Gender-sensitive care in Traditional Chinese Medicine

ByKingsley
Two pictures of Otis Bell, a white, trans Traditional Chinese Medicine practitioner. On the left picture, Otis is inserting an acupuncture needle into the arm of a patient. On the left is a picture of Otis' chest with acupuncture needles surrounding his chest surgery scars.

I recently sat down for a conversation with my friend Otis Bell, who is a transgender Chinese medicine student and bodywork practitioner here on Lkwungen Territories. Here are some of his thoughts on the considerations and applications of Traditional Chinese Medicine (TCM) with transgender, non-binary, and two-spirit clients!

Core principles of Traditional Chinese Medicine

In general, TCM is very adaptable to trans patients, because every human has yin and yang, excess and deficiency, heat and cold, damp and wind, femininity and masculinity. We are all essentially a microcosm of larger ecosystems, and which are fluid, adaptable, and in a constant state of transformation. Yin and yang are built into every aspect of life, from the most basic to the complex. A core practical application of TCM is bringing these yin (feminine) and yang (masculine) energies into a balanced flow that mirrors the energetic flows of the universe.

Trans, non-binary, and two-spirit TCM clients

While TCM is applicable to all bodies, here are some considerations when with respect to your intakes with trans, non-binary, and two-spirit clients:

Forms:

Most sections on intake forms are very neutral, but things relating to genitalia, development, puberty, pregnancy, aging, hormones, and sexuality are the areas where potential exists for practitioners to misgender people or have unfounded assumptions. These are the main areas for practitioners to educate themselves about the diverse possibilities for anatomies and health histories. Ensuring there is space on your forms to indicate indicate gender in an open ended way (i.e. Gender: ___________), and preferred name, and pronouns is a great place to start.

Intakes:

The most important thing we can do as practitioners is to check our assumptions. For instance, not assuming that someone who you perceive as female has a period or could become pregnant and similarly, not assuming that someone you perceive as a man is without a period (currently or in the past), or hasn’t ever given birth.

Questions about hormonal cycles are common in diagnostic questioning sessions. These questions primarily exist so the TCM practitioner can gain as accurate a picture as possible of your internal health landscape. The answers to them are not going to matter in the sense of gender determinism indicating particular treatment. They will simply lead to knowing if the person has menstruated/given birth/undergone surgery and did this head to significant loss of blood, qi, or yin for example.  The possibilities for gender diversity are not in conflict with practice.

TCM and “transition” as complementary practices

Transition will mean something really different to each trans, non-binary, or two-spirit person. Sometimes that means a change in name and/or pronouns, sometimes it can mean changes in expression and aesthetic, and sometimes it can mean accessing hormonal supplements or affirming surgery/ies. It can be stressful (and sometimes traumatic) to navigate these changes on both a personal and social level – TCM can help with managing and releasing these effects on a physiological and energetic level.

For trans, non-binary, and two-spirit clients to pursue elements of physical transition, TCM can:

  • address tissue/muscle pain from binding or gaffing (link NSFW…depending on where you work.)
  • help regulate changes in metabolism, sleep patterns, emotions, organ functions (renal, liver, etc), and body temperature that may accompany hormonal shifts
  • aid with pre and post care of surgeries

 Asking “the right questions”

From Ambit: As a practitioner, it can be hard to know what questions are appropriate to ask, how to ask them, and when. Before asking someone else any questions at all, though, ask yourself :

  1. Why do I want to ask this question?
  2. How will the answer help me better serve this client?

In an article by FORGE (an organization that offers assistance to professionals who aim to provide competent and respectful care to transgender individuals), they practice asking questions using the principle of “Know and Tell Why [.pdf].” This principle tells us to be very clear with ourselves about why we need certain information (whether it is about gender, income, marital status, etc) from a client, and having the transparency to then communicate those reasons to the client. By fully informing the client how information will be used, we offer them the most agency in choosing what to disclose.

Back to Otis: Asking “the right questions” is all about being curious, gentle, non-intrusive, and following the client’s lead for what they are wanting to disclose about their health history. Ultimately, they will tell you the pieces of their history that feel relevant and safe to tell you. It’s possible that as your client-practitioner relationship evolves over time, that the person will disclose more to you. But using the above guidelines for keeping your own assumptions in check is a great way to build trust, practice non-judgment, and create a sense of safety with clients of all a/genders.