A little over 18 million Americans self-identify as LGBTQ+, according to the most recent Gallup survey on the topic. That marks a significant 60% increase in Americans self-identifying that way from 2012 to 2020, and accounts for one in six young adults in Generation Z.
By and large, it seems pretty indicative of a really positive cultural sea change that more and more people feel comfortable with openly embracing their true identities. Unfortunately, while very significant strides have been made in the fight against discrimination, disparities, inequities, and stigmatization toward members of the LGBTQ+ community, far too many disparities and discriminatory, stigmatizing barriers still exist.
Many LGBTQ+ patients have unique physical, emotional, and sexual healthcare needs that most cisgender, heterosexual patients do not. Far too often, they also have to deal with unique discriminatory barriers that prevent them from accessing essential services, due to people being unfairly judgemental toward their sexual orientation or gender identity.
Read on to gain a better understanding of where such disparities exist, how and why this unfair marginalization persists, common myths and misconceptions surrounding LGBTQ+ which have been factually disproven, and helpful affordable healthcare resources for LGBTQ+ patients.
LGBTQ+ Healthcare Disparities
As is the case with people from any other historically marginalized group, a huge social determinant of the health and wellbeing of LGBTQ+ individuals is their surrounding external environment. Of course all people are most likely to thrive in healthy, supportive environments that fully accept them for who they are. Unfortunately, that is still not the reality for many LGBTQ+ individuals, both in this country and around the world at large.
Many LGBTQ+ people have to contend with uniquely unfair negative social determinants that could have maladaptive consequences on future health outcomes. These negative environmental factors could include examples like:
- Bullying and ostracization in school, and potentially, school officials who are apathetic to that bullying
- Discriminatory denials of access to things like housing, health insurance, employment, marriage, or employee benefits
- Discriminatory emotional, physical, or sexual abuse targeted against the individual because of their gender identity or sexual orientation
- A lack of adequate safe spaces for the person to fully embrace who they are
- A lack of adequate social services and healthcare services to meet needs unique to LGBTQ+ people
- Unsupportive parents who aren’t respectful or understanding of one’s orientation and gender identity, or worse yet, an entire family unit that is unsupportive of the person’s identity
LGBTQ+ people who grow up in unhealthy, unsupportive environments with many of the negative factors listed above are far more likely to risk dealing with negative overall health outcomes across the board. In turn, this has created many negative healthcare disparities that LGBTQ+ patients face relative to cisgender and heterosexual patients. Here are some alarming ones found by the Office of Disease Prevention & Health Promotion:
- Marginalized LGBTQ+ youth are 2-3 times more likely to attempt suicide.
- LGBTQ+ youth living under unsupportive parents or guardians face a greater risk of being unhoused.
- Gay men and trans women who lack access to effective contraceptives and preventative medications face a greater risk of contracting HIV and other STDs.
- Trans and gender-nonconforming individuals face greater risks of marginalization, mental health disorders, STDs, health insurance discrimination, and suicide than cisgender (hetero or LGB) individuals.
- LGBTQ+ populations face greater risks of suffering from substance abuse or substance misuse disorders.
When you really delve even further into the nitty-gritty of how these disparities break down by the numbers, the overall scope of them becomes even more alarming. Here are some particularly alarming figures that were compiled by Lighthouse, a New York-based health network that specializes in offering LGBTQ+ affirming care:
- A staggering 56% of LGBTQ+ people are believed to be maligned by healthcare discrimination in some capacity.
- Nearly one in five transgender and gender-nonconforming people (or roughly 19%) have been denied health coverage because of their gender identity.
- In that same survey about trans health discrimination, over 50% of all respondents reported having healthcare providers who were uneducated on trans-specific healthcare needs.
- Roughly 28% of trans and gender-nonconforming individuals have reported delaying treatments over healthcare discrimination, 75% of lesbians have reported delaying or avoiding treatments, and LGTBQ+ people of color face double the discrimination avoidance rates as white LGBTQ+ individuals.
