LGBTQ Health

A Physician’s Approach to Gender-Affirming Care

 

Recent events in Texas have shone a spotlight on gender-affirming care and its impact on young people who identify as being gender diverse and transgender. TMA's LGBTQ Health Section answers common questions about gender-affirming care and what it means for patients and physicians.

Read the Q&A  

TMA Staying Involved as Courts Rule on Gender-Affirming Care, SB 8

 

TMA is making sure medicine’s best interests are considered in two legal cases in which courts handed down significant decisions on March 11, impacting physicians and the patients they serve. One decision impacted the state's attempt to investigate gender-affirming care as child abuse, while the other cleared the way for a future ruling on whether the state's new abortion law is constitutional.

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TMA Supports Evidence-Based Gender-Affirming Care in Lawsuit

 

As the Doe v. Abbott lawsuit heads to a hearing today over whether to block state investigations involving certain care provided to transgender youth, among other issues, the Texas Medical Association has filed a friend-of-the-court brief in the case in support of medically necessary, gender-affirming care, and opposing the criminalization of such treatment.

Learn More About TMA's Position  

TMA in Talks With State Leadership on Gender-Affirming Care

 

In a series of meetings with state leadership, the Texas Medical Association has reiterated its opposition to the criminalization of medically necessary gender-affirming care and emphasized the need for protecting the patient-physician relationship with transgender youth and adolescents.

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TMA’s LGBTQ Health Section Elects Leaders

 

The LGBTQ Health Section is led by the LGBTQHS Executive Council, which is elected annually by the section membership. The Executive Council is currently comprised of the chair, chair-elect, secretary, and medical student representative. 

A copy of the section’s operating procedures is available here.

Meet the  LGBTQ Leaders  

TMA Delegates OK Policy on Certain Health Care Disparities, LGBTQ Health Section

 

At an unprecedented live virtual meeting Saturday, the Texas Medical Association House of Delegates took action on a variety of initiatives important to the health of all Texans, including adopting policy to address health care disparities specifically related to cancer; laying the foundation for the creation of an LGBTQ Health Section; and setting principles for community-based accountable care organizations (ACOs).

Get the Details Here  

Opportunities and Challenges

Physicians care for patients with unique health challenges, including adults and minors who identify as lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ). While 2015 national data noted 1.6% of adults identified as gay or lesbian and 0.8% as bisexual,¹ the latest Gallup poll finds that 4.5% of Americans, or an estimated 11 million adults, identify as lesbian, gay, bisexual, or transgender.²

Health data on the LBGTQ population are inconsistent. But we do know that compared with heterosexual populations, LGBTQ individuals are at greater risk for health conditions related to obesity, substance use, depression, anxiety, lack of primary care, and violence.³ In 2017, an estimated 2.6 million students across the nation identified as lesbian, gay, or bisexual, and compared with others, they experienced significantly higher risks for negative health outcomes due to substance use, suicide, violence, and sexual activity.⁴

1. Centers for Disease Control and Prevention. Table 1. Sexual orientation among U.S. adults aged 18 and over, by sex and age group: United States, 2015.
2. Frank Newport. In U.S., Estimate of LGBT Population Rises to 4.5%. Gallup. May 22, 2018.
3. Healthy People.gov. Lesbian, Gay, Bisexual, and Transgender Health (accessed July 11, 2019).
4. Centers for Disease Control and Prevention. Understanding Unequal Health Risks of LGBT Students (accessed July 11, 2019

Improving Care for LGBTQ Patients

 

LGBTQ patients experience a disproportionate number of health problems, including high rates of mental illness, HIV, obesity, suicide, homelessness, and tobacco, alcohol, and drug use. Many physicians who would like to treat LGBTQ patients often hesitate because they fear they lack the training. While it's important for physicians to educate themselves on caring for LGBTQ patients, it's equally important for those patients to have better access to care. "They haven't felt comfortable going to a doctor," said Kelly Bennett, MD.

A New Understanding  

LGBTQ Health Resources for Physicians

• Creating an LGBTQ-friendly practice provides tips from the American Medical Association.
• The GLMA: Health Professionals Advancing LGBTQ Equality website offers resources for physicians and patients, including Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients, and continuing education like the Quality Healthcare for Lesbian, Gay, Bisexual & Transgender People webinar series. The three-part series covers an introduction to understanding the needs of LGBTQ patients, how to create a welcoming environment, and clinical skills for the care of transgender individuals.
• National LGBT Health Education Center provides educational programs, resources, and consultation to health care organizations with the goal of optimizing quality, cost-effective health care for LGBT people.
• Healthcare Equality Index is the national LGBTQ benchmarking tool that evaluates health care facilities’ policies and practices related to the equity and inclusion of their LGBTQ patients, visitors, and employees. Visit the site to search for health care facilities with 100 or more employees that are participating in the quality improvement efforts, register your facility free of charge, or just learn more about the project.
• Gender-Affirming Pediatric Care Toolkit is a list of resources by the National LGBTQIA+ Health Education Center to assist providers and health care staff in gender-affirming care for transgender and gender diverse children and adolescents. The toolkit has resouces on concepts and terminology, non-medical gender affirmation, legal aspects of social gender affirmation, insurance policies and the process of getting coverage for gender-affirming care, social determinants of health, support for families, and organizational change and policy. 

Resources for Your Patients

The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, queer, and questioning youth. In addition to the toll-free number, text, and chat options answered by trained counselors, the Trevor Support Center webpage provides easy-to-access frequently asked questions about sexual orientation, gender identity, and more. Help is available by phone at (866) 488-7386 /Text / Chat  

TMA Policy

60.008 Rejection of Discrimination: The Texas Medical Association does not discriminate, and opposes discrimination, based on race, religion, disability, ethnic origin, national origin, age, sexual orientation, sex, or gender identity. TMA supports physician efforts to encourage that the nondiscrimination policies in their practices, medical schools, hospitals, and clinics be broadened to include “race, religion, disability, ethnic origin, national origin, age, sexual orientation, sex, or gender identity” in relation to patients, health care workers, and employees. (CSPH Rep. 1-A-18)

60.010 Opposing Legislation that Mandates Physician Discrimination: The Texas Medical Association (1) supports the removal of “opposite sex” as a requirement for affirmative defense to prosecution within the Texas Penal Code, and (2) opposes legislation or regulation that mandates physicians and other health professionals discriminate against or limit access to health care for a specific patient population (Res. 111-A-19).  

TMA News and Other Stories

“Conversion Therapy” Is Not Evidence-Based Care (May 1, 2019)

Supporting Transgender and Gender-Diverse Teens by Maria Monge, MD (March 22, 2018)