Guidelines Relating to Transgender and Gender-Diverse Medical Students


Perelman School of Medicine Guidelines Relating to Transgender and Gender-Diverse Medical Students

Purpose

These guidelines set forth recommendations to address the needs of gender-diverse (transgender, non-binary, genderqueer, gender nonconforming) medical students at the Perelman School of Medicine (PSOM) at the University of Pennsylvania (Penn) and aim to clarify the PSOM practices that pertain to the rights and safety of such students.

Disclaimer

These guidelines do not anticipate every situation that might occur with respect to transgender/gender-diverse students, and individual needs must be assessed on a case-by-case basis. Additionally, terms and concepts pertaining to gender identity are dynamic, such that language employed in these guidelines may not reflect the most current vernacular employed to convey concepts that pertain to gender-diverse individuals in the United States (U.S.). In all cases, the goal of this document is to ensure the physical and psychological safety, and healthy development, of every student, while promoting the individual’s success, inclusion and retention, and minimizing their marginalization, stigmatization, and exclusion.

Definitions

The definitions provided here are not intended to label students, but to assist in understanding these guidelines. Students may or may not use these terms to describe themselves and, as noted above, these terms are not comprehensive or static.

Gender: Socially constructed characteristics used to ascribe assumed behaviors to different sexes. Gender varies from culture to culture and across various time periods.

Sex Assigned at Birth: A term used to refer to the sex assigned to a child at birth (male, female, intersex) by the medical establishment, most often based on a child’s external anatomy.

Gender Identity: A person’s internal, deeply felt sense of being male, female, something other, or in-between, regardless of their sex assigned at birth.

Gender Expression: A person’s characteristics and behaviors (such as appearance, dress, mannerisms, speech patterns, and social interactions) that may be perceived as masculine, feminine, neither, something other, or something in-between.

Legal/Government Name: A person’s legal name is that which is/was given on their birth certificate or appears on other official documentation. A person does not have to have their name changed legally to use a name (and some cannot afford to do so). All people should be afforded the same respect in verbal interactions around their name.

Preferred/Chosen/Lived Name: A person’s preferred/chosen/lived name is the name that the person uses in their daily life. An individual may go through the process of aligning their legal name and chosen name, although there are many reasons why an individual may be unable or choose not to.

Pronouns: Personal pronouns take the place of specific nouns that name people, places, and things. These words can replace a name to avoid repetition and help ease the flow of sentences. An individual has the right to be addressed by their name and chosen gender pronoun(s). 

For example:  

Gender-binary:
  
 Masculine: he, him, his 
   Feminine: she, her, hers

Gender non-binary: 
   They, them, their
   
Ze, xe, hir, xem, hym

If someone chooses to indicate their pronouns, they are simply letting others know how they can be referred to without others having to make assumptions. It is worth noting the list of gender pronouns above is not exhaustive, and there are other gender pronouns an individual could use to self-identify.

Cisgender: A person whose gender identity aligns with their sex assigned at birth.

Transgender: An umbrella term that can be used to describe people whose gender identity is different from their sex assigned at birth. For example, a person whose sex assigned at birth was female but who identifies as male is a transgender man. Many identities fit under the transgender umbrella, including but not limited to agender, gender fluid, genderqueer, nonbinary, and gender nonconforming. Some people who may fit this definition do not consider themselves transgender. A person does not need to identify as transgender for an employer’s nondiscrimination policies to apply to them.

Non-Binary: An adjective describing a person who does not identify exclusively as a man or a woman. Non-binary people may identify as being both a man and a woman, somewhere in between, or as falling completely outside these categories. While many also identify as transgender, not all non-binary people do. Non-binary can also be used as an umbrella term encompassing identities such as agender, bigender, genderqueer or gender-fluid.

Gender Nonconforming: A term used to describe a person whose gender expression differs from gender stereotypes, norms, and expectations in a given culture or historical period. Terms associated with gender nonconformity include, but are not limited to, gender expansive, gender variant, or gender diverse.

