In regards to the United States in 2025:
"No one else should be allowed to determine one’s gender. It cannot be measured, assessed or diagnosed. Every person is entitled to their own identity." (via Transgender Europe, TGEU, Guidelines to Human Rights-Based Trans-Specific Healthcare, 2019.)
I'm not The Most Qualified Person(TM) to speak on this subject, but the LGBTQ+ community has been a special interest of mine since I was a Millennial teenager. I struggled with finding and forming my own identity for many reasons, and this community was one that felt the most accepting at the time.
As the person with seemingly the most lived experience in my limited social and professional circles, I have found that many people around me aren't as well-versed in the lingo as I am, particularly when it comes to the care and treatment of LGBTQ+ individuals -- and especially when it comes to transgender and gender diverse people.
Some basic definitions:
- Gender Identity: a person's core understanding of their own gender.
- Physical Sex: the development and changes of a person's body over their lifespan, as affected by their sex chromosomes, hormones, reproductive organs, secondary sex characteristics, related medical care, etc.
- Assigned Sex at Birth: sometimes based on the set of observable physical characteristics of an individual (phenotype). Some people believe there are strictly two options (male or female) but biology isn't always so clear and simple.
- Transgender/Trans: people whose gender identity does not match their assigned sex at birth.
- Cisgender: people whose gender identity does match their assigned sex at birth.
- Intersex: people born with sex characteristics, such as chromosomes, gonads, and/or genitals, that don't fit the "typical binary notions of male or female bodies." These people are often subjected to medical interventions at birth with lifelong consequences.
- Gender Expression: "all the ways a person communicates their gender, including clothing, voice, mannerisms, names, pronouns, etc. Norms for gender expression vary culturally, generationally, spiritually, regionally, and between communities and peer groups." (via Trans Care BC's "Exploring Gender Diversity" handout.) Therefore, what's "traditional" for one group of people may not be the tradition of another.
I don't have a lot of my own definitions and explanations for "what does this concept mean and why?" This post isn't meant to be all-inclusive (ha!) and cover everything there is to know on all the subjects. Originally, this was meant to provide guidance for, "how do we teach bodywork with non-gendered terms?" and I will come back to that.
One thing we're not going to use is the phrase "Biological Sex," as in, "biological men have ABC features and biological women have XYZ features." This is sometimes called biological determinism or genetic determinism: "the belief that human behavior is directly controlled by an individual's genes or some component of their physiology." Simply put: it is related to eugenics and scientific racism.
"'Biological Sex' -- common in scientific writing as a synonym for birth sex, natal sex, or assigned sex at birth. Outside of medical literature, 'assigned sex at birth' is preferable over 'biological sex'. Avoid using 'biological' in reference to people, rather than in broad references to the concept of biological sex. Noun phrases like biological men, biological males, biological women, or biological females are often used by anti-trans groups to invoke a person's assigned sex at birth as their 'real' gender, in contrast to their gender identity." - From TGEU's Trans Media Guide.
Usually I would save all of my resources to the end of a post, but many of these have been fundamental in my writing. Please consult these reputable resources to bolster your understanding:
- Trans Care BC -- a provincial clinical program operated by the Provincial Health Services Authority (PHSA) in British Columbia, Canada. "We work with our partners to set direction and provide leadership for trans health services across B.C. Our work helps ensure trans, Two-Spirit and non-binary people get the care they need when and where they need it."
- I highly recommend their Education Centre which features webinars, eCourses, and free downloadable .PDF handouts on Exploring Gender Diversity, Gender Inclusive Language, and Making Mistakes.
- TransHub, "an initiative from ACON, NSW’s leading health organisation specialising in community health, inclusion and HIV responses for people of diverse sexualities and genders."
- If you read nothing else, you must read their .PDF document: "Trans-Affirming Clinical Language."
- TGEU (Trans Europe and Central Asia) -- "a trans-led nonprofit for the rights and wellbeing of trans people in Europe and Central Asia."
- Check out their publication of "Trans Rights Are Human Rights: Dismantling Misconceptions About Gender, Gender Identity & the Human Rights of Trans People" here.
