LGBT topics in medicine are those that relate to lesbian, gay, bisexual, and transgender people's health issues and access to health services. According to the US Gay and Lesbian Medical Association (GLMA), besides HIV/AIDS, issues related to LGBT health include breast and cervical cancer, hepatitis, mental health, substance abuse, tobacco use, depression, access to care for transgender persons, issues surrounding marriage and family recognition, conversion therapy, refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."
Studies show that LGBT people experience health issues and barriers related to their sexual orientation and/or gender identity or expression. Many avoid or delay care or receive inappropriate or inferior care because of perceived or real homophobia or transphobia and discrimination by health care providers and institutions; in other words, negative personal experience, the assumption or expectation of negative experience based on knowing of history of such experience in other LGBT people, or both.
"Heterosexism can be purposeful (decreased funding or support of research projects that focus on sexual orientation) or unconscious (demographic questions on intake forms that ask the respondent to rate herself or himself as married, divorced, or single). These forms of discrimination limit medical research and negatively impact the health care of LGB individuals. This disparity is particularly extreme for lesbians (compared to homosexual men) because they have a double minority status, and experience oppression for being both female and homosexual."
Especially with lesbian patients, they may be discriminated in three ways:
- homophobic attitudes
- heterosexist judgements and behaviour
- general sexism – focusing primarily on male health concerns and services; assigning subordinate to that of men health roles for women, as for service providers and service recipients
- 1 Issues affecting LGBT people generally
- 2 Causes of LGBT health disparities
- 3 LGBT health and social support networks
- 4 Issues affecting lesbians
- 5 Issues affecting gay men
- 6 Issues affecting bisexual people
- 7 Pregnancy healthcare for lesbian women
- 8 Issues affecting transgender people
- 9 Health of LGBT people of color
- 10 Healthcare education
- 11 See also
- 12 References
- 13 External links
Issues affecting LGBT people generally
Research from the UK indicates that there appears to be limited evidence available from which to draw general conclusions about lesbian, gay, bisexual and transgender health because epidemiological studies have not incorporated sexuality as a factor in data collection. Review of research that has been undertaken suggests that there are no differences in terms of major health problems between LGBT people and the general population, although LGBT people generally appear to experience poorer health, with no information on common and major diseases, cancers or long-term health. Mental health appears worse among LGBT people than among the general population, with depression, anxiety and suicide ideation being 2–3 times higher than the general population. There appear to be higher rates of eating disorder and self-harm, but similar levels of obesity and domestic violence to the general population; lack of exercise and smoking appear more significant and drug use higher, while alcohol consumption is similar to the general population. Polycystic ovaries and infertility were identified as being more common amongst lesbians than heterosexual women. The research indicates noticeable barriers between LGB patients and health professionals, and the reasons suggested are homophobia, assumptions of heterosexuality, lack of knowledge, misunderstanding and over-caution; institutional barriers were identified as well, due to assumed heterosexuality, inappropriate referrals, lack of patient confidentiality, discontinuity of care, absence of LGBT-specific healthcare, lack of relevant psycho-sexual training. About 30 percent of all completed suicides have been related to sexual identity crisis. Students who also fall into the gay, bisexual, lesbian or trans gendered identity groups report being five times as more likely to miss school because they feel unsafe after being bullied due to their sexual orientation.
Research points to issues encountered from an early age, such as LGBT people being targeted for bullying, assault, and discrimination, as contributing significantly to depression, suicide and other mental health issues in adulthood. Social research suggests that LGBT experience discriminatory practices in accessing healthcare.
One way that LGB individuals have attempted to deal with discriminatory health care is by seeking "queer-friendly" health care providers
Causes of LGBT health disparities
Some causes of lack of access to healthcare among LGBT people are: perceived or real discrimination, inequality in the workplace and health insurance sectors, and lack of competent care due to negligible LGBT health training in medical schools. Healthcare professionals that have little to no knowledge about the LGBT community can result in a lack of or a decline in the type of healthcare these families receive. "Fundamentally, the distinctive healthcare needs of lesbian women go unnoticed, are deemed unimportant or are simply ignored" (DeBold, 2007; Weisz, 2009). This citation is from the article Marginalised mothers: Lesbian women negotiating heteronormative healthcare services, which talks about how heteronormative rhetorics affect the way lesbian couples are viewed. Views like these lead to the belief that health care training can exclude the topic related to the healthcare of LGBT and make certain members of the LGBT community feel as though they can be exempt from healthcare without any bodily consequences. An upstream issue is the relative lack of official data on gender identity that health policy makers could use to plan, cost, implement and evaluate health policies and programs to improve transgender population health.
LGBT health outcomes are strongly influenced by social support networks, peers, and family. One example of a support network now available to some LGBT youth include Gay-Straight Alliances (GSAs), which are clubs that work to improve the climate for LGBT youth at schools and educate students and staff about issues faced by the LGBT community. In order to investigate the effects of GSAs on LGBT youth, 149 college-aged students that self-identified as LGBT completed a survey that assessed their high school’s climate for LGBT youth, and their current health and alcohol dependency outcomes. Those participants who had a GSA at their high school (GSA+ youth) reported higher senses of belonging, less at-school victimization because of their sexual orientation, more favorable outcomes related to their alcohol use behaviors, and greater positive outcomes related to depression and general psychological distress when compared to those without a GSA (GSA- youth). Amongst other competing variables that contributed to these outcomes, the vast majority of schools that had a GSA were located in urban and suburban areas that tend to be safer and more accepting of LGBT people in general.
Family and social support networks also relate with mental health trajectories amongst LGBT youth. Family rejection upon a youth “coming out” sometimes results in adverse health outcomes. In fact, LGBT youth who experienced family rejection were 8.4 times more likely to attempt suicide, 5.9 times more likely to experience elevated levels of depression, and 3.4 times more likely to use illegal drugs than those LGBT youth who were accepted by family members. Family rejection sometimes leads youth to either run away from home or be kicked out of their home, which relates to the high rate of homelessness experienced by LGBT youth. In turn, homelessness relates to an array of adverse health outcomes that sometimes stem from homeless LGBT youths’ elevated rates of involvement in prostitution and survival sex.
One longitudinal study of 248 youth across 5.5 years found that LGBT youth that have strong family and peer support experience less distress across all time points relative to those who have uniformly low family and peer support. Overtime, the psychological distress experienced by LGBT youth decreased, regardless of the amount of family and peer support that they received during adolescence. Nonetheless, the decrease in distress was greater for youth with low peer and family support than for those participants with high support. At age 17, those who lacked family support but had high peer support exhibited the highest levels of distress, but this distress level lowered to nearly the same level as those reporting high levels of support within a few years. Those LGBT youth without family support but with strong support from their peers reported an increase in family support over the years in spite of having reported the lowest family support at the age of 17.
Similarly, another study of 232 LGBT youth between the ages of 16-20 found that those with low family and social support reported higher rates of hopelessness, loneliness, depression, anxiety, somatization, suicidality, global severity, and symptoms of major depressive disorder (MDD) than those who received strong family and non-family support. In contrast, those who solely received non-family support reported worse outcomes for all measured health outcomes except for anxiety and hopelessness, for which there was no difference.