Gender Affirmation: The process by which a person receives recognition and support for their gender identity and expression. There are many different ways for individuals to affirm their gender. For some people, it is a complex process that takes place over a longer period of time, while for others it is a one- or two-step process that happens more quickly. Affirming one’s gender socially may include “coming out” (telling family, friends, and coworkers), using a new name, and/or changing their gender expression. Changing one’s name and/or gender marker or sex on legal documents is considered legally transitioning. Changing one’s physical appearance to align with their gender identity is considered medical transition, and can include surgery and/or hormones. Gender affirmation may also be called “transition.” 

Sexual Orientation: A person’s physical and/or emotional attraction to people of the same, neither, both, and/or other gender. Straight, gay, queer, asexual, bisexual, and pansexual are some ways to describe sexual orientation. It is important to note sexual orientation is distinct from gender identity and expression. Transgender people can be any sexual orientation, just like cisgender people.

LGBTQ+: A common abbreviation that refers to lesbian, gay, bisexual, transgender, and queer or questioning individuals. While LGBTQ+ are the most commonly used letters in the acronym, there are many other identities and sexualities. LGBTQ+ operates as an umbrella term for the community. Other umbrella terms for the community are “queer” or “queer and trans.”

EVERYONE HAS A . . .

  • Sex Assigned at Birth 
  • Gender Identity 
  • Gender Expression 
  • Sexual Orientation

Privacy

Transgender/gender-diverse students have the right to discuss their gender identity or expression openly, or to keep that information private. The transgender/gender-diverse student decides when, with whom, and how much to share their private information. Information about an individual’s gender status (such as the sex they were assigned at birth) can constitute confidential medical information under privacy laws like HIPAA. The transgender and gender non-binary status of an individual is considered confidential and should only be disclosed on a need-to-know basis, and only with the consent of the specific individual. Transitioning students may participate in the necessary education of their peers at whatever level they are comfortable. However, it is the responsibility of PSOM to create a safe learning environment for all students and it is not a transgender student’s responsibility to educate their peers. Educational resources are available through the Faculty Director of Gender and Sexuality Curriculum, the Penn Program for LGBT Health, and the Penn LGBT Center.

Changing Official Records

In support of Penn’s commitment to providing an equitable and safe experience for students whose legal name does not reflect their gender identity and/or gender expression, Penn accepts requests from any student who identifies in the aforementioned communities seeking to use a lived first and/or middle name in University records. A student’s lived name can and will be used where feasible in all University systems unless the student’s legal name use is required by law or the student’s preferred name use is for intent of misrepresentation.

Consistent with University policy, a student’s lived name will be used where feasible in all University systems unless the student’s birth name and/or legal name use is required by law. Once changed, a student can secure a new PennCard at no cost and will receive two diplomas, one with their lived name and one with their legal name. Any student who changes their name through this process should also be offered assistance changing their email address and email display name in the UPHS system. 

After a student initiates the process of a name change in University records, PSOM will make every effort to ensure that the change is implemented as smoothly as possible. A haphazard name change makes for a more difficult process of transition for the student and detracts from their educational experience. Administrative staff should work with the student to ensure that their name is updated in all PSOM records, including notification, as needed, of persons such as course directors who may store lists of students outside of regularly-updated computer systems.

A student who begins using a lived name later obtains a legal name change, should receive assistance to ensure that their name is appropriately updated in appropriate University systems and documents that require the use of a legal name. Additionally, Penn policy allows students to request their PennKey be changed in the event of a legal name change. 

Students who identify in the broader transgender community, and want to request to use their lived name, may follow the process found here. (https://www.vpul.upenn.edu/secure/form/preferredname/)

Restroom and Locker Room Accessibility

Students will have access to safe and appropriate restroom and locker room facilities within PSOM that correspond most closely to their gender identity, regardless of their sex assigned at birth. Any individual who has a need or desire for increased privacy, regardless of their gender identity or underlying reason, should be provided access to a single use or an all-gender restroom when available and in the case of locker room facilities, a reasonable alternative changing area, such as a single-use restroom will be provided. However, no student will be required to use such a restroom or alternative changing area. Every individual has the right to determine the most appropriate and safest restroom option for them, which may change over time.

