Jan 182016
 

There’s been a cluster of publications and news recently that I won’t be able to dig fully into and write a full article on, but still needs mentioned. So this week’s post is a quick summary of a bunch of them!

Several articles came out pointing out that various health care professionals have a role to play in gender/sexual minority health. Articles like this are important in helping the wider medical community understand why learning about gender and sexual minority health issues is important. The articles include…

  • Obstetricians can help screen fetuses for being intersex and help to manage the medical aspect of intersex medical conditions. Gynecologists can help adult intersex people with both medical and social issues associated with being intersex. See the article.
  • Pharmacists can help with the care of trans people above and beyond just filling a prescription. They can help make sure that certain laboratory calculations are done correctly, based on the hormonal status of the patient. They can counsel on the various forms of hormones (e.g., pill vs patch vs injection). See the article.
  • Dermatologists may be able to assist in medical transition by providing hair removal and other noninvasive, aesthetic procedures. See the article.

Asking about sexual orientation and gender identity and recording it in the electronic health record is now a required part of all electronic health records by Medicare/Medicaid. This is part of “meaningful use”, and is part of the larger goal of having electronic health records that actually cooperate with each other and record the same things. Here’s a quick abstract discussing this. This is really the beginning of a change in health care around the United States — there’s now a financial incentive to screen for sexual orientation and gender identity and to handle patients who aren’t cisgender and straight. It’s good stuff.

A study of examined the effectiveness of therapy intended to change same sex sexual attraction as performed within the Church of Jesus Christ of Latter-day Saints. Less than 4% of those surveyed experienced a change. 42% reported that it wasn’t effective, and 37% found it to be moderately to severely harmful. Those who seek to modify their sexual orientation should keep this in mind — therapy intended to change sexual orientation is far more likely to do harm than good. For context, if this therapy was a new drug the FDA would never allow it into the marketplace. It would never get past early clinical trials. In contrast, acceptance therapy (i.e., therapy meant to help one be accepting of one’s orientation) in this study was found not only to reduce depression and improve self esteem but also improved relationships with family. See the abstract.

It’s well known that lesbian, gay, and bisexual cisgender people are at higher risk of suicide than the general public. A study recently clarified some of that risk, finding that bisexual cis women are at nearly 6 times higher risk of suicide than straight cis women (roughly 4-9% of the women). Gay men were 7 times more likely to attempt than straight men (roughly 3.5-13% of gay men). Lesbian and bisexual women were also more likely to attempt suicide at a younger age than straight women — roughly 16 years old vs 19 years old. Sad news. See the abstract.

Gay and bisexual men may be more likely to rely on chosen family for social and economic support than lesbian and bisexual women and heterosexuals, who may rely more on blood relatives. See the abstract.

And very exciting — the FDA has changed their blood donation policy for men who have sex with men! Instead of an “indefinite deferral”, people who quality as “men who have had sex with men” need to wait 12 months after the last sexual encounter to donate. This brings the guidelines for sex who have sex with men roughly equivalent to the guidelines for others who are at higher risk for HIV.

If you are transgender, the guidelines are still unclear. Transgender women who had ever had sex with a man (unclear if cis or trans) used to count as “men who have sex with men” in the FDA’s eyes. Now the FDA advises that transgender people should self report their gender. What this seems to say is that trans women should be counted as women and trans men should be counted as men regardless of hormonal/surgical status. So according to the guidelines, this should be the logic…

  • If you are a cis/trans man who has had sex with another cis/trans man once since 1977, but over 12 months ago: You may donate blood.
  • If you are a cis/trans man who has had sex with another cis/trans man within the past 12 months: Wait until 12 months after that sexual encounter to donate, whether you used a condom/barrier or not.
  • If you are a cis/trans woman who has had sex with a cis/trans man in the past year, and that cis/trans man has had sex with a cis/trans man in the past year: Wait until 12 months after your sexual encounter to donate, whether you used a condom/barrier or not.
  • If you are a cis/trans woman who has not had sex with a cis/trans man in the past year: You may donate blood.
  • If you are a cis/trans woman who has had sex with a cis/trans man in the past year, but that cis/trans man has not had sex with a cis/trans man in the past year: You may donate blood.

Confusing enough? I hope that still helped. Keep in mind that all of the guidelines I attempted to simplify assumes that you’re not HIV+ (no one who is HIV+ may donate). If you’re confused still, take a look at the new guidelines or reach out to your local blood donation center.

And that’s it for this week! I hope this was fun, interesting, and helpful! Have a wonderful week.