Social acceptance of lesbian, gay, bisexual, transgender and intersex (LGBTI) people has improved in the last decade. Public spaces and sports facilities are increasingly adjusted or redesigned to increase LGBTI inclusivity. But despite progress, many LGBTI persons are still denied equal treatment. Being unable or afraid to be your true self causes psychological distress and physical stress, and this of course has its consequences. In addition, LGBTI people also have specific sexual health needs and concerns. In this blog, you can read more about the health needs of LGBTI people.
International Day Against Homophobia
17 May is the International Day against Homophobia, Transphobia and Biphobia (IDAHOT). This day is aimed at raising awareness for problems of people with a different sexual orientation and gender identity. These problems include mental health issues such as stress or depression. This, in turn, can lead to physical health issues.
Psychological distress among LGBTI people
Even though lesbian, gay, bisexual and transgender acceptance has grown in the Western world, many LGBTI individuals experience mental health problems. Attempted suicide rates among lesbian, gay and bisexual youth are three to five times higher than among heterosexual youth. Psychological distress is even higher among transgender youth: transgender teens are five to ten times more likely to have suicidal thoughts than their heterosexual peers. Being ‘different’ can have a huge impact on mental health.
Self-acceptance: accepting who you are
Every child wants to belong and be ‘normal’. In a world where heterosexuality is the norm, it can be quite scary to discover that you are different. Different in the sense that you are attracted to the same sex or both sexes, or that your body doesn’t match how you feel on the inside. This can cause a great deal of stress.
As a teen, accepting yourself for who you are can be quite difficult. Especially when you find out that you have a different sexual orientation or gender identity. For LGBTI teenagers, this can make this stage of life particularly difficult. Many of them feel the need to hide their sexual orientation or gender identity and conform to heterosexual norms in order to ‘fit in’. This often leads to a negative self-image, which in turn can lead to stress and anxiety.
Coming out: fear of rejection
Knowing you are lesbian, gay or bisexual and keeping it to yourself is one thing. Telling your family and coming out is another. Our society seems to be very accepting to different sexual orientations and gender identities. Same-sex marriage is legal and celebrations that stand for LGBTI equality, such as the Gay Pride parades, are held annually. In many respects we have come a long way compared to, say, 30 years ago.
At the same time, however, research shows that homophobia is still prevalent among certain segments of society, such as religious groups, people with lower education and ethnic minorities. Many heterosexuals are also uncomfortable with public displays of same-sex affection. Gay couples are still being beat up for holding hands. And many transgenders don’t feel safe on our streets.
The fear of discrimination, rejection and exclusion among the LGBTI community is real and justified. Especially where it concerns personal relationships. What if your parents are disappointed or upset? Will your friends turn their backs on you? How will your classmates or colleagues take it? For many LGBTI individuals, coming out can feel like the most stressful thing that they have ever had to do.
Stress due to bullying
Calling someone ‘gay’ or ‘fag’ is still a common insult to throw around. Children instinctively sense when other children are ‘different’. This can make LGBTI children easy targets for bullies. Sadly, bullying does not end with childhood. Subtle forms of workplace bullying (e.g. withholding information, persistent criticism, being ignored by colleagues) are more common than you may think. Therefore, it is not surprising that LGBTI people are more likely to struggle with burn-out and depression than their heterosexual peers.
Effects of stress on physical health of LGBTI people
Mental distress triggered by homophobia in society often leads to an unhealthy lifestyle. Alcohol and drug abuse, smoking and/or weight issues are more prevalent among LGBTI people than in the general population. This increases the risk of health issues: being overweight or obese is linked to higher rates of conditions such as diabetes, heart and vascular disease, and certain types of cancer. Smoking and alcohol abuse further increase these risks.
Sexual health issues among LGBTI people
Research has shown that sexual problems are also very common among LGBTI people. Specific sexual issues include:
Lesbian, gay and bisexual men and women tend to have more sexual partners over their lifetime than heterosexual people. Because practising safe sex is not always a priority, they are more susceptible to sexually transmitted diseases (STDs), such as HIV. Although with the right treatment, HIV does not necessarily have to develop into AIDS, it is still a serious disease that requires lifelong treatment. Some STDs, such as hepatitis B and HPV, can cause serious health problems.