- I also recommend the "Trans Media Guide: A Community-informed, Inclusive Guide for Journalists, Editors & Content Creators" here -- it has a brief glossary of terms at the end.
- World Professional Association for Transgender Health (WPATH) -- a 501(c)(3) non-profit, interdisciplinary professional and educational organization devoted to transgender health. "Our professional, supporting, and student members engage in academic research to develop evidence-based medicine and strive to promote a high quality of care for transsexual, transgender, and gender-nonconforming individuals internationally."
- While it's a long read, I recommend skimming over their highly detailed Standards of Care (SOC) document: "These internationally accepted guidelines are designed to promote the health and welfare of transgender, transsexual and gender variant persons in all cultural settings."
Bodywork Education
"And so, life in the Shire goes on, very much as it has this past Age… full of its own comings and goings, with change coming slowly, if it comes at all." - Bilbo Baggins, Lord of the Rings: The Fellowship of the Ring
One of the biggest issues with traditional brick-and-mortar education is that many institutions still rely on physical, printed textbooks and publications. They are expensive. They fall out-of-date quickly, and updating and verifying written information takes time. Bias happens. Photography is an additional expense and doesn't always feature a variety of body types.
So, for those of us who want to embrace diversity and be inclusive in our teaching materials, what do we do?
When it is brought up in a classroom setting and it is a resource outside of your control, acknowledge the things that are problematic. Affirm that feedback will be or has been heard and given to the correct people. Apologize (briefly) for genuine mistakes. Express gratitude for the opportunity to learn! Request patience and grace. Carry on with the lesson as best you can, offering adjustments and accommodations where appropriate.
If you are teaching anatomy and physiology, you may run into issues around discussing reproductive system anatomy and the development of secondary sexual characteristics. Again, textbooks will often still focus on the "male reproductive system" versus the "female reproductive system," without consideration of the percentage of intersex individuals who have a mixture -- or lack -- of features of either one.
Be proactive -- if you recognize that a resource is lacking in representation or information, plan to supplement the information you're sharing. It may take a little extra effort, but it will be appreciated.
Language
Okay, but how do we actually talk about bodies and prepare to treat transgender and gender diverse students and clients respectfully? The simplest way is to use anatomic, gender-neutral terms. When appropriate, you can consider using the following standard of care:
"Statement 1.3 We recommend health care professionals discuss with transgender and gender diverse people what language or terminology they prefer. In providing health care to TGD [transgender and gender diverse] people, we recommend [healthcare providers] discuss with their patients what language or terminology they prefer be used when referring to them. This discussion includes asking TGD people how they would like to be addressed in terms of name and pronouns, how they self-identify their gender, and about the language that should be used to describe their body parts. Utilizing affirming language or terminology is a key component of TGD-affirming care (Lightfoot et al., 2021; Vermeir et al., 2018). [...] In electronic health records, organ/anatomical inventories can be standardly used to inform appropriate clinical care, rather than relying solely on assigned sex at birth and/ or gender identity designations." -- WPATH Standards of Care (SOC) document
Chest and abdominal massage, specifically, already holds a lot of emotions around it due to our Western society. This is sometimes compounded by gendered language and routines designed specifically "for men" and "for women." In these cases, it can be helpful to simplify routines and drop such distinctions altogether.
In my personal notes regarding chest massage, I list the following points:
- Do not assume based on gender perception/presentation.
- Use anatomic, gender-neutral terms and language.
- Do not make comments about a person's body, even if you intend it to be a compliment.
One practice you might consider is to drape all chests the same way, regardless of presence or amount of breast tissue. Breast tissue massage is an advanced technique that requires continuing education; it is not something that was taught at my school. For people who have received chest surgeries, they may require specific bolstering to be comfortable or may have to receive work in side-lying instead of prone. Have strategies for this and remember to practice!
Another area to think about is draping and treating the legs in a way that is comfortable for all bodies. When it comes to performing psoas or adductor work, consider saying, "If you have external genitals, you can move them aside." Again, it's important to not make assumptions about a client's body based on their gender presentation. Saying these things out-loud can feel awkward at first -- that's why you need to practice saying them in an assured, confident way.
