The number of transgender people continues to grow as resources become more readily available and the dialogue about gender becomes normalized. There is, quite simply, an increasing likelihood that someone who identifies as transgender will make their way onto your massage table.

It used to be that the T in LGBT was largely silent. Not anymore. According to a 2016 survey from the Williams Institute, a think tank focused on research on sexual orientation, it was estimated that about 0.6 percent of the U.S. population, or more than 1.3 million people, identified as transgender. Several sources note that this number could be underreported because many trans people don’t reveal their status as they feel they could be discriminated against.

While the term transgender has been in the media quite a bit lately, it’s safe to assume that most people do not personally identify with it and may not know exactly what it means.

Transgender is an umbrella term for any individual whose gender identity or gender expression varies from what is typically associated with the sex they were assigned at birth. The definition can be a mouthful, especially if you aren’t used to thinking of gender and sex as different things or if you don’t experience that dichotomy. (There is a word for people whose personal identity corresponds with their gender at birth, too: cisgender, cis– being a Latin prefix meaning “on the same side as” or “in alignment.”)

I have worked with the LGBT community since my high school days and have seen firsthand how disenfranchised transgender people feel.

Recent news reflects the discrimination transgender people face: In January 2019, the Supreme Court upheld a ban on transgender people serving in the military, and many anti-transgender bathroom bills introduced recently force transgender people to use public restrooms that conform with their gender at birth.

And yet, transgender progress is in the news as well, with transgender candidate Christine Hallquist running as the Democratic candidate for Vermont governor in 2018 (she lost to Republican incumbent Gov. Phil Scott), and an announcement in December 2018 that the second-oldest all-women’s college in the U.S., Stephens College in Columbia, Missouri, will begin accepting transgender women and non-binary (people who do not identify with a gender) students starting this fall.

No matter what the news or politics related to any type of clientele, the most important role of a massage therapist is to always meet and honor your client where they are.

What You Say Matters

With transgender massage clients, there are a few specific ways to really show that sensitivity. First, it is essential that you always use the name and pronouns your client identifies with. With a new client, this probably will not be a huge issue as you are starting with a clean slate. However, if you have worked with a client for a long time and they get their “Aha!” moment and come out to you, you will have to retrain yourself.

Transition does not just affect the individual in question, but also, to a lesser extent, the people in their lives. Be prepared to slip up and have to apologize—but continue to put forth effort. Your transgender clients will appreciate this more than you know.

Phrasing and sensitivity are important. You would never say, “So, what are you anyway?” or something comparably insensitive. You might introduce yourself by saying, “Hi, I’m Robert. My preferred gender pronouns are he, him and his.” This can feel very foreign at first. If it feels too weird, you could put a spot on your intake form for such preferred gender pronouns as she, her and hers, they, their and theirs, or other gender-neutral pronouns. Having that option, or hearing you speak in that way, will help a client feel more at ease. They will be reassured that their therapist sees them as valid.

Further, the term transgender is an adjective that is important to specify. Calling someone a transgender or multiple people transgenders is not particularly politically correct: In fact, some people consider this downright offensive. Describing someone as a transgender person or a group as transgender people is the appropriate verbiage.

The National Center for Transgender Equality ( suggests, “To treat a transgender person with respect, you treat them according to their gender identity, not their sex at birth. So, someone who lives as a woman today is called a transgender woman and should be referred to as ‘she’ and ‘her.’ A transgender man lives as a man today and should be referred to as ‘he’ and ‘him.’”

Being transgender, or trans, is only one aspect of who a person is. They still have a life, work, interests and relationships that are separate from their gender identity. Just as a cisgender woman may describe herself as a mother, daughter, writer, friend and activist, so might a transgender woman. The adjective in front is different, but the humanity remains the same.

The Transgender Massage Client

Gender transition is not about changing who you are, but about aligning yourself with your true self. Transition is not a one-size-fits-all. It can be broken down into three major categories: legal, social and medical, and an individual can include any or all of those categories in their personal transition. It is important to remember that not all transgender people undergo legal or medical transitions; however, their journeys are still valid.

As far as social or medical steps are concerned, we massage therapists can play an important role. We have all worked with clients who are disconnected from their bodies due to trauma, pain, low self-esteem and other conditions. For the transgender client beginning their transition, that disconnect is largely amplified. People who transition do so because they need to align their bodies with their spirits. Prior to taking whatever steps they feel necessary and are able to take—steps which can often be cost-prohibitive—they often literally feel uncomfortable in their own skin.

Transgender people are typically diagnosed with gender dysphoria. The word dysphoria means a state of unease or dissatisfaction with life. To apply that word to gender—something cisgender individuals have no reason to question—is to connect it with a key aspect of who you are. Massage is a way to bring transgender people comfort and show them their body is still worthy of care, even though it’s not how they want it to be.

If a client opts for a medical transition, there can be numerous scars, restricted range of motion and pain. Massage therapy can be helpful with all of these concerns.

While certain directly-impacted areas may be out of your scope, such as the area pertaining to genital reconstruction surgery, all surgeries impact the body as a whole. If you cannot directly work a scar, you can still work surrounding areas to increase ROM and release fascial tensions.

Two transgender men who transitioned from female to male spoke to me of their experiences. One man had undergone a bilateral mastectomy while the other had not. Both were draped in the standard way with the chest remaining covered.

Edwin,* who had not yet had surgery, remembered that his massage therapist had kept the sheet over his chest, “which was really helpful” so he could remove his chest binder and fully relax. He felt safe and found “[Massage] lets me get in touch with my body in a bit more friendly of a way.”

Mike* did not have the drape moved until he specifically asked for scar work, which he began receiving two weeks after his chest-masculinization surgery, with a doctor’s approval. Although the scars were small, as he had what is called the keyhole procedure, the impact to the entire pectoral area was major. (At this point in time, the scars are largely invisible and there were no notable restrictions in his chest due to scar tissue. “I am able to be shirtless in public without anyone batting an eye. I feel so free,” Mike said.)

Every Body Deserves Care

It is OK to not know about a topic or condition when you first come across it. When you started massage school, you probably did not know much about half the conditions in your pathology class. On day one, you might have said, “I’m never going to work on someone with X condition,” because it was foreign and you did not want to accidentally do harm.

As time went on, though, you kept an open mind and learned more about that condition and ways to work around or with it. Maybe you took continuing education courses.

Massage therapists are generally an open-minded, openhearted and well-intentioned group of people; in fact, those qualities are what frequently draw us to this healing field. Your transgender clients understand that you might not always know the right thing to do or say, that sometimes you will mess up on pronouns in the beginning—but as long as they see you continuing to put forth effort, most will feel safe with you. (Some clients will be willing to educate you, but others spend so much time educating already that they want their table time to be just that.)

All this aside, it is the goal of most transgender people to be treated like a person and not just a transgender person. When you get right down to it, we would be better off without the labels.

Transgender clients come to massage therapists seeking pain and stress relief, and the sanctuary that our hands and tables can provide. It is our role to hold the space and allow them to experience safe, compassionate touch. It is our role to show each of them that their body, regardless of how far they have or haven’t transitioned, is worthy of care.

*Clients’ names have been changed to protect confidentiality.

About the Author

Zeke Spooner, LMT, has been a licensed massage therapist since December 2014. He has run gay-straight alliances and done educational speaking for Stonewall Speakers, True Colors and the Institute for Sexuality Education and Enlightenment. In 2017 he debuted his workshop, “Transitioning With Your Transgender Client: Gender 101 and Sensitivity Training for LMTs,” approved by the National Certification Board for Therapeutic Massage & Bodywork.