There is very little information about transgender issues in audiology graduate education and continuing education. But with some simple adjustments, audiologists can help grow gender-diverse patients’ comfort and confidence as partners in their hearing care.
Madison Howe writes:
According to the chart, my next patient was a 9-year-old male with a history of unilateral hearing loss. But it was a girl that age who approached with her mother when I called them into the clinic. The family confirmed the birth date as correct, so I assumed registration must have input the wrong gender. I chose not to ask, since the family referred to the child as “she.” Ten minutes into our visit, the family confided that the patient was assigned male at birth but is female and uses she/her pronouns.
Thankfully, this was an ideal first experience working with a transgender patient. The family affirmed their daughter’s identity and shared her story with me without being prompted. This is not always the case, and often providers may feel uncomfortable without proper knowledge or training. You may also wonder, “How do I ask if the listed gender is correct?” or “What if I mess up and refer to them in the wrong way?” Many providers feel similarly.
I have seen an increase in gender diversity within my patient load and am hoping my experiences can assist fellow audiologists in providing services for the LGBTQ+ community. Here are some of the lessons I’ve learned since my first experience with that 9-year-old child and her family.
Be aware of implicit bias
Paediatric patients often view the colours of their hearing devices as a form of self-expression. It’s important to allow the patient to use their hearing device colour as their own form of expression, free from the audiologist’s bias or gender stereotypes.
I once had a patient who would not wear their hearing aids and struggled academically. At first, their teachers and parents thought perhaps other students bullied this child about their devices. However, months later the patient expressed they were not wearing their hearing aids because the devices were pink and increased his gender dysphoria, as the patient was transgender male. I learned from this patient the importance of allowing a patient to express themselves freely, and not letting implicit bias influence their decision based on a historical stereotype.
Mind patients’ names and pronouns
The words we use can have a major impact, especially when working to build trust. If a patient has shared their pronouns with you, it is critical to address them using those pronouns. Keep in mind, these are not considered “preferred” pronouns – just as with cisgender people, a person’s pronouns are non-negotiable.
If you are uncertain of a person’s pronouns, a good practice is to share yours first to spark the conversation. If you make a mistake and use the wrong pronoun, apologise quickly, correct yourself, and move on.
When using gender-affirming language make sure to avoid an individual’s former name. This may bring up the person’s gender assigned at birth, and, along with it, emotional trauma and gender dysphoria that can be harmful to the patient and to your relationship with them.
I learned the hard way about the importance of updating the patient’s name across every platform. I had successfully updated a patient’s name in our medical records and used their gender-affirming name and pronouns during our visit. However, I did not think to update the database where patient audiologic information is stored when programming their hearing aids.
At the next appointment, the patient reported they had not been connecting their hearing aids to their phone because every time they connected via Bluetooth, the phone asked to pair their past name’s hearing aids. I was heartbroken about my error. Thankfully, the patient forgave me, and I appreciated their willingness to help me learn.
Prep and coach interpreters
When working with an interpreter, I take steps to mitigate chances of tone and sincerity getting lost in translation. I check in with the interpreter before the visit to ensure they have knowledge of gender-diverse vocabulary. I introduce the patient by name and share their pronouns with the interpreter at the beginning of the appointment. Some patients have difficulty disclosing sensitive information when an interpreter is present, so remember to be patient and work to create an environment of trust.
Consider effects of frequency and voice alteration
Gender-diverse people who are deaf or hard of hearing face specific challenges. Many transgender individuals choose to alter their voice to better align with their gender. For a patient with a high-frequency hearing loss, raising the frequency of their voice could be difficult, as someone who can’t hear high frequency sounds will have difficulty reproducing them verbally. The same could be said for someone with a rising low-frequency hearing loss who wants to lower their pitch.
These are important factors to consider when programming hearing devices and counselling realistic expectations. For example, you might need to provide more high-frequency gain if the patient is trying to raise their vocal pitch (vice versa for lowering vocal pitch). You may also need to consider a different hearing aid or different technology if the patient wants their voice to sound different but doesn’t have good hearing access to the frequencies needed to modulate their voice in that way. I also recommend helping the patient find a speech-language pathologist who is familiar with both hearing loss and gender-affirming services or offering to collaborate with the patient’s SLP.
Strive for authenticity
Practicing gender-affirming care involves exactly that – practice. Keep educating yourself and using gender-affirming language until it becomes an authentic part of your professional life. Don’t be afraid to share with your patients that you are learning and show appreciation for their understanding while you grow. Use your patients as a resource and ask them to partner with you and help you become a more effective gender-affirming provider. Taking these steps will put you on the path to true patient-centred care, a goal we all strive to achieve.
The author of this article, Madison Howe, AuD, CCC-A (she/her/hers), is a paediatric audiologist at Arkansas Children’s Hospital in the U.S.A. howeml@archildrens.org
Published in ASHAWIRE.