Introduction to caring for the LGBTQIA+ population

LGBTQIA+ is an umbrella term that includes people with diverse sexual orientations, gender identities, gender expressions, and sex-related traits.

It stands for lesbian, gay, bisexual, transgender, queer, intersex, asexual or aromantic, and the plus sign recognizes that the list is not exhaustive.

LGBTQIA+ individuals often experience discrimination and barriers to healthcare that contribute to health disparities.

For clinicians, using respectful, accurate terminology is a clinical skill,

which for patients,

helps build trust, improves their experience, and supports better health outcomes.

Let’s first talk about affirming care. To affirm means recognizing, respecting, and supporting

a person's stated identity.

In practice, affirming care creates a clinical environment where patients feel respected, heard, and safe.

Affirming care doesn’t require expertise in hormone prescription or specialized surgery. It starts with respectful communication. One simple way to provide affirming care is to ask patients what name and pronouns they use rather than making assumptions.

Let’s see this in practice.

Brian is a 28-year-old individual assigned female at birth who identifies as a transgender man. He recently informed his doctor's office that he was living in accordance with his gender identity. Brian needed to make an appointment to discuss unexpected vaginal bleeding.

When Brian arrived for an appointment, a staff member called him by his birth name, Brianna. Brian wanted to correct them but felt embarrassed and concerned about drawing further attention to himself.

Uncomfortable with the interaction, he declined an examination and did not return for recommended cervical cancer screening.

Eighteen months later, the bleeding worsened, and Brian sought care at a different clinic.

Where staff asked for and respected his name, pronouns, and gender identity.

He felt comfortable being examined,

but he was ultimately diagnosed with stage IIA cervical cancer,

and required radical hysterectomy and radiation therapy.

Brian's experience shows how seemingly small interactions such as using the wrong name, pronouns, or making assumptions can create barriers to care.

Causing patients to delay or avoid care, miss recommended screenings, and present later with more advanced disease.

Brian's second clinic visit illustrates how using a patient's affirmed name and pronouns can help build trust. By providing affirming care clinicians can create a safe and welcoming environment for LGBTQIA+ patients.

Another important concept is coming out, which is the process of disclosing one’s sexual orientation or gender identity.

Coming out occurs in many settings, including healthcare.

Because coming out can be an ongoing process rather than a single event,

negative experiences may discourage people from seeking future support and care.

A clinician can also be an ally by actively supporting LGBTQIA+ people through respectful communication, advocacy, and inclusive behaviors.

Now, providing affirming care also requires understanding the terminology patients may use to describe themselves and their experiences.

The shorter acronym LGBTQ+ is commonly used, and conventions vary across regions and organizations.

The term queer has been reclaimed by many people within the LGBTQIA+ community as an umbrella term for diverse sexual orientations and gender identities. However, because it was historically used as a slur, some people may not identify with or welcome the term.

As with any identity label, follow the patient's lead. Because language and terminology continue to evolve, ask patients how they describe themselves and use the language they prefer.

Okay, let’s look at three concepts that are often confused but describe different aspects of a person's identity: sex-related traits, gender identity, and sexual orientation.

Sex-related traits are biological characteristics, including anatomy, chromosomes, hormones, and reproductive organs. Sex development refers to the biological processes that produce these characteristics.

Most people are assigned a sex at birth, typically male or female, and rarely intersex, based primarily on external genitalia. Intersex describes people born with variations in external genitalia, gonads, chromosomes, & hormones that do not fit typical binary definitions of male or female bodies.

Because sex assigned at birth is almost always based on visible anatomy alone, it may not reflect all of a person’s sex-related traits.