Some studies have found poorer mental health outcomes for bisexual people than gay men and lesbians, which has been attributed to some degree to this community’s lack of acceptance and validation both within and outside of the LGBT community. One qualitative study interviewed 55 bisexual people in order to identify common reasons for higher rates of mental health problems. The testimonials that were collected and organized into macro level (social structure), meso level (interpersonal), and micro level (individual) factors. At the social structure level, bisexuals noted that they were constantly asked to explain and justify their sexual orientation, and experienced biphobia and monosexism from individuals both within and outside of the LGBT community. Many also stated that their identify was repetitively degraded by others, and that they are assumed to be promiscuous and hypersexual. During dates with others that did not identify as bisexual, some sighted being attacked and rejected solely based their sexual orientation. One female bisexual participant stated that upon going on a date with a lesbian female, “...she was very anti-bisexual. She said, ‘You’re sitting on the fence. Make a choice, either you’re gay or straight’” (p. 498). Family members similarly questioned and criticized their identity. One participant recalled that his sister stated that she would prefer if her sibling were gay instead of “...this slutty person who just sleeps with everyone” (p. 498). At the personal level, many bisexual struggle to accept themselves due to society’s negative social attitudes and beliefs about bisexuality. In order to address issues of self acceptance, participants recommended embracing spirituality, exercise, the arts, and other activities that promote emotional health.
Issues affecting lesbians
According to Katherine A. O’Hanlan, lesbians "have the richest concentration of risk factors for breast cancer [of any] subset of women in the world." Additionally, many lesbians do not get routine mammograms, do breast self-exams, or have clinical breast exams.
There are also policy documents from both the UK and US Government that stated there could be higher rates of breast cancer among lesbian and bisexual women despite insufficient evidence. In a 2009 report by the UK All Party Parliamentary Group on Cancer's Inquiry into Inequalities in Cancer, it was stated that "Lesbians may have a higher risk of breast cancer.
Depression and anxiety
Depression and anxiety are thought to affect lesbians at a higher rate than in the general population, for similar reasons.
Domestic violence is reported to occur in about 11 percent of lesbian homes. While this rate is about half the rate of 20 percent reported by heterosexual women, lesbians often have fewer resources available for shelter and counselling.
Lesbian and bisexual women are more likely to be overweight or obese.
Lesbians often have high rates of substance use, including recreational drugs, alcohol and tobacco. Studies have shown that lesbian and bisexual women are 200% more likely to smoke tobacco than other women.
Lesbians who tell their health care providers they are sexually active report being pressured to obtain birth control, since the provider often equates female sexual activity with the possibility of pregnancy.
Issues affecting gay men
Human papilloma virus
Human papilloma virus, which causes anal and genital warts, plays a role in the increased rates of anal cancers in gay men, and some health professionals now recommend routine screening with anal pap smears to detect early cancers. Men have higher prevalence of oral HPV than women. Oral HPV infection is associated with HPV-positive oropharyngeal cancer.
Depression, anxiety, and suicide
According to GLMA, "the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection, and treatment of these conditions." Researchers at the University of California at San Francisco found that major risk factors for depression in gay and bisexual men included a recent experience of anti-gay violence or threats, not identifying as gay, or feeling alienated from the gay community.
Results from a survey by Stonewall Scotland published in early 2012 found that 3% of gay men had attempted suicide within the past year.
Eating disorders and body image
Gay men are more likely than straight men to suffer from eating disorders such as bulimia or anorexia nervosa. The cause of this correlation remains poorly understood, but is hypothesized to be related to the ideals of body image prevalent in the LGBT community. Obesity, on the other hand, affects relatively fewer gay and bisexual men than straight men
Men who have sex with men are at an increased risk of sexually transmitted infection with hepatitis, and immunization for Hepatitis A and Hepatitis B is recommended for all men who have sex with men. Safer sex is currently the only means of prevention for the Hepatitis C.
Sexually transmitted infections
The first name proposed for what is now known as AIDS was gay-related immune deficiency, or GRID. This name was proposed in 1982, after public health scientists noticed clusters of Kaposi's sarcoma and Pneumocystis pneumonia among gay males in California and New York City.
Men who have sex with men are more likely to acquire HIV in the modern West, Japan, India, and Taiwan, as well as other developed countries than among the general population, in the United States, 60 times more likely than the general population. An estimated 62% of adult and adolescent American males living with HIV/AIDS got it through sexual contact with other men. HIV-related stigma is consistently and significantly associated with poorer physical and mental health in PLHIV (people living with HIV).
Black gay men have a greater risk of HIV and other STIs than white gay men. However, their reported rates of unprotected anal intercourse are similar to those of men who have sex with men (MSM) of other ethnicities.
David McDowell of Columbia University, who has studied substance abuse in gay men, wrote that club drugs are particularly popular at gay bars and circuit parties. Studies have found different results on the frequency of tobacco use among gay and bisexual men compared to that of heterosexual men, with one study finding a 50% higher rate among sexual minority men, and another encountering no differences across sexual orientations.
Issues affecting bisexual people
Typically, bisexual individuals and their health and well-being are not studied independently of lesbian and gay individuals. Thus, there is limited research on the health issues that affect bisexual individuals. However, the research that has been done has found striking disparities between bisexuals and heterosexuals, and even between bisexuals and homosexuals.
It is important to consider that the majority of bisexual individuals are well-adjusted and healthy, despite having higher instances of health issues than the heterosexual population.
Body image and eating disorders
Youth who reported having sex with both males and females are at the greatest risk for disordered eating, unhealthy weight control practices compared to youth who only have same- or other-gender sex. Bisexual women are twice as likely as lesbians to have an eating disorder and, if they are out, to be twice as likely as heterosexual women to have an eating disorder.
Mental health and suicide
Bisexual females are higher on suicidal intent, mental health difficulties and mental health treatment than bisexual males. In a survey by Stonewall Scotland, 7% of bisexual men had attempted suicide in the past year. Bisexual women are twice as likely as heterosexual women to report suicidal ideation if they have disclosed their sexual orientation to a majority of individuals in their lives; those who are not disclosed are three times more likely. Bisexual individuals have a higher prevalence of suicidal ideation and attempts than heterosexual individuals, and more self-injurious behavior than gay men and lesbians. A 2011 survey found that 44 per cent of bisexual middle and high school students had thought about suicide in the past month.
Female adolescents who report relationships with same- and other-sex partners have higher rates of alcohol abuse and substance abuse. This includes higher rates of marijuana and other illicit drug use. Behaviorally and self-identified bisexual women are significantly more likely to smoke cigarettes and have been drug users as adolescents than heterosexual women.
Bisexual women are more likely to be nulliparous, overweight and obese, have higher smoking rates and alcohol drinking than heterosexual women, all risk factors for breast cancer. Bisexual men practicing receptive anal intercourse are at higher risk for anal cancer caused by the human papillomavirus (HPV).
HIV/AIDS and sexual health
Most research on HIV/AIDS focuses on gay and bisexual men than lesbians and bisexual women. Evidence for risky sexual behavior in bisexually behaving men has been conflicted. Bisexually active men have been shown to be just as likely as gay or heterosexual men to use condoms. Men who have sex with men and women are less likely than homosexually behaving men to be HIV-positive or engage in unprotected receptive anal sex, but more likely than heterosexually behaving men to be HIV-positive. Although there are no confirmed cases of HIV transmitted from female to female, women who have sex with both men and women have higher rates of HIV than homosexual or heterosexual women.
In a 2011 nationwide study in the United States, 46.1% of bisexual women reported having experienced rape, compared to 13.1% of lesbians and 17.4% of heterosexual women, a risk factor for HIV.
