Supporting Transgender Clients Part 2

This is a guest post from our friend Kat Mayerovitch. Kat is a massage therapist, writer, and award-winning speaker living in Vermont.

Part 1 of Supporting Transgender Clients can be found here.

I did then what I knew how to do. Now that I know better, I do better. -Maya Angelou

Ethical basics: trying to avoid being an accidental jerk

To create a space where we can effectively care for transgender clients, we need to avoid making them feel unsafe or unwanted. According to the 2011 National Transgender Discrimination Survey, 90% of transgender people report workplace harassment or discrimination, while 53% reported being verbally harassed or disrespected in a place of public accommodation, a category that includes restaurants, hotels, and (yes) massage businesses. A horrifying 41% have attempted suicide.

So yes, how we treat people matters. But you already knew that. What are the basics we need to know to prevent an experience in our massage practice from becoming another statistic? First are some things to actively avoid: misgendering, misnaming, making body assumptions, and outing.


Misgendering someone is awkward at best, and potentially dangerous at worst. (Remember those harassment statistics?) And it doesn’t just happen to trans people: being a woman with facial hair or even just sporting a short haircut and a unisex t-shirt is enough to get you labeled incorrectly.

Misgendering with forms:

In a massage environment, that labeling starts with your intake forms. Male? Or female?

For many trans people, this can feel like being asked if they’re an orange or a parakeet; there’s no correct answer. How do you respond? The way you look? The reproductive organs you have? What it says on your birth certificate? What it used to say on your birth certificate?

A quick fix like an “other” option can go a long way. Or you might consider doing away with the question altogether. (More on that later).

Misgendering with pronouns:

In English, we’ve been gifted with multiple words for just about everything, but our pronouns for fellow human beings are traditionally limited to only two sets: he/him/his, and she/her/hers. For whatever reason, we feel like gender is so important that it’s an inherent part of our grammar, while age, career, and preferred style of massage are not. In some languages, nobody has gendered pronouns. In others, everything from chairs to casseroles do. But whichever way you slice it, being called something you’re not is a whole bucket of no fun.

There are a few ways to tackle pronouns as a massage therapist. Spoiler: none of them are 100% comfortable for you all the time, but some have the potential to go much more smoothly than others.

  • You can do what most people do, making assumptions about pronouns based on appearances, apologizing when you mess it up, and trying to fix it afterwards.
  • You can ask in person what pronouns people prefer. A bit awkward in the beginning, but avoids the considerably more disconcerting experience of messing it up down the line.
  • You can ask about pronouns in your intake forms, or even in your online scheduling. This has the advantage of minimizing in-person awkwardness while also communicating that you take respecting people’s gender identities seriously.

No matter what method you choose, you may be wondering, what if you mess up? Apologize. Move on. Get it right next time. This gem from Star Trek shows how it’s done:

Captain Janeway: Ensign, despite Starfleet protocol, I don’t like to be addressed as Sir.

Harry Kim: I’m sorry … Ma’am.

Captain Janeway: Ma’am is acceptable in a crunch but I prefer Captain.

Yup, it’s really that simple. It’s not about you and your need for absolution, it’s about fixing your goof.


Names are so intensely personal. In addition to carrying information about our families’ cultural backgrounds and even our ages (I’m looking at you, Jessica-born-in-1982), most names carry a lot of gendered information as well. This is one reason why trans folks often choose a name that better fits their gender identity.

This could be similar to their former name or not. It could be distinctly gendered or gender-neutral. It could be a nickname or an invented name or a family name written a dozen times in the family Bible, but regardless, it is the name the client wishes to be called, and so that is the name to use.

This might not be the same as the name on the ID or billing information or the insurance documents. Not a problem. It doesn’t matter one bit that Susanna’s bank account says George, any more than it matters that Katie’s says Kathleen. If whatever fraud-avoiding tactics you take in your workplace check out, Katie is Katie and Susanna is Susanna.

This holds in the treatment room, at the reception desk, over the phone, and in emails. If you have multiple people working in your place of business, this means nobody gets to George Susanna. If that means having an all-staff meeting or putting a sticky note in her file (with the correct pronouns too), then do that. You can be as respectful as can be, but if the new nail tech looks at the calendar and says in front of everyone “George? Who’s George?” your safe environment is done for.

Body Assumptions

This is an area in which many (the idealist in me says most) massage therapists shine. We’re accustomed to asking questions about people’s bodies rather than making assumptions, which is how we avoid bruising the tough-looking client on blood thinners or injuring the dancer with a stress fracture.

