The lesbian, gay, bisexual * , and transgender (LGBT) community in the United States consists of a diverse group of people of all ages, races, cultures, genders, and socioeconomic backgrounds. Generally, the health issues of LGBT people are no different than those of heterosexuals, but some are of specific concern to LGBT communities. For instance, gay men are at a higher risk of contracting HIV * /AIDS * . Members of the LGBT community are also subject to societal bias, violence, and discrimination that can lead to such mental health problems as depression and anxiety.
In its simplest form, the word gender refers to a person's sex (male or female). For many reasons, people identify with gender and gender roles differently. Gender can be defined in many different ways, including physiologic gender, emotional gender, and social gender.
Before the 20th century, a person's sex was determined solely based on his or her external genitals * . Advances in technology have allowed for a fuller understanding of chromosomes and their effect on gender identity. Generally, human beings are considered either male (with XY chromosomes) or female (with XX chromosomes). In some cases, there are combinations of chromosomes and genitalia that do not comply with the traditional definitions of male and female gender. For example, a person born with male or female genitalia may exhibit physical characteristics that are traditionally attributed to the opposite sex. These androgynous * attributes include body shape, body and facial hair, and tone of voice. In addition, some studies suggest that homosexuality itself is genetically determined.
Some individuals emotionally identify more with the opposite gender. There is an apparent conflict between the person's physical sex and what his or her brain believes to be the essential or true identity, and this inner sense of identify may not comply with socially mandated roles. These people are transgender * . In some cases, this apparent conflict is resolved by social or professional choices that are fulfilling to individuals. But profound confusion or contradiction between the physical and emotional identities may cause some individuals to be diagnosed with gender dysphoria. Some transgender people opt to undergo hormone treatments or surgical procedures (gender reassignment) to change their sexual characteristics. Gender reassignment surgery strives to create in the body of an individual the sexual physical traits of the opposite sex. This kind of surgery might include either the removal of a person's breasts, testicles * , or penis, or the addition of breasts or female or male sex organs.
Social gender refers to the traditional roles that men and women are expected to conform to based on their physiological gender. In every society, men and women are typically assigned certain gender roles that are widely considered acceptable. For example, in the United States, girls often are encouraged to choose toys that are perceived to be feminine, such as dolls, dress-up clothes, kitchen toys, and play cosmetics. Boys usually are encouraged to choose toys that are perceived as masculine, such as cars, trucks, sports equipment, tools, and play weapons. When children grow up, these social norms predict the girls will become nurturers in roles such as nurses, grade-school teachers, and social workers, and boys will be masterful and dominant in roles such as doctors, scientists, and soldiers. As adults, although there is usually a majority of one sex in a given role, the opposite sex is represented too. Men are nurses; women can be truck drivers and soldiers. Thus, stereotypical expectations that condition children to accept gender-specific roles do not suit everyone.
One major issue with the LBGT population is that of seeking and receiving appropriate health care. Many people feel a level of embarrassment or inhibition that prevents them from seeking medical assistance. If the problem that draws them into the medical setting is assumed to trigger prejudice in the caregiver, people may be reluctant to seek medical help. Like other minorities, LBGT people may face bias and discrimination in healthcare settings. For that and other reasons, some people may be reluctant to seek routine medical treatment. LBGT people may feel uneasy discussing their concerns. Members of the LBGT community may feel hesitant to discuss a problem that is personal and sexual in nature and about which the patient fears the medical provider may have strong opinions.
Many medical professionals are not sensitized to treat their patients in a neutral and nonjudgmental way. LBGT individuals, like others seeking certain services, may be inclined to fear prejudice and criticism among the medical professionals from whom they are seeking help. In addition, because people in same-sex relationships may not have domestic partner benefits, these individuals are at risk for being uninsured, further compounding the problem of seeking medical help. The Affordable Care Act and other efforts are working toward eliminating discrimination in the health setting and insurance coverage.
For the most part, LBGT people have the same health concerns that heterosexual * people do, and their lives are as healthy or unhealthy as the rest of the population. All people can get cancer, heart disease, and HIV/AIDS. All sexually active people ought to be concerned about diseases that can spread through sexual activity and need to take precautions regarding them. But many individuals are uninformed or deny being at risk, and so they engage in activities that may hurt them and their sexual partners.