- Even experiencing one instance of medical discrimination places a patient at three times greater risk of postponing or avoiding care in that year.
- Only 16% of LGBTQ+ patients are believed to inform their doctor about their orientation, indicating that many still feel a culture of discomfort and discrimination.
- In 2015, many first-year medical students expressed implicit and explicit biases against LGBTQ+ people, with 80 percent expressing the former and 50 percent expressing the latter. That following year, over 175 anti-LGBTQ+ healthcare laws were proposed in 32 states across the country, and over 10 percent of which aimed to deny healthcare access.
If you’re wondering whether or not those legislative issues have gotten any better over the past five years, they, unfortunately, have not. The Human Rights Council has called 2021 a record year for the passing of discriminatory anti-LGBTQ+ laws, with over 250 anti-LGBTQ+ bills proposed across the country, and 17 of those bills being enacted into law.
These measures present grave threats to the healthcare accessibility and basic fundamental human rights of LGBTQ+ people, and especially those of trans and gender-nonconforming people, who require more extensive healthcare needs to overcome their dysphoria and complete their transition.
A lot of fear-driven myths, misconceptions, and discriminatory biases exist around these trans healthcare services, which is why we saw fit to debunk and dispel them.
Debunking Trans Healthcare Misconceptions
Many transgender people experience gender dysphoria, which is a term for the psychological dissonance experienced when one’s gender identity is incongruent with the sex they were assigned at birth. Overwhelmingly, the data shows that LGBTQ+ and gender-nonconforming individuals have better overall wellbeing when they’re able to live in environments that are supportive and affirming of their identity.
One report organized by The Trevor Project ascertained that LGBTQ+ youth who had at least one supportive adult in their lives were 40% less likely to report having attempted suicide in the past year. Furthermore, another study backed by the Family Acceptance Project found that LGBTQ+ youths with supportive families were 50% less likely to attempt suicide.
A crucial facet of affirming that identity, of course, is having access to a standard of care that adequately affirms that identity. Unfortunately, a lot of transphobic misinformation, myths, and misconceptions are perpetuated that unfairly defer people away from that care. Here’s a list of some common misconceptions associated with trans healthcare, and why those misconceptions are wrong.
Misconception #1: Children are too young to understand their gender identity
Why it’s wrong: Overwhelmingly, the scientific consensus actually points toward people understanding their gender identity from a very young age. Many pediatric medical experts, like those at the Children’s Hospital of Philadelphia, believe that most children formulate a sense of gender identity between the ages of 3 to 5, as well as an understanding of gender expectations in the world around them.
Misconception #2: Children are receiving hormone therapies and gender-affirming operations
Why it’s wrong: Medical experts encourage the parents of trans youth to be supportive of their children socially transitioning, which refers to legal, cosmetic, and social changes that are expressions reflective of one’s true gender identity, but NOT medical intervention.
Research published by the Journal Of Clinical Endocrinology And Metabolism recommends waiting until the trans youth turns 16, around the midpoint of puberty, before beginning hormone therapy care, and recommends waiting until the youth is legally no longer a minor before offering them gender-affirming surgery.
Misconception #3: Puberty blockers are irreversible
Why it's wrong: A lot of people conflate puberty blockers and hormone replacement therapies as the same thing, when both have vastly different effects. The types of hormone therapies most people would classify as “puberty blockers” don’t stop the effects of puberty outright, but just put certain elements of it on pause.
Should an adolescent working through their gender identity decide they no longer want to try hormone therapy, they can simply stop taking the medication (with the assistance of a trusted healthcare provider) and reverse the treatment’s effects, usually with little to no side effects.
While it’s true that hormone therapies will make a patient infertile over a long enough timeframe, and sometimes irreversibly, that infertility has to be weighed against the psychological risks of letting dysphoria perpetuate. Furthermore, the patient could always decide to have their sperm or egg cells frozen cryogenically before this stage in their transition, should they wish to conceive a child in the future.
See this St. Louis Children’s Hospital page for more information on puberty blocker therapy.
