Evaluating Documentation Patterns of Gender-Identity and Gender-Affirming Care in the ICU

Sunday, March 22, 2026

9:45 AM - 10:45 AM Central Time

Location: Connections Central - RST 10

Samar S. Bhat, MD

UTSW

Disclosure(s): No relevant financial relationship(s) to disclose.
ES

Esmeralda Segura, MD

Resident Physician
University of Texas Southwestern Medical Center

Disclosure information not submitted.
Alexander J. Gajewski, MD (he/him/his)

University of Texas Southwestern Medical Center, Texas

Disclosure(s): No relevant financial relationship(s) to disclose.
GD

George Doumat Kouja Makhoul, MD

Resident Physician
University of Texas Southwestern Medical Center

Disclosure information not submitted.
Adan (Adam) Mora, Jr., MD (he/him/his)

University of Texas Southwestern Medical Center, Texas

Disclosure information not submitted.

Introduction: There is increasing evidence that accurate documentation of gender identity in the health record correlates with more effective care for transgender and gender-diverse (TGD) populations. There remains however a dearth of literature pertaining to considerations of care for TGD patients in the critical care setting. Our aim through this observational study is to bring attention to aspects that may inform care for this unique population in the ICU.

Methods: An IRB-approved single-center retrospective study was conducted for TGD patients admitted to an intensive care setting (Surgical (SICU), Neurological (NSICU), Cardiovascular (CVICU), Medical (MICU)) at the University of Texas Southwestern Medical Center. Admissions over the past 15 years were included and produced 22 admissions for 18 patients. ICU admission notes were analyzed for documentation of prior cross-sex hormone therapy, and gender identity that matched patient-reported gender identity charted prior to ICU admission. Admissions were counted if they made accurate reference to a patient’s gender identity or history of hormone therapy at least once during encounter documentation.

Results: The age of patients in our study ranged from 26 to 76 (Median 42, SD 16). 15 (68%) were assigned male sex and 7 (32%) were assigned female sex at birth. Patients identified as transgender male (5, 23%), transgender female (9, 41%), nonbinary (5, 23%), and other (2, 9%). Among ICU encounters, 10 (45%) included accurate documentation of gender identity/hormone therapy. When stratified by ICU setting, 1 CVICU admission (25%), 5 MICU admissions (45%), 2 NSICU admissions (50%), and 2 SICU admissions (67%) included accurate documentation of gender identity.

Conclusions: With less than half of admission encounters including accurate documentation of gender identity and gender-affirming care, our study highlights an important area for improvement. Accurate documentation represents an opportunity to communicate with future providers and fortify the patient/provider therapeutic relationship. Moreover, it serves as an important step towards acknowledging the unique and intersectional psychosocial barriers, comorbidity burden, and exposure to complex gender-affirming therapy faced by this vulnerable population in a busy critical care setting.