A sexually transmitted infection (STI) is an infection that is passed from one person to another through sexual contact, which includes vaginal or anal * intercourse and oral sex. STIs are caused by bacteria, parasites, and viruses. There are more than 20 STIs, including the following:
STIs are prevalent among individuals who take sexual health risks and have multiple partners. HIV/AIDS is also a risk for drug users who share infected needles.
As a group, lesbians have fewer pregnancies and use less oral contraception * than heterosexual women. Those who do not use contraception or get pregnant face neither the risks nor the benefits of these choices. Lesbians who do not have health insurance may visit healthcare providers less frequently than insured individuals, which is also true for the general population. Individuals who use tobacco, have high alcohol consumption, have poor nutrition, and are obese * have physical concerns apart from their sexual orientation.
Gay men (clinically referred to as men who have sex with men, or MSM), along with drug-addicted men who share needles, are at higher risk than the rest of the population for contracting HIV/AIDS. When AIDS first appeared in the United States in the early 1980s, the disease was noted specifically among homosexual men. Although the disease is contracted by heterosexual men too and by both heterosexual and homosexual women, it has had particularly high rates among American gay men. During the late 20th century and into the early 2000s, knowledge about the risks of HIV/AIDS spread in the United States. Gay men, along with other men, need to take precautions to help protect them from this disease. Knowledge of HIV and better access to screening tests for HIV infection have reduced the rate of among gay men and other groups. MSM are also at risk of contracting STIs, as is anyone who engages in risky sexual behavior, such as not using condoms consistently, or who has multiple partners.
There is limited statistical health information about transgender people. Among this group, individuals who act as prostitutes are at particular risk for STIs, just as heterosexual prostitutes are. Risky behaviors such as having multiple sexual partners, sharing needles among intravenous *
Everyone is susceptible to becoming overwhelmed by stress and pressure, which can lead to mental health issues such as depression, anxiety, substance abuse, and suicide. Because of discrimination, bias, stigma, social pressure, and hate crimes, LGBT persons are at particular risk of having psychological problems. Research has shown that laws restricting marriage or other rights for LGBT people can have harmful psychological effects.
Just like many heterosexual individuals, many LGBT people choose to start their own families and raise children. But the difference is that samesex couples who wish to have children must select alternative paths similar to infertile heterosexual couples who want children. Some adopt children, and others use various methods to conceive and give birth. Several options are available to same-sex couples and to infertile heterosexual couples:
Hate crimes are illegal acts committed against people based on their race, ethnicity, gender, or sexual orientation and against individuals who sympathize or stand with members of these groups. Hate crimes may involve assault, battery, rape, torture, and murder. Sometimes these crimes have specific religious, political, or cultural motivations, but other times there seems to be no motivation besides hate. Hate crimes may be perpetrated by individuals or groups, but in some countries, governments torture and execute minority individuals, including those suspected or accused of being gay, lesbian, bisexual, or transgender.
The latest information from the National Coalition of Anti-Violence Programs (NCAVP) reports an overall decrease in hate-related crimes against LGBT individuals. Between the years 2011 and 2012, crime against this population decreased 4 percent. The groups most likely to experience hate violence include transgender people (particularly transgender women), people of color (particularly transgender people of color), and gay men.
Domestic violence is a serious problem among both heterosexual and homosexual people, and the incidence * is about the same for the two populations. Many kinds of abuse occur in intimate relationships, including physical violence, emotional and verbal abuse, sexual abuse, and financial intimidation. Many victims of domestic abuse are afraid or ashamed and do not seek help in dealing with their abusive partners.
LGBT people face many legal difficulties that heterosexual people do not face.
All people need to protect their estates with legal documents, but same-sex couples face certain hurdles that married heterosexual couples do not. The estates of people who do not prepare for serious illness, injury, or death with advanced legal directives may end up in the hands of the state. Rights of survivorship for married individuals direct the state to disperse an estate to the surviving spouse. It is expected that with the legalization of same-sex marriage nationwide, issues such as estate planning will decrease. All individuals can protect themselves by drawing up a will or trust, establishing medical power of attorney, drafting a living will, and designating power of attorney.
Another issue for same-sex couples concerns retirement benefits. In the event of a retired married person's death, the surviving spouse receives the retirement and Social Security benefits. This issue will most likely be reduced since the legalization of same-sex marriage nationwide.
