The LGBT (lesbian gay bisexual transgender) community is diverse and includes people from all types of communities, religions, races, socioeconomic statuses, ages, and other identifying factors. Because it is such a diverse group of American people, many of the health concerns for LGBT people are the same concerns as for men and women in general.
In addition to these general health issues, there are also some specific conditions, risks, and health care needs for the LGBT community. Some of these may be specific to gay men to transgender individuals or to gay women. Examples include sexually transmitted diseases, bullying and violence, suicide, and substance abuse. Greater awareness of the risks is needed to help individuals make better health decisions.
Common Health Issues
Men and women who identify as LGBT have any number of health concerns depending on each individual. Like the general population, there are some common threads. Heart disease and cancer are leading causes of death in the U.S. and the LGBT population is no exception. Heart disease includes a number of illnesses, many of which are fatal without treatment or prevention: heart attack, congestive heart failure, coronary artery disease, arrhythmias, and others. Risk factors for heart disease include smoking, obesity, and inactivity. Making healthy lifestyle choices, like eating a healthy diet, maintaining a healthy weight, and getting regular exercise can eliminate much of the risk.
Cancer is another big health risk for Americans in general, but there are some specific risks for LGBT people. For example, lesbians are at a greater risk of developing breast cancer than heterosexual women. This may be explained by the fact that lesbians are less likely to have full-term pregnancies, are more likely to be overweight, and are less likely to get mammograms and other cancer screenings.
Gay men are at a greater risk than their heterosexual counterparts for developing testicular, colon, and prostate cancers. Gay men and bisexual men who have sex with men are also at a greater risk for developing anal cancer because they are at a greater risk for being exposed to HPV, the human papilloma virus, which can cause cancer.
Violence and resulting physical injuries, trauma, and even deaths is a health concern for all people, but members of the LGBT community are at an increased risk for being victims of violence. Both lesbian women and gay men report more harassment and physical abuse from family members. Lesbians, gay men, and bisexual men and women are all more often victims of domestic partner violence than heterosexual men or women. Gay men are both more likely to be victims of domestic abuse and criminal physical violence based on sexual orientation.
People who identify as transgender may be at the biggest risk of all for experiencing violence. Several studies have come up with different results, but some show that as much as 60 percent of this population may experience violence. Transgender women of color are at the biggest risk of being victimized. Experts believe that the numbers may be even higher because of underreporting of incidents due to stigmatization. Physical violence is a major health issue because it causes physical injuries, some lasting or causing other complications, fatalities, and may trigger mental health conditions.
Lesbian women have some unique health needs in addition to those that face all women and other members of the LGBT community. Gay women are more likely to be overweight or obese than heterosexual women and are less physically active. Both of these factors contribute to an increased risk for heart disease, stroke, diabetes, certain types of cancer, and other serious health conditions. One study found that there were several barriers to getting adequate exercise: being unable to find a lesbian fitness partner or a lesbian-focused fitness group or gym. Not feeling welcomed at a gym or exercise class may be an important barrier to physical fitness.
Mental health is also a major concern for lesbians, including substance abuse disorders and suicide. Women with same-sex partners have been found in studies to experience more psychiatric disorders, including depression, post-traumatic stress disorder, and phobias. Studies also show that lesbians who are not “out” are more likely to attempt suicide than heterosexual women. Lesbians are also more likely to smoke and to drink heavily. Untreated mental health conditions impact quality of life and may lead to suicide attempts. Smoking and drinking contribute to a number of health problems from lung cancer to liver disease and accidents.
Men who have sex with other men, whether they are gay or bisexual, are at a greater risk of contracting sexually transmitted diseases. Nearly half of all new cases of HIV, for instance, are in gay and bisexual men. African American men carry the greatest burden. HIV is not the only risk and these men are also at risk for HPV, the human papilloma virus, which can cause cancer, and hepatitis. Syphilis, another sexually transmitted infection has also been on the rise in recent years, especially in large cities. Safe sex practices and precautions are crucial for any man who has sex with other men to help prevent the spread of these diseases.
Gay men are no more likely than heterosexual men to be overweight. In fact, they are more likely to be interested in fitness and being thin. They are at a greater risk of developing eating disorders, including anorexia and bulimia, than heterosexual men. A greater focus on body image and a pressure to be thin are likely to contribute to this increase in risk, as it does for young, heterosexual women.
As with gay women, mental health is a serious concern for gay men. They are more likely than heterosexual men to suffer from depression or anxiety. The disparity is greater for gay men who are not out. Suicide is also an important issue, and suicide attempts are much more numerous among gay men and youths than in heterosexual mean and adolescents. Gay men are also more likely to abuse alcohol and illegal drugs. They smoke cigarettes at much higher rates too. All kinds of substance abuse contribute to health problems, including physical health, but also addiction and mental illnesses.
