Pushing Back on LGBTQ+ Health Disparities, Medical Discrimination

For years, studies have confirmed what too many in the LGBTQ+ community know first-hand: Sexual minorities too often face bias and unequal treatment in health care settings.

In a 2018 article on such disparities, the Center for American Progress offered several real-life examples of how the medical establishment can fail to serve LGBTQ+ patients and their families. The shocking examples included a situation in which "after one patient with HIV disclosed to a hospital that he had sex with other men, the hospital staff refused to provide his HIV medication."

"In another case, a transgender teenager who was admitted to a hospital for suicidal ideation and self-inflicted injuries was repeatedly misgendered and then discharged early by hospital staff," the CAP article continued. "He later committed suicide."

Such instances of bias directly affect the most vulnerable of patients: "In Michigan, an infant was turned away from a pediatrician's office because she had same-sex parents," the CAP said.

The abuse encountered by LGBTQ+ patients are not limited to neglect, rejection, or simple disrespect; the CAP reported that among patients who are lesbian, gay, bisexual, or queer, "9% said that a doctor or other health care provider used harsh or abusive language when treating them," while "7% said that they experienced unwanted physical contact from a doctor or other health care provider (such as fondling, sexual assault, or rape)."

Transgender patients encounter even greater bias: "29% said a doctor or other health care provider refused to see them because of their actual or perceived gender identity," CAP noted, while "21% said a doctor or other health care provider used harsh or abusive language when treating them" and "29 percent said that they experienced unwanted physical contact from a doctor or other health care provider (such as fondling, sexual assault, or rape)."

One survey from last summer reaffirmed the gap between how LGBTQ+ patients are treated in the American health care system compared to cisgender and heterosexual patients: Axios reported on research by KFF which found that 13% of LGBTQ+ respondents said health care providers had suggested that patients "were to blame for a health problem," whereas only 8% of heterosexual and cisgender patients said the same thing.

Moreover, compared to non-LGBTQ+ respondents, twice as many LGBTQ+ respondents said health care professionals they interacted with did not accept them at their word when they tried to describe health concerns or symptoms, and nearly twice as many said that health care providers "dismissed [their] concerns".

Staying in the closet during a doctor's visit may be an understandable result of experiences in which patients have encountered harassment, misgendering, or outright denial of treatment instead of quality professional health care. But that in itself can constitute a health risk; also, as Forbes noted, "Closeted patients may miss out on valuable health information if they don't inform their doctor about their gender identity, sex, and sexual orientation."

"Different people need different doses of medicine depending on their metabolism," Forbes said, and other physiological considerations can affect how effective a treatment regimen is, making it crucial for doctors to hear, and respect, the facts around a patient's gender identity.

Avoiding medical care altogether can also be dangerous. "If a transgender person has menstrual problems or pelvic pain, they may wait to seek medical care until their symptoms become unbearable," Forbes added. "But that patient may have a serious chronic condition."

Hiding aspects of one's identity and medical history can conceivably sabotage even quality care from dedicated professionals. Trans patients taking testosterone, for instance, might avoid disclosing this information, but "if a gynecologist does not know that their patient is taking testosterone, they may accidentally prescribe unsafe or ineffective hormone treatments," Forbes said..

The article also noted that "Sexually active LGBTQ+ patients who have a supportive doctor may feel more comfortable asking questions about safe sex and STI tests."

Not everyone who encounters anti-LGBTQ+ bias in health care settings has the option to seek care elsewhere, but those who can do so might consider it. "If you're seeking a supportive doctor in your area, consider asking your local LGBTQ+ center for recommendations," Forbes suggested.

Meanwhile, there are signs that a younger generation of medical students might be more capable of setting aside bias in the name of medical professionalism – not to mention healing compassion. In 2019, NPR reported on initiatives from medical students themselves to secure more comprehensive training around LGBTQ+ patients and their needs.

More immediately, federal protections are once again in place. In a reversal of Trump-era policies, the Biden administration announced earlier this year that it would act to counter anti-LGBTQ+ discrimination in health care settings, as the Department of Health and Human Services now officially sees gender identity and sexual orientation as being covered under Section 1557 of the Affordable Care Act. That section, NPR noted in a report last spring, "prevents health care providers and insurance companies from discriminating on the basis 'race, color, national origin, sex, age or disability in certain health programs and activities.'"

That change, NPR noted, "puts the agency in position to more aggressively investigate and enforce LBGTQ discrimination complaints."