A landmark NHS report has laid bare the concerning health inequalitiesfaced by lesbian, gay and bisexual adults in the UK.
The first-of-its-kind report, published today (6 July) by NHS Digital, is based on data from 1,132 LGB adults who participated in the Health Survey for England between 2011–2018.
The research found that LGB adults are more likely to drink more, smoke more and have worse mental health than the straight population, with worse health outcomes as a result.
Despite LGB adults being 12 per cent less likely to be overweight or obese than straight people, a higher proportion of LGB people (7 per cent) reported “bad” or “very bad” health, compared with heterosexual adults (6 per cent).
The prevalence of limiting longstanding illness was also higher at 26 per cent compared to 22 per cent.
When asked about alcohol consumption, 32 per cent of LGB adults reported drinking levels which put them at increased or higher risk of alcohol-related harm (more than 14 units per week) compared to 24 per cent of heterosexual adults.
A similar trend was found with smoking, with more LGB adults (27 per cent) than heterosexual adults (18 per cent) saying they are current smokers. The proportion of adults who currently smoked cigarettes was highest among LGB women at 31 per cent, and lowest among heterosexual women at 16 per cent.
LGB adults also had lower average mental wellbeing scores on the Warwick-Edinburgh Mental Wellbeing Scale (48.9) compared with heterosexual adults (51.4), with LGB women reporting the lowest wellbeing scores (47.3).
Sixteen per cent of LGB adults said they had a mental, behavioural or neurodevelopmental disorder as a longstanding condition; the proportion of heterosexual adults reporting the same was significantly lower at 6 per cent.
LGBT+ people continue to face barriers to healthcare in NHS
The NHS Digital’s Chief Statistician Chris Roebuck said: “One of the biggest benefits to collecting and publishing health data is the ability to highlight health inequalities.
“We’re pleased to be able to publish these LGB statistics for the first time, which show important differences in health status and behaviours.”
Campaigners have long highlighted the prevailing gap in healthcare provision for the LGBT+ community, who commonly face barriers not experienced by the straight population.
Back in 2019 a leading advisor on UK public health committee warned a parliamentary committee that the NHS is “absolutely” prejudiced against LGBT+ people, saying that problems largely stem from lack of funding and reporting, improper training and ingrained prejudice.
Queer women in particular often struggle to be heard in healthcare settings, with lesbian and bisexual women’s health said to be “invisible” in the UK discourse.
Last year the LBT Women’s Health Week reported that lesbian, bi and trans women are more likely to experience inappropriate questions or curiosityfrom healthcare professionals, with 8.1 per cent of lesbians, 5.9 per cent of bisexuals, 12.1 per cent of queer cis women and 15.4 per cent of trans women reporting this happening to them in the past year.
LBT+ women are also more likely to experience difficulties accessing mental-health services, with more than half of lesbian, bisexual, queer and trans women saying they found it “not easy” or “not easy at all” to access mental healthcare in the past year.
The same year, a major NHS England report disturbingly appeared to characterise being LGBT+ as a disability, highlighting the continuing ignorance and insensitivity LGBT+ people often endure from health professionals – which in turn leads to fewer doctors’ visits and poorer health outcomes.
With one in ten young LGBT+ people now identifying on the asexual spectrum, many are questioning what asexuality is and how they can be an ally to asexual people.
Put simply, asexuals experience a lack of sexual attraction towards others, but there are many forms of asexuality and it can mean different things to different people.
Sadly asexuals are often overlooked both in and outside the LGBT+ community, and according to a 2019 survey, most British adults can’t even define the term.
But the first thing you need to know is that asexuals are valid – and they’re far more common than you might expect.
What does asexual mean?
Asexuals or “ace” people experience little or no sexual attraction to others and often don’t want any sexual contact at all. It’s not the same as celibacy or abstinence and it’s not a dysfunction either: it’s simply a natural human variation.
Sexual attraction is not necessary for a person to be healthy, and just because asexuals don’t experience sexual desire doesn’t mean they can’t be in relationships or non-sexual partnerships.
The term “asexual” covers a range of subcategories to describe varying levels of sexual and romantic attraction, and many asexuals will have more than one label to describe themselves.
What does the asexual spectrum look like?
Asexuality is a broad spectrum on which many other identities fall. For example, demisexuals only feel physically attracted to someone if they have an emotional bond, while greysexuals are people who do feel sexual attraction but only very rarely, or with very low intensity.
Some asexuals do masturbate and have sex. Their level of attraction can range from sex-averse, meaning they find the thought of sex unappealing, to sex-indifferent, meaning they don’t feel strongly either way, or sex-favourable, meaning they enjoy some aspects of sex even if they don’t experience that sort of attraction.
Many asexuals feel romantic attraction, which is the desire for a romantic relationship with someone, or aesthetic attraction, which is the feeling of being attracted to someone based on how they look.
Some asexuals simply want to touch, hold or cuddle a partner, otherwise known as sensual or physical attraction, while others feel platonic or emotional attraction, which is the desire for an emotional connection or friendship.
What does aromantic mean?
Aromantic people don’t experience romantic attraction toward individuals of any gender and have little or no desire for romantic relationships with others.
Being aromantic is different from being asexual but the two terms can and often do overlap, with many asexuals describing themselves as aromantic as well.
But don’t make the mistake of assuming that aromantic people are unfeeling or uncaring, or that they can’t have relationships. Lots of aromantic people have thriving social lives, and some form special “queerplatonic relationships” for emotional support.
A queerplatonic relationship could involve living together, co-parenting, and sharing finances and responsibilities.
Myths and misconceptions about asexuality
No, they’re not missing out, they’re not broken, and they’re not “waiting for the one”.