Pregnancy healthcare for lesbian women
There have been several studies that discuss healthcare experiences of pregnant lesbian women. Larsson and Dykes conducted a study in 2009 about lesbian mothers in Sweden. The participants wanted their healthcare providers to confirm and recognize both parents, not just the biological mother. They also wanted their healthcare providers to ask questions about their "life styles" to demonstrate their openness about sexuality. Most of the women in the study commented that they had good experiences with healthcare. However, birth education tended to focus on mother and father dynamics. The forms that were also used tended to be heterosexist (see Heterosexism), only allowing for mother and father identities. To account for these differences, Singer created a document about how to improve the prenatal care of lesbian women in the United States. She found that curiosity about a patient's sexuality can take over an appointment, sometimes placing the patient into a situation where they end up educating the provider. To be inclusive, Singer recommended that healthcare providers should be more inclusive in their opening discussions by saying "So tell me the story of how you became pregnant". Healthcare providers should, according to Singer, use inclusive language that can be used for all types of patients. Healthcare providers were also not aware of how much reproductive health care cost for lesbian couples and they should openly recognize this issue with their lesbian patients. Pharris, Bucchio, Dotson, and Davidson also provided suggestions on how to support lesbian couples during pregnancy. Childbirth educators should avoid assuming that parents are heterosexual or straight couples. They recommend using neutral language when discussing parent preferences. Forms, applications, and other distributed information should be inclusive of lesbian parents. They suggest using terms such as "non-biological mother, co-parent, social mother, other mother and second female parent" are good examples. Asking parents was also a suggested way to figure out what term should be used. Parents may also need help navigating legal systems in the area.
Midwife(wives) and Doula(s) have provided care for lesbian women and couples who are pregnant. In an article in Rewire News, there was a discussion of how midwives and doulas are attempting to improve the overall care of lesbian couples by having specific training based on providing care to these couples as well as having inclusive processes. In a study of lesbian and bisexual women in Canada about using healthcare services, researchers Ross, Steele, and Epstein found that the women in the study loved working with doulas and midwives. Midwives were considered helpful advocates with other healthcare providers that they encountered. Midwives also discuss their perspectives. Röndahl, Bruhner, and Lindhe conducted a study in 2009 about lesbian pregnancy experiences of women in Norway. They found that midwives were the ones who were responsible for creating a space to discuss sexuality. However, midwives in the study felt that they were inadequate about having the communication tools to create this space. Additionally, the researchers found that lesbian couples were seen as different compared to straight couples. The partners have a sense of both love and friendship. Their differences were also seen when trying to find the roles for the lesbian co-mothers (non-biological mothers), as the language and questions asked did not fit their roles. Finally, the researchers found that there needed to be a balance of asking questions and being overly assertive. Midwives could ask questions about the patients' sexuality, but asking too many questions caused discomfort in the patients.
Issues affecting transgender people
Access to health care
The World Professional Association for Transgender Health (WPATH) Standards of Care provide a set of non-binding clinical guidelines for health practitioners who are treating transgender patients. The Yogyakarta Principles, a global human rights proposal, affirms in Principle 17 that "States shall (g) facilitate access by those seeking body modifications related to gender reassignment to competent, non-discriminatory treatment, care and support.
Transgender individuals are often reluctant to seek medical care or are denied access by providers due to transphobia/homophobia or a lack of knowledge or experience with transgender health. Additionally, in some jurisdictions, health care related to transgender issues, especially sex reassignment therapy, is not covered by medical insurance.
In the UK, the NHS is legally required to provide treatment for gender dysphoria. As of 2018, Wales refers patients to the Gender Identity Clinic (GIC) in London, but the Welsh government plans to open a gender identity clinic in Cardiff.
In India, a 2004 report claimed that hijras 'face discrimination in various ways' in the Indian health-care system, and sexual reassignment surgery is unavailable in government hospitals in India.
In Bangladesh, health facilities sensitive to hijra culture are virtually non-existent, according to a report on hijra social exclusion.
Denial of health care in the United States
The 2008-2009 National Transgender Discrimination Survey, published by National Gay and Lesbian Task Force and the National Center for Transgender Equality in partnership with the National Black Justice Coalition, shed light on the discrimination transgender and gender non-conforming people face in many aspects of daily life, including in medical and health care settings. The survey reported that 19% of respondents had been refused healthcare by a doctor or other provider because they identify as transgender or gender non-conforming and transgender people of color were more likely to have been refused healthcare. 36% of American Indian and 27% of multi-racial respondents reported being refused healthcare, compared to 17% of white respondents. In addition, the survey found that 28% of respondents said they had been verbally harassed in a healthcare setting and 2% of respondents reported being physically attacked in a doctor's office. Transgender people particularly vulnerable to being assaulted in a doctor's office were those who identify as African-Americans (6%), those who engaged in sex work, drug sales or other underground work (6%), those who transitioned before they were 18 (5%), and those who identified as undocumented or non-citizens (4%).
An updated version of the NTDS survey, called the 2015 U.S. Transgender Survey, was published in December 2016.
Section 1557 of the Affordable Care Act contains nondiscrimination provisions to protect transgender people. In December 2016, however, a federal judge issued an injunction to block the enforcement of "the portion of the Final Rule that interprets discrimination on the basis of 'gender identity' and 'termination of pregnancy'". Under the Trump administration, Roger Severino was appointed as civil rights director for the U.S. Department of Health and Human Services (HHS). Severino opposes Section 1557 and HHS has said it "will not investigate complaints about anti-transgender discrimination," as explained by the National Center for Transgender Equality. When a journalist asked Severino if, under the HHS Conscience and Religious Freedom division whose creation was announced in January 2018, transgender people could be "denied health care," he said "I think denial is a very strong word" and that healthcare "providers who simply want to serve the people they serve according to their religious beliefs" should be able to do so without fear of losing federal funding. On May 24, 2019, Severino announced a proposal to reverse this portion of Section 1557.
On April 2, 2019, Texas Senate Bill 17 passed by a vote of 19-12. It would allow state-licensed professionals such as doctors, pharmacists, lawyers, and plumbers to deny services to anyone if the professional cites a religious objection. To reveal the motivations behind the bill, opponents proposed an amendment to prohibit discrimination based on sexual orientation or gender identity; the amendment failed 12-19.
On October 15, 2019, federal judge Reed O'Connor vacated the part of the Affordable Care Act that protects transgender people. The ruling means that federally-funded healthcare insurers and providers may deny treatment or coverage based on sex, gender identity or termination of pregnancy, and that doctors aren't required to provide any services whatsoever to transgender people—even if they're the same services provided to non-transgender people, and even if they're medically necessary.
Although they are not the only uninsured population in the United States, transgender people are less likely than cisgender people to have access to health insurance and if they do, their insurance plan may not cover medically necessary services. The National Transgender Discrimination Survey reported that 19% of survey respondents stated that they had no health insurance compared to 15% of the general population. They were also less likely to be insured by an employer. Undocumented non-citizens had particularly high rates of non-coverage (36%) as well as African-Americans (31%), compared to white respondents (17%).
While a majority of U.S. insurance policies expressly exclude coverage for transgender care, regulations are shifting to expand coverage of transgender and gender non-conforming health care. A number of private insurance carriers cover transgender-related health care under the rubric of "transgender services", "medical and surgical treatment of gender identity disorder", and "gender reassignment surgery". Nine states (California, Colorado, Connecticut, Illinois, Massachusetts, New York, Oregon, Vermont, and Washington) and the District of Columbia require that most private insurance plans cover medically necessary health care for transgender patients.
Depending on where they live, some transgender people are able to access gender-specific health care through public health insurance programs. Medicaid does not have a federal policy on transgender health care and leaves the regulation of the coverage of gender-confirming health care up to each state. While Medicaid does not fund sex reassignment surgery in forty states, several, like New York and Oregon, now require Medicaid to cover (most) transgender care.
Cancers related to hormone use include breast cancer and liver cancer. In addition, trans men who have not had removal of the uterus, ovaries, or breasts remain at risk to develop cancer of these organs, but trans women remain at risk for prostate cancer.