Misconception #4: Trans Women Have An Unfair Competitive Advantage In Athletics Over Cisgender Women
Why it’s wrong: A lot of anti-trans ideologues have glommed onto fear-mongering about the presence of trans women in women’s sports, trying to propose measures to restrict their inclusion. Simply put, there is very little (if any) scientific evidence that suggests that trans women retain a massive, long-term competitive edge over their cisgender competitors.
While a recent study by the British Journal Of Sports Medicine appears to suggest that trans women may retain a very slight advantage for a year after hormone therapy treatment, there’s not really any substantive evidence to suggest that possible slight advantage is retained after the first year or two of hormone therapy. Furthermore, that possible advantage (if there is any) was shown to vary heavily case-by-case; just like cisgender athletes, transgender athletes individually have varying talents and athletic abilities.
One strong counterexample against the notion of a long-term advantage is the work of Joanna Harper, a competitive runner and medical scientist who advised the International Olympic Committee on their guidelines for trans athletics. Harper, who is a trans woman herself, noticed a five-minute dropoff in her runtime after a year of hormone replacement therapy.
This inspired Joanna to research the performance of other trans athletes pre and post-transition, and she concluded that trans women don’t retain any long-term advantage after their transition. If anything, they may arguably be at a slight long-term disadvantage, as hormone-replacement therapies for trans women can considerably reduce muscle mass and red blood cell content.
(For more information on Harper’s research, check out this comprehensive profile published on Science.org)
Misconception #5: Widespread trans healthcare coverage would be too expensive
Why it's wrong: Policymakers who attempt to push discriminatory laws against trans healthcare accessibility often try to spin the notion that medically-necessary healthcare for trans people is too expensive to subsidize or have paid by a taxpayer or insurer. This notion is a patently false one, a notion so false that a researcher hired to defend it actually uncovered the precise reason why it’s false!
In a legal case meant to DEFEND the Wisconsin state government’s controversial medical coverage exclusion for trans healthcare treatments, one representative hired for that defense ironically determined that coverage for those treatments would only cost between 4 to 10 cents per insured person per month, which is a remarkably affordable price range.
If you would like to read more about that particular case, The American Civil Liberties Union has published the legal document for it in full. Furthermore, if you’d like to find additional resources related to affordable, accessible LGBTQ+ affirming healthcare, we’ve taken the time to compile some really helpful ones below.
LGBTQ+ Healthcare Organizations
- GLBT National Help Center
- GLBT National Youth Talkline
- Association Of Gay And Lesbian Psychiatrists
- Trevor Project/Trevor Helpline
- The Human Rights Campaign
- The National Center For Transgender Equality
- The National LGBT Cancer Network
- Trans Lifeline
- Folx Health
Whether it’s you or a loved one in need of support, there are fortunately many supportive, understanding resources that are worth your time and consideration. Even if you may feel lonely, we hope it at least offers some consolation to know that there are many compassionate, supportive, and understanding people who’ve navigated similar experiences as your own, and would be happy to support you through these experiences.
Furthermore, whether your needs pertain to physical, mental, or sexual healthcare, we hope some of these telehealth resources may be useful to your search for affordable, accessible, and convenient care.
LGBTQ+ & Trans Healthcare Online
If you need extra emotional support specific to your gender identity and/or sexual orientation, then you may want to consider speaking to an offline or online therapist who specializes in affirming LGBTQ+ mental health. One great resource we would recommend in that regard is Pride Counseling, which is one of the country’s largest networks of trained LGBTQ+ therapists.
Talkspace also has an entire search subcategory specific to finding trained online therapists from the LGBTQ+ community. For physical and sexual wellness, you may want to consider visiting online providers like Everywell for at-home STD tests, or using medication-by-mail providers like Ro Pharmacy, Valisure, or Honeybee Health.
Lastly, if you’re wondering where to find the best online doctors to suit your healthcare needs, then you may want to consider counting on providers like Sesame Care, Antidote Health, Health Sapiens, or Galileo Health. We hope these resources may be of some help for you if you ever need them, and that you know you are valid.