Using a condom correctly every time you have sex can help you avoid STDs. Vaccines are available to prevent HBV and HPV infections. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are methods for preventing HIV. These medicines should only be used if you are at high risk of being exposed to the virus or have HIV.
Fortunately, Most STDs can be treated with medicine and cured. Chlamydia, syphilis and gonorrhoea can be treated with antibiotics. Genital warts can be treated with topical creams. HIV is treated with antiretroviral drugs that have to be taken for life. This is important because these medicines prevent HIV from developing into the deadly disease AIDS.
Testing for STDs
A doctor can check you for STDs with a simple blood test or urine test. If you think you may have an STD but are afraid to see a doctor, there are tests available that you can perform anonymously in the comfort of your own home. In this case, you take body material yourself, such as urine or a swab, and send it to a lab. The test result is available online within several days.
If you test positive, it is important that you see a doctor as soon as possible. If you cannot see your own doctor (because you have none or feel uncomfortable talking to your doctor), you can book an online consultation.
STDs are contagious, so you should also inform any partners you have had sexual contact with so that they can have themselves tested and treated as well.
Besides the problem of STDs, there are also other specific health concerns that are of greater relevance to LGBTI individuals. For example, facial hair is a problem for most transgender women. In many cases, hormone therapy for male-to-female transgender patients does not sufficiently reduce male-pattern hair distribution. Shaving and depilation only provide temporary results, and waxing is not a suitable hair removal method for delicate facial skin. Laser therapy and electrolysis are the best methods right now for permanently getting rid of unwanted hair.
Furthermore, there are also health risks for transgender men and women on hormone therapy. Transgender women on oestrogen hormone therapy are more likely to suffer from blood clots (thrombosis), especially if they smoke. Testosterone treatment for transgender men is also not without side effects. The most common side effects include:
A doctor will be able to determine the dose that is right for you and may prescribe a different medicine if the side effects are too troublesome.
Seek help for mental health issues
Do you identify as LGBTI and are you struggling with stress, anxiety, depression or other mental health issues? Then talk to a doctor! There are also online support groups and local support groups you can go to for help. If you find yourself thinking about suicide and wanting to act on the thoughts, call a suicide prevention helpline immediately. You can find various helplines and telephone numbers on the NHS website.
For more information on the International Day against Homophobia, Transphobia and Biphobia, visit website May17.org.
Dokteronline.com is a platform for connecting patients with doctors and pharmacies, enabling targeted treatment and care. Dokteronline.com believes in responsible self-management of treatable health conditions.
AD.nl. (2018, 21 November). Leefsituatie LHBT’er slechter dan van hetero (Living conditions of LGBT people worse than heterosexual people). Consulted on 20 April 2020 on https://www.ad.nl/binnenland/leefsituatie-lhbt-er-slechter-dan-van-hetero~a6172db8/
NOS. (2019, 3 August). Waarom lhbti’ers kampen met discriminatie en geweld, en wie ze lastigvalt (Why LGBTI people struggle with discrimination and violence, and who discriminate and are violent towards them). Consulted on 20 April 2020 on https://nos.nl/artikel/2296153-waarom-lhbti-ers-kampen-met-discriminatie-en-geweld-en-wie-ze-lastigvalt.html
Soa Aids Nederland. (n.d.). Alle soa’s (All STDs). Consulted on 20 April 2020 on https://www.soaaids.nl/nl/alle-soas
Soa Aids Nederland. (2015, 3 April). De seksuele gezondheid van LHBT’s in Nederland (Sexual health of LGBT people in the Netherlands). Consulted on 20 April 2020 on https://www.soaaids.nl/nl/professionals/themas/seksoa-magazine/seksuele-gezondheid-van-lhbts-in-nederland
Transgender Infopunt. (n.d.). Ontharing (Hair removal). Consulted on 20 April 2020 on https://transgenderinfo.be/m/zorg/vervrouwelijking/epilatie/
Transvisie. (n.d.). Informatie over hormonen voor transgender mannen vrouwen (Information about hormones for transgender men and women). Consulted on 20 April 2020 on https://www.transvisie.nl/transitie/volwassenen/hormonen/
van der Sanden, G., & Duits, L. (2018, 28 July). Coming-out duurt het hele leven (Coming out lasts a lifetime). Consulted on 20 April 2020 on https://www.parool.nl/columns-opinie/coming-out-duurt-het-hele-leven~ba08aa4c/