When providers talk about cultural competency, they often focus on checking boxes—pronouns, policies, paperwork—but being technically proficient is not the same as being culturally competent. For trans people navigating healthcare systems, true competency shows up in how providers make us feel: whether we’re treated as a burden to manage or a human being on a journey worth celebrating.

Sociologist Dr. Apoorva Ghosh, in Cultural Competence in Transgender Healthcare, defines cultural competence as, “having the knowledge, skills, and attitude to meet patients where they are and provide care that respects their unique identities and experiences.” While continuing education on the subject tends to place a great deal of emphasis on knowledge and skills, both patients and providers I spoke to believe that too little focus is given to the third aspect: attitude. And it is in attitude that real allies for transgender healthcare shine.

Petrichor Kneeland-Campbell has both personal and professional experience in LGBTQ+ cultural competency, as a genderqueer person receiving gender-affirming care, and a public speaker and DEI expert serving as the DEIJB Committee Chair of the Maine State Breastfeeding Coalition. They avoided discussing their need for gender-affirming care with their primary care provider, who was not trans-friendly, for fear of losing access to care for their disabilities. But even the affirming clinic they went to instead failed at basic cultural competency.

“They misgendered me. They deadnamed me. They refused to give me referrals.” This was unfortunately not a single occurrence. Even after correction, Kneeland-Campbell says, “They refused to use the correct pronouns, they refused to use my right name, and they refused me gender-affirming services when I asked for them. That was really disappointing, when I was finally able to be out everywhere, that this clinic that was supposedly the best in the area for gender-affirming care was denying me gender-affirming care.” After their own experience, they heard from multiple other trans people in the area that it seemed to be a common experience, and so they were forced to find a new clinic. Luckily, their new provider had not just the knowledge and the skills, but also the attitude necessary to serve their needs.

Kneeland-Campbell appreciated a number of things about their new clinic. The website was upfront about providing gender-affirming care, and even included a database of trans-friendly businesses (including ones offering services other than direct medical care). Intake forms were available online, so they could gauge ahead of time how accepting and affirming the space might be. And when they visited for the first time, their correct pronouns were front and center on their chart. They have never been misgendered.

But the thing that made the biggest difference was the way the providers at their local Maine Family Planning seemed to think and speak about gender-affirming care. From their very first visit, they say, “Everyone was just really friendly and seemed excited for me. It wasn’t like I was just another patient. It seemed that they were really invested in my care, and really wanted to make sure that I was happy with the care I was receiving.”

This attitude was exemplified in a conversation with the intake nurse. “She specifically said that she loves it when gender-affirming patients come in because she loves seeing the changes that they go through, and she really likes celebrating the changes, like when a voice change happens, or when facial hair starts to grow. They’re just really excited for their patients to be going through all the changes, and they like to go through the changes with them.” Gratefully, this spirit of celebration isn’t unique to one clinic, but rather a guiding principle for many affirming providers.

Dominique Hamler is a registered nurse and the Executive Director of The Los Angeles Outpatient Center (LAOP) mental health clinic, who also works to help train other health professionals in LGBTQ+ cultural competency. The kind of celebration that Kneeland-Campbell experienced is a big part of how Hamler approaches cultural competency at the LAOP. “We have these graduation ceremonies, where we see clients from start to finish. I take a picture of them… before treatment, during treatment, and after treatment, and then at the graduation ceremony, we get a chance to—we call it a ‘rock out’—we get a chance to go around the room and really talk about the progress and the success of this person.”

“Nobody wants to be a burden,” Hamler says. “We’re already carrying so much trauma.” This is why it’s so important to her that patients at the LAOP see their providers celebrating them and the journey they take at the clinic. This attitude of celebration can go a long way in helping providers develop in the other two areas necessary for LGBTQ+ cultural competency: knowledge and skills, because it helps make queer trans patients and fellow care providers feel safer offering education.

Kneeland-Campbell is rather accepting about the fact that they frequently need to educate their care providers, whether that be about their disabilities or their experience as a trans person. “It’s something I’m just used to at this point, and because I essentially do teaching through my public speaking, it’s something I don’t mind doing. However there are definitely times where it’s like, ‘Do I have to do this again?’” While they accept education as an inevitable part of seeking care, they do sometimes find themselves thinking, “Okay, you should really know this basic thing by now. I shouldn’t have to be teaching this to you.”

Those feelings are doubly hard when care providers are reluctant to hear what patients have to say. It’s important for care providers to accept that “expert” is a word which applies to people with lived experience, including people who don’t necessarily have healthcare credentials. On the other hand, waiting until a patient or client educates you about their experience can be incredibly burdensome on them. This is why so many of the providers I’ve spoken with have recommended turning to practitioners who also have the lived experience about which you are seeking to learn.

This was mentioned by Shelley Washington in our Provider POV interview when I asked her about how she thought care providers could better serve her communities: “If you need help, reach out! Contact us and we’ll get you to the right spaces, make sure you have the resources you need.” I heard the same idea from Will Dempsey, LICSW and founder of Heads Held High counseling, who I interviewed for an upcoming edition of Queer in Practice.

“Reach out to queer providers in your area,” he says. “Just reach out and ask for support.” Be mindful of someone’s capacity, of course. “Don't expect that people have the energy to educate you, because most of the things you're probably going to ask about, they're dealing with on a daily basis. So just check in first before you start rattling off all the questions.” But don’t let a fear of saying the wrong thing stop you from seeking help. Even if the person you contact doesn’t have the bandwidth to answer your questions, they will probably know someone who is offering the kind of education you’re seeking. “Be intentional about how you reach out, and then do it.”

Do your best, whether you are seeking education or just realizing in a moment with a patient that you need it, to avoid harm. But also remember that true cultural competency isn't just about avoiding harm—it's about showing up with humility, listening deeply, and celebrating the full humanity of the people you serve. Einstein said, “Weakness of attitude becomes weakness of character; it becomes lack of power to act with courage proportionate to danger.” In the fight for trans rights, where the stakes are high and the dangers real, it is through a courageous, compassionate attitude that providers can act with the strength this moment demands.