A Nurse’s Guide to Caring for LGBTQ Patients
People who are lesbian, gay, bisexual, transgender, or queer (LGBTQ) face unique challenges because of their identities in many aspects of their daily lives. This includes seeking and receiving healthcare. In fact, over half of LGBTQ individuals report experiencing some kind of discrimination when attempting to seek medical care. Further, people in the LGBTQ community have specific health needs and concerns that differ greatly from those of the general population.
Institutional discrimination, lack of understanding of this group’s needs, and personal prejudice held by healthcare professionals can make it all but impossible for members of the LGBTQ community to receive proper care. However, nurses are in a position to provide the specialized healthcare that members of the LGBTQ community need and deserve.
This guide from Ohio University will give nurses the knowledge needed to provide culturally competent care to LGBTQ patients. By understanding the health issues that affect members of the LGBTQ population and researching how to properly provide care, nurses can improve the health outcomes of LGBTQ individuals while working to change the way they are treated by the healthcare system as a whole.
LGBTQ Health Disparities
About 4.5% of the American population identifies as LGBTQ, which translates to almost 15 million people. However, this estimate may be low. Some people in the LGBTQ community may not be able to safely come out, and therefore cannot be accounted for.
Regardless of the exact population, there are millions of people in this community who are at a significantly higher risk of experiencing certain health conditions because of their LGBTQ identity. Further, many of the conditions that disproportionately affect LGBTQ populations are serious, some even fatal, if left unaddressed or improperly treated.
Disparities Among the Whole LGBTQ Population
Though different subgroups within the larger LGBTQ community have unique health concerns, there are certain disparities that affect the population at large. Some of these include:
Anxiety and Depression
People who identify as LGBTQ are 1.5 to 2.5 times more likely to experience anxiety or depression than their cisgender and heterosexual peers. In addition, members of the LGBTQ community may contend with homophobia, transphobia, prejudice, and harassment. Discrimination, especially when experienced over a long period of time, can have an extremely negative effect on mental health and lead to myriad mental health conditions — including anxiety and depression.
LGBTQ individuals are more likely to struggle with substance abuse than the general population. According to the National Institute on Drug Abuse, LGBTQ people are:
- More than twice as likely to have used an illegal drug in the past year than heterosexual, cisgender peers;
- More likely to report binge drinking in the past year than non-LGBTQ peers;
- More likely to have any kind of substance use disorder at any point in life than people who are not LGBTQ.
Many experts attribute these high rates of substance abuse to minority stress. This theory suggests that people who belong to stigmatized minority groups experience higher levels of stress due to large-scale societal discrimination and prejudice. The increased stress levels then lead to poorer physical and mental health than peers in non-minority groups. Unfortunately, this can lead to a host of other problems, including mental health conditions, high-risk behaviors, and suicidal thoughts.
Suicidal thoughts and attempts are much more prevalent among LGBTQ communities, particularly in LGBTQ youth and adolescent populations, than they are in the general population. Lesbian, gay, and bisexual adolescents are almost four times more likely to attempt suicide, and transgender youth are almost six times more likely to do so, than their non-LGBTQ peers.
While internal factors like depression can certainly contribute to suicidal ideation or attempts, researchers note that higher rates of suicide in the LGBTQ community are laregly due to external factors, such as bullying, abuse, or trauma. For example, cisgender youth who are lesbian, gay, or bisexual are over eight times more likely to attempt suicide if they are rejected by their family members, whereas LGB youth with more accepting families were significantly less likely to do so.
Disparities Among the Lesbian Population
Lesbian and bisexual women are inordinately more affected by certain health conditions than heterosexual women and other groups in the LGBTQ community. Common health disparities among these populations include:
Reproductive Cancers and Breast Cancer
Researchers have determined that lesbian and bisexual women are at a greater risk of developing reproductive and breast cancers than heterosexual women. Lesbian women are not genetically different from their heterosexual peers, but they are more likely to be subject to additional risk factors that can cause these cancers to develop. For example,
lesbian women are less likely to get pregnant and breastfeed a biological child before the age of 30, which can reduce the risk of breast cancer.
