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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 75 Notes 1. Unwinding the Threads, "Loving What Is," July 2, 2015, accessed January 2017, http://unwindingthethreads. blogspot.com/2015_07_01_archive.html. 2. Claire Ainsworth, "Sex Redefi ned," Nature 518, no. 7539 (February 2015): 288–91. 3. A. R. Flores et al., "How Many Adults Identify as Transgender in the United States?" The Williams Institute, June 2016, accessed January 2017, http://williamsinstitute.law.ucla.edu/wp- content/uploads/How-Many-Adults-Identify- as-Transgender-in-the-United-States.pdf. 4. M. Blackless et al., "How Sexually Dimorphic Are We? Review and Synthesis," American Journal of Human Biology 12, no. 2 (March/ April 2000): 151–66. doi:10.1002/(SICI)1520- 6300(200003/04)12:2<151::AID-AJHB1>3.0.CO;2-F. 5. S. E. James et al., The Report of the 2015 U.S. Transgender Survey, Washington, DC: National Center for Transgender Equality (2016), accessed January 2017, www.transequality.org/sites/default/ fi les/docs/USTS-Full-Report-FINAL.PDF. 6. "Guidelines for the Primary and Gender-Affi rming Care of Transgender and Gender Nonbinary People," 2nd ed., ed. M. B. Deutsch, Center of Excellence for Transgender Health, June 17, 2016, accessed January 2017, www.transhealth. ucsf.edu/trans?page=guidelines-home. 7. Ibid. 8. J. D. Fernandez and L. R. Tannock, "Metabolic Effects of Hormone Therapy in Transgender Patients," Endocrine Practice 22, no. 4 (April 2016): 383–8. doi: 10.4158/EP15950.OR; J. D. Weinand and J. D. Safer, "Hormone Therapy in Transgender Adults is Safe with Provider Supervision; A Review of Hormone Therapy Sequelae for Transgender Individuals," Journal of Clinical and Translational Endocrinology 2, no. 2 (June 2015): 55–60. Ellen Santistevan is a licensed massage therapist who practices craniosacral therapy and polarity therapy, and has additional experience in geriatric work and shamanic practice. She teaches ethics, polarity therapy, and refl exology in Albuquerque, New Mexico. Her practice integrates elements of all these bodies of knowledge, as well as the most current research on wellness. You can fi nd out more about her at www.thirdgoddess.com. area. Just as many cisgender people do not bother telling massage therapists about all their health issues and surgeries, transgender people deserve the same respect and consideration for their privacy. You might fi nd out something in the course of your work, which you can note later. Using proper draping techniques and offering clothed treatment options really demonstrates your respect for a person's body and their boundaries. Single-stall restrooms or nongendered restrooms make it clear you respect all people's biological needs. If you work in a spa setting, giving people the option to have a private changing area will convey a sense of safety not only for transgender clients, but also for anyone who desires privacy. All these considerations will make it clear to a transgender client that you are knowledgeable about —and supportive of—their existence, which goes a long way toward establishing a trusting relationship. You, as the therapist, will need to back up your intake forms by making sure you can approach transgender issues and people with sensitivity and a clear and compassionate outlook. Remember, it is not the client's responsibility to teach you about transgender health needs for a whole population, just about their own specifi c needs. How else can you help? You might choose to display an ally or rainbow symbol, or safe space wording, on your business card, offi ce door, or website to indicate you are a safe and friendly practitioner. You can obtain Safe Space training from a local university; this educates allies about how to ensure members of the LGBTQ community feel safe and included. Make sure your client knows that with you they are part of a team working for the betterment of their own health. Develop and maintain a strong referral network of other transgender- friendly providers for specialty work. Be a real ally and advocate, and stay current on the research and the issues, because the subject is always evolving. A RE • SPECT • FUL PRACTICE Language can be used to empower or disempower your client. For this population, members of which are systematically erased from societal consideration on a daily basis, it is very important that we as therapists work actively to empower and respect our transgender clients. Transgender people experience the highest rates of discrimination and barriers to health care. This rate is even higher if the client is a person of color or is low income. By creating an inclusive practice, you will be creating a universally safer place for all your clients. Your session with a transgender client begins with your intake forms. You can make them friendlier by including small things like a section for "legal name" and "preferred name," which is helpful for everyone if you do a lot of work with insurance companies. You might include a question about preferred pronouns and allow the client to indicate how they like to be referred to. Instead of only offering "male/female" options for gender, open that part of your intake with a section like this: Assigned sex at birth: Male ____ Female _____ Trans ___ Other _____ Decline ____ Current gender identity: Male ______ Female ____ Trans _____ Other _____ Decline ___ Do you have gendered health forms? That means you have a separate section for men's and women's reproductive health issues. This is easily remedied by combining those questions into a single section or by repeating the questions for both sections. If you are wondering about surgeries, remember that it is OK to ask if it is recent and pertinent, meaning you are going to be working in a particular