Bisexual Men and Women
Bisexual men and women face many of the same health concerns that gay men and lesbians do. Bisexual women, for instance, are more likely than heterosexual women to be overweight or obese and to have resulting health complications. Both bisexual men and women are less likely than their heterosexual counterparts to get adequate amounts of exercise.
Sexual health issues are similar too, but there are some differences. For instance, bisexual women are more likely to engage in risky sexual behaviors, such as having unprotected sex with a man, than heterosexual women. This puts them at a greater risk for contracting sexually transmitted diseases. Bisexual men, like gay men, are generally at a greater risk for sexually transmitted infections than heterosexual men.
Mental health may be even more of a concern for bisexual men and women than for gay men and lesbians. Research has found that bisexual men and women have lower emotional well-being, quality of life, and support. These factors are likely to explain why this population experiences more mental health issue, including depression and anxiety than their homosexual or heterosexual counterparts. As with gay men and lesbians, suicide is a serious and life-threatening issue for this population.
Substance abuse is a serious problem in the bisexual population as well. This group has some of the highest rates of smoking of any demographic group. As much as 40 percent of people who identify as bisexual are smokers. Bisexual men and women are also more likely than other groups to binge drink. These can lead to serious health problems, like cancer or chronic respiratory problems from smoking, and addiction, violence, accidents, and liver disease from binge drinking.
Transgender Health Issues
Studies of the physical health of transgender men and women are limited. Some research may suggest that hormone therapy that some transgender people undergo to transition may cause health problems, but more studies need to be done to confirm the risks. A well-known health risk for anyone identifying as transgender is violence. This is one of the most victimized of any demographic group. Sexually transmitted diseases are probably also a serious risk for transgender men and women, but the data are limited.
Mental health is a huge issue for people identifying as transgender. Suicidal thoughts are high in this population and attempts at suicide may be as high as 32 percent according to some studies. Unfortunately, research into the incidence of specific mental illnesses in the transgender population is also limited, but from the data regarding suicide and violence, it is clear that mental health is a big concern.
Substance abuse is also an issue, and this contributes to both physical and mental health problems. Transgender men and women have higher than average rates of using illegal drugs and of smoking. There are especially high rates of the use of methamphetamine and injectable drugs. Smoking may be particularly risky for transgender women taking hormones. Estrogen combined with smoking increases the risk of developing dangerous blood clots.
Young people identifying as LGBT face all the same health risks as their adult counterparts, but they may also be at a greater risk for bullying and the resulting mental health issues. When young people who may identify with this community or who are questioning their sexuality or gender identity have a supportive environment at home and around peers, they have every opportunity to thrive and be well, but this is not always the case.
There are still many negative attitudes toward and stigma surrounding young people who are gay, bisexual or transgender, and as a result they are at a greater risk than their heterosexual and cisgender peers of being victims of bullying, harassment, and violence. One study found that more than one-quarter of LGBT students reported having been injured or threatened with a weapon at school, for example.
Living with the threat of bullying and violence takes a toll on mental health. LGBT young are more likely to have suicidal thoughts and to attempt suicide than their peers. According to some studies, they are as much as two times as likely to attempt suicide. While data for transgender students is limited still, studies show that lesbian, gay, and bisexual youth are more likely to abuse substances, experience depression, and be absent from school.
Members of the LGBT community have some unique health risks and some that are the same for the population as a whole. With mental health risks generally higher, this community may be more likely to use antidepressants. Drugs like Paxil, Prozac, Cymbalta, and many more help treat depression by stabilizing mood, but they also come with risks. They can cause serious and dangerous withdrawal, for instance, if cessation is not done with a doctor’s guidance.
For young people using these antidepressants, the risks are even greater. All of the drugs in this class carry a black box warning that states they may cause or increase suicidal thoughts and actions in people under the age of 24. For LGBT youth, suicide is also a major concern, so using antidepressants can be very risky. Anti-anxiety drugs like Valium or Xanax may also be used to treat anxiety and depression, but are susceptible to abuse and eventual addiction.
Because lesbians and bisexual women are more often overweight or obese than heterosexual women, they may also be at an increased risk for developing type 2 diabetes. Treating this chronic condition may mean taking drugs like Jardiance, Invokana, Onglyza, and others that aim to lower blood sugar levels. These drugs can help, but they also pose risks: pancreatitis, pancreatic cancer, bladder cancer.
Health concerns in the LGBT community coincide with many of those that affect the American population in general. This is a diverse group of people coming from all walks of life and representing all kinds of American demographic groups. However, they also have unique characteristics that come with special health concerns. LGBT people are at a greater risk for violence, for suicide, for bullying, and specific groups within the community are more likely to take health risks like unsafe sexual activity, smoking, binge drinking, and being inactive. With greater awareness, both individuals and the health care community can take steps to improve the mental and physical health of LGBT Americans.