According to transgender advocate Rebecca A. Allison, trans people are "particularly prone" to depression and anxiety: "In addition to loss of family and friends, they face job stress and the risk of unemployment. Trans people who have not transitioned and remain in their birth gender are very prone to depression and anxiety. Suicide is a risk, both prior to transition and afterward. One of the most important aspects of the transgender therapy relationship is management of depression and/or anxiety." Depression is significantly correlated with experienced discrimination. In a study of San Francisco trans women, 62% reported depression. In a 2003 study of 1093 trans men and trans women, there was a prevalence of 44.1% for clinical depression and 33.2% for anxiety.
Suicide attempts are common in transgender people. In some transgender populations the majority have attempted suicide at least once. 41% of the respondents of the National Transgender Discrimination Survey reported having attempted suicide. This statistic was even higher for certain demographics – for example, 56% of American Indian and Alaskan Native transgender respondents had attempted suicide. In contrast, 1.6% of the American population has attempted suicide. In the sample all minority ethnic groups (Asian, Latino, black, American Indian and mixed race) had higher prevalence of suicide attempts than white people. Number of suicide attempts was also correlated with life challenges - 64% of those surveyed who had been sexually assaulted had attempted suicide. 76% who had been assaulted by teachers or other school staff had made an attempt.
In 2012 the Scottish Transgender Alliance conducted the Trans Mental Health Study. 74% of the respondents who had transitioned reported improved mental health after transitioning. 53% had self-harmed at some point, and 11% currently self-harmed. 55% had been diagnosed with or had a current diagnosis of depression. An additional 33% believed that they currently had depression, or had done in the past, but had not been diagnosed. 5% had a current or past eating disorder diagnosis. 19% believed that they had suffered from an eating disorder or currently had one, but had not been diagnosed. 84% of the sample had experienced suicide ideation and 48% had made a suicide attempt. 3% had attempted suicide more than 10 times. 63% of respondents who transitioned thought about and attempted suicide less after transitioning. Other studies have found similar results.
Personality disorders are common in transgender people.
Gender identity disorder is currently classed as a psychiatric condition by the DSM IV-TR. The upcoming DSM-5 removes GID and replaces it with 'gender dysphoria', which is not classified by some authorities as a mental illness. Until the 1970s, psychotherapy was the primary treatment for GID. However, today the treatment protocol involves biomedical interventions, with psychotherapy on its own being unusual. There has been controversy about the inclusion of transsexuality in the DSM, one claim being that Gender Identity Disorder of Childhood was introduced to the DSM-III in 1980 as a 'backdoor-maneuver' to replace homosexuality, which was removed from the DSM-II in 1973.
Transgender individuals frequently take hormones to achieve feminizing or masculinizing effects. Side effects of hormone use include increased risk of blood clotting, high or low blood pressure, elevated blood sugar, water retention, dehydration, electrolyte disturbances, liver damage, increased risk for heart attack and stroke. Use of unprescribed hormones is common, but little is known about the associated risks. One potential hazard is HIV transmission from needle sharing. Cross-sex hormones may reduce fertility.
Some trans women use injectable silicone, sometimes administered by lay persons, to achieve their desired physique. This is most frequently injected into the hip and buttocks. It is associated with considerable medical complications, including morbidity. Such silicone may migrate, causing disfigurement years later. Non-medical grade silicone may contain contaminants, and may be injected using a shared needle. In New York City silicone injection occurs frequently enough to be called 'epidemic', with a NYC survey of trans women finding that 18% were receiving silicone injections from 'black market' providers.
Sexually transmitted infections
Trans people (especially trans women – trans men have actually been found to have a lower rate of HIV than the general US population) are frequently forced into sex work to make a living, and are subsequently at increased risk for STIs including HIV. According to the National Transgender Discrimination Survey, 2.64% of American transgender people are HIV positive, and transgender sex workers are over 37 times more likely than members of the general American population to be HIV positive. HIV is also more common in trans people of color. For example, in a study by the National Institute of Health more than 56% of African-American trans women were HIV-positive compared to 27% of trans women in general. This has been connected to how trans people of color are more likely to be sex workers.
A 2012 meta analysis of studies assessing rates of HIV infection among transgender women in 15 countries found that trans women are 49 times more likely to have HIV than the general population. HIV positive trans persons are likely to be unaware of their status. In one study, 73% of HIV-positive trans women were unaware of their status.
Latin American trans women have a HIV prevalence of 35%, but most Latin American countries do not recognize transgender people as a population. Therefore, there are no laws catering to their health needs.
Transgender people have higher levels of interaction with the police than the general population. 7% of transgender Americans have been held in prison cell simply due to their gender identity/expression. This rate is 41% for transgender African-Americans. 16% of respondents had been sexually assaulted in prison, a risk factor for HIV. 20% of trans women are sexually assaulted in prison, compared to 6% of trans men. Trans women of color are more likely to be assaulted whilst in prison. 38% of black trans women report having been sexually assaulted in prison compared to 12% of white trans women.
In a San Francisco study, 68% of trans women and 55% of trans men reported having been raped, a risk factor for HIV.
Trans people are more likely than the general population to use substances. For example, studies have shown that trans men are 50% more likely, and trans women 200% more likely to smoke cigarettes than other populations. It has been suggested that tobacco use is high among transgender people because many use it to maintain weight loss. In one study of transgender people, the majority had a history of non-injection drug use with the rates being 90% for marijuana, 66% for cocaine, 24% for heroin, and 48% for crack. It has been suggested that transgender people who are more accepted by their families are less likely to develop substance abuse issues.
In the Trans Mental Health Study 2012, 24% of participants had used drugs within the past year. The most commonly used drug was cannabis. 19% currently smoked. A study published in 2013 found that among a sample of transgender adults, 26.5% had abused prescription drugs, most commonly analgesics.
Health of LGBT people of color
In a review of research, Balmsam, Molina, et al., found that "LGBT issues were addressed in 3,777 articles dedicated to public health; of these, 85% omitted information on race/ethnicity of participants". However, studies that have noted race have found significant health disparities between white LGBT people and LGBT people of color. LGBT health research has also been criticized for lack of diversity in that, for example, a study may call for lesbians, but many black and minority ethnic groups do not use the term lesbian or gay to describe themselves.
Various bodies have called for dedicated teaching on LGBT issues for healthcare students and professionals, including the World Health Organisation and the Association of American Medical Colleges. A 2017 systematic review found that dedicated training improved knowledge, attitudes and practice, but noted that programmes often had minimal involvement by LGBT individuals themselves.
Several government-funded organizations have launched other initiatives to involve LGBT individuals:
"Healthy People 2020: Lesbian, Gay, Bisexual, and Transgender Health" is a government-funded initiative sponsored by the Office of Disease Prevention and Health Promotion, based on a 10-year agenda with the goal of improving the nation’s health in measurable ways. "The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding" written by the Institute of Medicine and based on research funded by the National Institutes of Health emphasizes the importance of collecting data on the demographics of LGBT populations, improving methods for collecting this data, and increasing the participation of LGBT individuals in research. "LGBT Health and Well-being" published by the US Department of Health & Human Services (HHS), this 2012 report outlines the LGBT Issues Coordinating Committee’s objectives for 2011 and 2012. The HHS also hosts an online center for information on LGBT health, including HHS reports, information on access to health care, and resources organized for specific communities within the LGBT population (including LGBT youth, people living with HIV, refugees, women, and older adults).
In addition, many private sector initiatives have worked to connect LGBT people to competent healthcare. Health Professionals Advancing LGBTQ Equality (formerly known as the Gay & Lesbian Medical Association) hosts an online directory of queer-educated medical professionals with expertise in hormone replacement therapy, LGBT reproductive services, and pain management. A similar organization called OutCare Health maintains a smaller directory concentrated in the Midwest.