In a world dominated by narratives of sex and romance, being asexual can be isolating – especially when you constantly find yourself having to educate others on your sexuality.
“When you’re asexual, people immediately think that you don’t love anyone because what’s the point in a relationship unless you have sex with another person?” asexual Eleanor Wilkinson told PinkNews.
“That really gets me because there are lots of different attractions: sensual attractions, aesthetic attraction, romantic attraction. They all play a part when it comes to your relationships.
“A lot of people would say: ‘Oh everyone feels like that before they’ve had sex,’ almost comparing it to being a virgin or celibacy,” she continued. “People think along those lines. Those are choices but it’s a misconception to think asexuality must be a choice.”
The best way to be an ace ally is to simply believe and accept asexuals when they tell you they’re asexual. Don’t ask intrusive questions about their sex life, and don’t forget to call out ace-erasure and acephobia where you see it.
Over 180 LGBTQI and allied community organizations have signed on to an open letter to health leaders calling for an end to the invisibility of LGBTQI people in health data. Community leaders ask for data collection in health records, research, surveillance, clinical trials and more. They provide sample measures and urge health leaders not to wait further before making LGBTQI health data collection routine.
The letter particularly calls out the lack of data related to COVID-19 impacts but notes how that builds on a foundation of major data gaps for most disease areas. The signers note the decades-long history of advocacy about ending invisibility for the LGBTQI communities, including how for years ACT-UP rallied around the slogan “Silence = Death”. “At the same time that we’re tripping over corporate pride merchandise in stores, it’s aggravating to know the health world is forcing us to stay in the closet,” says Dr. Scout, the Executive Director of the National LGBT Cancer Network. “Until we’re allowed to come out on health forms, key information like how many of us get COVID-19 or cancer every year will never be known.”
“Reliable, nationwide data on sexual orientation, gender identity and intersex status is critical to identify the health, economic status and well-being of communities that are still misunderstood, marginalized, and subjected to discrimination,” says Daniel Bruner, Whitman-Walker’s Senior Director of Policy. “And acknowledging sexual and gender diversity in surveys and questionnaires assures us that we are seen, and respected as full members of the community.”
The letter was initiated by a group of organizations convening as the National LGBTQI Health Roundtable, including Whitman Walker Institute, The National LGBT Cancer Network, Fenway Health, Howard Brown Health, Callen-Lorde Community Health Center, Center for American Progress, and more. The full text is included below and can be found online at this link: https://cancer-network.org/ending-the-invisibility-organizations-call-for-routine-lgbtqi-data-collection/. ###The National LGBT Cancer Network works to improve the lives of LGBTQ cancer survivors and those at risk by educating the LGBTQ communities about our increased cancer risks; training health care providers; and advocating for LGBTQ engagement in mainstream cancer organizations. We lead one of eight CDC funded national tobacco and cancer disparity networks and frequently educate about the need for LGBTQI health data collection to effectively monitor cancer disparities. Learn more at cancer-network.org.
The Whitman-Walker Institute is one of the country’s premiere organizations focused on advancing the health and wellbeing of people facing barriers to quality care, particularly LGBTQ people and people living with HIV, through the strategic integration of clinical expertise, research acumen, quality education and policy change. The Institute endeavors to remain grounded in community by seeking feedback and promoting ideas that reflect the lived experiences and identified needs of those we serve. The Institute conducts cutting edge research and engages in evidence-based education and policy advocacy to end the HIV epidemic, eliminate health disparities, and promote wellness and resiliency. Through such work, we empower all persons to live healthy, love openly and achieve equality and inclusion.
END THE INVISIBILITY An Open Letter to Health Leaders: In the 1950s and 1960s, brave, pioneering LGBTQI+ advocates such as Barbara Gittings, Marsha P. Johnson, Frank Kameny, and Sylvia Rivera took great personal risks to break the oppressive silence around human sexuality and end our invisibility. In the 1980s, ACT-UP protested government inaction regarding HIV/AIDS with the slogan “Silence = Death.” This Pride month, we, a group of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) health serving organizations and our allies, again call for an end to oppressive silence and invisibility in public health. We urgently call for routine collection and reporting on sexual orientation, gender identity, and variations in sex characteristics (also known as intersex status) (SOGISC) whenever demographic health data are collected.
We know almost nothing about COVID-19’s impacts on LGBTQI+ communities. We have a dearth of data on the impact of heart disease, cancer, tobacco use, diabetes, substance use, and any number of vital health issues on LGBTQI+ people. And we have almost no population-based data on intersex populations in the US. We need to be collecting voluntary SOGISC data from patients throughout every level of our health system. The failure of health institutions to routinely collect SOGISC data puts us at risk.
Thus SOGISC should be collected in the following places: ● Every electronic health record; ● Every insurance application; ● All research studies; ● All clinical trials; ● All health laboratory tests; ● Across all public health surveillance: including surveys, disease, and mortality reporting; this can be addressed via the $500 million CDC Data Modernization Initiative; ● Across COVID-NET, a network of 100 large hospitals reporting on COVID-19 care; and ● As required measures on the Behavioral Risk Factor Surveillance System, where the optional SOGI module used by 40 states provides the largest source of health data on LGBT people today.
We have years of experience in collecting information from our LGBTQI+ patients and colleagues, as do many health systems, local and state agencies, and their counterparts in many nations around the world. Here is a set of measures that have been widely tested and are currently being recommended by community experts. Funding is needed to test enhanced measures but the value of adding tested measures immediately has been amply demonstrated.