In Polarity Therapy, we discuss the "inner male" and "inner female." Personally, I prefer to discuss the inner masculine and inner feminine qualities of a person. Others will discuss Yin & Yang. You will find the terms that best fit you and your own spiritual practices.
Finally, I highly recommend checking out and printing TransHub's .PDF document: "Trans-Affirming Clinical Language." It contains many helpful suggestions in setting a welcoming tone, discussing reproductive anatomy, and how to address "specific needs, rather than making assumptions."
Questions & Intakes
While we are not considered primary healthcare providers, there are questions we should ask to ensure a client's comfort and safety within our practice.
Are you pregnant? Not all pregnant people are cisgender women; pregnant individuals can be trans men, non-binary, genderfluid, agender, etc. Educate your clients on how bodywork can affect pregnancies.
Any recent surgeries or implanted devices? You don't need to know the specifics -- you need to know how far along post-surgery or -treatment they are and if their medical providers have cleared them for receiving bodywork. Some surgeries and treatments may include mastectomy, breast augmentation/implants, facial masculinization or feminization surgeries, body masculinization surgeries, Adam's apple reduction, etc. Cisgender individuals also receive these gender-affirming surgeries and treatments. Typical post-surgical precautions will apply.
Are you receiving any Hormone Replacement Therapies? If so, how? Gender-affirming masculinizing or feminizing hormone therapies can be received topically (on/through the skin), through oral medication, or via injection, so it's important for us to know for our client's wellbeing and also our own. Remember, Hormone Replacement Therapy is often used for folks (both cisgender and transgender) who are experiencing symptoms of menopause.
Have your providers discussed any concerns about your cardiovascular or bone health? If not, then proceed with the rest of your intake. As for why it matters: "Estrogen and testosterone both support bone formation and turnover. Decreased sex hormone levels are associated with a greater risk of osteoporosis in older age (Almeida et al., 2017)." - WPATH Standards of Care (SOC) document. If your client is at risk of osteoporosis, you would need to consider using precautions in their treatment.
Other Considerations & Final Thoughts
While you might not want to ask specific questions, pay attention if a student or client discloses information about their mental health and whether they feel safe in their home and community. You may need to refer them to supportive resources and providers.
Provide sanitary products in your restroom(s). It's a small detail that can make a world of difference.
If you want to create an environment and a practice that is more inclusive, you will need to put in the time and the work to do your own research. This post barely scratches the surface of the issues facing the small percentage of the population that falls outside the gender binary.
I want to reiterate that mistakes will happen, particularly if this is all new language to you. You don't need to know all of the language -- you will likely be taught in-the-moment. Be sure to not only apologize for your mistakes, but also express gratitude for the opportunity to learn.
However: when someone is purposefully malicious in disrespecting an individual's gender identity and expression, especially after their wishes have been communicated, that is harassment.
Above all else: treat all individuals with dignity and respect.
(I can't believe this is a revolutionary concept in the year 2025, but here we are.)
Other Resources:
- Elm R's video on trans & nonbinary inclusion in massage! -- Elm has been a great resource and source of inspiration for me.
- Healwell.org: "Creating an Affirming and Inclusive Practice" Paid Course -- "Learn about the health disparities in the LGBTQ+ community. Gain a basic understanding of the needs of this community. Examine your own biases and assumptions, and learn some practical ideas for making your practice more welcoming and affirming."
- Folx Health -- "FOLX is the largest health and wellness platform for the LGBTQIA+ community, serving over 50,000 people. Get the health care you deserve."
- I can't speak to their actual healthcare, but I do appreciate their free library of articles and resources.
- Klein A, Golub SA. Enhancing Gender-Affirming Provider Communication to Increase Health Care Access and Utilization Among Transgender Men and Trans-Masculine Non-Binary Individuals. LGBT Health. 2020 Aug/Sep;7(6):292-304. doi: 10.1089/lgbt.2019.0294. Epub 2020 Jun 3. PMID: 32493100; PMCID: PMC7475086.
