LGBTQ+ Health: Common Health Concerns and Care Needs

Everyone deserves healthcare where they feel comfortable, respected and understood. But finding that care can be challenging for people in the LGBTQ+ community.

While LGBTQ+ individuals share many health needs with everyone else, some face higher rates of depression, anxiety and certain sexually transmitted infections (STIs).

Discrimination, limited insurance coverage and high costs can contribute to LGBTQ+ health disparities, making it harder to get care and recommended screenings.

Finding a doctor you trust can make a difference.

“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,” says Manish Champaneria, MD, a plastic surgeon specializing in transgender surgery at Scripps Clinic Del Mar.

Here are six important areas of LGBTQ+ health and preventive care.

LGBTQ+ individuals may experience higher rates of depression and anxiety, especially when facing discrimination, rejection or bullying. Coming out can also be stressful, particularly for young people who worry about how family or friends will respond.

Doctors can help patients navigate these challenges and find support.

“It’s something that we definitely pay attention to when we see our patients. We check in with them,” says Brian Kim, MD, a family medicine physician and HIV specialist at Scripps Coastal Medical Center Hillcrest.

“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,” Dr. Kim adds.

If you’re feeling persistently sad or anxious or having trouble sleeping, talk with your doctor or a mental health professional. Counseling, medication or both can help.

Regular cancer screenings can help detect cancer early, when it may be easier to treat. But some LGBTQ+ individuals face barriers to screening, including discrimination concerns and difficulty finding supportive doctors.

The American Cancer Society notes that lesbian and bisexual women may face certain cancer risks and barriers to preventive care.

The screenings you need depend on your age, medical history, anatomy and personal risk factors, not just your sexual orientation or gender identity.

Important cancer screenings include:

• Breast cancer: Mammograms help detect breast cancer early. Some transgender patients may need individualized screening based on hormone use and surgical history.
• Cervical cancer: If you have a cervix, you may need regular cervical cancer screening, including if you're a transgender man or nonbinary person.
• Colorectal cancer: Most adults at average risk should start screening at age 45.
• Anal cancer: Some people at higher risk, including certain people with HIV, may benefit from screening.

The human papillomavirus (HPV) can also cause several cancers, including cervical, anal, throat and other cancers. HPV vaccination helps prevent infections that can lead to these cancers.

Not sure which screenings you need? Talk with your doctor about what's right for you.

Transgender and nonbinary people need routine healthcare and preventive screenings like everyone else. Some may also seek gender-affirming care, including hormone therapy, mental health support or surgery.

Some experience gender dysphoria, or distress related to a difference between their gender identity and sex assigned at birth. Not everyone experiences it.

“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,” says Dr. Champaneria.

If you're receiving hormone therapy, regular checkups help monitor treatment and possible side effects.

Anyone who is sexually active can get an STI. But some groups, including gay and bisexual men and transgender women, have higher rates of certain infections.

Common STIs include chlamydia, gonorrhea, syphilis, HPV and HIV. Many cause no symptoms, so regular testing is important even if you feel fine. Some can be cured, while others can be managed with treatment.

The Centers for Disease Control and Prevention recommends testing for certain STIs at least once a year for sexually active gay, bisexual and other men who have sex with men. Those at higher risk may need testing every three to six months.

How often you need testing depends on your sexual activity and personal risk factors.

Condoms can lower your risk of HIV and many other STIs, though they offer less protection against infections spread through skin-to-skin contact, such as herpes and HPV.

Not sure when to get tested? Talk with your doctor about STI screening and ways to protect your sexual health.

HIV treatment has come a long way. While there is no cure, today's medications can help people with HIV live long, healthy lives.

“With the evolvement of newer antiretrovirals, 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.

With effective treatment, HIV can become undetectable in the blood. People who maintain an undetectable viral load cannot transmit HIV through sex. This is known as undetectable equals untransmittable (U=U).

Medications can also prevent HIV:

PrEP (pre-exposure prophylaxis): Medication for people without HIV who want to lower their risk. Options include daily pills and long-acting injections, including one given every six months.

PEP (post-exposure prophylaxis): Emergency medication after possible HIV exposure. Treatment must begin within 72 hours, preferably sooner, and usually lasts 28 days.

PrEP does not protect against other STIs, so condoms and regular testing remain important.

Think you've been exposed to HIV? Seek medical care right away. Don't wait for symptoms.

Staying up to date on vaccines helps protect against infections and certain cancers. Some vaccines are especially important for people at higher risk.

Vaccines to discuss with your doctor include:

HPV vaccine: Helps prevent several cancers. Routine HPV vaccination is recommended at ages 11 or 12 but can start at age 9. Catch-up vaccination is recommended through age 26. Some adults ages 27 to 45 may also benefit.

Hepatitis A vaccine: Recommended for certain groups, including men who have sex with men and people with HIV.

Hepatitis B vaccine: Recommended for all adults ages 19 to 59, and adults 60 and older with certain risk factors. Other adults may also receive it.

While there is no vaccine for hepatitis C, treatment can cure most infections.

Finding a doctor who makes you feel comfortable, respected and heard can make it easier to talk about your health and get the care you need.

Look for a doctor who:

• Has experience caring for LGBTQ+ patients.
• Respects your identity, name and pronouns.
• Listens without judgment.
• Recommends screenings based on your needs.
• Connects you with specialists when needed.

Not sure where to start? The LGBTQ+ Healthcare Directory can help you find providers familiar with LGBTQ+ health needs.

A trusted primary care doctor can help you stay healthy, manage health concerns and get the support you need.

Watch the San Diego Health video with host Susan Taylor discussing LGBTQ+ health issues with Drs. Champaneria and Kim.