Ep 94: Perioperative Updates for Care of Transgender Patients

As transgender patients become more common for hospitals across the country, procedures and processes continue to be updated to meet their needs. Jose D. Castillo, III, PhD, MS, CRNA, ARNP, has spent a lot of time researching this subject and educating CRNAs. Today, he’ll address some of our questions and provide us with a better understanding of how best to care for transgender patients.

Click the timestamps below to help you navigate through the many topics we discussed.

On This Episode:

As of a few years ago, there were an estimated 1.4 million adults in the United States that identified as transgender. It’s easy to assume that the number has increased since that time, which means that there’s a good chance you’ve cared for or will soon care for a transgender patient.

Because this segment of the population rather small, it can be difficult to find any information on the subject for healthcare professionals. But that’s changing thanks to FANA president Jose D. Castillo, III, PhD, MS, CRNA, ARNP. He’s been a leader in this area and we wanted to get his expertise on the subject.

You have to go back to three or four years to an experience Castillo had with his first transgender patient to understand why he’s dedicated so much time to learning more. Back on day in 2016 or 2017, there were whispers on the floor when the transgender patient came in, which he admittedly participated in. When he got home later that night, he felt that he should have handled it much differently. So he began researching the subject and found there was very little information available. The only areas that produced these materials were the ones that performed sex reassignment surgery. That’s what initiated his interest and it grew from there.

A lot of the controversy within healthcare and the public as a whole comes from pronouns and the best practices for using them. This is why procedures are put into place but at the end of the day, Castillo explains why you should ultimately just ask the question directly. Being presumptive is much more offensive than asking someone.

If this is something that you still struggle with, don’t worry that you’re alone. That’s why we wanted to have this conversation and share our experiences. By helping people what to consider both clinically and personally, we hope it can improve our practice and the environment we work in.

If you’re looking to learn more about the topic, Castillo will be presenting at the AANA Virtual Congress.

Here are some of the other topics we will cover on the show:

  • Definitions related to the care of patients
  • Pronoun use and best practices
  • Testing patients
  • Medications for hormone replace therapy
  • The emotional considerations

Check it out the interview at the top of the page and use the timestamps to help you navigate through the many topics we discussed.

[2:33] – Introducing our guest today

[3:58] – Why this is a timely topic

[6:00] – Definitions related to the care of transgender patients 

[8:20] – Pronoun use and best practices

[14:30] – The different stages of transition

[17:33] – Perioperative experience Sharon had

[19:53] – Anesthesia considerations for transgender patients

[24:15] – Common medications with hormone replacement therapy

[29:10] – Be aware of your biases and prejudices for every patient you care for.

[30:26] – How to get more information from our guest


“If we think of it like that in an anatomical perspective and a structural perspective, I think we can formulate better policies to address what needs to be done clinically.”

-Jose D. Castillo, III, PhD, MS, CRNA, ARNP

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