In 2019, WAXOH, in partnership with DatingPositives, The Phluid Project, Bi.org, Hairrari, the OUT Foundation, launched #WeNeedAButton, a campaign that calls for patient-matching sites like Yelp and ZocDoc to add a queer-friendly button or filter, so that consumers can easily see which doctors are LGBTQ-friendly. The campaign was launched during Pride 2019, on the 50th anniversary of Stonewall, and was supported by ambassador and journalist Zachary Zane and sexual health advocate Josh Robbins.
Kaiser Permanente, the third-largest health care organization in the country and headquartered in Oakland, has been recognized by the Human Rights Campaign Foundation for its commitment to LGBTQ in its 2018 Healthcare Equality Index, and has designated the organization a "healthcare equality leader"every year since 2010.
- LGBT healthcare in the United States Veterans Health Administration
- Health equity § LGBT minority group health disparities
- Healthcare inequality
- LGBT people in prison#Health care
- Minority stress and health outcomes among sexual minorities
- Steven Epstein (academic)
- Tamsin Wilton
- "About GLMA". Gay and Lesbian Medical Association. Retrieved 2008-12-28.
- "Guidelines for care of lesbian, gay, bisexual, and transgender patients" (PDF). Gay and Lesbian Medical Association. Archived from the original (PDF) on August 26, 2006. Retrieved 2008-12-28.
- Gochman, David S. (31 August 1997). Handbook of Health Behavior Research I: Personal and Social Determinants. Springer. ISBN 9780306454431 – via Google Books.
- [Heterosexism in Health and Social Care, Julie Fish, 2006]
- S. Trettin; E. L. Moses-Kolko & K. L. Wisner. "Lesbian perinatal depression and the heterosexism that affects knowledge about this minority population" (PDF). Archived from the original (PDF) on 2014-03-07. Retrieved 2013-04-28. Cite journal requires
- Meads, C; Pennant, M; McManus, J; Bayliss, S (2009). "A systematic review of lesbian, gay, bisexual and transgender health in the West Midlands region of the UK compared to published UK research". Unit of Public Health, Epidemiology & Biostatistics, West Midlands Health Technology Assessment Group. Cite journal requires
- King, M; Semlyen, J; See Tai, S; Killaspy, H; Osborn, D; Popelyuk, D; Nazareth, I (2009). "Mental disorders, suicide, and deliberate self harm in lesbian, gay and bisexual people: a systematic review of the literature". Department of Mental Health Sciences, Royal Free and University College Medical School, University College London. Cite journal requires
- "Gay Bullying Statistics - Bullying Statistics". Bullying Statistics. July 7, 2015. Retrieved January 29, 2018.
- Rates and predictors of mental illness in gay men, lesbians and bisexual men and women, British Journal of Psychiatry, (2004) 185: 479-485
- Rivers, I (2001). "The bullying of sexual minorities at school: Its nature and long-term correlates". Educational and Child Psychology. 18 (1): 32–46.
- Rivers, I (2004). "Recollections of Bullying at School and Their Long-Term Implications for Lesbians, Gay Men, and Bisexuals". Crisis. 25 (4): 169–175. doi:10.1027/0227-5910.25.4.169. PMID 15580852.
- Wilton, Tamsin (2000). Sexualities in health and social care: a textbook. Open University Press. ISBN 978-0-335-20026-9.
- Wilton, Tamsin (1999). "Towards an understanding of the cultural roots of homophobia in order to provide a better midwifery service for lesbian clients". Midwifery. 15 (3): 154–164. doi:10.1016/s0266-6138(99)90060-8.
- Wilton, T.; Kaufmann, T. (2001). "Lesbian mothers' experiences of maternity care in the UK". Midwifery. 17 (3): 203–211. doi:10.1054/midw.2001.0261. PMID 11502140.
- Hudak, Nicole; Bates, Benjamin (2018). "In Pursuit of "queer-friendly" Healthcare: An Interview Study of How Queer Individuals Select Care Providers". Health Communication. 34 (8): 818–824. doi:10.1080/10410236.2018.1437525. PMID 29482359.
- "Barriers to LGBT Healthcare » The National LGBT Cancer Network". cancer-network.org. Archived from the original on 2016-04-28. Retrieved 2016-04-12.
- "How to Close the LGBT Health Disparities Gap". name. Retrieved 2016-04-12.
- Hayman, Brenda; Wilkes, Lesley; Halcomb, Elizabeth; Jackson, Debra (2013). "Marginalised Mothers: Lesbian Women Negotiating Heteronormative Healthcare Services". Contemporary Nurse. 1 (44): 120–127.
- Pega, Frank; Reisner, Sari; Sell, Randall; Veale, Jaimie (2017). "Transgender Health: New Zealand's Innovative Statistical Standard for Gender Identity". American Journal of Public Health. 107 (2): 217–221. doi:10.2105/ajph.2016.303465. PMC 5227923. PMID 27997231.
- Heck, Nicholas C.; Flentje, Annesa; Cochran, Bryan N. (2013). "Offsetting risks: High school gay-straight alliances and lesbian, gay, bisexual, and transgender (LGBT) youth". Psychology of Sexual Orientation and Gender Diversity. 1 (S): 81–90. doi:10.1037/2329-0382.1.s.81. ISSN 2329-0390.
- Ryan, C.; Huebner, D.; Diaz, R. M.; Sanchez, J. (2009-01-01). "Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults". Pediatrics. 123 (1): 346–352. doi:10.1542/peds.2007-3524. ISSN 0031-4005. PMID 19117902.
- Saewyc, Elizabeth M. (2011-02-15). "Research on Adolescent Sexual Orientation: Development, Health Disparities, Stigma, and Resilience". Journal of Research on Adolescence. 21 (1): 256–272. doi:10.1111/j.1532-7795.2010.00727.x. ISSN 1050-8392. PMC 4835230. PMID 27099454.
- McConnell, Elizabeth A.; Birkett, Michelle; Mustanski, Brian (December 2016). "Families Matter: Social Support and Mental Health Trajectories Among Lesbian, Gay, Bisexual, and Transgender Youth". Journal of Adolescent Health. 59 (6): 674–680. doi:10.1016/j.jadohealth.2016.07.026. ISSN 1054-139X. PMC 5217458. PMID 27707515.
- McConnell, Elizabeth A.; Birkett, Michelle A.; Mustanski, Brian (March 2015). "Typologies of Social Support and Associations with Mental Health Outcomes Among LGBT Youth". LGBT Health. 2 (1): 55–61. doi:10.1089/lgbt.2014.0051. ISSN 2325-8292. PMC 4855776. PMID 26790019.
- Ross, Lori E.; Dobinson, Cheryl; Eady, Allison (March 2010). "Perceived Determinants of Mental Health for Bisexual People: A Qualitative Examination". American Journal of Public Health. 100 (3): 496–502. doi:10.2105/ajph.2008.156307. ISSN 0090-0036. PMC 2820049. PMID 20075326.
- "TEN THINGS LESBIANS SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS". Gay and Lesbian Medical Association. Retrieved 2008-12-28.
- 2009 Report of the All Party Parliamentary Group on Cancer's Inquiry into Inequalities in Cancer
- Struble CB, Lindley LL, Montgomery K, et al. Overweight and obesity in lesbian and bisexual college women. J Am College Health. 2010;59(1):51-6.
- Hidalgo, Danielle Antoinette; Royce, Tracy (23 February 2011). "Heterosexism". The Multimedia Encyclopedia of Women in Today's World. SAGE Publications. p. 684. ISBN 9781452266541.
- "TEN THINGS GAY MEN SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS". Gay and Lesbian Medical Association. Retrieved 2008-12-28.