A list and map of single use and all-gender restrooms on Penn’s campus can be found here.

Dress Codes

Students may follow professional dress and grooming styles that align with their gender identity, expression, and role within the organization.

Standards for Professionalism

Students, staff and faculty are expected to conduct themselves at all times in ways that are consistent with the high value that PSOM places on being an inclusive, welcoming, respectful and mutually supportive community.  Below are examples of actions and behaviors that would not be consistent with the values PSOM nor expectations for medical student or physician professionalism.

1. Refusal to Use the Name or Pronouns with which a Person Self-Identifies

a. Intentional or repeated refusal to use a person’s name, pronouns, or title. For example, repeatedly calling someone “him” or “Mr.” after she has made clear that she uses she/her and Ms.

b. Refusal to use a person’s name, pronouns, or title because they do not conform to gender stereotypes. For example, insisting on calling a person “Mr.” after they have requested to be called “Mx.”

c. Conditioning the use of a person’s name on them obtaining a court-ordered name change or providing legal identification in that name. For example, students may not refuse to call a transgender man who introduces himself as Manuel by that name because his identification lists his name as Maribel.

d. Requiring a person to provide information about their medical history or proof of having undergone particular medical procedures to use their affirming name, pronouns, or title.

2. Refusing to Allow People to Utilize Single-Gender Facilities and/or Programs Most Closely Aligned with their Gender Identity

a. Prohibiting a person from using a particular program or facility because they do not conform to gender stereotypes.

b. Prohibiting a transgender person from using the single-gender facility or resource most closely aligned with their gender identity. For example, a transgender man cannot be prohibited from using the men’s restroom.

c. Requiring a gender nonconforming person to provide identification or proof of their gender to access the appropriate single-gender resources.

d. Barring a non-binary student from any single-gender program or activity out of concern they will make other students uncomfortable.

e. Forcing a transgender, non-binary, gender nonconforming, or intersex person to use a single-occupancy restroom instead of a shared restroom.

3. Gender Stereotyping

a. Making unwelcome remarks about a person’s sexuality, gender expression, or gender identity based on their nonconformity with gender norms.

4. Imposing Different Grooming Standards Based on Gender

a. Enforcing grooming and appearance standards that apply differently to men or women, or that have gender-based distinctions. For example, permitting only women to wear jewelry or make-up or requiring only men to have short hair.

5. Engaging in Retaliation

a. Engaging in any unequal or discriminatory treatment of a student because the student made an internal complaint of discrimination.

To report breaches of these professional standards, students should contact the Associate Dean for Student Affairs and Wellness and/or file a report through Safety Net, which can be done anonymously.

LGBTQ+ Organizations and Resources at Penn Medicine

Penn Medicine Program for LGBTQ Health

The Penn Medicine Program for LGBTQ Health is committed to providing the best care for the LGBTQ community in a safe and friendly environment. It is one of the only programs in the nation that is dedicated to serving the LGBTQ community by providing culturally competent, judgement-free health care, and is supported by Penn Medicine's Center for Health Equity Advancement, which sets system-wide health equity priorities. The Penn Medicine Program for LGBTQ Health has been designated as a “Leader in LGBT Healthcare Equality” by the Human Rights Campaign Foundation, and firmly believes that LGBTQ patients deserve access to respectful, compassionate and equitable health care at all times.

