When it comes to everyday health risks, LGBTQ+ communities generally share the same concerns as everyone else. No one wants to get sick. Everyone wants the best care.
But certain disparities exist that put lesbian, gay, bisexual, transgender and queer people at greater risk for specific health issues. These include HIV and other sexually transmitted infections (STIs), certain types of cancer and behavioral health issues.
LGBTQ+ people face many obstacles when it comes to taking care of their health. Many lack access to proper medical attention. Others are reluctant to see a doctor due to bad experiences or a lack of understanding of their health needs.
Fewer doctor visits can lead to poorer outcomes, which is troubling. Many health issues facing LGBTQ+ people are preventable or can be treated better with early detection or the right expertise.
“There are a lot of new treatments available to help us help our patients feel better and healthier from the inside out,” says Manish Champaneria, MD, a plastic surgeon specializing in transgender surgery at Scripps Clinic Del Mar.
Mental health is a significant issue in LGBTQ+ communities. Many individuals are prone to depression and anxiety, which can stem from fear of discrimination or actual rejection.
“It’s unfortunate that despite all the progress that we’ve made, there is still a lot of discrimination,” says Brian Kim, MD, a family medicine physician and HIV specialist at Scripps Coastal Medical Center Hillcrest.
“A lot of people still live in the closet, especially while they’re still young, and there is increased depression and anxiety in the community,” Dr. Kim says. “It’s something that we definitely pay attention to when we see our patients. We check in with them.
“The people who are actually the happiest are the people who have completed their process of coming out and are able to live the lives that they wanted to live. We see more issues with people who have not been able to come out because of fear of discrimination or rejection,” he adds.
For transgender people, gender dysphoria is a major concern. “Gender dysphoria is feeling depressed or anxious about the gender you were born into, but you identify with another gender,” explains Dr. Champaneria.
“These patients can feel lonely, anxious, depressed. It’s important for them to seek the correct care for that, meaning a mental health professional, a social worker, a psychiatrist, even a family medicine doctor.
“Access can be a problem. But once they find the right physicians and the right practitioners — who can help prescribe their hormones, who can help them with their mental health and finding the right surgeons — that will provide them the best care possible.”
Transgender individuals may seek medical and surgical treatments, including hormone therapy and gender-confirming surgery, as part of their care. Dr. Champaneria says patients must be emotionally prepared to make the change to their ideal gender prior to any surgery.
Anyone who is sexually active can get an STI. However, certain groups are at higher risk. They include gay and bisexual men, and transgender women.
The most common STIs are chlamydia, gonorrhea and syphilis, which are bacterial infections. STIs are also caused by viruses, including HIV and human papillomavirus or HPV.
STIs are very treatable, especially when caught early, including HIV, the virus that causes AIDS. While there is still no cure for HIV and AIDS, new medications have made them easier to handle.
Pre-exposure prophylaxis (PrEP) is a prescription drug that helps prevent HIV infection. Postexposure prophylaxis (PEP) is for those who don’t have HIV but may have been exposed to it.
“With the evolvement of newer anti-retrovirals, we’re really not seeing the death sentence that we used to see in the past with HIV. It’s become more of a chronic disease, very manageable,” says Dr. Kim.
“There are still some challenges with HIV,” he adds. “There is increased risk of cardiovascular disease, and more premature aging with HIV, but besides that, it’s come a long way.”
Dr. Kim recommends gay men be tested for STIs as frequently as necessary, and at least annually.
Condoms are still recommended to prevent infections spread through body fluids, including HIV, gonorrhea and chlamydia. However, condoms may be less effective in preventing diseases that can spread through skin contact, such as herpes and genital warts.
Gay men are at increased risk for HPV-related anal and throat cancers. The HPV vaccine protects against the cancer-causing forms of HPV.
Screening options may include an anal pap test. An anoscopy, which is another test, examines the lining of the anus for signs of pre-cancer or cancer.
Vaccinations are also recommended for hepatitis A and hepatitis B, which are more prevalent in the LGBTQ community.
Health care providers sensitive to LGBTQ+ needs can be found in many places. Scripps has repeatedly been recognized as a leader in LGBTQ health care equality.
The LGBTQ+ Healthcare Directory is a free online list of medical professionals who have an understanding of the unique health concerns of LGBTQ+ individuals.
Dr. Champaneria says it’s helpful if LGBTQ+ people can find a physician who is sensitive to their health needs or is a member of their community.
“It would be great if they are part of the LGBTQ community but that’s not a mandatory requirement. Just make sure you are comfortable with whoever you seek care with,” he says.