Non-Binary Standards of Care 

We believe the standards of healthcare for transgender and gender expansive patients are considerably lower than ideal, and the existing standards can even be even lower when someone identifies as non-binary. This content has been developed to help prospective patients understand that  Dr. Mosser performs non-binary top surgery and he also has processes in place at his practice that are aimed at creating a safe and gender affirming environment throughout the entire top surgery experience.   

The introduction to non-binary top surgery gives a more in-depth definition of what non-binary is. Binary gender refers to “male” or “female,” whereas non-binary refers to persons who don’t identify exclusively as male or female.  Although it’s estimated that about 25-35% of the transgender population are non-binary, trans healthcare settings are largely binary and often don’t lend the space they could to those identifying outside of it. The goal of this content is to start a conversation between all of us about: 

  • People with non-binary identities seeking care and how we can best fit the needs of the non-binary population 
  • Gender affirming surgeries exclusively categorized as FTM or MTF when there are many other gender identities seeking these same services 
  • What a non-binary affirming healthcare experience can look like and the ways Dr. Mosser was able to implement those practices 

Non-Binary Inclusive Healthcare Forms: Paper and Electronic 

Any identifying forms (paper or electronic) the patient comes into contact at our office will have: 

  1. Multiple non-binary gender identity options, as well as a space to write in a gender identity that may not be listed
  2. Differentiating language between legal name and the name currently used by the patient
  3. Gender neutral pronoun options (they, per, ve, xe, ze/zie, etc.), including space to input pronouns that may not be listed  

Non-Binary Affirming Communication 

Any written or verbal communication with Dr. Mosser and the rest of the team will re-affirm the identifying characteristics the patient established (gender identity, name, pronouns). Other requests, such as the patient not wanting to be referred to by any pronouns, can also be accommodated.  

Non-Binary Comprehensive Electronic Medical Records 

An Electronic Medical Records (EMR) system is an electronic record of your health-related information that healthcare providers use. These programs are generally not set up for the transgender and non-binary population. What would it look like if healthcare providers demanded that their EMR systems make concrete changes to be more trans and non-binary inclusive? Dr. Mosser did just that and was able to achieve the following changes in our EMR systems: 

  • Distinction between assigned sex (male, female, intersex) and gender identity (male, female, neutral/non-binary) 
  • Distinction between legal name and name the patient uses 
  • Pronouns (he/him, she/her, they/them, ze/hir) 

As healthcare providers, it is our responsibility to demand change if the systems in place are not serving our patients. Institutional changes, such as the ones mentioned above, send a message that transgender and non-binary identities exist and they are valid in are seeking affirming care.  

Gender Neutral Top Surgery Consultations 

Dr. Mosser uses the informed consent model, which means that a letter from a therapist is not required unless the patient is seeking insurance approval (insurance companies always require a letter of support). It is our hope that as time progresses, more plastic surgeons will accommodate the needs of those seeking gender neutral results (i.e. patients requesting an end result that does not look like a chest that has undergone a full androgenic development).   Regardless of how someone identifies, it is the responsibility of the surgeon to: 

  • Ask the patient what their goals are 
  • Explain the different surgical techniques available  
  • Explain the advantages and disadvantages of each technique  
  • Describe the limitations of each procedure to achieve “ideal” results 
  • Discuss risks and possible complications of the various techniques as well as communicate their own complication rates for each procedure  

Asking the patient about their goals while actively listening and explaining the procedure types available is key. If a patient’s goal is to get top surgery with no nipples because this will make them feel more aligned, then the surgeon should only speak objectively on the matter. Surgeons who are unfamiliar with top surgery techniques that aim at achieving non-anatomical or gender-neutral results should remain informed on which surgeons do so they can provide a trusted referral. 

In Conclusion: 

  • Standards of care should be established and upheld for the non-binary population 
  • Documents and systems related to transgender and non-binary care should reflect the patient’s identity on their own terms (name, gender identity, pronouns, etc.)  
  • Providers can demand change from the systems in place that aren’t inclusive of trans and non-binary identities  
  • Consultations should be shaped around the patient’s goals and should not be steered subjectively by the surgeon 
  • Non-binary and gender neutral top surgery techniques exist and are available
  • Providers caring for trans and non-binary persons should stay informed on what the needs of community are