For questions or assistance connecting with healthcare at Penn Medicine: lgbthlth@pennmedicine.upenn.edu

Penn Med Pride

Penn Med Pride is Penn Med’s lesbian, gay, bisexual, transgender, queer student, and student ally organization. This group is committed to increasing visibility of LGBTQ+ people at Penn Med, educating the Penn Med community about LGBTQ+ health best practices, promoting LGBTQ+ health related community outreach, providing opportunities for professional development, and cultivating our vibrant community of LGBTQ+ students, faculty, staff and allies at Penn Med. Contact: pennmedpride@gmail.com

  • LGBTQ Mentor Program: The LGBT Mentoring Program is organized by Penn Med Pride and the Penn Medicine Program for LGBT Health. The LGBT Mentoring Program aims to create a bridge between our faculty, students, and trainees at Penn and foster a sense of community.
Penn LGBT Center

Penn’s Lesbian Gay Bisexual Transgender Center’s mission is to enrich the experiences, foster success, celebrate victories, and affirm the existence of Penn’s LGBTQ+ undergraduates, professional and graduate students, staff, faculty, and alums using the lenses of social justice and intersectionality. Through education, support, and advocacy, the Center cultivates a campus climate where all students, regardless of their gender or sexual identity, can live authentically. We are the nation’s second oldest and largest campus LGBT Center, housed in a historic carriage house which includes study spaces, a library, a large multipurpose room with a catering kitchen, a computer lab and more.

The Center supports 25+ student groups (including Penn Med Pride and LGBTQIA Students in Biomedical Graduate Studies), provides educational opportunities for all Penn constituents, and advocates on behalf of the greater LGBTQ+ community in campus matters. We also have a fund to financially assist Penn students making a gender transition.

Gender Affirmation at the Perelman School of Medicine

Some students find that their years at PSOM are an appropriate time for affirming their gender identity. It is important for such students to know that there are a number of stakeholders to whom they can turn for support and planning, and to understand that PSOM is committed to supporting students. These include:

Creating a Plan for Gender Affirmation

If a student wants to transition, a plan for gender affirmation can help smooth an individual’s process by minimizing uncertainties and giving everyone involved a common roadmap from which to work. It is important to remember that these are only suggestions. It is up to the student to decide how to move forward with their transition.

The following steps to navigate on-campus gender affirmation for a transgender, non-binary, or gender non-conforming student at PSOM were created and vetted in a collaborative effort by the PSOM Inclusion, Diversity, Equity, and Learner Experience Program in Medical Education (IDEAL MEd), the Penn Medicine Program for LGBTQ Health, and the Penn LGBT Center.

  1. Get support: Do you have the support you need? Consider other places (friends, family, on-campus/off-campus entities such as the LGBT Center or the Mazzoni Center) where you can also get support. 
  2. Your personal timeline: What does being transgender, non-binary, genderqueer, or gender nonconforming mean to you? How, if at all, would you like to share your gender identity and with whom? What things do you want to do personally to affirm your identity? Use a new name? Express yourself differently through your clothing? Seek medical transition? Will you need time off for anything? Again, your timeline is yours and it is okay if it changes. 
  3. Sharing with others: Consider who, and if anyone, you would like to share your gender identity or gender history with, and how you would like them to support you. Do you want everyone, just some, or no one to know? Who is going to share this information and how? 
  4. Talk to faculty or administrators at PSOM: PSOM has a responsibility for being mindful of your health and wellbeing. To what extent, if any, would you like to share your gender identity with PSOM? What do you want support with? Would you like an advocate and/or friend to come with you to meetings when talking to PSOM administrators? 
  5. Construct a timeline with PSOM: What do you want to happen and when (e.g. if/when to change your name and/or pronouns at school, etc.)? 
  6. Would you like to make legal changes to your gender marker and/or name? Whether or not you would like to do this impacts timelines and how such markers may appear in different official systems. 
  7. Open dialogue: Would you like to maintain an open dialogue with PSOM about your gender identity? What is the best way of doing this and with whom?

[*] This document was adapted from a comparable set of guidelines in the student handbook for New York University Grossman School of Medicine.  The Perelman School of Medicine is very grateful to them for granting us permission to do so.

Posted 5/5/2022