Figures with different gender identities

Kelcey E. Harper, MLS(ASCP)CM

Figures with different gender identitiesI was working the night shift at the hospital after picking up an extra shift. The night shift staffing included one person who covered all departments, including phlebotomy draws for inpatients. After a relatively quiet night, 5:00 am hit and I was on my way up to the floor to draw our patients in ICU for their morning labs.

One patient in particular was fairly chatty—it was nice to talk to someone that morning after being the only person in the lab and having no one to talk with … except maybe one of the blood bank analyzers whose QC refused to come in.

Resource List

Below are some resources if you would like to further educate yourself on the topics of gender and gender identity.
The Genderbread Person is a teaching tool used for breaking down the complexity of gender into smaller pieces that are easier to understand.
GLAAD provides resources and tackles issues surrounding the LGBTQ+ community to promote acceptance and cultural change.
A national organization providing crisis intervention and suicide prevention services to LGBTQ+ young people under the age of 25. They offer a variety of educational resources as well.
The Human Rights Campaign is one of the largest LGBTQ+ civil rights organizations. They provide several resources surrounding gender identity.

While talking with the patient, I could not help but notice that they continued to call me, “sir.” I didn’t say anything to the patient or correct them, I just collected my specimens and headed back to the lab. I worked through the situation in my head—I have very short hair and a more masculine haircut. I also wear clothing that is perceived as masculine. That night, I was wearing khakis and a dress shirt. How could this awkward situation have been avoided? I felt embarrassed, ashamed even.

I would like to say this was the first instance of my gender being assumed by other people based on my appearance, but it’s not—it happens regularly.

Excuse me, sir, you’re in the wrong bathroom.

May I help you, sir?

Get out of this bathroom, this is for women ONLY! Can’t you read?

For most of my life, I never felt comfortable in my own skin. I never felt comfortable going into public bathrooms. I never felt comfortable when my parents would make me wear a dress or force me to wear female gendered clothing—I never felt like me. I always felt as if I was confined to a small box where the only genders were female or male. I did not know how I identified; I just knew I felt different.

Growing up, I did not know any better because no one ever talked about it. I grew up in a small town where gender identity was not taught and where it was never discussed openly. I had no idea that there was an umbrella of gender identities and expressions that I had yet to discover that were outside of the societal norms and gender binary. It took a significant amount of my own research to help come to terms with how I feel about myself and my gender identity.

Let Us Look at Some Common Definitions

Gender can be broken down into the terms gender identity, gender expression, and biological sex.

  • Gender Identity is the innermost concept of self as male, female, a blend of both, or neither—generally speaking, this is how individuals perceive themselves and what they call themselves.1,2 This is who you think you are.
  • Gender Expression is the way in which a person demonstrates their gender through external modes of expression, such as clothing, behavior, haircut, etc.1,2
  • Biological Sex revolves around physical characteristics of gender described at birth—sex organs, hormones, and chromosomes.2,3 Someone who’s biological sex matches their gender identity is termed cisgender.4 In turn, transgender is a term that describes people whose biological sex assigned at birth differs from their gender identity.4

This is not a complete list of terms, but if you are interested in learning more, there are resources listed included with this article.

How Do I Identify Myself?

My identity is something I am still discovering.

I identify as genderfluid and do not identify with a fixed single gender. My gender expression is androgynous. Although my sex assigned at birth is female, I feel that this does not accurately describe how I feel internally and, therefore, do not pigeonhole myself into one gender binary.

As for my preferred personal pronouns, I have usually preferred she/her/hers, but I have been also using they/them/theirs, recently.

Where Am I Going with This?

It’s time we break down the social constructs of gender to better serve our patients. This applies not just in healthcare, but in our everyday lives and conversations as well. We want to be affirming of a person’s gender, gender identity, and expression in the healthcare environment and beyond. Misgendering a person is extremely hurtful—these can create awkward conversations, tension, and embarrassment.5 These feelings can be detrimental and may lead to a person not feeling of value—as a patient, as an employee, or as a human being.

We cannot assume gender based on someone’s outward appearance. By doing so, we are creating toxic environments and a less than affirming environment for our patients, colleagues, friends, and family.

How Can We Be More Affirming of One’s Gender?
  1. Ask the person you are speaking with what their preferred personal pronouns are. You may find this to be uncomfortable—and that’s okay! But it will be more uncomfortable and problematic if you decide to assume a person’s gender instead of just asking.
  2. Managers should ask all new employees at the beginning of their employment what their preferred pronouns are. This establishes pronouns at the start and minimizes chances for misgendering later.
  3. I will never forget when I took a new job and my manager asked in my first meeting what my preferred pronouns were. I felt a sense of relief, validation, and affirmation. Most importantly, I felt comforted and valued.
  4. Allow personal pronouns to be added to name badges, email signatures, and business cards. Begin meetings by going around the room and include pronouns.
  5. Be comfortable with the uncomfortable. Have an open mind. Educate yourself through various resources so you can better understand the complexities of gender and gender identities.
  6. When in doubt—just ask! Create a culture where asking someone’s preferred pronouns is the norm. By committing to this, it is a sign of respect.

Remember: Gender identity is not visible. It’s entirely internal to one’s self. By asking someone’s pronouns, it shows you care. So do the right thing and ask.

  1. Human Rights Campaign (2020). Sexual Orientation and Gender Identity Definitions | Human Rights Campaign. Retrieved 7 August 2020, from
  2. The Genderbread Person. (2020). Retrieved 7 August 2020, from
  3. Killermann, S. (2020). Breaking Through the Binary. Retrieved 7 August 2020, from
  4. GLAAD Media Reference Guide – Transgender. (2020). Retrieved 7 August 2020, from
  5. Talking About Pronouns in the Workplace | Human Rights Campaign. (2020). Retrieved 7 August 2020, from

Kelcey Harper is Associate Technical Services Specialist at Sekisui Diagnostics in Burlington, Massachusetts.