LGBTQ+ health: Easing fears of seeking care

The LGBTQ+ community includes people of all races and ethnicities, religions, and social classes. People who identify as lesbian, gay, bisexual, transgender, asexual or gender-nonconforming may face specific health concerns. Many experience stigma around their identity and may fear discrimination when seeking healthcare.

Here are answers to six common health questions from members of the LGBTQ+ community:

1. I'm nervous to seek medical care out of fear of being judged and treated differently. How can I find a trustworthy and affirming healthcare team?

Trust is paramount to the patient-healthcare professional connection. At Mayo Clinic Health System, compassion and respect are core values practiced at every location. Discrimination of any type is not tolerated. All healthcare professionals are expected to be open and welcoming to create an inclusive environment where everyone receives the care and support they need.

Many healthcare professionals have dedicated services for the LGBTQ+ community. You can search for a healthcare professional who has identified LGBTQ+ health as a priority aspect of their care.

2. Where can I find support and resources?

First, being a member of the LGBTQ+ community is normal. Being gay, bisexual, pansexual or asexual is normal. Being transgender is normal. Being nonbinary, gender-nonconforming or gender-fluid is normal. Your identity is normal.

You can ask your healthcare team for resources in your local area. Pride Counseling Services is an available resource in Minnesota that provides counselors specifically for the LGBTQ+ community, along with other resources. Programs such as the Gay and Lesbian Alliance Against Defamation and The Trevor Project also provide resources.

3. I have a new partner. How can I be proactive regarding sexual health?

If desired, your local healthcare team can screen you and your partner for sexually transmitted infections. You can use barrier contraceptives, such as condoms or dental dams, to provide protection. Other birth control methods, such as pills, injections, patches, or arm implant or intrauterine devices, do not protect against sexually transmitted infections.

If you're interested, you also can talk with your healthcare team about a medication to prevent HIV transmission, more commonly known as pre-exposure prophylaxis or PrEP therapy.

4. I know the LGBTQ+ community has a higher likelihood of smoking and vaping, which is having adverse effects on our health. For those interested in quitting, what tools and resources are available to help?

The benefits of quitting smoking are endless. Quitting smoking decreases the risk of 12 types of cancer, heart disease and lung disease, according to the Centers for Disease Control and Prevention.

Here are some tricks to help quit smoking:

• Try to avoid your usual triggers.
  If these triggers are unavoidable, have a plan to focus your attention elsewhere. For example, if you tend to smoke during your break at work, plan on going for a walk or calling a friend during that time instead. You also can chew on items like sugarless gum or sugarless candy.
• Get moving.
  Physical activity can curb cravings.
• Try relaxation techniques.
  Try deep breathing or meditation to cope with stress instead of reaching for a cigarette.
• Find support.
  Support can be from family and friends, a local or web-based support group, or a telephone quit line. Call 1-800-QUIT-NOW for free counseling.

Nicotine patches, gum and lozenges have less nicotine than cigarettes. They help address the cravings while reducing the overall risk, and they are available for free through 802quits.org. If you need additional help, you also can talk to your healthcare team about prescriptions like Chantix or bupropion.

5. As I continue exploring and embracing who I am, this journey produces mixed emotions. Although I am excited and relieved, I sometimes feel depressed and anxious. What should I do?

Mental health is just as important as physical health. Diseases like anxiety and depression profoundly affect your well-being. Talk with your healthcare team if you are mentally struggling. There are several avenues of proven treatment options, including medications and counseling. You also could contact your health insurance provider to ask which counselors in your area are covered by your health plan. Many counselors do not require a referral from a healthcare professional to make an appointment. There may be a waitlist for an appointment with a counselor. Ask your healthcare team about temporary, short-term counseling options with immediate availability to provide support.

Contact a crisis center if you are contemplating suicide at any point. You can call or text 988 to talk with someone at the 988 Suicide and Crisis Lifeline. This service is available 24/7 for free. Alternatively, you can seek medical care in your local emergency department for emergencies.

6. What routine care is recommended for members of the LGBTQ+ community?

Talk to your healthcare team about how often you should have a physical. At this appointment, your primary care provider will perform a physical exam, discuss any concerns that you have, and review your medical and social history and medications.

There are many recommended health screenings at different times in your life. Adults should be screened for colon cancer, starting at age 45. A colonoscopy is the preferred test for this, but you also can consider a Cologuard stool test.

All vaccines are strongly recommended. You should be screened for diabetes, depression and high cholesterol. It also is recommended that everyone is screened at least once for hepatitis C and sexually transmitted infections, including HIV. A low-dose CT scan may be recommended for people 55 to 80 depending on their smoking history.

Some screening recommendations are based on the reproductive organs present at birth. Your healthcare team can explain these exams and ensure you are comfortable before proceeding.

Additional recommended screenings may include:

• Prostate-specific antigen (PSA) test
  This blood test is recommended for between ages 55 and 69 for cisgender men or people assigned male at birth with an average risk of prostate cancer. Those at higher risk may benefit from a PSA test earlier. The prostate typically is not removed as part of gender-affirming surgery, so it should be monitored over time.
• Abdominal ultrasound
  This one-time screening for an aortic aneurysm is recommended for cisgender and transgender men or people assigned male at birth ages 65 to 75 with a history of smoking.
• Mammogram
  A mammogram is recommended annually, beginning at age 40, for cisgender women of average risk for breast cancer. Screening mammograms also are recommended for women or people who have been taking gender-affirming hormones, such as estrogen, for more than five years. For transgender men or people who were assigned female at birth, a chest cancer screening may be recommended in the future. This recommendation is based on the length of time using testosterone therapy and if there has been a gender-affirming surgery. Discuss specific recommendations with your healthcare team.
• Pap smear
  This test screens for signs of HPV, a sexually transmitted infection, and cervical cancers. It's recommended for anyone with a cervix every three years from ages 21 to 29 and every five years from ages 30 to 65. A Pap smear is generally not recommended for transgender women unless they have had bottom surgery. If you have had this surgery, discuss screening recommendations with your healthcare team.
• Bone density
  This screening determines if you have osteoporosis or are at risk for osteoporosis. Bone density scans are recommended for cisgender women and all transgender people ages 65 and older.

Words matter. Your healthcare team should discuss your identified vocabulary to describe your anatomy so you're comfortable with your care. Let your team know if something is said that makes you feel uncomfortable.

Sara Robinson, M.D., is a Family Medicine physician in Mankato, Minnesota.