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Transgender And Non-Binary Physical Therapy: Implications For Practice

by Dr. Roy Rivera, Jr., PT, PhD, DPT, MCHES


More often than not, people are intimidated by the complexities of our vast health care system. Unfortunately, these same individuals become even more nervous when it comes to seeking physical therapy services.

It’s easy to understand where this intimidation comes from. People must commit to a therapeutic exercise routine while in a state of pain, and the process can leave them feeling extremely vulnerable. However, a particular community of people face additional pressures and challenges over others.

Transgender and gender-diverse people often must leap over hurdles when seeking safe, gender-affirming health care. For example, while choosing a provider by word of mouth or based on online reviews can be helpful, these avenues don't always reveal a practitioner's bias. Moreover, even health care providers who desire to create safe spaces for the LGBTQ+ community may lack the appropriate training and resources.

How can healthcare providers ease the burden that physical therapy takes on overlooked groups? It begins with erasing negative stereotypes about the rehabilitative experience, learning about the community’s struggles, and promoting an inclusive environment.

Creating a safe space for LGBTQ+ patients helps them feel congruent with their health and well-being. In addition, this practice fosters a rewarding recovery experience for transgender and non-binary individuals who need physical therapy.

LBGTQ+ Friendly Physical Therapists are Desperately Needed

In today's world, businesses are devoting more energy and resources to client comfort than ever before, and this effort is more genuine in some sectors than in others. However, there are still shortfalls, primarily in serving vulnerable populations, such as the transgender and non-binary communities.

A survey conducted by the National Center for Transgender Equality shined a light on the issues facing LGBTQ+ patients. It found 23% of respondents neglected to seek medical attention when needed simply out of fear of being discriminated against. In addition, according to the survey, 33% of transgender patients reported negative experiences when seeking care for themselves.

These incidents included encountering health care professionals who refused to provide treatment or didn’t have the training or knowledge to treat a transgender patient’s condition. In addition, transgender people who didn’t have LBGTQ+ friendly health care providers faced verbal harassment.

There are shortcomings in treating transgender patients in the physical therapy sector as well. The number of rehabilitation facilities that openly embody transgender inclusion and have providers qualified to assist with gender reassignment surgery recovery are few and far between.

Katie McGee, PT, DPT, a physical therapist who specializes in transgender care, elaborated on the lack of medical options in a Women’s Health Magazine article. She discovered that out of the 300,000+ providers listed online for the treatment of pelvic floor conditions, only 367 in the U.S. served the transgender community.

The Referral Process Gets Complicated

Physical therapy for the transgender community isn't inherently complex. Oftentimes, transgender or non-binary individuals require physical therapy for reasons that don’t involve their sex assigned at birth. However, members of this community may refrain from seeking professional care if LGBTQ+ friendly physical therapists aren’t available.

An even more concerning issue is that transgender patients may require physical therapy to support gender-affirming surgeries. And unfortunately, getting a referral to a transgender-inclusive physical therapy facility isn't always straightforward.

Medical science has rapidly advanced, but the health care industry isn’t always up to speed. For example, physical therapy is a built-in step of the recovery program for patients with knee replacements to regain the ability to walk. Conversely, some medical providers don’t acknowledge the impact that gender-affirming surgeries have on functionality and activities of daily living. Furthermore, they haven’t recognized how physical therapy can aid in the recovery of these procedures.

How Physical Therapy Helps Trans Women Recover From Gender-affirming Surgeries

Studies, such as one published by Obstetrics & Gynecology, show that physical therapy plays a positive role in the treatment of gender-affirming surgeries. It states trans women undergoing vaginoplasty procedures have significantly lower rates of pelvic floor dysfunction following surgery when they attend physical therapy pre- and post-operatively.

Before undergoing a vaginoplasty, physical therapy can help detect potential pelvic floor issues before they cause recovery issues. Following the procedure, a properly trained physical therapist can assist tremendously with roadblocks that surface while a patient attempts to follow their dilation protocol to maximize surgical outcomes.

However, there isn’t substantial research currently available that examines the struggles transgender people experience in the medical field. This lack of information and gap in the literature is yet another way the medical field is underserving the LGBTQ+ community.

How Physical Therapy Helps Trans Men Recover From Gender-affirming Surgeries

Those undergoing a phalloplasty procedure also face the risk of having pelvic floor dysfunction impact the recovery process. Additionally, since a phalloplasty requires a skin graft to create a penis, a patient could develop issues with mobility and strength in the area where the skin gets taken from.

A skilled transgender-inclusive physical therapist can work with an individual to recover motion and functionality in the impacted areas.

Additionally, trans men and women may opt to get top surgery and or breast augmentation. Each of these procedures can significantly impact the upper body and its overall functionality. So it’s no surprise that physical therapy helps transgender patients restore posture and movement. In addition, this recovery process can reduce scar tissue’s impact on pain levels and physical appearance as well.

What You Can Do to Further Transgender Physical Therapy Inclusion

An expert team of practitioners is crucial to providing trans and non-binary people with the care they deserve. However, transgender inclusion goals fall short when other staff members don’t foster a welcoming environment.

For example, a judgmental front office or administration could negate the competency and compassion put forth by LGBTQ+ friendly physical therapists. Judgment isn’t limited to voicing overtly hurtful remarks. Sometimes, all it takes is the look on a person's face to know what they’re thinking beneath the surface.

With this in mind, you should thoroughly vet all of your staff to ensure that they're genuinely interested in co-creating an inclusive space.

Physical Therapy is Multifaceted

It's time to show people that physical therapy is not just for athletes or those looking to improve their performance at the gym. Instead, it's a deep-reaching tool with the potential to have a positive, long-lasting impact on a patient’s physical and emotional well-being.

Physical therapy can be incorporated in conjunction with other medical services provided by primary care physicians and mental health providers. That’s why we at Elation Physical Therapy believe that transgender physical therapy can play a crucial role in improving a patient’s overall quality of life.

Having practiced in the Houston area since 2005, I can attest to the shocking level of impact that something as seemingly simple as providing a safe, inclusive space brings into the lives of LBGTQ+ patients.

I’ve been devoted to staying ahead of the curve by learning and utilizing cutting-edge physical therapy techniques and practices. While this factor contributed to my being named the Best Male Physical Therapist yearly from 2018-2021 by OutSmart Magazine, our team and our shared commitment to inclusivity are the fundamental ingredients to our success.

We’re proud to say that Elation Physical Therapy’s values have helped make Houston a transgender-inclusive environment for those seeking physical therapy. And we hope our efforts help inspire other LGBTQ+ friendly doctors, health care providers, and medical facilities better serve their respective communities.

Dr. Roy Rivera, Jr., PT, PhD, DPT, MCHES Dr. Roy Rivera, Jr., PT, PhD, DPT, MCHES Dr. Rivera is a licensed physical therapist and owner of Elation Physical Therapy in Houston and Pearland, Texas. Working across a variety of health care settings, Dr. Rivera has a philosophy and interest in helping people reach or return to their peak physical conditions in the face of physiological setbacks. After earning his Bachelor of Arts in Biology at Southwestern University in Georgetown, Texas, Dr. Rivera went on to earn his Master of Physical Therapy (MPT) at The University of Texas Medical Branch at Galveston. Dr. Rivera continued his education at the Rocky Mountain University of Health Professions in Provo, Utah, completing his Doctor of Physical Therapy (DPT). He then went on to earn his Doctor of Philosophy in Health Studies at Texas Woman’s University in Denton, Texas.

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