Members within the LGBTQ community are as diverse as the total population. They cover the entire spectrum of race, sex, gender, age, religion and socioeconomic status; so many of the recommended health screenings and medical evaluations for LGBTQ people are the same as the heterosexual and cisgender communities. However, there are certain health concerns that carry higher risk factors for members of the LGBTQ community.
Because of that, we spoke with LGBTQ-friendly doctors in Central Florida and Tampa Bay about specific community healthcare issues to help you begin the conversation with your primary care physician and get 2019 started off right.This general information is not intended to diagnose any medical condition or replace your healthcare professional. Consult your physician for further information.
Access to LGBTQ-friendly healthcare
Being able to access consistent, qualified and understanding healthcare providers is the first step to a healthier you. One of the biggest obstacles preventing LGBTQ people from accessing regular care, however, is the fear of discrimination from their doctor.
A study from the National LGBTQ Task Force found that more than half of all LGBTQ people have experienced some form of discrimination while seeking medical treatment. Those numbers increase for lesbians, transgender people and people of color.
“I think that comfort with the provider is a huge barrier,” says Dr. Luke Johnsen, medical director for Tampa Bay’s Metro Wellness and Community Centers. “If someone goes to a doctor and discloses that they have a same-sex partner and they’re given a strange look or asked really inappropriate questions or receive inappropriate comments, that will make them less likely to go and see a doctor unless they get really sick.”
Dr. Johnsen says another reason LGBTQ people have traditionally avoided annual visits to a primary care doctor has been lack of insurance.
“Before the [Affordable Care Act], a lot of LGBTQ people did not qualify to be insured under their partner’s insurance and so they didn’t have coverage or they could not get coverage themselves because of pre-existing conditions, so they can’t maintain a primary care relationship and just utilize urgent care when they are sick.”
Dr. Johnsen recommends researching doctors in your area to see which ones are advertising as LGBTQ-friendly.
“One thing I suggest for people all the time, if you are new to the area or if they are thinking about looking for an LGBTQ-friendly provider for the first time is to go online and look up the GLMA directory,” he says.
GLMA, or Health Professionals Advancing LGBTQ Equality (formerly known as the Gay and Lesbian Medical Association) is an international organization of more than 1,000 LGBTQ medical professionals whose focus is to ensure equality in healthcare for LGBTQ people.
“They have a directory online where you can look up your zip code and it lists providers that have elected to be listed on the directory who are LGBTQ friendly,” Dr. Johnsen says.
Dr. Johnsen also recommends, while in a doctor’s office, looking for signs that point to that practice being LGBTQ-friendly, literally.
“I have given lectures and done workshops in the past with general primary care providers where I have encouraged them to post signs in the waiting room that say ‘We are an all-inclusive practice that welcomes the LGBTQ community.’ That way you don’t have to ask, it’s there. Nobody should have to ask.”
If you would like to locate the LGBTQ-friendly physicians in your area, visit GLMA.org and click on the link for Patient Resources and select “Find a Provider.”
Sexual health
An area of healthcare that shows higher risk factors for the LGBTQ population is in sexual health.
Men who have sex with men (MSM) account for more than 65 percent of new HIV infections annually, according to the Centers for Disease Control and Prevention (CDC), and transgender women are 49 times more likely to test HIV-positive than the general population.
General guidelines from the CDC recommend anyone who is sexually active be tested for HIV at least once a year; however, depending on sexual habits, it is recommended that certain high risk groups be tested every three to six months.
“The frequency in testing for HIV and other Sexually Transmitted Infections (STIs) will, in general, depend on how sexually active the individual is,” says Dr. Rafael Pinero, a well-known family practice physician in Orlando’s LGBTQ community. “Ideally, everyone should be checked twice a year. If you are not in a monogamous relationship, you should talk to your doctor about going on [Pre-Exposure Prophylaxis (PrEP)], which would require you to be screened for STIs every three months.”
Dr. Pinero emphasized the importance of using safe-sex practices—even if you are on PrEP—to help protect against other STIs. He says that it is important to be able to have an open and honest dialogue with your doctor about your sex life.
Dr. David Lyter, an LGBTQ-friendly general internal medicine physician in Tampa, agrees.
“When they go for STIs screenings, they’re given a blood test and a urine test, but that does not pick up an oral infection or rectal infection,” Dr. Lyter says. “Unless the doctor knows to swab in those areas, if somebody does bottom or perform oral sex, then often those infections go undetected. So being sure that one is open about one’s sexual preferences and behavior, in order to get the appropriate testing done, is important.”
All the doctors we spoke with emphasize the importance of being up-to-date on vaccinations, specifically the vaccines for Hepatitis A and Hepatitis B among MSM.
“These aren’t vaccines many doctors think about much in the United States for the general population,” says Dr. Johnsen, “but right now we are seeing an uptick of Hepatitis A in MSM nationwide.”
The Hepatitis A and Hepatitis B vaccines are administered by your healthcare provider either as three doses over a period of six months, or three shots administered over one month with the addition of a booster shot after one year, according to the CDC.
The most common STI in the U.S., across all populations, is the human papillomavirus (HPV). The CDC estimates that around 79 million Americans are infected with one of the nearly 150 different strands of HPV.
Some types can cause health problems including genital warts and cancers, but a vaccine is available and recommended for all men through age 21, and for all women, MSM and transgender individuals up through age 26.
Check with your primary care physician to see which STI vaccines they recommend for you.
Cancer
Cancer is the second leading cause of death in the U.S., behind only heart disease. Cancer is an undiscriminating disease that affects all groups of people across the board; however, some cancers carry higher risk factors for the LGBTQ community.
