1555 - Considerations for Transgender Patients with Traumatic Brain Injury

Case Diagnosis: Care of a transgender patient after traumatic brain injury.

Case Description: A 22 year-old female to male transition (pronouns he/him) with extensive psychosocial history including post-traumatic stress disorder and previous suicide attempts sustained a severe traumatic brain injury (TBI) in a motorcycle collision. He presented to rehabilitation with moderate to severe cognitive deficits. His transgender status and distrust in healthcare systems posed unique rehabilitation challenges.

He was initially observed to be anxious and difficult to engage. As his cognition and communication improved, concerns about low mood and distrust became more apparent. His pre-injury records noted history of medical noncompliance due to lack of trust in hospitals and care providers. To overcome these challenges, the rehabilitation team established a therapeutic relationship emphasizing compassionate and culturally-sensitive care specific to his preferences and mental health history. Over the remainder his hospitalization, clear improvements in mood and therapy engagement were noted. His functional recovery progressed rapidly thereafter, and he successfully discharged back to the community.

Discussions: Transgender individuals represent a growing population, yet traditional healthcare models often fail to meet their medical and psychosocial needs. These individuals face distinct challenges related to their gender identity and are disproportionately affected by trauma, violence, and mental health disorders. Moreover, they are at a higher risk of experiencing TBIs. Discrimination, social stigma, and a lack of education among healthcare providers are common barriers to the effective care of these individuals. Ensuring all team members consistently provide compassionate, inclusive, and culturally-sensitive care is critical to establishing a therapeutic alliance between the patient and the treatment team and will promote better outcomes.

Conclusions: Transgender individuals with TBI require specialized care incorporating their specific needs and preferences. Additional research establishing evidence-based guidelines and best practices for this challenging and vulnerable patient population is desperately needed.