Lesbian, gay, bisexual, and transgender persons face health disparities and experience unique health issues relevant to dermatologists.
Dermatologists should follow guidelines for men who have sex with men from the Centers for Disease Control and Prevention and other public health agencies for HIV and other sexually transmitted diseases screening; HIV preexposure prophylaxis and HIV postexposure prophylaxis; and human papillomavirus, hepatitis A and B viruses, and meningococcal vaccination.
Gender-affirming hormone treatments for transgender persons have distinct dermatologic effects.
Eliciting a patient’s sexual history and gender identity can facilitate diagnosis and management of dermatologically relevant diseases.
Lesbian, gay, bisexual, and transgender (LGBT) is an umbrella term referring to broad communities of individuals with diverse sexual orientations and behaviors, gender identities, and/or gender expressions, and distinct health needs.1 Over 30 years into an ongoing HIV epidemic that disproportionately impacts LGBT persons, which dermatologists were among the first to recognize by helping to identify an epidemic of Kaposi sarcoma among gay men,2 LGBT persons continue to face substantial health disparities related to both infectious and noninfectious diseases. These include higher rates of HIV and other sexually transmitted diseases (STDs), substance use, body image disorder, obesity, violence and victimization, mental health issues, and suicidality.1,3 LGBT patients also encounter barriers in accessing health care that result from disparities in health insurance coverage, real or perceived discrimination by health care providers, and delayed or inappropriate care from providers unfamiliar with their specific health concerns.4
Improving the health of LGBT persons has become a priority, not only of clinicians, but also of educators,5 researchers,1 public health officials,3 regulators,4 and legislators.6 Dermatologists should familiarize themselves with LGBT health issues, which have been rarely discussed in the dermatology literature, to provide patients with medically appropriate and patient-centered care.7 For example, eliciting a patient’s sexual history and gender identity can influence the assessment of the probability of diseases with higher prevalence among LGBT patients. Physicians can then recommend screening tests, vaccinations, and HIV prophylaxis appropriate for LGBT patients that might not apply to non-LGBT patients. This chapter reviews terminology and demographics related to LGBT health; health disparities faced by LGBT persons; dermatologic issues relevant to men who have sex with men (MSM), women who have sex with women (WSW), and transgender persons; and approaches to providing culturally competent and patient-centered care to LGBT persons.
TERMINOLOGY AND DEMOGRAPHICS
Terminology related to LGBT health is complex, evolves over time, and may not be accepted by all LGBT persons. Table 107-1 shows selected terminology and concepts.8 Familiarity and openness with the use of appropriate and patient-preferred terminologies are essential in eliciting relevant sexual history and gender identity, discussing risk behaviors and contraception, and demonstrating respect and affirmation to patients.4,5
Table 107-1Selected Terminology and Concepts in LGBT Health8