In addition, lesbian women tend to get preventive care and tests, including mammograms and pap smears, at a lower rate than heterosexual women, often because of previous negative experiences with a doctor or nurse. While this does not affect the development of any cancers, it does make it more difficult to detect them early on. Even if cancer is detected, lesbian women may be more likely to hesitate to seek treatment due to a prior discriminatory experience with a healthcare professional.
Sexually Transmitted Diseases
The risk factors for sexually transmitted infections (STIs) and sexually transmitted diseases (STDs) for lesbian women are poorly understood by the general population. Some may incorrectly believe that lesbians and bisexual women are immune to STIs when having sexual interactions with other women. However, despite this common misconception, lesbian women can still acquire STIs when having unprotected sexual contact with another person, even if that partner is a woman.
Disparities Among Gay Men
Gay and bisexual men also face certain health problems at higher rates than other LGBTQ populations. Some of the largest health disparities among gay men include:
Body Image and Eating Disorders
Gay and bisexual men are significantly more likely to have an unhealthy relationship with body image and food than heterosexual men. Gay men make up roughly 42% of all men who have eating disorders, despite making up about 5% of the entire male population. Minority stress, anti-gay violence, and the perceived inability to live up to male body ideals are all thought to be risk factors that make gay men more likely to develop an eating disorder.
Sexually Transmitted Diseases
Gay and bisexual men contract STIs at higher rates than lesbian women and their heterosexual peers. These higher rates are likely due to a number of individual factors, including unprotected sexual contact and the frequency of new partners. There are also external factors that put gay men at a higher risk of developing STIs. The inability to access healthcare and discrimination due to sexual orientation also increase the likelihood that gay men will acquire an STI.
Disparities Among Transgender People
The health needs of people who are transgender are significantly different from those of individuals who are cisgender, even if they are otherwise part of the LGBTQ community.
Transgender men and women experience mental health conditions at significantly higher rates than their cisgender peers, regardless of sexual orientation. Roughly 50% of both transgender men and women experience symptoms of depression, compared to about 6% of adults in the U.S. Similarly, around 40% of both transgender men and women exhibit symptoms of anxiety, compared to 18% of American adults.
Transgender individuals do not suffer from mental health conditions more frequently than other individuals because of any inherent genetic or biological differences. Further, if someone is transgender, it does not automatically mean they will develop anxiety or depression. Transgender men and women deal with a multitude of external factors that can exacerbate or cause mental health conditions, including minority stress, discrimination, and lack of social support.
Depending on the steps someone has taken to transition, transgender people may still be susceptible to sex-related and reproductive cancers related to their assigned gender at birth. For instance, a transgender man may still develop cervical cancer, despite having medically transitioned.
Another concern is how medical transition affects transgender people, as it often involves taking large quantities of sex hormones over long periods of time. For instance, a transgender woman may take estrogen or progesterone as a part of her transition, which could increase her risk of developing breast cancer. However, experts acknowledge that not enough research has been done to definitively say how medical transition can affect cancer risk, and that more work is needed to accurately make those determinations.
Further Research Is Needed
Similarly, one of the biggest issues with transgender healthcare as a whole is the lack of research on transgender individuals, their health concerns, and their needs. Many healthcare professionals, including doctors and nurses, are unfamiliar with how to provide adequate care to transgender patients. In a 2011 survey, half of all transgender and gender non-conforming respondents reported having to teach their doctor about transgender care. This lack of knowledge severely limits the healthcare options of transgender individuals and makes it difficult for them to receive the care they need.
Access to Care for LGBTQ Individuals
Many of the health problems that LGBTQ individuals face can be traced back to the difficulties they have accessing comprehensive, inclusive medical care. The issue is twofold: LGBTQ individuals either experience discrimination when trying to obtain care, or fear that they might. This barrier to healthcare affects thousands, as almost 7% of LGBTQ people report avoiding a visit to the doctor’s office out of fear of discrimination. Negative experiences with healthcare providers in the past can further dissuade LGBTQ people from pursuing treatment or medical care in the future — even if they are developing serious health problems.