- "Depression in the Gay Community". Gay.com News. Archived from the original on 2008-09-07. Retrieved 2008-12-28.
- "Suicide rates among gay men eight times higher".
- Feldman MB, Meyer IH (2007). "Eating disorders in diverse lesbian, gay, and bisexual populations". Int J Eat Disord. 40 (3): 218–26. doi:10.1002/eat.20360. PMC 2080655. PMID 17262818.
- Smith AR, Hawkeswood SE, Bodell LP, Joiner TE (2011). "Muscularity versus leanness: an examination of body ideals and predictors of disordered eating in heterosexual and gay college students". Body Image. 8 (3): 232–6. doi:10.1016/j.bodyim.2011.03.005. PMC 3124584. PMID 21561818.
- "Gay men are less likely to be obese, study finds". Science Recorder. July 17, 2014.
- "The History of AIDS and ARC" at the LSU Law Center
- "A Cluster of Kaposi's Sarcoma and Pneumocystis carinii Pneumonia among Homosexual Male Residents of Los Angeles and Orange Counties, California. MMWR, 31(23);305-7 (June 18, 1982)". Retrieved 2007-01-24.
- "Statistics from the Ministry of Health, Labor and Welfare". Archived from the original on 2008-12-13.
- Go VF, Srikrishnan AK, Sivaram S, et al. (March 2004). "High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India". J. Acquir. Immune Defic. Syndr. 35 (3): 314–9. doi:10.1097/00126334-200403010-00014. PMID 15076248.
- Lee HC, Ko NY, Lee NY, Chang CM, Ko WC (May 2008). "Seroprevalence of viral hepatitis and sexually transmitted disease among adults with recently diagnosed HIV infection in Southern Taiwan, 2000-2005: upsurge in hepatitis C virus infections among injection drug users". J. Formos. Med. Assoc. 107 (5): 404–11. doi:10.1016/S0929-6646(08)60106-0. PMID 18492625.[dead link] Increased Risk for Entamoeba histolytica Infection and Invasive Amebiasis in HIV Seropositive Men Who Have Sex with Men in Taiwan
- UNAIDS 2006 report on the global AIDS epidemic, Chapter 05, June 2006
- Research, Center for Biologics Evaluation and (2019-04-11). "Questions about Blood - Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products - Questions and Answers". FDA.
- Estimated numbers of persons living with HIV/AIDS at the end of 2006, by race/ethnicity, sex, and transmission category—33 states with confidential name-based HIV infection reporting Archived 2012-10-23 at the Wayback Machine, Center for Disease and Control Prevention
- De Wit, John B. F; Murphy, Dean A; Adam, Philippe C. G; Donohoe, Simon (2013). Strange Bedfellows: HIV-Related Stigma Among Gay Men in Australia. Stigma, Discrimination and Living with HIV/AIDS. pp. 289–308. doi:10.1007/978-94-007-6324-1_17. ISBN 978-94-007-6323-4.
- Wolitski, Richard J; Fenton, Kevin A (2011). "Sexual Health, HIV, and Sexually Transmitted Infections among Gay, Bisexual, and Other Men Who Have Sex with Men in the United States" (PDF). AIDS and Behavior. 15: 9–17. doi:10.1007/s10461-011-9901-6. PMID 21331797.
- Fields EL, Bogart LM, Smith KC, Malebranche DJ, Ellen J, Schuster MA (2013). "HIV Risk and Perceptions of Masculinity among Young Black MSM". J Adolesc Health. 50 (3): 296–303. doi:10.1016/j.jadohealth.2011.07.007. PMC 3281559. PMID 22325136.
- Addictions in the Gay and Lesbian Community, Jeffrey R. Guss, Jack Drescher, Published by Haworth Press, 2000, ISBN 0-7890-1037-2, ISBN 978-0-7890-1037-7
- Susan D. Cochran; Frank C. Bandiera; Vickie M. Mays (2013). "Sexual Orientation–Related Differences in Tobacco Use and Secondhand Smoke Exposure Among US Adults Aged 20 to 59 Years: 2003–2010 National Health and Nutrition Examination Surveys". American Journal of Public Health. 103 (10): 1837–1844. doi:10.2105/ajph.2013.301423. PMC 3780743. PMID 23948019.
- Russell S. T.; Joyner K. (2001). "Adolescent sexual orientation and suicide risk: Evidence from a national study". American Journal of Public Health. 91 (8): 1276–1281. doi:10.2105/ajph.91.8.1276. PMC 1446760. PMID 11499118.
- Robin L.; Brener N. D.; Donahue S.F.; Hack T.; Hale K.; Goodenow C. (2002). "Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students". Archives of Pediatrics and Adolescent Medicine. 156 (4): 349–355. doi:10.1001/archpedi.156.4.349. PMID 11929369.
- Koh A. S.; Ross L. K. (2006). "Mental health issues: A comparison of lesbian, bisexual and heterosexual women". Journal of Homosexuality. 51 (1): 33–57. doi:10.1300/j082v51n01_03. PMID 16893825.
- Mathy R.; Lehmann B.; Kerr D. (2003). "Bisexual and Transgender Identities in a Nonclinical Sample of North americans: Suicidal Intent, Behavioral Diffulties, and Mental Health Treatment". Journal of Bisexuality. 3 (3–4): 93–110. doi:10.1300/j159v03n03_07.
- Balsam K. F.; Beauchaine T. P.; Mickey R. M.; Rothblum E. D. (2005). "Mental health of lesbian, gay, bisexual and heterosexual siblings: Effects of gender, sexual orientation, and family". Journal of Abnormal Psychology. 114 (3): 471–476. CiteSeerX 10.1.1.530.9976. doi:10.1037/0021-843x.114.3.471. PMID 16117584.
- Forrest, Sharita. "News Bureau - ILLINOIS".
- Udry J. R.; Chantala K. (2002). "Risk assessment of adolescents with same-sex relationships". Journal of Adolescent Health. 31 (1): 84–92. doi:10.1016/s1054-139x(02)00374-9. PMID 12090969.
- Eisenberg M. E.; Wechsler H. (2003). "Substance use behaviors among college students with same-sex and opposite-sex experience: Results from a national study". Addictive Behaviors. 28 (5): 1913–1923. doi:10.1016/s0306-4603(01)00286-6. PMID 12788264.
- Ford J. A.; Jasinski J. L. (2006). "Sexual orientation and substance use among college students". Addictive Behaviors. 31 (3): 404–413. doi:10.1016/j.addbeh.2005.05.019. PMID 15970397.
- Russell S. T.; Driscoll A. K.; Truong N. (2002). "Adolescent same-sex romantic attractions and relationships: Implications for substance use and abuse". American Journal of Public Health. 92 (2): 198–202. doi:10.2105/ajph.92.2.198. PMC 1447042. PMID 11818291.
- McCabe S. E.; Hughes T. L.; Bostwick W.; Boyd C.J. (2005). "Assessment of difference in dimensions of sexual orientation: Implications for substance use research in a college-age population". Journal of Studies on Alcohol & Drugs. 66 (5): 620–629. doi:10.15288/jsa.2005.66.620. PMC 3156552. PMID 16331847.
- Case, Patricia; Austin, S. Bryn; Hunter, David J.; Manson, Joann E.; Malspeis, Susan; Willett, Walter C.; Spiegelman, Donna (December 2004). "Sexual orientation, health risk factors, and physical functioning in the nurses' health study II". Journal of Women's Health. 13 (9): 1033–1047. doi:10.1089/jwh.2004.13.1033. PMID 15665660.
