Audiometry with transgender people

This is a subject area which although rare, does come up and is one I have had to address myself on small number of occasions when doing audiometric tests.

In any audiometry done for health screening purposes, a basic part of the test is the categorisation of the result, which is done against expected standard for that person's age and gender. Women generally have better hearing than men, a difference which widens with age, meaning a woman and a man with exactly the same level of hearing could be a Category 2 (acceptable) for the man, but Category 3 (needs follow-up examination) for the woman as it is weaker than it should be for her age. This means assessing a man against a the standard for a woman could register as a problem whereas for male standards it is perfectly fine.

With transgender people, although they may have transitioned to their current gender, genetically they are still their original gender. Someone who started out as male and has transitioned to female still has XY chromosomes - they still have 'male ears' as it were. The same is true for people who don't see themselves as either gender - psychologically they have no gender, but genetically they still have either XX or XY chromosomes, (with the exceptions of very rare cases of things like XXY or XYY) and therefore would have the expected hearing ability of that gender.

This means that within the scope of a hearing test, some sensitivity and tact is needed as being presented with a result stating their gender to be different to the one they live as can be offensive or upsetting to some people. This is how I used to do it:

  1. During the medical history review I would be told they had undergone gender reassignment.
  2. I used to start the test using the gender they have identified as, and run the test as that.
  3. Once the test was complete, the category of result would be identified. 
  4. If that category of result was normal I would leave it at that.
  5. If the category of result was showing an issue, I would change the gender to the one they were born with and see what that did to the result.
  6. If that changed the result to 'normal' then I would switch it back, explain it to them, and print it out showing their preferred gender with a note on it saying 'no issues'. On our in-house record I would keep a note that future tests would need this double-check.
  7. If the switch of gender didn't eliminate a category showing an issue and the problem remained, I would discuss it further with the attendee. If their transition was recent or ongoing then the cocktail of drugs used can have an impact on hearing, otherwise I would refer.

A gender does have to be assigned though as the category of result cannot be calculated without it.