We are heartened by the increasing number of organizations recognizing Pride month but we want to be very clear: if you truly value our lives, collect our data. Signer list: National LGBT Cancer Network National Black Justice Coalition Equality Federation CenterLink: The Community of LGBT Centers National Center for Transgender Equality National LGBTQ Task Force The Trevor Project Transgender Law Center Whitman Walker Institute Transhealth Northampton interACT: Advocates for Intersex Youth Movement Advancement Project Center for American Progress The Fenway Institute Howard Brown Health The Center for LGBTQ Health Equity of Chase Brexton Health Care Callen-Lorde Community Health Center Families USA Human Rights Campaign GLAAD SAGE GLMA: Health Professionals Advancing LGBTQ Equality Transgender Legal Defense & Education Fund Advocates for Youth1Hood Power African American Office of Gay Concerns AIDS Foundation Chicago AIDS Resource Alliance Alaskans Together For Equality Alder Health Services All Under One Roof LGBT Advocates of Southeastern Idaho American Trans Resource Hub Arizona Trans Youth and Parent Organization Association of Transgender Health Nurses Atlanta Pride Committee Aunt Rita’s Foundation BiNet USA Bradbury-Sullivan LGBT Community Center Brooklyn Community Pride Center California LGBTQ Health and Human Services Network CAMP Rehoboth Community Center CANDLE Cascade AIDS Project Center for Black Equity Center for Law and Social Policy (CLASP) Center for LGBTQ Economic Advancement & Research (CLEAR) Center on Halsted Centre LGBTQ Support Network Charlotte Transgender Healthcare Group COLAGE Community Catalyst Compass LGBTQ Community Center CRUX LGBTQIA+ Climbing DBGM, Inc. Dolan Research International, LLC EDIT Program, Northwestern Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) ENC – Equality NC Equality California Equality Florida Equality Illinois Equality Michigan Equality Nevada Equality New Mexico Equality Ohio Equality Texas Equality Utah Erie City Mayor’s LGBTQIA+ Advisory Council Erie County Democratic Party LGBTQIA+ Caucus Erie Gay News Fair Wisconsin Fairness Campaign FORGE, Inc. Garden State Equality Gay City: Seattle’s LGBTQ Center GenderNexus Georgia Equality Georgians for a Healthy Future GLAA Great Lakes Bay Pride Guilford Green Foundation & LGBTQ center Health Equity Alliance for LGBTQ+ New Mexicans Henderson Equality Center HIV Medicine Association Hudson Pride Center Hugh Lane Wellness Foundation Identity Indiana Youth Group (IYG) Interfaith Voices for Reproductive Justice (IVRJ) Justice in Aging Lancaster LGBTQ+ Coalition Legacy Community Health LGBT Center of Greater Reading LGBT Community Center of Greater Cleveland LGBT Elder Initiative LGBT Technology Partnership & Institute LGBT÷ Center Orlando LGBTQ Center of Bay County LGBTQ Center of Bay County Lighthouse Foundation Live Out Loud Lyon-Martin Health Services Massachusetts Transgender Political Coalition MassEquality Mazzoni Center Medical Students for Choice Modern Military Association of America National Black Justice Coalition National Center for Lesbian Rights National Equality Action Team (NEAT) National Health Law Program National Working Positive Coalition New York Transgender Advocacy Group NJ LGBTQ Democrats NWPA Pride Alliance Oklahomans for Equality Dennis R Neill Equality Center One Colorado ONE Community one-n-ten Onslow County LGBTQ+ Community Center Out and Equal Out Boulder County OUT MetroWest Out To Innovate OutCenter of Southwest Michigan OutFront Kalamazoo Outright Vermont Parity Pennsylvania Equality Project, Inc. PFLAG Greensburg PFY – Long Island Crisis Center PGH Equality Center Phoenix Pride Pizza Klatch Pride Action Tank Pride at Work Pride Center of Staten Island Pride Center San Antonio Pride Community Services Organization PROMO Rainbow Rose Center Rescue I The Behavior Change Agency Resource Center Ricky’s Pride Rockland County Pride Center Sacramento LGBT Community Center Safeguarding American Values for Everyone (SAVE) SAGE Metro Detroit San Diego LGBT Community Center Secular AZ Silver State Equality SOJOURN Southwest Center The Center on Colfax The Charlotte Transgender Healthcare Group The Cranky Queer Guide to Chronic Illness The DC Center for the LGBT Community The Frederick Center The LGBTQ Center Long Beach The LGBTQ Community Center of Southern Nevada The Montrose Center The Pride Center at Equality Park The Pride Center of New Jersey The TransLatin@ Coalition Trans Empowerment Project TransFamily Support Services Transgender Education Network of Texas (TENT) Transgender Resource Center of New Mexico TransOhio TriVersity – The Pride Center True Colors United University of Nevada, Las Vegas Vivent Health Washington AIDS Partnership Washington County Gay Straight Alliance, Inc. Waves Ahead and SAGE Puerto Rico Waves Ahead Puerto Rico Wellness AIDS Services, Inc. William Way LGBT Community Center Woodhull Freedom Foundation Zebra Coalition
The British government on Monday (14 June) eased blood donation rules for gay, bisexual and queer men – yet activists warn harmful restrictions remain.
Blood donation rules in England, Scotland and Wales have long screened out donors if they are a man who has had oral or anal sex with another man.
This is because male donors were asked to disclose whether they have had sex with another man during checks.
But coming into effect on World Blood Donor Day and following recommendations from a health committee, British blood services will now assess donor eligibility on a person-by-person basis instead of applying a blanket restriction.
So, rather than just men, all people regardless of gender and sexuality will be asked the same questions on recent sexual activity, if any.
