"I don't think I have been out of fight or flight. Ever." Transgender people's experiences in inpatient psychiatric treatment.
Kristen D Clark, Jordon D Bosse, Kasey B Jackman and 6 others
PMID 40043471WHAT IT FOUND
Transgender adults described inpatient psychiatric care as exhausting because staff misgendered them, withheld hormones, and ignored their distress.
Nurses who actively corrected names and advocated for affirming care were rare but made the difference between feeling safe and feeling targeted.
Key findings
01Participants reported that electronic health records often failed to communicate chosen names and pronouns, leading to frequent accidental misgendering by staff.
02Five of seven participants taking gender-affirming hormones had them withheld during admission, often for the entire stay, due to staff beliefs that these medications caused or worsened their psychiatric crisis.
03Nurses were described as the primary professionals who disrupted institutional transphobia by creating workarounds for correct name and pronoun usage, though this occurred rarely and relied on individual staff members.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small (n=15), predominantly white, and entirely from the US, limiting generalizability to other racial, ethnic, or geographic groups. The study was cross-sectional, so causal relationships between specific staff behaviors and patient outcomes cannot be inferred. The shift to Zoom interviews during the pandemic may have excluded individuals without reliable internet or private space. External perspectives from the transgender community were not sought, though some team members were transgender.
Declared interests
The authors declare no conflicts of interest. Funding details are not explicitly stated in the provided text, but the study was approved by institutional review boards at UCSF and the University of New Hampshire.
The easy way to misread this
Do not interpret the withholding of hormones as a standard or safe practice. The paper notes that this was often based on staff misconceptions that hormones caused the crisis, contradicting evidence that they often improve mental health outcomes. Always verify the medical necessity and history of these medications before pausing them.