Similarly, making unwarranted assumptions about people’s bodies based on their gender presentation can also get us into trouble. A few potential pitfalls:

  • Assuming that, because someone does not have breasts, that they are comfortable with their chest undraped.
  • Assuming that you do or do not need to navigate around external genitalia, just because your client is a woman.
  • Assuming that, due to a transgender client’s convincing gender presentation, they must have undergone surgery of various sorts.
  • Assuming that techniques that are unsafe during pregnancy are okay, because your client is a man.

Transgender clients have all the physical quirks that our cisgender clients have. Some may have a few more. Things to consider:

  • Beginning hormone therapy as an adult can lead to what is functionally a second puberty. Remember being a teen? Voice breaking, breasts aching, acne, mood swings, inopportune sexual arousal? Imagine going through all that again at 20. Or 60.
  • Surgery of any kind leaves marks on those who experience it. Scarring is an obvious example. Tenderness or numbness are others. But also consider how someone’s posture changes after breast reduction or augmentation. How their activity levels decrease while in recovery. You may find yourself working in tandem with your client’s physical therapist or other members of their healthcare team.
  • Just because it’s the body your client wanted doesn’t mean it’s not different from the one they had before. It’s not strange to feel weird, or emotional, or nervous about this body being touched by a relative stranger.

Again, not only is this list not exhaustive, but none of these experiences are universal, and as a massage therapist it’s important to avoid making assumptions. There are plenty of trans individuals who undergo no radical changes to their bodies. And increasingly, trans children are being recognized and supported in their gender identities, which means that more transgender teens are able to avoid sex-associated changes to their bodies before they happen. This also means that massage therapists who focus on pediatric populations are not exempt from the need to avoid assumptions about gender.


The importance of not sharing private information about clients cannot be overstated. If you wouldn’t share a client’s billing information or HIV status or the fact that they have a tattoo of Donald Duck right over their gluteus maximus, you shouldn’t be telling the whole world that your client is transgender.

People share a lot of very private information with their massage therapists. Don’t let that be a mistake.

But of course, it’s more complicated than just not talking about it on the nightly news. It takes good judgement. Consider a few scenarios: what would you do?

  • Your 17-year-old client you’ve known as Dan for the last year confesses that they’d always wished they were born female, and asks if you’d call them Cordelia while in private. They also mention that they haven’t spoken to their mother about the matter yet. Soon after, the Cordelia’s mother calls and asks if Dan has been behaving strangely lately.
  • Your genderqueer client walks out after her session. Another client asks you, “Is that a man or a woman? I can’t even tell.”
  • You regularly volunteer at an organization supporting the transgender community, which is how you first came into contact with your client Lisa, who receives services there as well as volunteering herself. You chat briefly about mutual acquaintances and another practitioner asks “Oh, how do you two know each other outside of massage?”
  • You are a recent massage school graduate with a new practice in a small town, and one of your clients is a trans man who recently moved from out of state. Another massage therapist in a public group on Facebook asks whether you have any experience working with transgender clients.

A final note on outing: when it comes to sexual orientation, the idea of “coming out” is generally seen as a positive thing. It means that someone was hiding their true reality, but is now living it openly. In the T part of the LGBT community, things are a little more complicated. Someone who has transitioned to life as a woman and is living as such is already publicly living her reality. Telling people about being trans may only complicate this honest living of her truth.

This is not to say that trans people talking openly about their experiences isn’t important, but it isn’t the right decision for everybody. When it comes to coming out, let people make difficult choices for themselves.

Better than basics: doing good

Working to avoid harming folks is vital, but going beyond is even better. While there are dozens of things you can do to actively support trans clients in your massage practice, here are a few high-impact steps you can begin to take right away: publicly declaring your support, eliminating unnecessarily gendered practices, educating yourself and others, and going beyond your practice to support the trans community.

Declare your support

If you’re an ally, say it. It’s said that talk is cheap, but it’s also necessary. If you’re not afraid to support your transgender clients, don’t be afraid to say it to the world. If you’re making changes to your practice, share them. If you’ve realized you’ve been making assumptions about people’s gender, own up to it. Will people be turned off? Quite possibly.

But they probably won’t assault you on the street for it. There’s privilege there, so use it for good.

Do you have a personal statement of nondiscrimination? Does it include trans people? If not, fix it.

Do you blog? Have you talked about the steps you are taking to support transgender clients? If not, start typing.

Does your website say nothing about your policies on gender? Are all the images in your marketing materials of traditionally masculine men and feminine women? How would somebody in your reception area know your stance as an ally to trans people? What about walking past your front door?