This means anyone who has had the same sexual partner for the last three months will be eligible, allowing more LGBT+ folk than ever before to donate blood, platelets and plasma.
It’s a long-sought for shift in policy quickly hailed as “historic” by top LGBT+ advocates, but sexual health groups warned that the blood donation process is still riddled by “barriers”.
“Patient safety is at the heart of everything we do,” said the blood service’s chief nurse for blood donation Ella Poppitt.
“This change is about switching around how we assess the risk of exposure to a sexual infection, so it is more tailored to the individual.
“We screen all donations for evidence of significant infections, which goes hand-in-hand with donor selection to maintain the safety of blood sent to hospitals.”
It’s a simple fact that LGBT+ people are at high risk of developing eating disorders.
A Stonewall study found one in eight LGBT+ people experience an eating disorder and, according to a Beat survey, 37 per cent of LGB respondents wouldn’t feel confident seeking help.
Researchers recently found 18 per cent of boys who identify as gay and 13 per cent of boys who are bisexual experience eating disorders, compared with three per cent of heterosexual boys.
Gay men have battled eating disorders for decades, which are often connected with anxiety and confusion regarding sexuality, but many still struggle to access treatment.
Here are the stories of five gay men who have lived with eating disorders.
Lawrence Smith: ‘I felt destined to fail at existing as an adult’
Lawrence Smith, 29, is an actor and singer who had long-term issues with anorexia nervosa, diabulimia and general disordered eating.
“A key factor in my issues was lack of confidence in myself,” he explained.
“I felt destined to fail at existing as an adult, so I adopted the misguided belief that, were I to be ill, I wouldn’t need to engage with the real world.
“This had dangerous effects on my Type One diabetes.”
Lawrence also possessed a hatred of his body and the diabetes he’s had since a young age and used his eating disorder as punishment.
“I’ve been out as a gay man for ten years,” he said.
“I was lucky with the reaction to my coming out, but I had a lot of internal confusion proceeding this, and I was convinced I didn’t deserve love.
“I was surrounded by folks my age discussing their sex lives, so I felt isolated even further with my added eating disorder habits.”
Lawrence wishes his treatment focussed more on his diabetes, as none of his therapists were well versed in diabetes, so diabulimia continued to affect him.
He also highlighted the need to stop viewing eating disorders as a “women’s illness”.
“When I was seeking help 12 years ago, the resources I received all focused on female experiences of eating disorders. I felt absolutely alienated.
“I can only hope things have improved over the years, especially when the number of gay men battling eating disorders has risen.”
Jason Wood: ‘Embracing my vulnerability has been so scary’
(Jason Wood)
Jason Wood, 35, is an office events coordinator and blogger who has struggled with orthorexia.
“After joining Weight Watchers in high school I became fixated on counting calories, which made me feel in control during turbulent times,” Jason said.
“Several years later I was classified as high risk for colorectal cancer, the same disease that took my dad when I was 11.
“I didn’t want to die young so I developed a mental list of ‘good’ and ‘bad’ foods based on fad diets and clean eating influencers, whose diets I viewed as the epitome of health.”
Jason never thought he had an eating disorder, as he didn’t match the stereotypes.
He realised he needed help after an outburst in a restaurant when the food he wanted wasn’t available.
“My husband expressed concerns, so I scheduled an appointment the following week, but it wasn’t until months later I realised orthorexia was what I was battling,” he said.
Jason found it difficult actually finding treatment, however, as a man with a lesser-known eating disorder, and saw several professionals before receiving appropriate care.
Fortunately, he’s now in recovery and wants other gay men to know they deserve help.
“Embracing my vulnerability has been so scary,” he said, “but also really rewarding because I’m getting my life back.”
Dr Sunni Patel: ‘I just wanted to be accepted and avoid bullying for my size’
Dr Sunni Patel, 35, is a business director and gut health advocate who suffered from bulimia and excessive fasting as a teen.
“My issues stemmed from the insecurity of how I looked,” he shared.
“Coming from an Asian background there’s an unhealthy focus on how one looks and acts, and I gained weight as a teenager, so fasting felt like a quick way to lose weight and seem attractive.
“I just wanted to be accepted and avoid bullying for my size.”
Sunni is still on his coming out journey, but anxiety about how others may perceive him made him body-conscious.
“Coming from a conservative background and studying in healthcare meant I couldn’t discuss my eating disorder,” he added. “I was ashamed of my struggle, so I chose to self manage it.
“The gay dating scene also seems very body focused and extremely difficult to navigate because the easiest access to the gay world is through hookup apps and porn.
“It was hard to find people who understood what I was going through.”
Sunni wishes he was able to confidently talk about his struggle because he still battles with BDD (body dysmorphic disorder).
When asked his advice for fellow gay men, Sunni wants people to remember that others in the community shouldn’t pressure you to be a certain way: “Be you and find contentment in that, then you’ll attract the right people.”
Sam Thomas: ‘I would hide in the toilets during lessons and eat’
(Sam Thomas)
Sam Thomas, 35, is a writer and mental health campaigner who developed bulimia as a result of homophobic bullying in school, which manifested into CPTSD (complex post-traumatic stress disorder).
“I would hide in the toilets during lessons and eat,” Sam said. “Over time I evolved from bingeing episodes to bingeing and purging.
“Hardly anyone knew or had reason to be concerned.”
Sam attempted to seek help at 16 and again at 18 but never received treatment for bulimia. Fortunately, he was eventually able to recover, but his bulimia was replaced with alcoholism years later.
“At 18 the doctor focused on my depression rather than bulimia, I was put on antidepressants and referred for counselling,” he continued.
“I’ve often wondered if I were a woman with the same symptoms I might’ve been referred to eating disorder services.