Supporting gay, lesbian, bisexual, or transgender loved ones can be difficult, given the dominant social prejudice against them. Many people benefit from counseling, therapy, or support groups that help them to understand the problems that their loved ones may face, including discrimination; abuse; and work, family, and relationship difficulties. Such groups as Parents, Families, and Friends of Lesbians and Gays (PFLAG) teach tolerance and acceptance and work to normalize people's attitudes toward sexual differences.
See also AIDS and HIV Infection • Gender Dysphoria • Sexually Transmitted Infections (STIs): Overview
Harcourt, Jay. Current Issues in Lesbian, Gay, Bisexual, and Transgender Health. London: Routledge, 2013.
American Psychological Association. “Lesbian, Gay, Bisexual and Transgender Issues.” http://www.apa.org/about/gr/issues/lgbt/ (accessed March 17, 2016).
Centers for Disease Control and Prevention. “Lesbian, Gay, Bisexual, and Transgender Health.” http://www.cdc.gov/lgbthealth/index.htm (accessed March 17, 2016).
GLAAD (Gay & Lesbian Alliance Against Defamation). 5455 Wilshire Blvd., #1500, Los Angeles, CA 90036. Telephone: 323-634-2034. Website: http://www.glaad.org (accessed March 17, 2016).
National Association of Social Workers. 750 First St. NE, Suite 800, Washington, DC 20002. Toll-free: 800-742-4089 Website: https://www.socialworkers.org (accessed March 17, 2016).
National Coalition for Anti-Violence Programs. 116 Nassau St., 3rd Floor, New York, NY 10038. Telephone: 212-714-1184. Website: http://www.avp.org/ (accessed March 17, 2016).
National Coalition for LGBT Health. 2000 S St. NW, Washington, DC 20009. Telephone: 202-507-4727. Website: http://www.healthhiv.org (accessed March 17, 2016).
PFLAG (Parents, Families & Friends of Lesbians and Gays). 1828 L St. NW, Suite 660 Washington, DC 20036. Telephone: 202-467-8180. Website: https://community.pflag.org/ (accessed March 17, 2016).
* bisexual (bi-SEK-shoo-al) means being sexually attracted to both sexes.
* HIV or human immunodeficiency virus (HYOO-mun ih-myoono-dih-FIH-shen-see) is the virus that causes AIDS (acquired immunodeficiency syndrome).
* AIDS or acquired immunodeficiency (ih-myoo-no-dih-FIH-shensee) syndrome is an infection that severely weakens the immune system. It is caused by the human immunodeficiency virus (HIV).
* genitals (JEH-nih-tul) refers to the external sexual organs.
* androgynous (an-DRAW-gin-us) refers to having characteristics of both sexes.
* transgender is a person who identifies with and expresses a gender identity that differs from the one that corresponds to the person's sex at birth.
* testicles (TES-tih-kulz) are the paired male reproductive glands that produce sperm.
* heterosexual (he-te-ro-SEKshoo-al) refers to a tendency to be sexually attracted to the opposite sex.
* anal refers to the anus, the opening at the end of the digestive system through which waste leaves the body.
* herpes simplex (HER-peez SIMplex) is a virus that can cause infections of the skin, mouth, genitals, and other parts of the body.
* syphilis (SIH-fih-lis) is a sexually transmitted infection that, if untreated, can lead to serious life-long problems throughout the body, including blindness and paralysis.
* chlamydia (kla-MIH-dee-uh) are microorganisms that can infect the urinary tract, genitals, eye, and respiratory tract, including the lungs.
* gonorrhea (gah-nuh-REE-uh) is a sexually transmitted infection (STI) spread through all forms of sexual intercourse. The bacteria can also be passed from an infected mother to her baby during childbirth. Gonorrhea can affect the genitals, urethra, rectum, eyes, throat, joints, and other tissues of the body.
* contraception (kon-tra-SEPshun) is the deliberate prevention of conception or impregnation.
* obesity (o-BEE-si-tee) is an excess of body fat. People are considered obese if they weigh more than 30 percent above what is healthy for their height.
* intravenous (in-tra-VEE-nus), or IV, means within or through a vein. For example, medications, fluid, or other substances can be given through a needle or soft tube inserted through the skin's surface directly into a vein.
* incidence means rate of occurrence.