You might be thinking to yourself, “This is a lot. If I mention transgender people everywhere, do I also have to mention disabled people, and people of different religions and nationalities, and every other group that’s discriminated against? Where does it stop?”

The answer, of course, is that it stops wherever you decide it stops. You don’t have to change everything from your educational handouts to your window dressings. But everything is worth examining to decide whether or not it is conducive to a welcoming environment. If you never look, you don’t get to make that call.

Ditching gender

This may sound radical at first, but it’s actually not as bizarre as it sounds at first: you might want to consider dumping gendered practices in your massage practice altogether.

Sex and gender on forms

Back to those pesky intake forms again. You’ve satisfied basic courtesy by adding an “other” option, which is great. But it’s worth your time to think about why you’re asking about sex or gender in the first place.

Good reasons to ask about sex on your intake forms:

  • You’re part of a larger medical practice that requires this information.
  • You’re a nonprofit that’s required to track this information about your clients or you’ll lose your gender-specific grant funding.

Bad reasons to ask about sex on your intake forms:

  • You really, really, really like to know everyone’s business.
  • You’ve always done it that way.

Are you worried about not being aware of the risk of sex-specific conditions? Just ask everyone about everything. It’s no more trouble for a man to indicate he’s not pregnant than it is for a woman to do so. (And it often gets a laugh, which is nice for breaking the ice.)

Are you worried about how you’ll know someone’s gender (rather than sex) if it’s not on their forms? This is where asking about pronouns makes sense. If you’ve been asking if someone is male or female, could you use that space to ask instead whether someone prefers she/her/hers, he/him/his, they/their/theirs, or something else? Or, if you use online scheduling and already ask about things like names and phone numbers, could you add a place to select pronouns? That way you know your initial interactions with people will involve speaking to people the way they choose to be spoken to.


Bathroom bills have been all over the news, and it’s something everyone needs to address.

  • You can make it explicit that people are free to use whatever bathrooms they want.
  • You can make a single-occupancy bathroom available, in addition to gendered bathrooms.
  • You can get rid of segregated bathrooms.

If you don’t have control over the construction of your space, you may or may not be able to offer the second two. But if you’re doing a serious remodel anyway, the third option might be the way to go. No more lines out one door while another, perfectly functional restroom goes unused. No more trans guy wishing desperately that they had a bin for their tampons in the men’s room. No more dads not knowing where to take their preschool daughters when they “gotta go RIGHT NOW.”

Plus, you can have more fun with unisex bathroom signs.

Educating yourself

Change happens. Science advances, society shifts, language evolves, and wide-legged pants become cool, then not cool, then surprisingly cool again. This article is not going to be a functional reference five years from now. And that’s okay.

This does mean that you need to stay on top of things.

Visit trans-related websites regularly, ideally ones that actual transgender people have had a hand in creating and updating. Read news stories, including the hard ones. It doesn’t help you to pretend bullying and harassment don’t exist. But also the positive stories. The local mom who blogs about going to bat for her transgender daughter, the trans author who’s in town for a book signing, the gender-free contra dance group where leads and follows don’t have to be worried about being called “gents” and “ladies” anymore. When there’s a new law, or a medical study, or a catchy song that relates to transgender people, take a moment or five to read about it.

Keep up on what resources are available for trans folks in your community. Do you have an LGBT community center that is open to (really open to, not just lip service) trans membership and involvement? Is there a formal or informal directory of trans-friendly healthcare providers or businesses, or places people can pee safely without being given the stink-eye by management? How about a crisis hotline? A trans family potluck Meetup? There’s probably a Facebook group for your state or region, if not your immediate town or metro area. (Isn’t there a Facebook group for everything?) Find it. Read it. Learn.

Stepping up

They say that knowing is half the battle, but it’s only half. And stepping up in support of the trans community is the other half. What if there isn’t a list of trans-friendly organizations in your town? Maybe you’ll be the one to create it. You read about that anti-trans bill in your State Senate? Say something about it. Saw a group of high school kids defending their trans classmate outside the smoothie shop next door? Write a letter to the editor about it. Trans woman was let go from her job when she started to transition? Maybe you know someone who’s hiring a person with her skillset. (Maybe that someone is you?) There’s no one way to be supportive. But just because it’s nebulous, doesn’t mean it’s unnecessary.

  • Confront.
  • Welcome.
  • Acknowledge.
  • Contribute.
  • Volunteer.
  • Listen.

And keep learning. Because we all deserve a better world.

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