- Daling J. R.; Madeleine M. M.; Johnson L. G.; Schwartz S. M.; Shera K. A.; Wurscher M. A.; Carter J. J.; McDougall J. K. (2004). "Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer". Cancer. 101 (2): 270–80. doi:10.1002/cncr.20365. PMID 15241823.
- Jeffries, William L.; Dodge, Brian (July 2007). "Male bisexuality and condom use at last sexual encounter: Results from a national Survey". Journal of Sex Research. 44 (3): 278–289. doi:10.1080/00224490701443973. PMID 17879171.
- Zule W. A.; Bobashev G. V.; Wechsberg W. M.; Costenbader E. C.; Coomes C. M. (2009). "Behaviorally bisexual men and their risk behaviors with men and women". Journal of Urban Health. 86 (Suppl 1): 48–62. doi:10.1007/s11524-009-9366-3. PMC 2705485. PMID 19513854.
- Solarz, Andrea L. (1999). Lesbian health: Current assessment and directions for the future. Washington, D.C.: Institute of Medicine and National Academies Press. ISBN 9780309174060.
- "National Intimate Partner and Sexual Violence Survey (NISVS): 2010 findings on victimization by sexual orientation". cdc.gov. Injury Prevention & Control: Division of Violence Prevention, Centres for Disease Control and Prevention. 2019-02-07. Pdf.
- Larsson, Anna-Karin; Dykes, Anna-Karin (December 2009). "Care during pregnancy and childbirth in Sweden: Perspectives of lesbian women". Midwifery. 25 (6): 682–690. doi:10.1016/j.midw.2007.10.004. ISSN 0266-6138. PMID 18222576.
- "Improving Prenatal Care for Pregnant Lesbians - ProQuest". search.proquest.com. Retrieved 2018-04-24.
- Pharris, Angela; Bucchio, Justin; Dotson, Carmelita; Davidson, Wanda (2016). "Supporting Lesbian Couples During Pregnancy". International Journal of Childbirth Education. 31: 23–24.
- "How Doulas and Midwives Around the Country Are Filling the Gaps in Birth Care for Queer Families - Rewire.News". Rewire.News. Retrieved 2018-04-24.
- Ross, Lori E; Steele, Leah S; Epstein, Rachel (2006-06-01). "Service Use and Gaps in Services for Lesbian and Bisexual Women During Donor Insemination, Pregnancy, and the Postpartum Period". Journal of Obstetrics and Gynaecology Canada. 28 (6): 505–511. doi:10.1016/S1701-2163(16)32181-8. ISSN 1701-2163. PMID 16857118.
- Röndahl, Gerd; Bruhner, Elisabeth; Lindhe, Jenny (November 2009). "Heteronormative communication with lesbian families in antenatal care, childbirth and postnatal care". Journal of Advanced Nursing. 65 (11): 2337–2344. doi:10.1111/j.1365-2648.2009.05092.x. ISSN 0309-2402. PMID 19737324.
- Coleman, Eli; Bockting, Walter; Botzer, Marsha; Cohen-Kettenis, Peggy; DeCuypere, Griet; Feldman, Jamie; Fraser, Lin; et al. (2011). "Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7". International Journal of Transgenderism. 13 (4): 165–232. doi:10.1080/15532739.2011.700873.
- The Yogyakarta Principles, Principle 17. The Rights to the Highest Attainable Standard of Health
- "TEN THINGS Transgender persons SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS". Gay and Lesbian Medical Association. Retrieved 2008-12-28.
- "Gender Dysphoria: Guidelines (4 Dec 2016)". NHS Choices. Retrieved 20 January 2018.
- "Progress for Wales' first transgender clinic 'unacceptable'". BBC News. 20 January 2018. Retrieved 22 January 2018.
- Venkatesan Chakrapani; Priya Babu; Timothy Ebenezer. "Hijras in sex work face discrimination in the Indian health-care system" (PDF).
- Khan SI, Hussain MI, Parveen S, et al. (August 2009). "Living on the Extreme Margin: Social Exclusion of the Transgender Population (Hijra) in Bangladesh". J Health Popul Nutr. 27 (4): 441–51. doi:10.3329/jhpn.v27i4.3388. PMC 2928103. PMID 19761079.
- National Transgender Discrimination Survey
- Grant, Jaime; Mottet, Lisa; Tanis, Justin; Harrison, Jack; Herman, Jody; Keisling, Mara (2011). "Injustice at Every Turn: A Report of the National Transgender Discrimination Survey" (PDF). Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force. Cite journal requires
- "2015 U.S. Transgender Survey" (PDF). National Center for Transgender Equality. Retrieved 20 January 2018.
- Greenbaum, A.; Wrigley, J; George, T. (3 January 2017). "Federal Judge Blocks Transgender Protections". Fisher Phillips. Retrieved 20 January 2018.
- Green, Emma (7 June 2017). "The Man Behind Trump's Religious-Freedom Agenda for Health Care". The Atlantic. Retrieved 20 January 2018.
- "Know Your Rights: Healthcare". National Center for Transgender Equality. Retrieved 20 January 2018.
- McEvers, Kelly (18 January 2018). "Roger Severino Discusses The HHS Division Of Conscience And Religious Freedom". All Things Considered. NPR. Retrieved 20 January 2018.
- "Trump Administration Proposes Rule To Reverse Protections For Transgender Patients". NPR.org. Retrieved 2019-05-25.
- Rights (OCR), Office for Civil (2019-05-23). "HHS Proposes to Revise ACA Section 1557 Rule to Enforce Civil Rights in Healthcare, Conform to Law, and Eliminate Billions in Unnecessary Costs". HHS.gov. Retrieved 2019-05-25.
- Slovacek, Randy. "Texas Senate Approves 'License To Discriminate' Bill" (2 April 2019). Instinct. Retrieved 3 April 2019.
- Bollinger, Alex (26 March 2019). "Texas Republicans advance a bill that would allow doctors to refuse LGBTQ patients". LGBTQ Nation. Retrieved 28 March 2019.
- Weixel, Nathaniel (2019-10-15). "Federal judge overturns ObamaCare transgender protections". TheHill. Retrieved 2019-10-15.
- Gorton, Nick; Grubb, Hilary (2014). Erickson-Schroth, Laura (ed.). Trans Bodies, Trans Selves. Oxford: Oxford University Press. pp. 215–240. ISBN 978-0-19-932535-1.
- "Finding Insurance for Transgender-Related Healthcare". Human Rights Campaign. Retrieved 2 March 2015.
- Hartocollis, Anemona (2014-12-10). "Insurers in New York Must Cover Gender Reassignment Surgery, Cuomo Says". The New York Times. Retrieved 2 March 2015.
- Spade, Dean; Arkles, Gabriel; Duran, Phil; Gehi, Pooja; Nguyen, Huy (2010). "Medicaid Policy & Gender-Confirming Healthcare for Trans People: An Interview with Advocates". Seattle Journal for Social Justice. 8: 497–514.
- Khan, Liza (2013). "Transgender Health at the Crossroads: Legal Norms, Insurance Markets, and the Threat of Healthcare Reform". Yale Journal of Health Policy, Law, and Ethics. 11 (2).
- "New York Drops Medicaid's Ban on Trans Health Care". The Advocate. 2014-12-18. Retrieved 2 March 2015.
- "Victory! Oregon's Medicaid Program to Cover Transgender Health Care". The Transgender Law Center. Retrieved 2 March 2015.
- Bazargan, Mohsen; Galvan, Frank (2012). "Perceived discrimination and depression among low-income Latina male-to-female transgender women". BMC Public Health. 12: 663. doi:10.1186/1471-2458-12-663. PMC 3497862. PMID 22894701.
