Our clients come from diverse communities and have varying needs and rich backgrounds. We may not always know how best to support them in their journey to wellness.
In this article, I hope to specifically address the ways in which you can actively support your trans and gender-nonconforming clients.
Educating yourself on working with trans and gender-nonconforming individuals will not only benefit your clients but also create a wider net for your services that other trans and gender-nonconforming folks may choose to access in the future. The more you learn and practice being an effective support person, the more you’ll notice how truly needed you are.
Depending on where you live and how diverse your area is, you may very well be the only service provider your client encounters who demonstrates competency with trans clients. Consider it your responsibility to be the best trainer you can be for them.
Being an advocate for underserved communities is a lifelong passion of mine. I have had the privilege of serving members of the LGBTQIA+ community as well as folks in larger bodies virtually my entire time as a coach. By sharing some of my experience and things I’ve learned along the way, I hope this information supports you in your work as well as your personal life.
Here are four key ways you can support your trans clients, both in general and in the case of surgical procedures.
Language is critical. The terms you use on your forms as well as your conversational terminology absolutely need to be in alignment with your clients’ terminology. If you haven’t already updated your forms to include trans-inclusive language, now is the time.
For example: Are you currently asking your clients their “sex” or “relationship status?” If so, why? Consider what it is that you’re hoping to learn by gathering this information.
Instead of asking about one’s “sex,” try asking for their pronouns instead. While “sex assigned at birth” is the preferred terminology for “sex,” remember that if you’re not directly working with an individual’s sex organs, you don’t need this information.
Clients will disclose information when and if they deem it necessary — and when and if they’re comfortable. That goes for surgeries too; if you ask about surgical history in your intake, your client may or may not disclose any gender confirmation procedures they’ve had.
(Side note: Most people think of surgeries related to gender transition as only pertaining to surgeries on the genitals. However, there are various surgeries that folks may choose, ranging from chest reconstruction to breast implants, genital surgery, facial feminization surgery, and more. I will discuss the two most common surgeries in more detail shortly.)
You can offer opportunities for clients to share more about themselves and feel more comfortable by offering open-ended questions when possible instead of checkboxes. You don’t need to prepare a form for every possibility; you can allow your clients to choose the language that suits them best!
Clients' gender identity, sex assignment at birth, and sexual activities are absolutely no one else's business. They are, in fact, only our business if it directly affects our ability to serve them.
If a colleague asks you any personal questions about your clients (for example, trying to “figure out” their gender identity), it is your responsibility as an ally to trans people to respect their privacy and potentially use it as a teaching moment for your colleague.
While trainers aren’t required by law to follow HIPAA standards, it’s likely recommended by your certifying body’s code of ethics. Additionally, it’s a sign of respect that adds to the integrity of the coach-client relationship.
There are several procedures that individuals may receive. Before I dive into two of the most common ones, I want to highlight that not all trans or gender-nonconforming people choose to pursue surgery as an option.
Even when surgery is something that an individual would like to pursue, accessing surgery may not be an option due to the cost, lack of insurance coverage, and lack of providers in the area.
When people do not have access to a surgical procedure that they need in order to feel comfortable in their body, it can drastically change their relationship with their body, their feelings of safety, and their ability to feel comfortable in fitness or wellness spaces.
I’ve included resources at the end of the article you can refer to if you would like more information.
OK, now let’s take a closer look at the two most common procedures: vaginoplasty and mastectomy with chest reconstruction.1
If you’re working with a client who’s had a chest reconstruction, they may also have a history of chest binding (though not always).
This is a process that folks use to minimize the appearance of breast tissue by flattening the chest with restrictive garments, and some may have done this process for years.
Because binding is restrictive, there’s likely some work to be done to encourage your client to breathe deeply and fully, and to address any restriction along the sides of the chest and lats. This goes for both pre- and post-chest reconstruction. It’s also not uncommon to see an exaggerated kyphotic curve (i.e., rounding of the upper back) with these clients.
In attempting to help your client change their posture or alignment, it’s important to be gentle and understanding — realize that your client’s gender identity and safety may be in play with this posture. I strongly encourage my clients to spend some time on their own, in a safe space, working on their breath, filling their chest and belly fully, and allowing their chest to expand.
I also work with them on increasing mobility in the lats and armpit areas as well as their upper back. They can do this via gentle massage with a roller or lacrosse ball. This will greatly support them in increasing their range and freedom of movement. Often with these clients, I focus work on the back muscles more than the chest muscles.
Remember: If you’re using tactile cues (touching to cue), always ask permission first. No exceptions.
Trans and gender-nonconforming individuals are more likely to have experienced physical violence in their lives than their cisgender counterparts.2
When working with folks who have had or are planning to have vaginoplasty, there are a few important things to know. I’ll start with a definition, and then share potential coaching implications.
Vaginoplasty is an extensive procedure lasting between two and six hours. During the surgery, one's existing penis, testicles, and scrotum are removed, and a vaginal canal and sensate clitoris are created.
I would suggest any client seek out a trans-competent pelvic health physical therapist one month prior to surgery and then again about two weeks post-surgery. Ideally, their surgeon will have an appropriate referral for them, but it’s always a good idea as a coach to have your own referral network.
Individuals may take between four and six weeks off of work to recover from this surgery. This surgery will make walking difficult for quite a while, though short repeated walks can help in the healing process. All bodies are different, of course, but you can expect that your client won’t be working with you in the gym for at least a few weeks and up to two months post-op.
When your work with your client resumes, be aware that walking and sitting on any kind of cardio equipment (such as a bicycle) may still be uncomfortable.
Additionally, note that vaginoplasty comes with the risk of prolapse. Therefore, it’s important to avoid the Valsalva maneuver and breath-holding while lifting.3 I always cue to exhale on exertion, and my suggestion would be to address core stability, breathing patterns, and pelvic floor awareness and strength before anything else.
There are several articles already on the GGS website about isolating and training the pelvic floor muscles; this includes strengthening as well as learning how to relax the pelvic floor muscles. Those recovering from a vaginoplasty will need to learn how to intentionally relax the pelvic floor when they start dilation procedures, which will often start between one and two weeks post-surgery.
Dilation is a process of post-operative care that involves inserting a dilator inside the vaginal canal to preserve its shape and depth. This process should be continued to some degree for the duration of the person’s life. With this in mind, it’s important that your client has the capacity to intentionally relax their pelvic floor muscles.
In any given session, I may find that my client needs a service I am not qualified to provide. It could be a mental health counselor, a Health at Every Size™ dietitian, a physical therapist… the list goes on and on.
I do not try to fit myself where I do not belong. I am a strength and life coach, and that’s where my expertise ends. I’m always trying to expand my list of referral partners.
I work with populations who are consistently underserved. Finding other trans-competent providers isn’t always easy, but I consider it a part of my job as a coach. This means doing the work of calling or visiting an office and making an appointment to speak with someone about their practices and experience serving trans and gender-nonconforming patients.
If you think this is time-consuming or a challenge for you, imagine what it’s like for your clients.
Do yourself a favor and do the work. Your clients will appreciate it immensely, and you will make yourself known as a coach who truly cares about your clients.
Girls Gone Strong and the author would like to thank Daniel Dugi III, MD, and Sandi T. Gallagher, PT, of the OHSU Transgender Health Program as well as sexuality educator and consultant Erica Smith, M.Ed., for their help in reviewing this article.
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