LGBTQ+ Affirming Care: Guiding Principles

At Fishtown Medicine, we work at the pace of your trust. Relationship-based care requires more than clinical expertise. It requires a real commitment to affirming the identity of every person who walks through our door or enters our virtual clinic. These standards guide our communication, documentation, and clinical approach for transgender, non-binary, and gender-expansive patients.

1. Foundational Terminology

We recognize that gender and sex are distinct concepts. Precise language is a clinical tool that improves accuracy and builds rapport.

• Gender Identity: One's internal, deeply held sense of being male, female, both, neither, or another gender.
• Sex Assigned at Birth: The label (typically male or female) given by a medical professional at birth, usually based on external genitalia.
• Sexual Orientation: An individual's emotional, romantic, and sexual attraction to others.
• Cisgender: When gender identity aligns with sex assigned at birth.
• Transgender: An umbrella term for those whose gender identity differs from their sex assigned at birth.

2. Affirming Communication Standards

2.1 Names & Pronouns

• Use Chosen Names: We always lead with your chosen name. Using a "deadname" (a name no longer used) is clinically disruptive and disrespectful.
• Respect Pronouns: We use the pronouns you provide (for example, he/him, she/her, they/them). Pronouns are not "preferred." They are yours.
• Normalize Sharing: Our team often leads by sharing our own pronouns (for example, "I'm Dr. Ash, I use he/him pronouns") to make space for yours.

2.2 Avoiding Assumptions

• Gendered Honorifics: We avoid "Sir" or "Ma'am" unless explicitly requested.
• Voice & Appearance: We never assume gender identity or sexual orientation based on vocal pitch, physical appearance, or clothing.
• Partner Language: We use gender-neutral terms like "partner" or "spouse" until you tell us your preferred terminology.

3. Clinical & Data Accuracy

3.1 Legal vs. Clinical Identity

We understand that legal documents (ID, insurance) often mismatch a patient's true identity due to systemic barriers.

• Our medical records prioritize your Chosen Name and Gender Identity for all communication.
• Legal name and markers are stored strictly for billing, prescriptions (where required by law), and insurance coordination.

3.2 Proportional Inquiry

We only ask questions that are clinically necessary.

• We do not ask about surgical history or anatomy unless it directly affects the diagnosis, treatment, or safety of the care we are providing.
• If we must ask a sensitive question (for example, to confirm the risk of pregnancy with a specific medication), we will explain why the information is needed for your safety.

4. Troubleshooting & Clinical Safety

4.1 When Mistakes Happen

Mistakes in names or pronouns can happen. If we misgender you or use an incorrect term:

1. Apologize quickly.
2. Correct the mistake.
3. Move on. We do not make the moment about our own guilt. We refocus on your care.

4.2 Pregnancy & Lactation Safety (Anatomy-Based)

We screen for safety based on anatomy and clinical risk, not just gender identity.

• Capacity for Pregnancy: Transgender men and non-binary individuals assigned female at birth may retain the capacity for pregnancy, even on testosterone therapy. Testosterone is not birth control.
• Chestfeeding/Lactation: Transgender men may chestfeed, and some transgender women may induce lactation.
• Sample Language: To keep you safe, we use neutral language: "To ensure this medication is safe for you, we need to confirm whether there is any chance you could be pregnant or breastfeeding/chestfeeding."

5. Product & Protocol Considerations

We provide nuanced care that accounts for the intersection of biology and identity.

• Skin (Tretinoin): Used for acne (common on testosterone therapy) or anti-aging. Requires pregnancy screening for any patient with a uterus.
• Hair (Finasteride/Minoxidil): Often used as adjuncts to gender-affirming hormone therapy. Must be avoided if there is a risk of pregnancy.
• Sexual Health (ED Meds): Sildenafil and Tadalafil are vasodilators that can be used by patients of any gender identity with the appropriate anatomy. We treat the symptom, not the label.
• Reproductive Health:
  • Birth Control: Used by transgender men and non-binary people for pregnancy prevention or period cessation.
  • Feminizing/Masculinizing Hormones: We support structured pathways using Estradiol, Spironolactone, or Testosterone with careful biomarker monitoring.
• Anatomical Care: We make sure that preventive screenings (breast exams, prostate screenings) are based on the organs present, regardless of gender identity.

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Local Affirming Care Hubs

We are proud to serve as a medical home for the LGBTQ+ community across Philadelphia. If you are looking for affirming care in your specific neighborhood, explore our local guides.

• Fishtown & 19125: Our physical home and a hub for inclusive primary care.
• Northern Liberties & 19123: Modern, tech-forward health optimization for the NoLibs community.

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Fishtown Medicine is committed to providing a safe, intelligent, and affirming medical home for the LGBTQ+ community in Philadelphia and beyond.