LGBTQ+ Healthcare Specialty Specific Resources

LGBT Cultural Competence of Acute Care Nurses

• Improved cultural competence through professional development can lead to decreased barriers to care.

Acute Clinical Care for Transgender Patients: A Review

•  Topics considered in this narrative review include terminology, how to address transgender patients, obtaining an inclusive history that takes into account gender-affirming surgery, managing hormone therapy and other clinical issues, consideration for hospitalized patients, interpreting laboratory values in the setting of hormone use, legal issues, and considerations for health systems.

Acute Pancreatitis in the Transgender Population

• Hormone replacement therapy in the transgender population is an underrecognized cause of elevated triglyceride (TG) levels and may put this group at a higher risk for severe pancreatitis.

Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study

• Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use.

Does Gender Affirming Hormone Therapy Increase the Risk of Kidney Disease?

• In this review, we introduce the current information related to GAHT and kidney health and highlight the significant gaps in our understanding of how GAHT may affect kidney physiology and pathophysiology.

Impact of gender-affirming hormone therapy on the development of COVID-19 infections and associated complications

• Sexual and gender minority (SGM) people face multiple health disparities. Clinicians often lack adequate training to address health needs of SGM people. In this setting, some health care organizations have sought to develop system-wide curricula to build clinician knowledge and capacity around SGM health

Health care seeking behaviors and experiences of transgender people

Minority stress theory applied to conception, pregnancy, and pregnancy loss in LGBTQ patients

• This qualitative study aimed to explore the experiences of multi-level stigma and resilience among LGBTQ+ people in the context of conception, pregnancy, and loss. 

Lesbian Pregnancy: Care and Considerations

• This review seeks to provide culturally sensitive guidance on the specific concerns and challenges lesbians face, from preconception care to postpartum care, and briefly addresses legal issues and considerations for the nonbiologic mother. 

Preconception, Pregnancy, Birthing, and Lactation Needs of Transgender Men

•  A literature review was conducted to explore the reproductive health needs of transgender men related to reproductive desires, contraception, family planning, fertility preservation, pregnancy, birth, and lactation. 

Fertility preservation options in transgender people: A review

• Gender affirming procedures adversely affect the reproductive potential of transgender people. Thus, fertility preservation options should be discussed with all trans people before medical and surgical transition.  

Moving Beyond Misconceptions

• Many transgender men are incorrectly told by health professionals that taking testosterone will make them “sterile” and potentially unable to conceive. This can result in unplanned pregnancies or a lack of awareness that desired pregnancy is possible. If a transgender man stops taking his testosterone, his menstrual cycle often returns, reportedly within about 6 months. While there have been no long-term studies, nothing so far has shown cause for concern. Reproductive endocrinologist Dr. Sara Pittenger Reid told the New York Times that with the “limited amount of data we have” it seems that taking testosterone before pregnancy doesn’t have any effect on the baby’s health.
• The language and culture around pregnancy and birth is highly gendered, from the terms “maternity ward” and “women’s health,” to the assumptions someone in the grocery store makes about a pregnant person passing by. The factors that most people don’t think of twice can cause significant hurt for pregnant people who aren’t women. “The whole process is difficult — it really is tailored for women, essentially, in the language and everything about it,” Ethan Clift told NBC News. Clift said that when he was pregnant he corrected health professionals caring for him at a Reno, Nevada clinic who called him “she” over and over until he gave up. 
• Others have described “getting laughed at” by providers, nurses refusing to see them, and being denied lactation coaching in the hospital. Treatment like this is part of why 30.8 percent of transgender patients delayed or didn’t seek medical attention, according to a 2016 study. One transgender man told a researcher in a 2017 study “I just didn’t like leaving the house at all because I knew that I was going to be read as pregnant female, and it just ugh. After I’d worked so hard the past couple of years to get [people to see me as male].”

Changes in Anxiety and Depression from Intake to First Follow-Up Among Transgender Youth in a Pediatric Endocrinology Cl

• The current study examined changes in anxiety, depression, and suicidality from initial appointment to first follow-up in 80 youth, ages 11-18.

Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation

• Our objective for this study was to examine associations between access to pubertal suppression during adolescence and adult mental health outcomes. 

Gender-Affirming Pediatric Care Toolkit

• This toolkit is a curated list of resources created by the National LGBTQIA+ Health Education Center to aid medical and behavioral health providers who are either starting on their journey in gender-affirming care for TGD youth or are looking to refresh or further their learning and understanding of creating safe, supportive, affirming health care experiences for TGD children and adolescents.

Factors associated with time to receiving gender affirming care at a multidisciplinary pediatric gender clinic

• Describing barriers to care for a cohort of transgender and nonbinary (TNB) youth and examine factors associated with delays in receiving puberty blockers (PBs) or gender-affirming hormones (GAHs).

The Role of Consent in Regulating Access to Care for Transgender Youth Under 18

• Identify power dynamics present in transgender youths’ relationships with parents and providers, particularly related to age and youths’ status as legal minors. Better understand how the construction of consent – what it stands for & who get to execute it at what age – impacts transgender young people’s health & wellbeing.

Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents

• In its dedication to the health of all children, the American Academy of Pediatrics (AAP) strives to improve health care access and eliminate disparities for children and teenagers who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) of their sexual or gender identity. Despite some advances in public awareness and legal protections, youth who identify as LGBTQ continue to face disparities that stem from multiple sources, including inequitable laws and policies, societal discrimination, and a lack of access to quality health care, including mental health care. Such challenges are often more intense for youth who do not conform to social expectations and norms regarding gender. Pediatric providers are increasingly encountering such youth and their families, who seek medical advice and interventions, yet they may lack the formal training to care for youth that identify as transgender and gender diverse (TGD) and their families.
• Adolescents and adults who identify as transgender have high rates of depression, anxiety, eating disorders, self-harm, and suicide. Evidence suggests that an identity of TGD has an increased prevalence among individuals with autism spectrum disorder, but this association is not yet well understood. In 1 retrospective cohort study, 56% of youth who identified as transgender reported previous suicidal ideation, and 31% reported a previous suicide attempt, compared with 20% and 11% among matched youth who identified as cisgender, respectively. Some youth who identify as TGD also experience gender dysphoria, which is a specific diagnosis given to those who experience impairment in peer and/or family relationships, school performance, or other aspects of their life as a consequence of the incongruence between their assigned sex and their gender identity.

Mental Health in Sexual Minority and Transgender Women

• The purpose of this study was to describe positive and negative experiences of transgender people when accessing health care.

Comparing eating disorder treatment outcomes of transgender and nonbinary individuals with cisgender individuals

• The purpose of this study was to compare symptom severity of eating disorders (EDs), depression and anxiety at admission and discharge for transgender and nonbinary (TNB) individuals and cisgender adult individuals.

Advancing Trans-Affirming Practice to Recognize, Account for, and Address the Unique Experiences and Needs of Transgender people

• We outline the design and evaluation of a trans-affirming care curriculum for forensic nurses. We also discuss the planning, formation, and maturation of an intersectoral network through which to disseminate our curriculum, foster collaboration, and promote trans-affirming practice across health care and social services.

Care Considerations for LGBTQ Patients in Acute Psychiatric Settings

• This article highlights best practices to address the needs of LGBTQ patients in acute psychiatric settings, including inclusive and affirming communication and culturally competent history taking, risk assessment, treatment environments, and discharge considerations.

NAMI LGBTQI Resources

• Although the full range of LGBTQ+ identities are not commonly included in large-scale studies of mental health, there is strong evidence from recent research that members of this community are at a higher risk for experiencing mental health conditions — especially depression and anxiety disorders. LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition. Transgender individuals are nearly four times as likely as cisgender individuals (people whose gender identity corresponds with their birth sex) individuals to experience a mental health condition.
• LGB youth also experience greater risk for mental health conditions and suicidality. LGB youth are more than twice as likely to report experiencing persistent feelings of sadness or hopelessness than their heterosexual peers. Transgender youth face further disparities as they are twice as likely to experience depressive symptoms, seriously consider suicide, and attempt suicide compared to cisgender lesbian, gay, bisexual, queer and questioning youth.
• For many LGBTQ+ people, socioeconomic and cultural conditions negatively impact mental health conditions. Many in the LGBTQ+ community face discrimination, prejudice, denial of civil and human rights, harassment and family rejection, which can lead to new or worsened symptoms, particularly for those with intersecting racial or socioeconomic identities.

LGBTQ Primary Care Toolkit

• Individuals who are SGM (sexual and gender minorities) are more likely to suffer from health disparities than heterosexual and cisgender people, including poorer mental health, substance misuse, sexually transmitted infections, and other conditions that are often first identified in primary care. Health disparities among SGM people are linked to minority stress, which happens when people experience stigma and discrimination in their daily lives because of their minority identities, including at work and in public places and healthcare settings. These experiences can be harmful to health.
• Providers and staff who work in the healthcare field may harbor negative attitudes and beliefs about SGM people. Many are not trained to provide quality care to members of this population. SGM people face numerous challenges to getting primary care services and sometimes avoid seeking care altogether because they worry that they will not be treated well.

Decreasing Barriers to Sexual Health in the Lesbian, Gay, Bisexual, Transgender, and Queer Community

Access to health services for lesbian women: a literature review

Prostatic Metaplasia of the Vagina and Uterine Cervix

Intimate Partner Violence in the LGBTQ+ Community: Experiences, Outcomes, and Implications for Primary Care

LGBTQ+ Inclusive Palliative Care in the Context of COVID-19: Pragmatic Recommendations for Clinicians

LGBT Hospice and Palliative Care Network

New Hospice and Palliative Care Resource Guide for LGBTQ+ Communities

• Hospice providers have a history of meeting the unique needs of diverse communities going back to the early days of the AIDS pandemic in the 1980s when compassion, dignity, and care were so desperately needed by those marginalized at the time. 

The Aging Experiences of LGBTQ Ethnic Minority Older Adults: A Systematic Review

• The experiences of LGBTQ ethnic minority older adults echo those of LGBTQ ethnic majority older adults when they are shaped by gender and sexual identity factors. Nevertheless, significant differences in experiences-both positive and negative-emerge when cultural and ethnicity-related factors come to the fore.

