Please Mind Your Pronouns - A Guide for Proper Nursing Communication and the Gender Identity Spectrum

Katrin Moskowitz, DNP, FNP, PMHNP - 08/06/19

We are lucky enough to live in a world where individuals can live as heir authentic selves. Although those identifying themselves as part of the LGBTQ+ community are finding increased acceptance, improvements can always be made. As a mom of a gender fluid child, I have had to become comfortable with understanding correct pronouns, gender identities and sexual orientations. Here is a quick guide to clarifying some of the most common misunderstandings.

Anatomical Sex

            Sex (sometimes called biological sex, anatomical sex, or physical sex) is comprised of things like genitals, chromosomes, hormones, body hair, and more. This is not the same thing as gender although it is often grouped together by society. Sex is a label. You are either male or female. You are assigned this at birth based on the genitals you’re born with and the chromosomes you have.


Gender is much more complex: It’s a social and legal status, and set of expectations from society, about behaviors, characteristics, and thoughts. Each culture has standards about the way that people should behave based on their gender and part of cultural competency is to understand this for the populations and communities that we serve. This is also generally male or female. But instead of being about body parts, it’s more about how you’re expected to act, because of your sex.

Gender Identity

            Gender identity is your psychological sense of self. Who you, in your head, know yourself to be, based on how much you align with what you understand to be the options for your gender. Gender identity is how you feel inside and how you express your gender through clothing, behavior, and personal appearance. It’s a feeling that begins very early in life. Gender identity can be broken down into several categories. Some are listed below:

  • Transgender: Someone whose gender identity is different from the one they were assigned at birth might identify as transgender. Sometimes trans or transgender gets used as an umbrella term for gender diverse people. However, not everyone uses it to describe themselves. When in doubt ask, and always respect someone’s personal terms when it comes to gender identities.
  • Genderqueer: Someone may identify as genderqueer if their gender identity is neither male nor female, is between or beyond genders, or is some combination of genders. This identity is often related to or in reaction to the social construction of gender, gender stereotypes and the gender binary system.
  • Non-Binary: Someone who does not identify as a man or a woman, or solely as one of those two genders. It’s often used as an umbrella term for identities that fall outside the male/female gender binary. Being non-binary means different things to different people, so this definition is purposely broad.
  • Cisgender: Cisgender is a term to describe someone whose gender matches what they were assigned at birth. For example, they were assigned female at birth based on being born with a vagina and know themselves to be female.
  • Two-Spirit: A modern English term that an Indigenous person might identify as that comes from the traditional knowledge of Indigenous peoples in certain areas of the world. It can mean a person who walks between genders; one who carries the gifts of both males and females, or one who is gender unique. Today, many Indigenous Peoples are reclaiming the ancient understanding that there are more than two genders.

Gender Expression

            Gender Expression refers to the ways you present gender, through your actions, clothing, demeanor, and more. Your outward-facing self, and how that’s interpreted by others based on gender norms. Gender expression is about how someone acts and presents themselves to world. Gender expression is not related to someone’s gender or sex, but rather about personal behaviors and interests. Sometimes people don’t express their gender in the way they would like to because they don’t feel safe to do so. Therefore, it’s important to not assume someone’s gender just based on how they look, but rather by checking in with them.

Gender Pronouns

             A gender pronoun is the word someone uses to describe their gender. It is important to never assume which gender pronoun someone uses. If you aren’t sure what pronoun someone uses just ask them!

She/her/hers and he/him/his are a few commonly used pronouns. Some people call these “female/feminine” and “male/masculine” pronouns, but many avoid these labels because not everyone who uses hefeels like a “male” or “masculine.”

There are also lots of gender-neutral pronouns in use. Here are a few you might hear:

  • They/them/theirs. This is a pretty common gender-neutral pronoun and it can be used in the singular.
  • Ze/hir/hir. Ze is pronounced like “zee” can also be spelled zie or xe, and replaces she/he/they. Hir is pronounced like “here” and replaces her/hers/him/his/they/theirs.
  • Just my name please! Some people prefer not to use pronouns at all, using their name as a pronoun instead.

Electronic health records can allow for the identification of LGBTQ patients, assign preferred names and pronouns. It is our job as healthcare professionals to understand how we can be aware of these preferences and use this to provide compassionate and comprehensive care.