“The concept of being a gay man having eating disorders was unknown 20 years ago. There was no information easily available, nor were there any support groups.”
Sam wants to remind readers that people from all walks of life have eating disorders: “Eating disorders are indiscriminate and anyone can be affected.”
Cassius Powell: ‘Seeing my father in tears encouraged me to seek help’
(Cassius Powell)
Cassius Powell, 38, is a dancer and personal trainer who was diagnosed with anorexia at 15, which was a result of low self-esteem and confusion in his teens.
“I placed a lot of self-worth on my physicality,” Cassius explained.
“I read an article about Leonardo DiCaprio that became the catalyst for my eating disorder. I thought his size was why he was so desired. This was also wrapped up in my suppressed sexual desire for him.
“I quickly became obsessed with exercise and food.”
Cassius didn’t realise the impact of his eating disorder until he confessed to giving away food at school to his father.
“He broke down at the wheel as we drove home one night. Seeing my father in tears encouraged me to seek help.”
Cassius rebuilt his relationship with food following appointments with a dietician, but it’s taken a long time to realise his value isn’t measured by looks.
“Even now I sometimes catch myself over-exercising and being strict with food but, because I’m kinder to myself, I can manage it.”
Cassius’ eating disorder was impacted by suppressing his sexual identity until coming out aged 25.
“I felt like being gay wasn’t acceptable,” he said, “so I tried to shut off any gay thoughts or feelings, which of course is impossible to control.
“What is easy to control, however, is the food you put into your body.”
He also wishes more attention could’ve been given to the mental aspect of eating disorders during treatment, as well as the eating.
“It’s only in the last five years I’ve tackled my OCD, anxiety and depression, which were key factors in my eating disorder,” Cassius shared.
A British midwifery magazine has shared an incredible cover that shows that, yes, trans men can give birth – and you bet it ticked off transphobes.
In a cover designed by illustrator Lauren Rebbeck for its 24th volume in May, The Practising Midwife emphatically said that trans men who give birth are “amazing”.
Part of the magazine’s Normal Birth series, the cover features a trans Black man after giving birth to a baby as his partner looks on in pride. His fist raised in the air, showing a rainbow tattoo with the words “right on” underneath.
Of course, because their hobby is hate, the cover quickly became the target of transphobic Twitter trolls and anti-trans pressure groups.
After The Practising Midwife shared a roundup of some of its recent covers in June, it abruptly entered the radar of a cavalcade of anti-trans Twitter accounts who decided to focus their collective efforts on attacking a… midwifery magazine.
This being from the same group who have previously assailed a mental health charity for, er, proudly standing up for trans rights.
But the magazine refused to be buffeted by the pile-on and issued a statement on Twitter on Monday (28 June), proudly coming out swinging for trans rights.
“We are committed to representation at all levels and also to ensuring that our publications provide a safe space for all birthing people and maternity care workers to learn, care and share with one another,” it read.
The American Medical Association (AMA) has delivered a firm rebuke to the spate of anti-trans bills attempting to criminalise healthcare for trans youth.
Arkansas became the first state to ban puberty blockers and gender affirming treatment for trans minors in April, while similar bills are currently being considered in up to 20 state legislatures
State representatives are pushing their discriminatory bans through despite firm opposition from medical and healthcare advocacy groups, including the AMA – which is the largest association of physicians in the United States.
The American Medical Association recommitted to its already established position in a wide-ranging statement issued on Tuesday (15 June).
The group characterised such bills as “governmental intrusion into the practice of medicine” and said efforts to ban healthcare for trans minors will ultimately prove “detrimental”.
“Legislatures in 20 states this year proposed banning physicians and other health care professionals from providing medically necessary gender-affirming care to transgender and gender-diverse youth,” the AMA said in a statement.
“In response to this legislative trend, physicians and medical students at the AMA’s House of Delegates meeting voted to meaningfully expand the organisation’s strong opposition to undue restrictions on medical care to populations that have been politicised in state legislatures.”
AMA will support human rights by opposing anti-trans bills
Michael Suk, AMA board member, said that gender-affirming care is “medically necessary” and “evidence based” and insisted that it “improves the physical and mental health of transgender and gender-diverse people.”
The AMA drew attention to a letter it delivered to the National Governors Association in April which argued government overreach in healthcare can have “tragic consequences for transgender individuals”.
“The AMA is a strong supporter of human rights and freedoms and will continue to strongly oppose discrimination based on an individual’s sex, sexual orientation, or gender identity,” the statement said.
The group promised to keep working to protect trans and gender diverse young people’s right to “explore their gender identity under the safe and supportive care of a physician”.
There was widespread outcry when Arkansas legislators banned healthcare for trans youth in April – but that law is far from the end of the road for transgender people in the United States.
Similar bills are either currently being considered, or have already been considered, in Tennessee, Texas, Florida, Missouri, Alabama, Montana, Louisiana, New Hampshire, South Carolina, North Carolina, Utah, Georgia and others.
Dr. Stephanie Ho, a family medicine physician in Fayetteville, Arkansas, said she’s had state legislators in her exam room before.
Ho, who has provided gender-affirming care to transgender people in the state since 2015, is also an abortion provider, so she is familiar with lawmakers’ restricting the care she provides. She said she wasn’t surprised when the Legislature overrode Gov. Asa Hutchinson’s veto of a bill last month that would ban puberty blockers, hormones and surgery for transgender minors.
“I think that it’s kind of ridiculous that we’ve gotten to the point that we’re letting politicians dictate how health care is delivered and what kind of care can be given to whom,” said Ho, a fellow with Physicians for Reproductive Health.
