tool for communication; it can deeply affect the patient’s experience, their level of comfort, and ultimately, their healing journey (1). The key to respectful communication is empathy. It is important to approach each patient with a nonjudgmental attitude and offer a space where they feel safe and validated in expressing themselves.
There is research showing that gender diverse and trans individuals are at significantly higher risk of mental health challenges compared to cisgender people. One key factor contributing to these challenges is the pervasive use of non-inclusive language. Studies indicate that when transgender individuals are misgendered or subjected to non-inclusive language, it can contribute to feelings of isolation, rejection, distress, anxiety and suicidal ideation (2,3,4).
Affirmation of gender identity, including the correct use of pronouns and names, is crucial for the mental health of trans people. Studies have demonstrated that when healthcare providers use correct pronouns and respect gender identities, it can have a significantly positive impact on the patient’s well-being (5).
Creating environments that are supportive of trans and gender diverse individuals and using inclusive language can drastically reduce the mental health risks they face. Gender-affirming language fosters an atmosphere of respect and trust, which can help reduce the stress and anxiety trans individuals’ experience when seeking healthcare services.
Gender diversity
Gender diversity is a term used to describe a wide range of gender identities that go beyond the traditional idea of male and female, man and woman. People can use different terms to describe themselves: trans, non-binary, gender non-conforming, gender fluid, or genderqueer, for example. These identities reflect a variety of ways that individuals express and experience their gender, which may not fit into the binary framework of strictly male or female (6).
The words trans, transgender, and gender diverse are often used as umbrella terms. These terms refer to people whose gender is different from the one they were assumed to have when they were born. This includes both trans men and trans women, as well as non-binary people who may also identify as trans.
Using umbrella terms helps us talk about a wide variety of gender identities and experiences in a way that brings people together. While no single word can fully capture every person’s unique experience, these terms can be useful for discussing a group of related identities. Not all trans people will relate to the word in the same way. What connects many trans people is the shared experience of living in a world that often makes assumptions about gender.
Some gender-inclusive terminology
- Cisgender: A person whose gender identity aligns with the sex they were assigned at birth.
- Transgender: A person whose gender identity does not align with the sex they were assigned at birth.
- Non-binary: A person whose gender identity falls outside the traditional male and female binary.
- Genderfluid: A person whose gender identity may shift over time.
- Agender: A person who does not identify with any gender.
People who are not cis, can identify as trans, non-binary, genderfluid and/or agender at the same time. They are not exclusive of one another.
Gender dysphoria
Dysphoria is a word that generally describes a feeling of discomfort, distress, or unease. For some trans people, this feeling is connected to their gender, their bodies, or how others see and treat them. When this kind of discomfort is related to gender, it is often called gender dysphoria (7).
In 2013, the term ‘gender dysphoria’ was officially added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association (8). Many viewed this change as a step forward, because it shifted attention away from a person’s identity and instead focused on an experience some people have. Rather than seeing being trans as something that needed to be fixed, the focus became about recognising and responding to emotional distress (6).
However, this also created a misunderstanding — that all trans people must experience dysphoria in order to be recognised as truly trans. This is not the case. Not every trans person experiences gender dysphoria, and those who do, experience it in different ways. For some, the feelings can be very strong and affect many areas of life. For others, the feeling may not be present at all. It can also change over time, especially during or after gender-affirming care (7).
Practical advice on gender-inclusive language
As a general rule, instead of asking yourself “what is this person’s sex and gender?”, a better way to go around this is: “what do I need to know about this person?” (6).
When trans and non-binary people seek healthcare, there are several important things they look for in a practitioner. One of the most essential aspects is respect for their identity and pronouns. This means using the correct names and pronouns for each person and not making assumptions about their gender based on appearance or voice.
Another important factor is the use of gender-affirming language. Healthcare providers should try to avoid using gendered terms unless it is necessary and should be open to learning and using more inclusive language. This helps patients feel seen and respected.
For example, words like ‘woman’ and ‘man’ are not always appropriate, especially in diverse gender identities. Instead, use gender-neutral terms when possible. For instance:
- ‘Person’ instead of ‘woman’ or ‘man’
- ‘Partner’ instead of ‘husband/boyfriend’ or ‘wife/girlfriend’
- ‘Parent’ instead of ‘mother’ or ‘father’
- ‘Sibling’ instead of ‘brother’ or ‘sister’
- ‘Pregnant people’ instead of ‘pregnant women’
For example, instead of saying, “As a woman, you should avoid…” it is better to say, “As someone with this health condition, you may need to avoid […]”
Other examples:
It is better to say: “If a person with a prostate has urinary symptoms, they should speak with their doctor.”
Instead of: “If a man develops urinary symptoms […]”.
It is better to say: “We recommend that anyone who has a cervix consider having a cervical screen.”
Instead of: “We recommend women should have a cervical screen […]”.
