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Contributed by Erik Stanley Haugland, MD
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In recent years the healthcare industry has done an increasingly better job of creating strong, effective experiences for diverse population segments. However, many challenges still remain when it comes to providing primary care for individuals within the LGBTQ + population. LGBTQ + individuals often face a host of social and economic barriers that keep them from seeking primary care and obtaining important health screenings. These barriers can range from a lack of consistent insurance coverage, to higher rates of unemployment, to less cultural competence among providers, to outright bias and discrimination.
Concerning Statistics Regarding the Health of the LGBTQ + Population
Data compiled by the US Office of Disease Prevention and Health Promotion provides some startling facts concerning the health of LGBTQ + individuals such as: • The LGBTQ + population has the highest rate of tobacco use in the US. • Transgender individuals are much less likely to have health insurance. • Lesbians and bisexual females are more likely to be overweight or obese. These factors and a host of others contribute to poor health outcomes for many LGBTQ + individuals, including higher rates of heart disease, diabetes, STDs including HIV/AIDS and substance abuse. The current pandemic is also causing greater health issues for senior members of this population. Recent studies from the Human Rights Campaign Foundation
and Sage report that older LGBTQ + adults are particularly vulnerable to becoming seriously ill from COVID-19. To explain the reasons for this greater risk, experts have pointed to additional stressors for the LGBTQ + population that can lead to chronic conditions later in life, including a much higher rate of tobacco use, as noted earlier. In addition to experiencing more risk in terms of their physical health, the LGBTQ + population also faces a higher rate of mental health issues. Older LGBTQ + individuals are often isolated and more fearful of stigma, while LGBTQ + youths contemplate suicide at three times the rate of their peers, according to the CDC. This is particularly frightening given that suicide is often reported as the second or third leading cause of death among young people in the US. For transgender customers, health care can be even more complex. Most transgender individuals do not have one place for comprehensive health care. So, they are required to visit separate specialty gender clinics to ensure they get all the care they need. This can make receiving quality care more problematic given their unique health needs.
The Importance of Primary Care
The LGBTQ + community tends to avoid primary care, as they often feel stigmatized and don’t want to experience uncomfortable conversations. And yet as they face higher rates of tobacco use, high blood pressure, obesity and other chronic conditions, it is arguably even more important for LGBTQ + individuals to have access to a primary care provider for overall health assessments and to recommend routine screenings. In addition, those doctors need to understand the unique needs and additional guidelines for preventative health for the LGBTQ + population including: • Men who have sex with men (MSM) within this population have a risk of anal cancer that is 80 times that of their heterosexual peers. As a result, they may need to have routine anal pap smears every one to three years. • Transgender women may need more routine cancer screenings and could require both a prostate check and a mammogram on a regular basis. • Testosterone treatments may cause higher levels of cholesterol, hypertension and coronary artery disease, indicating a need for more routine screenings. • Estrogen treatments increase the risk of high cholesterol and cardiovascular
disease, so cardiovascular screenings are even more vital for transgender women. Primary care physicians are typically quite involved in screening mental as well as physical health for the LGBTQ + population. Understanding the unique life experiences of LGBTQ + individuals can be crucial to evaluating and treating potential and existing mental health problems. Of course, it’s important to note that hormones can also play a large role in how people are feeling, and primary care doctors need to acknowledge that as well. The National Alliance on Mental Illness (NAMI) reports that mental health conditions like post-traumatic stress disorder, anxiety and depression are almost three times as high for the LGBTQ + population. Stigma and discrimination play a large role in this statistic. Healthcare providers need to be not only aware of that fact, but also aggressively working to improve those numbers overall. To ensure the needs of this community are being met, it’s important to have more holistic primary care programs designed specifically for LGBTQ + individuals, from preventative care, to supportive programs that address chronic conditions. The transgender community, in particular, has complex needs that go far beyond hormone therapy programs. While gender care clinics as a specialty are still the norm within most healthcare networks, that model is considered outdated by many experts today.
North Memorial Health Answers the Need for Quality Health Care for the LGBTQ + Community
North Memorial Health is committed to creating an environment where the LGBTQ + community can receive care from care teams who are both culturally and medically competent. Many of our North Memorial Health providers and team members are LGBTQ + or straight allies, and experts in the different aspects of the physical, sexual and emotional health of the LGBTQ + population. In fact, North Memorial Health Clinics in Brooklyn Center and Maple Grove are two of the few places in the state of Minnesota where LGBTQ + patients, including transgender individuals, can obtain both primary and gender-related medical care, psychological support, and clinical pharmacy services all in one location. Because this type of holistic care doesn’t exist in greater Minnesota, many people come from cities as far away as International Falls and Moorhead to receive health care at these clinics. The clinic is also one of just a few in the state that can treat youth with puberty blockers, to avoid some of the defining sexual characteristics that may happen if those individuals go through puberty normally. Most young customers are seen by counselors as well as clinical pharmacists with specific skills in managing these types of programs, helping to avoid many of the emotional and physical problems experienced from too much of the “wrong” hormones. For adult transgender customers, initial visits are with the primary care physician, who identifies a care plan and refers the customer to a counselor with a specific background and training in working with transgender individuals. Clinical pharmacists can then help set the stage for potential hormone therapy, follow up on existing prescriptions and troubleshoot medication problems. All customers within the clinic have access to a full team of providers, clinical pharmacists, counselors and care coordinators focused on specific issues like diabetes. Holistic care like the kind provided at North Memorial Health Clinic is crucial to reducing many of the healthcare problems the LGBTQ + population faces today. Although the situation is getting better, it’s not improving as quickly as it could. Many healthcare providers are still untrained when it comes to LGBTQ + care and too many doctors and team members aren’t interacting with LGBTQ + individuals correctly. The right standard of care is vital, from writing notes consistent with the patient’s expressed gender, to prescribing the correct routine screenings, to using the right pronouns. Long-term health management for the LGBTQ + community is a problem that is often overlooked within our healthcare system today. It’s important that LGBTQ + individuals have a place to go where they can feel comfortable showing up as their true authentic selves, and where providers and team members are aware of, and sensitive to, their specific emotional and physical healthcare needs. That’s why at North Memorial Health Clinic we’re dedicated to improving care for LGBTQ + individuals across the Minnesota healthcare system. Our Brooklyn Center and Maple Grove Clinic teams regularly visit other groups of providers to provide information on becoming culturally competent in terms of providing health care to LGBTQ + individuals, and to educate doctors and team members on the latest guidelines for preventative health care for the LGBTQ + population. North Memorial Health Clinic–Brooklyn Center is also a training site for medical students and residents to gain more exposure, and hopefully a deeper understanding, of the unique aspects of LGBTQ + health care. Everyone experiences better health outcomes when they see a provider on a regular basis, and it’s important to have a primary care provider who can prescribe the correct routine screenings and who is educated on specialty care needs. Continuing to see the same doctor year over year means that the conversation can be carried on, not repeated with every new visit. That’s especially important for the LGBTQ + community who are often met with enormous challenges when it comes to staying healthy, both physically and emotionally.
Erik Stanley Haugland, MD is a family and transgender medicine provider at North Memorial Health Clinic–Brooklyn Park focusing on geriatric customers, customers with sexual health concerns, and lesbian, gay, bisexual, transgender and queer (LGBTQ + ) customers. He consistently works to support LGBTQ + health by partnering with clinical pharmacists to complete hormone management for transgender customers and follows World Professional Association of Transgender Health (WPATH) standards of care.
