I had a cousin who met me when I was a toddler. He was the same age as me so, of course, I don’t remembered him. and then years later, I was 18-years-old and my mother said that Aunt Mae’s son, “Bill,” (not his real name), started going to a psychiatrist because Aunt Mae found him in her closet trying on her dresses and shoes. Aunt Mae wanted to avoid the inevitable.Â
The family took on the perspective that he was, in today’s vernacular, a transgender. My mother just found out through another cousin, and said in hushed tones, “Ta, ta, ta,” which in her vernacular meant it was a disgrace. “Bill” went to the psychiatrist for 8 years where he was forced by his family to meet a girl, and they were married a year later. I’m never saw him again since I was 3-years-old. From time to time, I always wondered if he is happy. My bet is he’s not.
That story, brief though it may be, led me many years later to another transgender saga, when Kris Kardashian found out that Bruce Jenner, her husband, now called Caitlin, is a transgender.Â
Reaction from a listener to one the episodes:
Season 10 is when the sit-down and reveal happens, and during that episode they each speak on looking back at different times where they caught Cait dressing as a woman. Kourtney caught him first in the garage a long time ago back before the show started and found him dressed as a woman, and she ran to Khloe crying because she was so confused.
I think Cait even addressed them and said he just liked dressing up sometimes, made it out to be more of a transvestite thing than a transgender one. And then there’s been conflicting stories about Cait telling Kris very early on in their marriage, which she vehemently denies. I think she was one of the last to find out.Â
I was starting to wonder, what if you already made up your mind to be a transgender AND THEN you had a stroke or a TBI? What then!
Reacting to the needs of transgender individuals who had a stroke or traumatic brain injury (TBI) requires professional skills, constructive sensitivity, and meticulous care. Transgender rehabilitation can be more complicated because of their medical, psychological, and social elements.
Always use positive conversation:
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Ask for the patient’s precise name and pronouns.
- Use chosen names and pronouns consistently across all medical records and interactions with staff.
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Ensure intake forms and EMRs allow for gender identity and chosen name fields.
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Avoid assuming someone’s gender based on voice, appearance, or medical records.
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Train all staff members on respectful communication and LGBTQ+ cultural competency.
Assess hormone therapy and medical history
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Health teams should keep up with hormone replacement therapy (HRT) when medically appropriate, as stopping treatment can cause anguish and affect recovery. Some medications used in stroke/TBI treatment may interact negatively with HRT, so coordination between specialists is needed.
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Brain injuries can sometimes affect memory and emotional regulation, for example, which may affect a person’s ability to advocate for their gender-affirming care needs. Healthcare providers should be prepared to work with patients who may have difficulty speaking these needs.
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Ask if the patient is taking hormone replacement therapy (HRT) such as estrogen or testosterone. These can influence clotting risk, relevant to stroke, and mood regulation, relevant in TBI.
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Coordinate care with the patient’s physician.
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Don’t stop HRT with the patient after a stroke of TBI because there are risks.
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Transgender patients are at higher risk for:
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Depression
- Stress
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Anxiety
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PTSD
Ensure safety and comfort in inpatient settings
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Assign rooming based on gender identity, not legal sex.
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Offer gender-neutral restrooms and privacy during care.
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Train all staff to avoid misgendering.
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Stroke and TBI can significantly impact identity and self-image. For transgender individuals, this may compound existing challenges related to gender dysphoria (a mental state in which a person has a profound sense of unease) or social acceptance.
- Mental health support should be integrated into treatment plans, with providers who understand both brain recovery and transgender profiles.
Adapt rehabilitation goals with respect
Getting social support
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If the patient is estranged from family, defaulting to biological next-of-kin for decisions could set the patient back in recovery.
- Ask who the patient wants involved in care planning.
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For transgender individuals with stroke or TBI, for example, this may complicate existing challenges related to gender dysphoria or social acceptance.Â
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Help connect them with transgender peer support groups on Facebook or community groups.
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If family relationships are broken due to the patient’s gender identity, social workers can help navigate these complex paradigms while advocating for the patient’s desirable outcome.
Ongoing recovery and follow-up
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Some transgender patients may have cognitive challenges that affect solving problems, making plans, managing emotions, memory, or communication.
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Be mindful that these may:
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Help transgender patients access:
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Language challenges may make it hard to correct misgendering.
- Occupational therapy might need to address specific activities of daily living that are important to the person’s gender identity.
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Provide regular training on:
- Inclusive language
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Transgender health
- Legal protections
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Facial recognition signs after brain injury may make it harder for a trans person to recognize allies vs hostile healthcare providers.
- Recovery planning should note how cognitive or physical changes might affect the person’s ability to continue gender-affirming treatments or maintain their gender expression.
The famous tennis star, Billie Jean King, said it best: “Everyone has people in their lives that are gay, lesbian or transgender or bisexual. They may not want to admit it, but I guarantee they know somebody.”
Whether they “came out” or not, I share Billie Jean’s opinion.