“I think the last thing I’ve ever wanted, being an abortion provider or somebody who provides gender-affirming care, is to have a politician in the back of my mind in the exam room making me think about ‘Oh, I wonder if I should do this, if it’s OK,’” she said. “They’re essentially trying to practice medicine without a license. And that’s incredibly wrong.”
Arkansas was the first state to pass a ban on transition care for minors. Tennessee Gov. Bill Lee last week signed a similar billbarring prepubertal youths’ access to transition care like hormone therapy. Advocates say no doctors in the state provide hormone therapy for prepubertal youths, The Associated Press reported.
So far this year, state legislatures have considered 35 bills to ban or limit gender-affirming care for trans minors, according to the Human Rights Campaign. Physicians say that the bills negatively affect their patients’ health before they even become law and that they require doctors to go against medical standards of care. Legal experts say the bans could also open providers and hospitals up to lawsuits or put them at risk of losing federal funding.
Ho is trying to support her patients as best she can until Arkansas’ law takes effect this summer.
“It’s just a matter of making sure that my patients know that, whether I can provide them hormones or not, we’re still here for them to support them in any way that we can,” she said. “Of course, I’m going to practice within the bounds of the law, whether I agree with it or not, because me being in jail doesn’t help any of my other patients at all.”
Creating ‘contingency plans’
Some physicians, like Dr. Izzy Lowell, who founded a telemedicine practice called QMed in Atlanta in 2017, started planning for the bills months ago.
Dr. Izzy Lowell, second right, founder of QMed.Bonnie Heath
In April, Alabama’s Senate passed a bill that would have made it a felony for doctors to provide minors with gender-affirming care. The bill died Monday after the House missed the deadline to vote on it. Lowell said that when it first passed, the minor patients she treats in Alabama were scared and frustrated.
“It was clear that the state of Alabama was coming after transgender teens, and we talked about some contingency plans,” she said. “Based on each case, I tried to give them as many refills as possible and told them: ‘Go pick up as much of your medicine as you can. I don’t know when I’ll see you again.’”
Lowell is licensed and practices in 10 states via telemedicine, so she also talked with her legal team and with patients in states considering bans about how her patients could continue care should their states ban it. She said her patients’ parents would have to drive to other states, which would “place an extraordinary burden on these families.”
“If they were, for example, able to get over the border into Tennessee or South Carolina and sit in a parking lot somewhere, I could see them technically with my South Carolina license or Tennessee license or my North Carolina license and perhaps find a local pharmacy there and have them pick up the prescription, but it would be a day’s worth of driving for them to get somewhere where I could see them legally,” she said.
Because leaving the state just to get care would be a burden, families in states where transition care restrictions have passed have movedor are considering moving.
The costs of losing ‘lifesaving’ care
Many minors whose parents don’t have the time or money to drive out of state would be forced to stop transition care if their states passed laws like Arkansas’, which comes with potentially life-threatening health risks, physicians say.
Major medical organizations, including the American Medical Association, the American Academy of Pediatrics, the Endocrine Society and the American Psychological Association, support gender-affirming care for trans youths and oppose efforts to restrict access.
Supporters of the Arkansas bill argue that transition care for minors is “experimental” and that trans minors often change their minds about their genders and detransition later in life. Medical experts say neither of those claims are backed by scientific evidence. On the contrary, research has found that access to gender-affirming care such as puberty blockers reduces the risk of suicide among trans youths.
Ho said the danger is evidenced by what happened when Arkansas’ bill passed through one legislative chamber. Dr. Michele Hutchinson, a physician at the Arkansas Children’s Hospital Gender Spectrum Clinic, testified before the state Senate in March that there were “multiple kids in our emergency room because of an attempted suicide, just in the last week,” after the House passed the bill.
Ho said that “since then, I have had one of my own patients attempt suicide,” adding that she has talked to her patients about what would happen if a judge doesn’t block Arkansas’ law from taking effect. The law also bars her from referring her patients to other physicians who provide gender-affirming care. Unless her patients were able to leave the state, they would be likely to lose access to hormones, so she talked to them about what that would mean.
Lowell said forcing people who were assigned female at birth to stop testosterone would cause them to suffer symptoms of low testosterone, which include inability to concentrate and low energy. “They would start doing badly in school most likely, until their bodies started producing estrogen a few months later, and then they would restart their periods, restart breast growth, and it would undo all of the changes that we tried to achieve with testosterone.”
If people assigned male at birth were forced to stop taking estrogen, it “would be like going through instantaneous menopause,” Lowell said. For about a year, they could have symptoms like hot flashes, night sweats, irritability and mood swings, among other issues, such as negative impacts on emotional well-being.
Doctors worry that minors who already receive and rely on transition care would get hormones illegally if they had to. Dr. Ricardo Correa, a board member of GLMA: Health Professionals Advancing LGBTQ Equality, treats trans veterans in Phoenix, where, he said, trans people have traveled to the border to buy hormones illegally when they can’t get them. He said state bans would worsen the problem.
“It will just create chaos in the system from black markets that are going to start selling this kind of medication in that state,” he said.
Lowell said that hormone therapy is safe when it is monitored by a doctor but that using it without medical supervision could cause health problems, such as liver failure, kidney failure or heart problems.
“There’s very serious consequences of completely unmonitored, sort of black market medication use in this situation,” she said.
‘A form of medical malpractice’
Legal experts and advocates say that in addition to having dangerous health impacts, bans on gender-affirming care for transgender youths could expose health care providers to legal and regulatory problems.
Valarie Blake, a law professor at West Virginia University specializing in health care law, said there’s “a pretty strong case” that Arkansas’ law is discriminatory under Section 1557 of the Affordable Care Act, which protects against discrimination based on sex.