These issues are even more extreme for people who are transgender. Nineteen percent of transgender individuals reported that they were denied care outright because they were transgender or gender non-conforming. Transgender people are also more likely to face additional issues when trying to access healthcare, such as the high cost of health services and lack of health insurance coverage.
Trans Broken Arm Syndrome
Transgender patients might also encounter “Trans Broken Arm Syndrome” when they go to see a doctor or other provider. This phenomenon occurs when a medical professional attributes any and all health problems that a transgender patient is experiencing to the fact that they are transgender. Even issues that are in no way related to gender identity, such as the stomach flu or a broken bone, are connected back to a patient’s transgender status.
Trans Broken Arm Syndrome often involves asking transgender patients uncomfortable, unnecessary questions about their gender identity. Fifteen percent of transgender individuals who had seen a doctor in the past year reported that they were asked invasive questions about their transgender status that were completely unrelated to the reason for their visit. This can result in transgender patients being misdiagnosed or not receiving any treatment for the health issue they need addressed.
How to Close the LGBTQ Health Disparities Gap
The challenges in healthcare that LGBTQ individuals face are immense and serious, but they are not impossible to overcome. Educating healthcare providers about the LGBTQ community and teaching them cultural competency are the first steps toward overcoming those challenges, but they aren’t enough. Healthcare leaders must also make an active effort to be respectful to all patients, regardless of their sexual orientation or gender identity.
Medical professionals are in a unique position to effect this change. In particular, nurses are emerging as leaders in the healthcare industry, and have the power to make sensitivity and inclusivity the norm in the medical world. It’s vital for nurses to do their part to close the LGBTQ health gap and ensure that LGBTQ patients have access to the care they need.
Education and LGBTQ Care
A lack of education about LGBTQ care and health concerns is one of the primary reasons there are such large disparities between this community and the general population. Nurses can become even more educated on the needs of unique communities by pursuing a master’s in nursing.
LGBTQ Cultural Competency Training
Diversity training in nursing education and for all medical professionals can help them become more aware of the unique needs of different minority groups. Cultural competency training about the LGBTQ community and their needs in a healthcare setting gives medical providers the nuanced understanding they need to give customized care to all of their patients. Diversity and inclusivity training can not only help providers avoid negative or discriminatory situations entirely, but also help them understand how to address LGBTQ patients’ concerns related to their sexual orientation and gender identity. The benefits of cultural competency training are huge, as it works to improve care and reduce health disparities.
Respect for a Patient’s Sexual Orientation and Gender Identity
Ultimately, healthcare professionals have to learn how to respect the sexual orientation and gender identity of their patients. They may have to put personal beliefs or feelings aside to do so, but all medical providers have a responsibility to give the best care possible to their patients. Not assuming one’s sexual orientation or gender identity, as well as asking and using someone’s preferred name and pronouns, are simple ways to show LGBTQ patients they are respected. LGBTQ individuals deserve and need to feel safe, welcomed, and respected when seeking care. Those who don’t may end up avoiding seeking care altogether.
LGBTQ individuals have encountered such discrimination in the medical world that it will take a conscious and continued effort to close the LGBTQ healthcare gap. There is no single or simple solution to doing so, but nurses have the power to make an impact in the lives of their LGBTQ patients each day. By understanding the health needs of LGBTQ individuals and striving to give the best care possible, that impact can be a positive one.
LGBTQ Resources for Healthcare Providers
For further reading and additional information on LGBTQ healthcare, nurses and other healthcare providers should consult the following resources:
- American Medical Association: Creating an LGBTQ-Friendly Practice;
- Centers for Disease Control and Prevention: LGBT Health Services;
- Health Professionals Advancing LGBTQ Equality (GLMA);
- Human Rights Campaign;
- National Coalition for LGBT Health;
- National LGBT Health Education Center;
- National LGBT Task Force;
- Nurses Health Education About LGBT Elders (HEALE);
- The Williams Institute;
- The World Professional Association for Transgender Health: Standards of Care;