- Jacqueline Gahagan (2013). Women and HIV Prevention in Canada: Implications For Research, Policy and Practise. Canadian Scholars' Press. ISBN 9780889614864.
- Bockting, Walter O.; Miner, Michael H.; Swinburne Romine, Rebecca E.; Hamilton, Autumn; Coleman, Eli (14 March 2013). "Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population". Am J Public Health. 103 (5): 943–951. doi:10.2105/AJPH.2013.301241. PMC 3698807. PMID 23488522.
- Jay McNeil; Louis Bailey; Sonja Ellis; James Morton & Maeve Regan (September 2012). "Trans Mental Health Study 2012" (PDF). Archived from the original (PDF) on 2014-09-08. Retrieved 2013-04-28.
- "The Health of Sexual Minorities Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations" (PDF). Archived from the original (PDF) on 2013-05-12. Retrieved 2013-05-07. Cite journal requires
- "Suicide Attempts among Transgender and Gender Non-Conforming Adults" (PDF). Retrieved 16 April 2014.
- The Health of Sexual Minorities (PDF). Springer. p. 491. Archived from the original (PDF) on 2013-05-12. Retrieved 2013-05-07.
- Gender Identity Disorders in DSM IV, TR (PDF).
- "APA Removes Gender Identity Disorder from DSM-V". Ms Magazine.
- Zucker, Kenneth; Robert Spitzer (2005). "Was the Gender Identity Disorder of Childhood Diagnosis Introduced into DSM-III as a Backdoor Maneuver to Replace Homosexuality? A Historical Note" (PDF). Journal of Sex & Marital Therapy. 31 (1): 31–42. doi:10.1080/00926230590475251. PMID 15841704.
- The Health of Sexual Minorities (PDF). Springer. Archived from the original (PDF) on 2013-05-12. Retrieved 2013-05-07.
- Sanchez NF, Sanchez JP, Danoff A (2009). "Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City". Am J Public Health. 99 (4): 713–9. doi:10.2105/AJPH.2007.132035. PMC 2661470. PMID 19150911.
- Jamie L. Feldman; Joshua Goldberg (January 2006). "Transgender Primary Medical Care: Suggested Guidelines for Clinicians in British Columbia" (PDF). Archived from the original (PDF) on October 22, 2007.
- "The Health of Sexual Minorities Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations" (PDF). The Health of Sexual Minorities. 44 (11): 44–6263. 2007. doi:10.5860/choice.44-6263. Archived from the original (PDF) on 2013-05-12. Retrieved 2013-05-07.
- Jeffrey H. Herbst; Elizabeth D. Jacobs; Teresa J. Finlayson; Vel S. McKleroy; Mary Spink Neumann; Nicole Crepaz (2008). "Estimating HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: A Systematic Review". AIDS and Behavior. 12 (1): 1–17. doi:10.1007/s10461-007-9299-3. PMID 17694429.
- van Griensven, Frits (2013). "HIV surveillance and prevention in transgender women". The Lancet Infectious Diseases. 13 (3): 185–186. doi:10.1016/S1473-3099(12)70326-2. PMID 23260127.
- Murrill CS, Liu KL, Guilin V, Colón ER, Dean L, Buckley LA, Sanchez T, Finlayson TJ, Torian LV (June 2008). "HIV Prevalence and Associated Risk Behaviors in New York City's House Ball Community". Am J Public Health. 98 (6): 1074–80. doi:10.2105/AJPH.2006.108936. PMC 2377289. PMID 18445806.
- http://www.aidsalliance.org/publicationsdetails.aspx?id=90623&dm_t=0,0,0,0,0[permanent dead link]
- Gretchen P. Kenagy (2005). "Transgender Health: Findings from Two Needs Assessment Studies in Philadelphia" (PDF). Health and Social Work. 30 (1). Archived from the original (PDF) on November 2, 2013.
- Mathews, Jennifer; Parkhill, Amy L.; Gainsburg, Jeanne & Fearing, Scott (2011). "The Need for Transgender Health Content in the Pharmacy Curriculum". Innovations in Pharmacy. 2 (4).
- Walter O. Bockting; Eric Avery (2006). Transgender Health And HIV Prevention: Needs Assessment Studies from Transgender Communities Across the United States. CRC Press. p. 6. ISBN 9780789030153.
- San Francisco State University (December 6, 2010). "Family Acceptance of Lesbian, Gay, Bisexual and Transgender Youth Protects Against Depression, Substance Abuse, Suicide, Study Suggests". ScienceDaily.
- Benotsch EG, Zimmerman R, Cathers L, McNulty S, Pierce J, Heck T, Perrin PB, Snipes D (2013). "Non-medical use of prescription drugs, polysubstance use, and mental health in transgender adults". Drug and Alcohol Dependence. 132 (1–2): 391–394. doi:10.1016/j.drugalcdep.2013.02.027. PMID 23510637.
- Ellen Taylor; Andrew Jantzen; Barbara Clow (2013). Rethinking LGBTQ Health (PDF). Halifax, NS, Canada: Atlantic Centre of Excellence for Women's Health. ISBN 978-0981045986. Archived from the original (PDF) on 2016-01-26.
- Balsam, Kimberly F. Molina, Yamile. Breadness, Blair. Simoni, Jane. Walters, Karina. (2011). Measuring multiple minority STress: The LGBT people of color microaggressions scale. Cultural and Ethnic Minority Psychology, 17(2), 163-174.
- Fish, Julie (2017). "Navigating Queer Street: Researching the Intersections of Lesbian, Gay, Bisexual and Trans (LGBT) Identities in Health Research". Sociological Research Online. 13 (1): 1–12. doi:10.5153/sro.1652. hdl:2086/4749.
- Salkind; Gishen; Drage; Kavanagh; Potts (2019). "LGBT+ Health Teaching within the Undergraduate Medical Curriculum". International Journal of Environmental Research and Public Health. 16 (13): 2305. doi:10.3390/ijerph16132305. PMC 6651354. PMID 31261831.
- World Health Organization. "Improving the Health and Well-Being of Lesbian, Gay, Bisexual and Transgender Persons: Report by the Secretariat." World Health Organization: Geneva, Switzerland, 2013. http://www.ghwatch.org/sites/www.ghwatch.org/files/B133-6_LGBT.pdf
- AAMC Advisory Committee on Sexual Orientation GI, and Sex Development. "Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who are LGBT, Gender Nonconforming, or Born with DSD." AAMC: Washington, DC, USA, 2014.
- Sekoni, Adekemi Oluwayemisi; Gale, Nicola K.; Manga-Atangana, Bibiane; Bhadhuri, Arjun; Jolly, Kate (2017). "The effects of educational curricula and training on LGBT-specific health issues for healthcare students and professionals: A mixed-method systematic review". Journal of the International Aids Society. 20 (1): 21624. doi:10.7448/ias.20.1.21624. PMC 5577719. PMID 28782330.
- "This Campaign Uses Butt Selfies to Help LGBTQs Get Proper Healthcare". Pride. 2019-06-26. Retrieved 24 July 2019.
- Elison, Meg. "Online Extra: Q Agenda: Hashtag campaign aims to identify queer-competent doctors". The Bay Area Reporter. Retrieved 24 July 2019.
- Sonkin, Karl (2017-04-05). "Kaiser Permanente earns "leader in LGBTQ healthcare equality" designation". Patch. Retrieved 24 July 2019.
|Wikimedia Commons has media related to Healthcare and the LGBT community.|
- Lesbian, Gay, Bisexual and Transgender Health (Centers for Disease Control and Prevention)
- Planned Parenthood's LGBT Health & Wellness Project, "Out for Health"
- Center of Excellence for Transgender Health
- Publications on health and social care compiled by research from Stonewall, an LGB rights organisation in the UK