You, he, she and me equals us

February 14, 2020
Mike Paul, DVM
Mike Paul, DVM

Dr. Paul is the former executive director of the Companion Animal Parasite Council and a former president of the American Animal Hospital Association. He is currently the principal of MAGPIE Veterinary Consulting. He is retired from practice and lives in Anguilla, British West Indies.

dvm360, dvm360 March 2020, Volume 51, Issue 3

As society evolves, veterinary practices must adapt to new norms. Today, gender is one of those areas where a “new normal” means you have to adjust how you address employees and clients who may not think as you do.

We learn very early in life how to speak. In society, we learn to communicate in a manner that is generally standardized so that we can be understood by others. As infants and children, we learn language primarily by exposure and imitation; you say a word and I repeat something similar. (Remember your first days of high school French?)

Learning languages as a child is easier than learning as an adult because there is less complex information to digest and transmit. We learn to associate words with meanings. Conceptual applications are generally very simple, and grammatical rules are of little importance. If you listen to people speak English in developing countries, you’ll notice that the use of incorrect verb tense and incorrect pronouns is common.

I remember as a small child learning pronouns to the tune of a children’s song. Sixty-plus years later I can remember not only the tune but all of the pronouns. And while they are a relatively small part of our language, pronouns make a big impact when used incorrectly. Living in the Caribbean for some years, I am still amused when I hear an elderly Anguillan ask, “When them went?” or “Where she be?”

The gender shift

Increasing numbers of employees entering the workplace have gender identities and expressions that differ from what we commonly might think of when discussing gender. Recently someone close to me shared that they had struggled with their gender identity for years, finally realizing that their assigned gender at birth was not who they are. In fact, this person feels neither male nor female but both and at the same time. This is known as “gender fluid.”

After the surprise wore off, I became confused … not so much by who my friend was but by how I would relate to them and honor their wishes. The first thing that hit me was “How do I address them?” Do I say “he” or “she” or some other newly coined term? Then I realized it wasn’t just me who had always referred to them by their gender-associated pronoun. What about their other friends? Their family? Their coworkers?

So, I started reading and found to my surprise that the issue is less confusing than we might think. Keep in mind that gender and sexual orientation are very different. Sexual orientation indicates who you are attracted to, while gender applies to who you are. Most of us grew up with two genders—male and female—but it isn’t that simple anymore. A term commonly applied today is “nonbinary,” which means neither exclusively male nor exclusively female. (Some people who are nonbinary experience their gender as both male and female, while others experience their gender as neither male nor female.) According to the most widely cited definition, a person is called transgender (or trans) if their gender identitytheir internally experienced gender—differs from the gender identity expected on the basis of what was legally assigned at birth.

It’s nothing new

Gender diversity may be new to most of us, but it is not new to society. There is evidence of transgender and nongender people dating back 4,000 years, and research indicates well over 100 instances of diverse gender expression in Native American tribes at the time of early European contact. “Two-Spirit” is a modern term used by some indigenous Native Americans to describe Aboriginal people in their communities who fulfill a traditional and necessary third gender ceremonial role in their culture. The cultural legacy of these people was nearly erased by religious indoctrination and the imposition of laws criminalizing varied sexuality and gender expression.

More recently, a UCLA study showed that the percentage of trans adults has doubled in the past 10 years from 0.3% to 0.6%.1 In some survey reports, up to 2.7% of today’s youth identify as gender nonconforming.3,4

As it should be, most communities in recent years have become more inclusive and accepting of gay and lesbian neighbors, employees and coworkers. Long a less visible part of society, LGBTQ individuals have made great strides socially, politically and economically. Today there is increased awareness of nonbinary individuals being subjected to harassment and denial of basic rights. Nonbinary and transgender colleagues, coworkers and clients deserve and will demand equality.

So, what impact will this have on your practice culture? How will it affect your business? (And it will.) We will have to learn sensitivity to LGBTQ employees, clients and colleagues.

Nonbinary in the workplace

The implications for the workplace in general and for veterinary practices in particular are obvious: Things will change. According to social-science company CivicScience, nonbinary people have higher unemployment rates than those who identify with a specified gender.2 Masculine nonbinary people who still appear male or are not "passing as female" generally have a harder time in the work environment. Yet many companies are making small but measurable efforts to recognize nonbinary employees and customers, and nonbinary is increasingly offered as an option with male or female on credit applications, insurance forms and driver’s licenses.

In English,a noun can be one of four genders: masculine (man, actor), feminine (woman, mare), common (parent, friend), and neuter (house, car). So, If a person can appear male but consider themselves female, or they were born female but consider themselves male—or consider themselves neither male nor female—how should we address or refer to or them?

First, avoid using the gender-specific pronouns “he,” “she,” “her” or “his.” Rather than struggle uncomfortably with searching for the correct pronoun, it is common and surprisingly easy to simply ask how the individual wants to be referred to. In some settings, applications and email signatures include the individual’s preferred pronouns.

The bottom line

All of this may be new to you and unprecedented in your workplace. But acceptance of political, religious, racial, sexual differences will broaden horizons and enhance our experience of life. So the most important thing to remember is that while their experience may seem foreign, all of your employees, coworkers and clients should always be addressed with tolerance, respect and courtesy.


1. Flores AR, Herman JL, Gates GJ, et al. How many adults identify as transgender in the United States? The Williams Institute website: Published June 2016. Accessed February 14, 2020.

2. Counting counts: Quantifying LGBTQ experiences & sentiment (Part 1). Civic Science website: Published 2019. Accessed February 14, 2020.

3. Herman JL, Flores AR, Brown TNT, et al. Age of individuals who identify as transgender in the United States. The Williams Institute website: Published January 2017. Accessed February 14, 2020.

4. Rider GN, McMorris BJ, Gower AL, et al. Health and care utilization of transgender and gender nonconforming youth: A population-based study. Pediatrics 2018;141(3):e20171683.

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