LGBTQ and Health Care

Angela Johnson, Clinical Educator

LGBTQIA: what does it stand for?

▪ Lesbian
▪ Gay
▪ Bisexual
▪ Transgender
▪ Questioning
▪ Intersex
▪ Asexual
These organizations recommend/require
it!

▪ 2000 the Office of Minority Health

▪ Center for Medicare and Medicaid Services
▪ Health Resources and Service Administration
▪ Healthy People 2020

*Despite these recommendations how many of

you have been trained?
Transgender Health Care Horror Stories

▪ https://youtu.be/pvRYamafT0c
Specific Disparities affecting
population

▪ LGBT youth are 2 to 3 times more likely to attempt suicide.

▪ LGBT youth are more likely to be homeless.
▪ Lesbians are less likely to get preventive services for cancer.
▪ Gay men are at higher risk of HIV and other STDs, especially among
communities of color.
▪ Lesbians and bisexual females are more likely to be overweight or
obese.
Specific Disparities affecting
population

▪ Transgender individuals have a high prevalence of

HIV/STDs, victimization, mental health issues, and suicide and are
less likely to have health insurance than heterosexual or LGB
individuals.
▪ Elderly LGBT individuals face additional barriers to health because of
isolation and a lack of social services and culturally competent
providers.
▪ LGBT populations have the highest rates of tobacco, alcohol, and
other drug use.
How can we help?

▪ Sexual Orientation ▪ Legal Name and Preferred Name

– Who are you attracted to?
▪ What pronouns do you prefer?
▪ Gender Identity
– Male ▪ LGBTQ friendly signs
– Female
– Transgender
– Other

▪ Relationship status (not Marital status)

– Single
– Married
– Divorced
– Widowed
– Domestic partnership

▪ Use the word “partner”

Bathrooms…
Gender Reassignment Surgery

▪ Helps elevate severe suffering

▪ Three stages
– Diagnostic phase
– Hormone therapy
– Gender reassignment

▪ Standards of Care (SOC) of the WPATH

▪ http://www.aetna.com/cpb/medical/data/600_699/0615.html
Gender Reassignment Surgery: Female to
Male

▪ SUBCUTANEOUS
MASTECTOMY
▪ Hormone therapy doesn’t
affect breast tissue
Gender Reassignment Surgery: Female to
Male

▪ Phallic reconstruction with the

radial forearm flap: creation of
a tube (urethra) within a tube
(penis).
▪ High rate of complications
▪ Requires 3 physicians
– Endocrinologist
– Urologist
– Plastic Surgeon
After implant of erection prosthesis
Arm scaring
Gender Reassignment Surgery: male to
female
Gender Reassignment Surgery: male to
female
Meet Cole Black
Cole’s Story

▪ Not considering gender reassignment surgery

▪ Can not find a physician in the area with transgender experience
▪ Transgender care and loss of support (lived in LA)
▪ Feels people want to do the right thing but do not know how
▪ Wrong wristband
Cole’s Story

▪ Huge fear of having to use the bathroom

▪ On hormone therapy
– Physician in Detroit (transgender experience)
– None of his transgender care is covered by insurance

▪ Name change process and legal sex change process

▪ Has undergone mastectomy
▪ Scheduled for a hysterectomy
LGBT Healthcare Training Video: "To
Treat Me, You Have to Know Who I Am"

▪ https://youtu.be/NUhvJgxgAac
References:

▪ Maragh-Bass, A. C., Torain, M., Adler, R., Ranjit, A., Schneider, E., Shields, R.
Y., & ... Haider, A. H. (2017). Is It Okay To Ask: Transgender Patient
Perspectives on Sexual Orientation and Gender Identity Collection in
Healthcare. Academic Emergency Medicine, 24(6), 655-667.
doi:10.1111/acem.13182
▪ Monstrey, S. J., Ceulemans, P., & Hoebeke, P. (2011). Sex Reassignment
Surgery in the Female-to-Male Transsexual. Seminars in Plastic Surgery,
25(3), 229–244. http://doi.org/10.1055/s-0031-1281493
▪ http://www.modernhealthcare.com/article/20150822/MAGAZINE/30822997
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▪ http://lgbtqia.ucdavis.edu/educated/glossary.html