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Chapter 18: LGBTQ+ Healthcare

Jill Blumenthal, MD, MAS

INTRODUCTION

The lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual/aromantic/agender, and two-spirit (LGBTQIA2S+; henceforth to be referred to as LGBTQ+) community as a whole experiences many health disparities that are associated with stigma, discrimination, and denial of basic civil and human rights. While many LGBTQ+ young adults thrive during adolescence, these factors and others put them at increased risk for negative short- and long-term health outcomes. It is critical for providers to be aware of existing health disparities in order to provide more inclusive, evidence-based, and compassionate medical care to LGBTQ+ individuals. For transgender and nonbinary (TGNB) individuals in particular, institutional and interpersonal gender discrimination can impact their experiences in the medical system. Healthcare providers can foster significant improvements in the health and well-being of the LGBTQ+ community.

PEARL: Clinicians should be aware of existing health disparities to provide more inclusive, evidence-based, and compassionate medical care to LGBTQ+ individuals.

KEY TERMS AND DEFINITIONS

Table 18-1 provides definitions for commonly used LGBTQ+-related terms but is by no means exhaustive. Remember that the language used by and describing LGBTQ+ individuals may change over time, so what is recommended now may be different in the future.

TABLE 18-1Key Terms and Definitions
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TABLE 18-1 Key Terms and Definitions

Term

Definition

Agender

An individual who does not identify with any socially recognized gender.

Asexual

An individual who does not experience sexual attraction to others and/or has little or no desire to engage in sexual activity. Shorthand: “ace.”

Bisexual

An individual who experiences sexual/affectional attraction to more than one gender identity. Some may use the term to connote the experience of attraction to all individuals regardless of gender. Shorthand: “bi.”

Cisgender

An individual whose gender identity is congruent with their sex assigned at birth. Shorthand: “cis” or “cis-.”

Demi-sexual

An individual who only experiences sexual/affectional attraction with people who they know very well.

Gay

An individual who experiences sexual/affectional attraction to others of the same gender.

Gender

A construct drawing from social expectations, an individual’s internal feelings, and expressed behaviors. Commonly confused with “sex” or “biological sex,” gender is an internal construct and not determined by physical features or expression.

Gender identity

How an individual perceives themselves and/or how they feel they align within gender categories.

Gender expression

How an individual presents themselves to the world relative to gender (typically as masculine, feminine, or androgynous). This expression may include, clothing, haircut, body language, vocal tone, and behaviors.

Genderfluid

An individual who does not experience their gender identity in a stagnate form. Their identity shifts between 2 or more genders.

Gender nonconforming

An individual whose gender expression and/or gender identity does not match the social expectations of gender (ie, does not adhere to a category of man/masculine or woman/feminine). Shorthand: “GNC.”

Genderqueer

An individual whose gender identity and/or expression falls outside societal expectations.

Intersex

An individual ...

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