When referring to body parts, the best thing to do if you are unsure about what will make your patient comfortable is to ask them what terms they would prefer for key body parts like the upper body, their genitals, their reproductive organs, the menstrual cycle and the anus. Often using certain terminology can contribute to feelings of dysphoria (7).
If you haven’t asked, using neutral terms can be helpful. For example:
- ‘Upper body’ instead of ‘chest’ or ‘breasts’
- ‘Genitals’ instead of ‘penis’ or ‘vagina’
- ‘Reproductive organs’ or ‘internal/external gonads’ instead of ‘uterus’, ‘ovaries’, ‘testes’
- Avoid assumptions about gendered health needs
Do not assume that certain health issues, especially those related to sexual or reproductive health, are exclusive to one gender. For example, assume that a person assigned female at birth who now identifies as male may still need guidance on managing menopause, or someone who identifies as non-binary may seek help with managing hormone therapy side effects.
Use open-ended questions to understand the health needs of the patient. For example:
- “What are the most important aspects of your health and wellness at the moment?”
- “Do you experience any symptoms or challenges that you would like support with?”
This creates space for the patient to communicate their concerns without feeling constrained by gender norms.
If you want to address someone’s reproductive organs, and are unaware of the people’s anatomies, instead of asking questions like: Are you female or male?”, it is better to ask questions like: “I am concerned about your cancer screening, do you have a cervix or a prostate?”.
Examples to speak about symptoms or topics related to reproductive organs (6):
- “This medication can sometimes influence people’s periods. Do you or have you menstruated in the past?”
- “This test can be done via a urine sample or an internal genital swab. Do you have a preference?”
- “Is there a risk of pregnancy for any of the sex that you’re having?”
Herbal medicine often intersects with hormonal health and wellbeing. Many plants and herbs interact with the endocrine system, which influences biological sex characteristics. Many patients may seek herbs to support their hormones (such as vitex or black cohosh), and it is essential to consider the implications for individuals who are transitioning or undergoing gender-affirming treatments. These patients may experience different responses to herbs due to hormone therapy or surgeries they’ve undergone. When discussing menstruation, be mindful that not everyone who menstruates identifies as a woman, and some cisgender women may not menstruate for a variety of reasons.
Summary
Practical tips that herbalists can use to make their practice safer for gender diverse individuals:
- Use intake forms and ask for pronouns.
- Introduce yourself using your pronouns, this gives patients a hint that you are aware that assuming someone’s pronouns is not right. If you have not used an intake form to know what their pronouns are, follow your introduction with a question such as, “may I ask what pronouns you prefer?”
- Do not assume people have ‘gender dysphoria’ and do not diagnose it unless your patient tells you that that is what they are experiencing.
- If you don’t use the right pronouns or you misgender your patient, don’t dwell on it, just acknowledge it, quickly apologise and move on. A lengthy apology can alienate them.
- Use gender affirming language, and if unsure, ask patients how they would like to refer to a specific body part or body function. If you do it from a place of kindness and respect, patients prefer you asking than using terms that can contribute to a feeling of dysphoria.
And last but not least, it is important to remember that body modifications such as top surgery or bottom surgery or taking hormones are not a synonym of someone’s ‘transness’. There are different ways in which people want to express their gender. That might be in how they dress, how they style their hair, using or not using makeup, what name they use, what pronouns they use or indeed taking hormones (oestrogen, testosterone), or having surgery (6,9).
References
- Cox C, Fritz Z. Presenting complaint: use of language that disempowers patients. BMJ. 2022;377:e066720. https://doi.org/10.1136/bmj-2021-066720
- Glynn TR, Gamarel KE, Kahler CW, Iwamoto M, Operario D, Nemoto T. The role of gender affirmation in psychological well-being among transgender women. Psychol Sex Orientat Gend Divers. 2016;3(3):336–344. https://doi.org/10.1037/sgd0000171
- Budge SL, Adelson JL, Howard KA. Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping. J Consult Clin Psychol. 2013;81(3):545–557. https://doi.org/10.1037/a0031774
- Pinna F, Paribello P, Somaini G, et al. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry. 2022;34(3-4):292–359. https://doi.org/10.1080/09540261.2022.2093629
- Glynn TR, Gamarel KE, Kahler CW, Iwamoto M, Operario D, Nemoto T. The role of gender affirmation in psychological well-being among transgender women. Psychol Sex Orientat Gend Divers. 2016;3(3):336–344. https://doi.org/10.1037/sgd0000171
- Trans Hub. https://www.transhub.org.au/. Accessed April 5, 2025.
- Cooper K, Russell A, Mandy W, Butler C. The phenomenology of gender dysphoria in adults: A systematic review and meta-synthesis. Clin Psychol Rev. 2020;80:101875. https://doi.org/10.1016/j.cpr.2020.101875
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
- Preciado B. Testo Junkie: Sex, Drugs, and Biopolitics in the Pharmacopornographic Era. New York, NY: The Feminist Press at CUNY; 2013.