The Biden administration announced this month that it would interpret Section 1557 to protect against discrimination based on sexual orientation and gender identity — reversing a Trump-era policy that cut protections for transgender people.
Hospitals and physicians receiving federal funding, such as Medicare and Medicaid payments, are required to comply with laws like Section 1557, Blake said; otherwise, they risk losing the funding.
Arkansas’ law could trigger that risk by allowing physicians and hospitals to prescribe puberty blockers and hormones to cisgender minors for precocious puberty but not transgender teens.
“If the reason that they’re not doing it for transgender teens is because of the fact that they’re transgender, then there’s a very good case that the reason that they’re refusing the treatment is based on the gender identity and not anything else,” Blake said.
“It really puts health care workers in an untenable position when the federal government makes it plain that this is discrimination and has the money to back it up to basically say, ‘We can pull away all of the resources,’ and yet the state persists,” she said.
The American Civil Liberties Union argued in a lawsuit it filed Tuesday against Arkansas that the trans health restrictions are unconstitutional, but Blake said that’s not set in stone.
“We don’t have clear precedent on the books yet to suggest that LGBTQ categories are fully protected in that manner, which is why we’ve been seeing various kinds of Equal Rights Amendment-type laws trying to work their way through Congress,” she said, referring to the Equality Act, a bill that would protect LGBTQ people from discrimination in housing, employment, public accommodations, education and other areas of life.
The bill passed the House in February, but it has stalled in the Senate. “If something like that passes, then suddenly Arkansas as a state is in big trouble,” Blake said.
Lowell said thinking about the potential legal issues “keeps me up at night.” Physicians are required to give patients several months’ warning when they can’t see them anymore and to do their best to find other providers who can see them if they’re unable to.
But laws like Arkansas’ bar physicians from referring patients to other providers for transition care. “In this case, I can’t do any of those things, and I just have to say, ‘Bye,’ and ‘I’m not allowed to see you anymore,’” she said. “That’s patient abandonment, which is a form of malpractice.”
Lowell said that when the first restrictions were introduced several months ago, she felt angry and anxious all the time.
“I worry about what might happen to my patients if these bills are passed and worry about going to jail myself,” she said. “I struggle with the question of what I would do: continue to support my patients and risk going to jail for years or follow these hateful laws? Thankfully, I have not had to answer this question yet, but I will never abandon my patients.”
I’ve been teaching at a New York City college for almost five years, and I’m still in touch with a number of my former students. Many reach out for career advice, or help on getting a job, or wanting a letter of recommendation, and I’m always happy to oblige.
However, I was caught off guard recently when a former student told me that he decided not to get the COVID-19 vaccine. This person reads my column and knows that I’ve written a lot about the pandemic during the last year, including speaking to a number of medical experts including Dr. Fauci, Dr. Mike Osterholm and science writer Laurie Garrett. The student assumed that I was the closest thing to an “expert” that they could find, and I sensed he was challenging me about his decision.
My immediate answer was, “Get the damn vaccine!” The student did not respond to my strong command, and I’m worried that I might have missed an opportunity to convince him otherwise?
I’m wondering if many of us have friends, relatives or even partners who are hesitant to get the vaccine, and when confronted with that uncertainty, are we left trying to figure out how to provide the right response?
Vaccine rates have started to fall precipitously, with the pace of daily inoculations falling 35 percent from their highest levels just a couple of weeks ago. Some still lack access to the vaccine, others have just not got around to getting one, and many are either still wavering or adamantly saying it’s not for me. And many are confused, afraid or feel slighted.
The New York Timesreported this week about LGBTQ+ people feeling invisibile with regard to how COVID data is accrued.
The Times also said, “Communities of color and other marginalized groups have faced some of the most severe coronavirus outcomes, yet have received a smaller share of vaccines. L.G.B.T.Q. people could face similar problems but may be overlooked because they aren’t counted.”
The vaccine debate is likely to be raging for the next few months. President Biden is determined to have 70 percent of Americans vaccinated by July 4. The argument seems to be, unfortunately, a political one. Nearly 60 percent of U.S. adults have now received at least one shot, according to a recent poll, but a whopping 45 percent of Republicans say they did not plan to get vaccinated, while two-thirds of Democrats have already been vaccinated.
Why is there so much hesitancy and controversy around these life-saving and life-alerting vaccines? Is the Biden administration doing enough to convince wavering Americans to get vaccinated? And how do you go about changing the mind of someone you know who is opposed to getting the shot?
I reached out to out ABC News Medical Contributor Dr. Darien Sutton for some help getting answers to these questions. First, why all the debate and why all the waffling?
“Throughout the pandemic, there has been a consistent environment of fear and misinformation, instigated from the previous administration, and it all started at the beginning when people often felt there were too many mixed messages and too many signals. Eventually it became more and more difficult to make decisions about how to deal with the virus,” Dr. Sutton explained.
“With the change in administrations in January, we have been given more straightforward information and more relevant data that has helped unionize the message. So, while things have changed, it doesn’t negate where we started. All the confusion created a lot of deliberation, and increased deliberation time periods, and this has resulted in a more elongated and difficult process about whether or not to get the vaccine.”
The Biden administration has been more honest and upfront, but will they be able to sell the vaccine across party lines across the country? Right now, it seems the message is that you can get back to normal sooner if you just get these shots?
“Yes, you can tell patients what they can do with the vaccine versus what they cannot do,” Sutton said. “However, I think patients want to hear answers to questions about what’s in it for them. Specifically, how does it benefit them in their personal lives? I think people don’t care as much about going to the movies again, for example, versus getting assurance that the vaccine is safe, effective and useful.”
