Beyond Allyship: Leveraging Activism Tools to Improve Transgender and Nonbinary Health

Content Warning: Some linked resources contain outdated or medicalized language regarding transgender and nonbinary experiences.

Each month, dozens of new thinkpieces on Trans allyship cross my desk—

7 Steps to Be A Better Trans Ally in 2022

Allyship Means Showing Trans People We Can Trust You

Actionable Allyship for Introverts and Trauma Survivors

As a queer, nonbinary person working in public health communications, I often wonder: how many of these vulnerable stories and actionable guides translate to improved health outcomes for gender expansive people? Does this immense focus on allyship effectively translate to equity, or is this just another way for straight, cisgender folks to center themselves in our world?

In the Transgender and Nonbinary (TGNB) community, allies have been critical partners in pushing for movement on entrenched issues including bathroom rights, standards of healthcare, trans-inclusive workplaces, and HIV decriminalization. 

In modern social justice activism, however, discussions of allyship—or the practice of leveraging power from privileged in-groups to advance well-being and equity alongside marginalized groups—often focus on improving allyship itself, the personal growth of individual allies, and vague, forward-focused concepts like building equitable futures. This emphasis provides both a guiding light to eager change-makers, and controversial quicksand for marginalized community members struggling to make their own voices heard. While improving allyship is important, allies’ personal growth should always come second to marginalized community members’ immediate (often life-threatening) concerns.

From Allyship to Impact

Because Transgender and Nonbinary peoples’ health is inextricably tied to their gender and ability to express their gender, allies have an opportunity that is rare in social justice activism: allies can directly improve TGNB health outcomes without lived experience, medical training, or formal mental health support training. This is because social transition—one of the foundations of TGNB health and mental health care—is a medical process that takes place largely outside the formal medical system. Instead, it is carried out primarily by TGNB individuals and their social circles, support systems, and surrounding communities.

[TGNB] health is dependent upon not only good clinical care but also social and political climates that provide and ensure social tolerance, equality, and the full rights of citizenship. Health is promoted through public policies and legal reforms that promote tolerance and equity. -World Professional Association for Transgender Health

Thinking about social transition as a form of healthcare in which allies have the opportunity to directly participate opens up a world of possibilities. This is where allies can expand beyond a mindset of participating in allyship and improving themselves into a space of participating in and improving health outcomes for Transgender and Nonbinary people

This direct approach can be especially powerful when leveraged throughout influential and anchor institutions. Explore four key action areas where allies can make an immediate impact:

  1. Care & service settings
  2. Places of work
  3. Places of learning
  4. Places of power

Illustration of six people standing side-by-side, each with a different color shirt (red, orange, yellow, green, blue, purple) and their pronouns written across their chest.
Beyond Inclusion: Pronoun Use for Health and Well-Being
Story - Original
Brought to you by Community Commons

Care & Service Settings

Care and social services settings-–from public health and mental healthcare, to wrap-around services and medical insurance—are often the focal point of TGNB activism and advocacy. Despite decades of diversification work, these fields and underlying infrastructure  remain dominated by white, straight, cisgender, abled men, who are largely undereducated regarding TGNB people and their health. Moving these institutions forward in their understanding and service of Transgender and Nonbinary people can have direct impacts on their well-being.

Concrete actions to take:

  • Understand the science of gender and trans care
  • Be able to articulate how using proper pronouns and chosen names improves health outcomes for TGNB people
  • Know, use, and push others to use best practices, well-established standards for transgender care, emerging improvements to standards of care, and alternative models like the Informed Consent Model
  • Update forms and software to list chosen name and pronouns. If legal name is required (for insurance purposes, for example), that should be listed in a separate, deprioritized field.
  • Update processes to communicate health information based on individuals’ medical needs, not their gender (i.e. sending communications about postpartum depression to all people who give birth, not just people listed as “female”; trans men can give birth too!)
  • Correct the false assumption that Transgender and Nonbinary people need to see “transgender specialists” for basic care. While it is crucial that providers be trained in Transgender and intersecting cultural competences, all TGNB people should not have to seek out specialists for basic needs, such as establishing a Primary Care Provider.
  • Prioritize TGNB people in services which disproportionately impact them, such as trauma, violence, and sexual assault services (50% of transgender people have been sexually assaulted in their lifetime and are significantly more likely than cisgender people to be the victims of violent crimes in general)

Image of transgender person in a wheelchair leaving a care facility
Protecting and Advancing Health Care for Transgender Adult Communities
Resource - Report
Brought to you by Center for American Progress
Screenshot of webpage: Informed Consent Model for Gender Affirming Hormone Therapy
Informed Consent Model for Gender Affirming Hormone Therapy
Resource - Website/webpage
Brought to you by Johns Hopkins University School of Medicine

Places of Work

Places of work—including businesses, nonprofit organizations, networking groups, and professional development spaces—are often one of the most difficult for TGNB people to navigate. Workplaces are often unsafe (90% of transgender people have experienced harassment, mistreatment, or discrimination at work), which fuels major disparities in employment security and opportunity (white transgender people are twice as likely to be unemployed due to discrimination, while transgender people of color are four times more likely.) 

Despite the 2020 Supreme Court ruling that expanded federal anti-bias laws to protect gender and gender expression, laws are unevenly applied and workplaces remain unsafe for gender expansive people. These systemic issues can be met head-on to create safer environments and more equitable employment for TGNB people now.

