Trans broken arm syndrome: A mixed-methods exploration of gender-related medical misattribution and invasive questioning

Wall, Catherine S. J.; Patev, Alison J.; Benotsch, Eric G.

doi:10.1016/j.socscimed.2023.115748

Cited by 37 publications

(18 citation statements)

References 63 publications

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“…Providers with inadequate training on gender-affirming care may draw on cultural scripts that perpetuate biases ( Shuster, 2021 ). For example, the experience of gender-related medical misattribution and invasive questioning, a phenomenon also known as “trans broken arm syndrome,” demonstrates the propensity for bias among medical practitioners who incorrectly reduce a patient’s health issue to stereotypes associated with TGD identities ( Wall et al, 2023 ). This may include incorrectly assuming psychological distress, mental illness, and confusion; hyperfocusing on biological and physical components of transition; and being dismissive of one’s gender identity ( Howansky et al, 2021 , Wall et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

“…For example, the experience of gender-related medical misattribution and invasive questioning, a phenomenon also known as “trans broken arm syndrome,” demonstrates the propensity for bias among medical practitioners who incorrectly reduce a patient’s health issue to stereotypes associated with TGD identities ( Wall et al, 2023 ). This may include incorrectly assuming psychological distress, mental illness, and confusion; hyperfocusing on biological and physical components of transition; and being dismissive of one’s gender identity ( Howansky et al, 2021 , Wall et al, 2023 ). Interventions to increase clinician knowledge about TGD health may aid in mitigating the impacts of HCST that create barriers to having a personal provider for TGD populations.…”

Section: Discussionmentioning

confidence: 99%

“…Social, psychological, medical, and legal gender affirmation in healthcare contexts is vital to support TGD individuals and communities ( Reisner et al, 2016 ). Utilizing gender-affirming practices during appointments, such as asking only medically relevant questions, validating TGD identity, and finding ways to highlight the patient’s resiliency, can support TGD self-esteem ( Goldenberg et al, 2019 , Lambrou et al, 2020 , Wall et al, 2023 , Reisner et al, 2016 ). Creating affirming clinical spaces and waiting rooms, and educating providers, administrative, and medical staff can also minimize environmental cues that invoke stereotype threat ( Goldenberg et al, 2019 , Kcomt et al, 2020 , Lambrou et al, 2020 , Lelutiu-Weinberger et al, 2016 , Radix, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults

LeBlanc,

Trinh,

Zubizarreta

et al. 2024

Preventive Medicine Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults

LeBlanc,

Trinh,

Zubizarreta

et al. 2024

Preventive Medicine Reports

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“…There are certain unique considerations for pediatric providers caring for TGD youth. Providers should take care to avoid ‘broken arm syndrome,’ which describes the inappropriate attribution of medical issues to one's gender identity [26 ▪▪ ]. Youth-serving clinicians should carefully assess a TGD youth's growth and weight patterns.…”

Section: Role Of the Pediatric Provider In Caring For Transgender And...mentioning

confidence: 99%

Transgender and gender-diverse youth: an update on standard medical treatments for gender dysphoria and the sociopolitical climate

Arnold

McNamara

2023

Current Opinion in Pediatrics

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Purpose of review Transgender and gender-diverse (TGD) youth experience a discordance between their binary sex assigned at birth and gender identity. All TGD youth benefit from compassionate care delivered by clinicians who are informed in matters of gender diversity. Some of TGD youth experience clinically significant distress, termed gender dysphoria (GD), and may benefit from additional psychological support and medical treatments. Discrimination and stigma fuel minority stress in TGD youth and thus many struggle with mental health and psychosocial functioning. This review summarizes the current state of research on TGD youth and essential medical treatments for gender dysphoria. These concepts are highly relevant in the current sociopolitical climate. Pediatric providers of all disciplines are stakeholders in the care of TGD youth and should be aware of updates in this field. Recent findings Children who express gender-diverse identities continue to express these identities into adolescence. Medical treatments for GD have a positive effect on mental health, suicidality, psychosocial functioning, and body satisfaction. The overwhelming majority of TGD youth with gender dysphoria who receive medical aspects of gender affirming care continue these treatments into early adulthood. Political targeting and legal interference into social inclusion for TGD youth and medical treatments for GD are rooted in scientific misinformation and have negative impacts on their well being. Summary All youth-serving health professionals are likely to care for TGD youth. To provide optimal care, these professionals should remain apprised of best practices and understand basic principles of medical treatments for GD.

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“…Studies of transgender men and cisgender women who have sex with women found cervical screening disparities due to physical discomfort or gender dysphoria exacerbated by the screening process 31 32. Transgender patients may also be more likely to experience diagnostic error due to the trans broken arm syndrome, a phenomenon where providers misattribute health concerns to patients’ transgender identity; for example, symptoms of a health condition are blamed on the transgender individual’s hormone replacement therapy (HRT) usage 33 34…”

Section: Introductionmentioning

confidence: 99%

“It’s probably an STI because you’re gay”: a qualitative study of diagnostic error experiences in sexual and gender minority individuals

Wiegand,

Sheikh,

Zannath

et al. 2023

BMJ Qual Saf

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BackgroundThere is a critical need to identify specific causes of and tailored solutions to diagnostic error in sexual and gender minority (SGM) populations.PurposeTo identify challenges to diagnosis in SGM adults, understand the impacts of patient-reported diagnostic errors on patients’ lives and elicit solutions.MethodsQualitative study using in-depth semistructured interviews. Participants were recruited using convenience and snowball sampling. Recruitment efforts targeted 22 SGM-focused organisations, academic centres and clinics across the USA. Participants were encouraged to share study details with personal contacts. Interviews were analysed using codebook thematic analysis.ResultsInterviewees (n=20) ranged from 20 to 60 years of age with diverse mental and physical health symptoms. All participants identified as sexual minorities, gender minorities or both. Thematic analysis revealed challenges to diagnosis. Provider-level challenges included pathologisation of SGM identity; dismissal of symptoms due to anti-SGM bias; communication failures due to providers being distracted by SGM identity and enforcement of cis-heteronormative assumptions. Patient-level challenges included internalised shame and stigma. Intersectional challenges included biases around factors like race and age. Patient-reported diagnostic error led to worsening relationships with providers, worsened mental and physical health and increased self-advocacy and community-activism. Solutions to reduce diagnostic disparities included SGM-specific medical education and provider training, using inclusive language, asking questions, avoiding assumptions, encouraging diagnostic coproduction, upholding high care standards and ethics, involving SGM individuals in healthcare improvement and increasing research on SGM health.ConclusionsAnti-SGM bias, queerphobia, lack of provider training and heteronormative attitudes hinder diagnostic decision-making and communication. As a result, SGM patients report significant harms. Solutions to mitigate diagnostic disparities require an intersectional approach that considers patients’ gender identity, sexual orientation, race, age, economic status and system-level changes.

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Trans broken arm syndrome: A mixed-methods exploration of gender-related medical misattribution and invasive questioning

Cited by 37 publications

References 63 publications

Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults

Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults

Transgender and gender-diverse youth: an update on standard medical treatments for gender dysphoria and the sociopolitical climate

“It’s probably an STI because you’re gay”: a qualitative study of diagnostic error experiences in sexual and gender minority individuals

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