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, queer or gender-nonconforming, may face specific health concerns. Many experience stigma around their identity and may fear discrimination when seeking health care.

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 provider?

Trust is paramount to the patient-health care 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 health care professionals are expected to be open and welcoming.

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

2. If I may identify as LGBTQ+, where can I find support and resources?

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

You can ask your health care team for resources in your local area. Pride counseling also is an available resource that provides counselors specifically for the LGBTQ+ community.

More resources also are available through programs such as the Gay and Lesbian Alliance Against Defamation or The Trevor Project.

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

If desired, your local health care 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. Birth control methods, such as pills, injections or patches, or implant or intrauterine devices, do not protect against sexually transmitted infections.

If you're interested, you also can talk with your health care 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 negative effects on our health. For those of us 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 quitting smoking:

• Try to avoid your usual triggers.
  If these triggers are unavoidable, have a plan in place to focus your attention elsewhere. For example, if you tend to smoke during your break at work, plan on going for a walk or call 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, compared to the cigarettes. They help address the cravings while reducing the overall risk, and they are available for free through 802quits.org. If additional help is needed, you also can talk to your health care team about prescriptions to help, like varenicline, which is also called Chantix.

5. As I continue to explore and embrace who I am, this journey is producing mixed emotions. Although I am sometimes 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 health care 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.

In case anyone needs to hear this, 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. Finally, you can seek medical care in your local emergency department.

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

People should see their health care team for an annual 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. Everyone should be screened for colon cancer, starting at age 45. A colonoscopy is the preferred test for this.

All vaccines, including the COVID-19 vaccine, are strongly recommended. You also should be screened for diabetes, depression and high cholesterol. It is also recommended that everyone is screened at least once for hepatitis C and sexually transmitted infections, including HIV. A low-dose CT scan is recommended for people 55 to 80 who smoked for a long time or are smokers.

Additional recommended screenings include:

• Prostate-specific antigen (PSA) test
  This blood test is recommended for cisgendered men or people assigned male at birth with an average risk of prostate cancer between ages 55 to 69. Those at higher risk may benefit from a PSA test earlier. The prostate is not typically removed as part of gender reassignment surgery, so it should be monitored over time.
• Abdominal ultrasound
  This one-time screening for aortic aneurysm is recommended for cisgendered men or people assigned male at birth who are smokers or previously smoked and are ages 65 to 75.
• Mammogram
  A mammogram is recommended annually, beginning at age 40, for cisgendered women of average risk for breast cancer. For women, nonbinary people, and other people who are not cisgender male but were assigned male at birth, screening mammograms are recommended if you have been taking gender-affirming hormones such as estrogen for more than five years. For men, nonbinary people, and other people who are not cisgender women but were assigned female at birth, a chest cancer screening through a mammogram is recommended annually, beginning at age 40.
• Pap smear
  This test screens for signs of HPV, a sexually transmitted infection, and cervical cancers. It is 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 bottom surgery has occurred. If so, talk to your health care team about screening recommendations.
• Bone density
  This screening determines if you have osteoporosis or are at risk for osteoporosis. Bone density scans are recommended for cisgendered women ages 65 and older.

Words matter. Your health care team should discuss the vocabulary used to describe your anatomy so you are comfortable with your care. Let your team know if there is something said that makes you feel uncomfortable.

Sara Robinson, M.D., is a resident in the Mayo Clinic Family Medicine Residency Program in Mankato, Minnesota.