Transgender, Intersex, Non-binary and Gender Expansive Physical Therapy: Part 4
To recap previous blog posts, physical therapy is for everyone, and Gender Expansive folx — people who are Transgender, Intersex, and/or Non-binary — can benefit from a more specialized approach to PT by someone who understands Queer culture and history, is knowledgeable about gender affirming procedures and is trauma informed.
Physical therapy can be for any body part, including the pelvic and abdominal regions and this special type of PT is called pelvic floor or pelvic health physical therapy. Pelvic health PT can treat many issues that you wouldn’t think a PT could treat, including incontinence, difficulty urinating, constipation, pelvic pain, pregnancy related issues, pelvic organ prolapse, preparing for or recovering from gender affirming surgeries, and more.
Any physical therapist can say they specialize in pelvic health but only those who are trained in internal evaluation and treatment of the pelvic floor muscles are true specialists. Any physical therapist can also say they are trauma informed, so it is important to ask a few questions of your physical therapist if you are seeking trauma informed, gender affirming care for pelvic health. Some questions can be “Are you trained to perform internal examinations?” “Do you have a way to document my name and pronouns if they are different from my medical chart?” “Do you have any signs/books/art that shows your support for the LGBTQ+ community?” “How would you modify my exam if I don’t want (fill in the blank)?” Most physical therapists are happy to have a conversation with you to answer any questions and what to expect in an appointment.
Concurrent conditions
It’s a huge bonus if the physical therapist is familiar with conditions that can be concurrent with Queerness, including connective tissue disorders, hyper mobility syndromes, Ehlers Danlos Syndrome (EDS), Gastro-intestinal Disorders, Postural Orthostatic Tachycardia (POTS), Mast Cell Activation Syndrome (MCAS), and neurodivergence such as Autism and ADHD. Up to 70% of Autistic individuals identify as gender diverse and are in search of medical gender-related care, according to a small 2018 study, and 32% say their gender identity has been questioned because of their autism diagnosis (Strang et al). An another important article was published February 2022 titled The “Connectivome Theory”: A New Model to Understand Autism Spectrum Disorders by Zoccante et al. which illustrates the relationship between the these disorders and a difference in collagen functioning. There is growing awareness of the overlap of being Transgender, Intersex, Non-binary and Gender Expansive and the increased incidence of differences in collagen functioning that can result in these conditions. If the physical therapist is aware of this, it’s a major green flag because they may be able to refer you to other providers who can help you with any of these issues. A PT who is familiar with connective tissue disorders and POTs can modify treatment so that you are able to progress in physical therapy without increased pain or injuries.
I personally see many patients with these overlapping conditions and can identify muscle imbalances and postural abnormalities that can accompany them. To read more about Arrow PT’s experience with gender expansive folx, please see About page, or schedule a free consultation.
What you should expect from a gender affirming physical therapist
A physical therapist who treats Transgender, Intersex, Non-binary and Gender Expansive individuals should ask what name you like to be referred to and pronouns. They should offer a private room if a body part needs to be exposed or they need to ask personal health questions, and only ask health questions directly related to the reason you are seeking physical therapy. They should have general knowledge about surgeries, hormones and other gender affirming procedures. The physical therapist should ask for consent prior to physical touch and continue to ask for consent throughout the visit. Finally, the physical therapist should be flexible during the appoint to allow for modification of examination and use words for body parts that make you feel comfortable.
