Sexual orientation, gender identity, and LGBT health care

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LGBT practice management includes routine cancer screening in accordance with current guidelines.
LGBT practice management includes routine cancer screening in accordance with current guidelines.

I am happy to see this important topic covered [“Healthcare issues in the LGBT community”], but concerned that the authors are perpetuating misinformation that will actually do more harm than the good that I'm sure they intended. Transgender is not a sexuality. Sexual orientation includes labels such as lesbian and gay, which describe sexual attraction. This is not directly related to gender identity and may not reflect a person's sexual behavior. Heterosexual-identified persons may engage in sexual activity with members of the same sex. Therefore, sexual orientation should be defined by the individual, and the healthcare provider should inquire about sexual behaviors. For transgender folks, sexual orientation is described based on the lived gender; a transgender woman attracted to other women would be a lesbian, and a transgender man attracted to other men would be a gay man.Also inaccurate are the cancer risks attributed to cross-sex hormone therapy. 

Long-term, follow-up, case control studies have not identified differences in cancer rates in transgender patients undergoing hormone therapy compared with birth-sex controls. Current recommendations are to conduct routine cancer screening for all transgender patients in accordance with current guidelines.You can find accurate, evidence-based information on primary and gender-affirming care of transgender people at: http://transhealth.ucsf.edu/tr—Angie Magaña, NP, Los Angeles  (216-1)

Labels such as MSM and WSW are behavioral labels only and do not describe underlying romantic or physical attraction. A 2006 study by Pathela et al in the Annals of Internal Medicine found that nearly three-fourths of MSM identified as heterosexual. Transgender is a large umbrella term that includes other terms such as transsexual, cross-dresser, performer, gender non-conforming/expansive/fluid, and intersex identities. Transsexual individuals, otherwise those diagnosed with gender dysphoria, may or may not elect to have any surgical treatment as part of their care. These are important details and nuances in care that can otherwise exclude those with non-binary identities.For those interested in learning more about LGBT health, I recommend the website for GLMA (www.glma.org).—HENRY NG, MD, MPH, FAAP FACP, Cleveland (216-2)


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.

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