Quality of Life among LGBTQ Older Adults in the United States: A Systematic Review

• Common findings indicate that LGBTQ older adults face challenges related to personal experiences of discrimination, anticipated discrimination in health care settings, and lack of family support.

Lesbian, Gay, Bisexual and Transgender Aging

• As a group, LGBT older adults experience unique economic and health disparities. LGBT older adults may disproportionately be affected by poverty and physical and mental health conditions due to a lifetime of unique stressors associated with being a minority, and may be more vulnerable to neglect and mistreatment in aging care facilities. They may face dual discrimination due to their age and their sexual orientation or gender identity. Generational differences and lack of legal protection may cause older LGBT adults to be less open about their sexuality. Social isolation is also a concern because LGBT older adults are more likely to live alone, more likely to be single and less likely to have children than their heterosexual counterparts. All of these considerations can be compounded by intersections of sex, race, ethnicity and disability.
• Psychologists, mental health facilities and aging services treating older adults are working with LGBT people, whether they have chosen to disclose or not, and providers should be cognizant of their presence and their unique needs should integrated into systems of care. Services intended for the older adult population must be assessed proactively and changes implemented as may be necessary to be welcoming for people who are both older and identify as LGBT.

Characteristics of Transgender Individuals With Emergency Department Visits and Hospitalizations for Mental Health

• Examines the additional factors unique or prevelent within the LGBTQ population presenting to the Emergency Department.

"Sometimes You Feel Like the Freak Show": A Qualitative Assessment of Emergency Care

• Qualitative assessment of 32 LGBTQ patients and their experiences around the Emergency Department.

LGBT Patients in the ED (Do Ask, Do Tell)

• A recent Canadian study on the ED visits of about 400 transgender patients showed that more than half had “trans-specific negative ED experiences.” The results for this patient population, which was about equally divided between transgender men and transgender women in Ontario, indicate that many avoid the ED predominantly because of fear of discrimination. (Ann Emerg Med 2014;63[6]:713.) Thirteen percent of those seen at U.S. EDs felt they had received unequal treatment, and 16 percent reported being harassed or disrespected, according to a canvass conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. (Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, 2011; http://bit.ly/1dy3LIy.)
• Jakob Rumble, who began transitioning when he was 15, presented to the ED at Fairview Southdale Hospital in Edina with “inflamed reproductive organs,” according to the Star Tribune in Minneapolis. (March 20, 2015; http://strib.mn/1FcVHm5.) A registrar clerk gave him an ID bracelet that said he was female, despite his explanations about being transgender, and the EP treating him conducted a history in a “hostile and aggressive manner,” including asking if “he had ever had sex with objects,” according to the StarTribune report. Mr. Rumble's lawsuit said the EP conducted a “rough” genital exam that was characterized as “assaultive” by the judge permitting the case to proceed, the news article said. The hospital and EP's employer, Emergency Physicians Professional Association, declined comment because of the pending litigation when approached by the Star Tribune.
• Acceptance and universal use of common and descriptive terminology would assist in collecting gender-identity data during a medical visit, said Madeline Deutsch, MD, an assistant clinical professor of family and community medicine at the University of California, San Francisco, and the clinical director for the Center of Excellence for Transgender Health. She and her colleague David Buchholz, MD, have demonstrated how an electronic medical record could be used to document identifiers associated with gender identity to make data collection inclusive of transgender patients. 

Urethral Complications After Transgender Phalloplasty: Strategies to Treat Them and Minimize Their Occurrence

• Radial forearm free flap phalloplasty (RFFP) is the current standard of care for most FTM gender confirmation surgeries. This procedure is associated with a rate of urethral stricture as high as 51%, which falls only to 23-35% even among the most experienced contemporary surgeons. While some modifications have been proposed to combat this high complication rate, it still remains a major source of lasting morbidity. 

Genital gender-affirming surgery for transgender women

• In this article, we discuss the various types of gGAS for transgender women, (contra)-indications, intraoperative considerations, techniques, surgical outcomes, and postoperative patient-reported outcomes.

The evolution of transgender surgery

• This article presents an overview of the evolution and current approaches to genital surgical procedures available for both male-to-female, as well as female-to-male gender-affirmation surgeries.

The Perioperative Care of the Transgender Patient

• This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient.

LGBTQ+ in Orthopaedics: Creating an Open and Inclusive Environment

• Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals may encounter added challenges in the healthcare setting. Both providers and patients may face discrimination based on their sexual orientation or gender identity, which may lead to avoidance or delay in seeking care. LGBTQ+ physicians often choose not to disclose their sexual orientation because of concerns about harassment, isolation, and depression. Orthopaedic surgery remains the least diverse medical specialty and there is inconsistent training about the needs and cultural issues that affect sexual and gender minority individuals. Furthermore, orthopaedic research specific to LGBTQ+ patients and physicians is exceedingly limited. By encouraging mentorship and improving awareness of the challenges that this community faces, the field of orthopaedic surgery can work to foster an open and inclusive environment that is conducive to the experience of all patients, trainees, and healthcare personnel.