As discussed above, HPV affects a large section of the population, including the LGBTQ community, and certain strands carry a chance of developing into cervical, rectal, anal and oral cancers if left untreated.
“I think that anyone who has receptive anal intercourse needs to have anal Pap smear,” says Dr. Johnsen. “There aren’t really established guidelines, probably the guidelines somewhat parallel the cervical Pap smear guidelines. So we are aiming to screen people for changes in the area, cellular changes and also for HPV.”
Pap smears, both of the cervical and anal areas, are recommended every three years starting at age 21, according to the American Cancer Society. They can be recommended more frequently by your doctor if abnormalities are found or if you engage in what they call “high risk sexual behavior.”
Breast cancer is the most common form of cancer to affect women with some studies showing an increase in breast cancer among lesbian and bisexual women. Robin Maynard-Harris, founder of Libby’s Legacy Breast Cancer Foundation, explained one possible reason of why that is in an interview with Watermark in Nov. 2017.
“Breastfeeding reduces your chance of getting breast cancer,” Maynard-Harris said. “Not so many lesbians now, but back in the day lesbians weren’t having children and weren’t breastfeeding often. Those women are now in their 40s and 50s, and didn’t have children.”
Several other risk factors include being over 40 years old, having a family history of breast cancer and anyone undergoing hormone replacement therapy.
“This is a risk factor so many doctors are not talking about,” Maynard-Harris said. “Many of the various types of breast cancer are estrogen fed, and if you already have a family history and you are transitioning and taking estrogen pills you increase your risk of breast cancer.”
The national LGBT Cancer Network recommends lesbian, bisexual and transgender women should follow the same guidelines laid out for heterosexual, cisgender women. It is recommended that annual breast cancer screening with mammograms start at age 45, with the choice to start as early as age 40, and clinical breast exams start at age 20.
Smoking
LGBTQ adults are two and a half times more likely to use tobacco products than straight adults, according to Tobacco Free Florida.
Heart disease is the leading cause of death in the U.S. and smoking is a big risk factor for it. Tobacco-related health problems can also include lung cancer, lung disease, high blood pressure and a whole host of other serious problems.
“Basically, you should not smoke at all, period,” says Dr. Pinero. “Also, I do not think vaping or those types of alternatives to cigarettes are the solution because they have still been shown that they can carry a risk of cancer, so vaping is not a substitute for tobacco.”
If you smoke, speak with your doctor about smoking cessation programs and/or medications that are offered to help you quit.
“The most effective medication out there is Chantix but depending on the patient, you have to be monitored by your doctor while on it,” Dr. Pinero says. “Now most insurances are starting to cover it, so that’s a good thing.”
While Dr. Pinero says no one should be a smoker, he puts extra emphasis on anyone taking hormones.
“For members of the transgender community on hormones, smoking carries the risk of developing blood clots and if you develop blood clots you have to be taken off the hormones,” he says. “A person on hormones should not be smoking at all, period.”
Nicotine replacement therapy (NRT)—such as nicotine gum and patches— are available through several local and state organizations for free.
If you are a former smoker who smoked for many years and/or smoked a great deal, make sure you are speaking with your doctor about monitoring possible health issues that may come up from years of use.
“I’m not sure every insurance company covers them, but if somebody has an excessive smoking history, either in the past or currently, then a chest x-ray or even sometimes a CT scan can be done,” says Dr. Lyter.
Mental health
LGBTQ individuals are almost 3 times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder, according to the National Alliance of Mental Illness (NAMI).
It is important to not only feel comfortable discussing your mental health with your primary care doctor, but to also engage in an open and honest dialogue about how your feeling and how you remedy the stresses in your life.
“In the LGBTQ community, depression and anxiety is very prevalent,” says Dr. Pinero. “I think that gets complicated when they start using alcohol and other substances to self-treat or self-medicate those symptoms, which then becomes another issue of addiction.”
NAMI reports that an estimated 20 to 30 percent of LGBTQ people abuse substances, compared to about nine percent of the general population. 25 percent of LGBTQ people abuse alcohol, compared to five-10 percent of the general population.
“Mental health screenings are important across all populations but I think they are particularly important with vulnerable populations,” says Dr. Johnsen. “I think a good provider should be aware of their patient’s social history and support system and so on, even if on the surface they seem ok, because things can creep up.”
All the doctors we spoke with say that a mental health screening for depression is recommended during a patient’s annual physical and should be common knowledge for all primary care physicians to conduct. If it isn’t done by your doctor, don’t be afraid to ask about it, even if you don’t think you have depression.
“A lot of people that I see who are complaining about anxiety have underlying depression, so depression is very important to treat,” says Dr. Pinero.
When it comes to finding the right therapy for an LGBTQ person’s mental health, all the doctors we spoke with agree that a multi-layered approach is best.
“I don’t think that medication alone is the right solution to managing depression,” Dr. Pinero says. “But a problem I have encountered is finding the right mental health provider for the patient. I run into issues where an LGBTQ person’s insurance will only cover one provider and that provider starts in with the bible-thumping and that is certainly not helpful. I wish we had a wider, more affordable network of mental health specialists.”
GLMA’s website does include mental health providers in its directory. Visit GLMA.org for more information.
Want more information? Click the links below to find healthcare information specific to your concerns for where you fall LGBTQ spectrum.
Start the conversation: Gay/Bisexual men
Start the conversation: Lesbian/Bisexual women
Start the conversation: transgender people
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