Is that the answer then to the quandary about trying to convince someone to get the vaccine? Push its safety and effectiveness? “I think it’s important to listen and ‘ask’ the undecided first what is the basis of their concern,” Sutton believes. “Is it fear? Is it fear of reaction? Is it fear of getting sick and not having health care to get treatment.”
After you’ve heard out the person’s concerns, Dr. Sutton said the next thing you should do is “tell.” “You need to tell the person that the vaccine has been proven to be effective, protective, and it prevents person to person transmission, so there’s less chance to spread the virus, and as such it will keep you, and your loved ones, out of hospital and not cause financial burdens. After that, you need to just give the person space to think about their decision.”
I told Dr. Sutton about my former student, who is Black, and that it seems tricky to push him on something he seems sensitive about. “I’m having the same issue with my own family,” he revealed. “I come from a large Black family that remains hesitant and was raised in an environment where medicine is not trustworthy.”
“Historically, you have instances like the Tuskegee experiment for example, or in Puerto Rico with women and birth control, where minorities and poorer communities were used as guinea pigs. Many Black families and people of color feel they were used for research that benefited privileged white communities, so there’s a whole history there that has resulted in disinclination and unwillingness.”
On top of all this hesitation, understandable in some circumstances, comes the news that a booster shot might be required later this year or early next. Did Dr. Sutton feel that was the case? That we would all have to queue up again for another round of shots?
“It’s hard to say. We’re still closely following the efficacy rates and ranges of the first vaccines. What we’re seeing is that it has been effective in bolstering the immune system, and we’re hopeful that it will remain durable and long lasting and protect against other variants.”
Sutton theorized that the COVID-19 vaccine might be what’s referred to as a repetitive vaccine, similar to the annual flu shot that most of us get each fall and winter.
Finally, the CDC has said that Americans could be almost back to normal by this summer, July specifically. Did Sutton concur with that optimistic outlook? “Yes,” he quickly agreed. “People ask me all the time if we will have to go into lockdown again, and I don’t think that will happen.”
“We have done a great job of vaccinating those 65 and over, and others who were more susceptible to the disease. And we’ll ramp up vaccinations for teens and children in the next few weeks. As we know, young people were commonly asymptomatic transmitters of the virus, so as they get vaccinated, we’ll see further reductions in transmissions. All of this means that we will decrease the chances of our hospitals being overrun again, and that most of us will start to resume a normal way of life.”
A consistent level of parental support, even if it’s negative, leads to better mental health outcomes for lesbians and gay men, according to a small new study.
The report, released this week at the American Psychiatric Association’s annual meeting, found that individuals whose parents were initially unsupportive of their sexual orientation but became more accepting with time were most likely to report symptoms of anxiety and depression.
Researchers at the Chicago School of Professional Psychology surveyed 175 cisgender gay men and lesbians about the initial and current levels of parental support they received regarding their sexuality.
Based on their responses, the subjects were divided into three groups: Those whose parents’ reaction was consistently positive, those whose parents’ reaction was consistently negative and those whose parents’ reaction shifted from negative to positive. (A fourth group, individuals whose parents were initially positive but shifted to negative, was excluded because it was too small to analyze.)
The groups were then given two assessments frequently used to determine mental health: the general anxiety disorder-7questionnaire and a patient health questionnaire. The first questionnaire found those with consistently positive support and those with consistently negative support had “mild anxiety,” while those whose parents evolved from negative to positive had “moderate anxiety.” The latter questionnaire, which rates symptoms of depression, found those with static parental reactions exhibited “mild depression,” while those whose parents shifted their support had what is considered “moderate depression.”
Lead author Matthew Verdun, a doctoral candidate in applied clinical psychology at the Chicago School of Professional Psychology and a licensed family therapist, said many factors could be at play, including that family rejection can lead gays and lesbians to find new, healthier support systems.
“In coming out, we learn how to cultivate meaningful relationships and navigate across social context,” he said. “Who are safe people to come out to? How do I identify the people who are going to accept all of me, including my orientation?”
Re-establishing the bond with a previously unaccepting parent could mean ending therapy or abandoning a chosen family, he said. And just because a parent is more accepting doesn’t mean the environment is a positive one.
“If a parent goes from being unsupportive to supportive, are they abandoning some of their relationships that may still be unhealthy?” Verdun said. “Are they part of a faith tradition that rejects their child or says they’re an abomination? If the parent comes around but doesn’t shift out of that belief system, that’s going to affect their child.”
Previous research has generally linked negative responses from family to a higher probability of LGBTQ mental health issues: According to a 2010 study by the Family Acceptance Project, lesbian, gay, bisexual and transgender young adults who reported low levels of family acceptance in adolescence were over three times more likely to have suicidal thoughts and to report suicide attempts, compared to those with high levels of family acceptance.
But those studies, Verdun noted, look at the dynamic at one point in time, usually when the individual has just come out or is still living at home. “I wanted to know what happens over time,” he said.
The findings can be useful for mental health providers, he said, but they shouldn’t be interpreted as meaning that rejecting your gay or lesbian child is a healthy response.
“If I was talking to parents, I’d say supporting your child is key,” Verdun said.
Psychiatrist Jack Drescher, author of “Psychoanalytic Therapy and the Gay Man” and a former editor of the Journal of Gay and Lesbian Mental Health, called the findings “rather surprising.”
“It’s not the result we expect, based on clinical evidence,” Drescher, who was not involved in the study, said. “But when we don’t know the answer, the answer is always to do more study. I’d love to see qualitative research — get narratives of the people involved and see what themes emerge among those who had the experience of having negative and later positive responses.”
