本文結合臨床護理實務、跨性別陪伴經驗與實際就醫案例，探討跨性別者在醫療體系中面臨的醫療品質與病人安全議題。觀察發現，即使跨性別者已完成身分證性別變更, 在就醫過程中仍可能因法律性別、生理構造與醫療專科分類的落差，面臨「被動現身」的風險；此非個別事件而是影響病人安全與醫療品質的結構性風險，進而干擾臨床判斷、醫病溝通與照護品質。本文比較臺灣國內外制度與經驗，說明第一線醫療人員的性別敏感度、溝通技巧，對提升就醫信任感具有關鍵作用。最後提出以器官導向評估、尊重自我認同為核心的建議，期能作為醫療機構建立友善揭露環境與推動性別友善、提升照護品質之實務參考。

This article integrates clinical nursing practice, experiences of accompanying transgender individuals, and real-world healthcare cases to examine issues of healthcare quality and patient safety faced by transgender people within the medical system. Observations indicate that even after completing legal sex marker changes on national identification documents, transgender individuals may continue to face risks of involuntary disclosure during healthcare encounters due to misalignment among legal gender,physical anatomy, and specialty-based clinical classifications. Such involuntary disclosure is not an isolated or incidental phenomenon; rather, it constitutes a structural risk that adversely affects patient safety and healthcare quality, potentially interfering with clinical decision-making, patient–provider communication, and overall quality of care. This article compares Taiwan’s current legal gender change requirements with international trends toward non-surgical legal gender recognition, and, through both local and international healthcare experiences, illustrates the critical role of frontline healthcare professionals’ gender sensitivity, communication practices, and clinical responses in enhancing patient safety and trust in healthcare settings. Finally, this paper proposes transgender-inclusive care strategies centered on organ based clinical assessment, respect for self-identified gender, and the establishment of supportive environments for safe disclosure, aiming to provide practical guidance for healthcare institutions seeking to advance gender-inclusive practices and healthcare quality improvement.