Concrete actions to take:

  • Hire diverse staff, including TGNB people and organizations—and not just to work on TGNB-related issues.
  • Work TGNB perspectives and priorities into all levels of your organization, from staff and volunteer recruitment, to centering TGNB equity in long-term planning, work flows, and both internal and external communications
  • Implement inclusive workplace policies, including a pronouns policy encouraging (but not requiring) staff to share pronouns, and a pronoun use and coming out policy (for when a TGNB person is hired or an existing staff member or volunteer comes out as Transgender or Nonbinary)
  • Know the laws regarding workplace discrimination and have plans and procedures in place to reduce risk of liability—not just for TGNB people, but for all people who experience marginalization and are at risk of workplace harassment
  • Start with an organization-wide Trans 101 training and follow this up with an annual Equity, Diversity, and Inclusion (EDI) training focused on competence with Transgender and Nonbinary people specifically. Having a 10 minute block on Transgender issues during an hour-long EDI training is simply not adequate to create safety and equity for gender expansive people.

Places of Learning

Educational settings—including K-12 schools, colleges, universities, and even research facilities and academic journals—have long legacies of inequity and injustice for Transgender and Nonbinary people. According to the National Transgender Discrimination Survey report, transgender and gender non-conforming children and teens (grades K-12) reported “alarming rates of harassment (78%), physical assault (35%), and sexual violence (12%).” Across K-12 and higher education settings, the harassment was so severe that it led almost one-sixth (15%) of gender expansive students leaving school.

Activists today—primarily young Transgender and Nonbinary students—are deeply engaged in dismantling these legacies of exclusion in higher education. Allies can partner with TGNB activists to propel these efforts forward with clearer purpose and greater urgency.

Concrete actions to take:

  • Center TGNB students, professors, and staff in all policies, programs, and strategic thinking
  • Always include gender expansive people in campus well-being studies, campus improvement guides, and other institutional initiatives, even if the focus is not on TGNB people and issues. Immediately update any materials, which include demographic data but ignore transgender and nonbinary identities.
  • Gather data (quantitative and qualitative) about TGNB experiences in your institution through surveys, feedback forms, and listening sessions
  • Enable students to list (and update) chosen name and pronouns in college records
  • Create an EDI statement and plan, which specifically addresses TGNB experiences and health outcomes—both historically and the goals for improving equity moving forward
  • Hire a TGNB consultant to begin the work, especially if your educational setting is small or lacks existing policies and programs to create safety for TGNB people
  • Partner with mental health organizations like the National Alliance on Mental Illness (NAMI) to reduce stigma regarding mental health, making it safer and easier for TGNB students who are struggling to seek care
  • Advocate for gender-neutral bathrooms and gender-inclusive housing options where relevant (boarding schools, college campuses)

Places of Power

Despite their resilience and self-advocacy, LGBTQ+ people are four times as likely as cisgender people to experience violence. This is especially prominent for Transgender and Nonbinary people (an overwhelming 53% of transgender people have been harassed in a public place), and even more prominent for transgender women of color:

This epidemic [of fatal violence against transgender and gender non-conforming people] disproportionately impacts trans women of color, who comprise approximately 4 in 5 of all known violent killings of transgender, non-binary and gender non-conforming people. –Human Rights Foundation, Dismantling a Culture of Violence Report

Often, the legal and justice systems TGNB people rely on to protect them from this extreme burden of violence are equally (or more) excluding, discriminatory, and dangerous. Transgender people are seven times more likely than cisgender people to experience violence from law enforcement, and are more likely to be arrested for and found guilty of crimes than cisgender people. Once incarcerated, Transgender people experience significantly increased rates of harassment by correctional officers, detention and separation due to gender identity or expression, violence from peers, sexual assault, and denial of routine healthcare.

Governments, public health authorities, city and county offices, legislatures, and all facets of the justice and legal systems, require deep transformation to address these extreme, life-threatening dangers. While many places are making great strides toward justice and equity for gender expansive people, some places and sectors lag behind. 

Concrete actions to take:

  • Familiarize yourself with anti-discrimination laws, transgender rights, and accommodations–these are critical for both policy and legislative advocacy, and allyship in public places where trans people are most likely to experience discrimination
  • Check to see if your city and county are on the Gender Identity Anti-Discrimination map. If your city and/or county is on the list, take time to find your local policies and familiarize yourself with them. If your city or county is not on the list, learn about your local process for writing and implementing a non-discrimination ordinance, or updating your local ordinance to include gender identity and expression.
  • Advocate for your state, county, and city to implement best practice policies regarding transgender bathroom rights, HIV decriminalization, and trans healthcare standards
  • Follow proposed pro- and anti-transgender legislation, such as efforts to ban healthcare for transgender youth, and join collective actions to write or call legislators in support of TGNB people across the U.S.
  • Partner with local organizations that advocate for TGNB justice and equity, through donations of time, money, and resources

Next Steps

While active allyship is an excellent long-term personal goal, it is critical that we not emphasize the personal growth of allies and the improvement of allyship itself over the critical needs, voices and input of the marginalized groups that allyship seeks to serve. Professionals and organizations working to improve community health and equity can move beyond allyship and directly partner with Transgender and Nonbinary people to improve health outcomes. 

    1. Start by choosing one of the four action areas above (Care and Service Settings, Places of Work, Places of Learning, and Places of Power)
    2. Explore the listed resources
      • Choose one concrete action to take or begin working on today
        • Curate your own list of actions and set dates to complete them
          • Share key resources and actions with social circles, colleagues, local officials, and legislators

          Let us know of any resources or concrete actions you think should be included on this page or on Community Commons in general. We would love to hear from you!

          Sarah Bond-Yancey (they/she) is a Senior Communications & Design Consultant at IP3, and a contributing editor at Community Commons.

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