Nov 212016
 

On October 6, 2016 the National Institutes of Health in the United States designated gender and sexual minorities a disparity population for the purposes of research. This is tremendous news. The NIH is the health research arm of the US government. It gives grants. Scientists working there do crucial research. The NIH provides training and research opportunities for students and professionals alike.

Long time readers of Open Minded Health may remember the many times I’ve said “we need more research.” This is part of how we get that research. Through incentives that can now be provided by the NIH, and through the hard work of all connected with it.

Slowly but surely gender and sexual minority health is becoming better understood. And only through understanding it can we even begin to improve it. Ultimately so that we can all live healthier, longer, happier lives.

Read the full declaration below.

Sexual and Gender Minorities Formally Designated as a Health Disparity Population for Research Purposes

On behalf of many colleagues who have worked together to make today possible, I am proud to announce the formal designation of sexual and gender minorities (SGMs) as a health disparity population for NIH research. The term SGM encompasses lesbian, gay, bisexual, and transgender populations, as well as those whose sexual orientation, gender identity and expressions, or reproductive development varies from traditional, societal, cultural, or physiological norms.

Mounting evidence indicates that SGM populations have less access to health care and higher burdens of certain diseases, such as depression, cancer, and HIV/AIDS. But the extent and causes of health disparities are not fully understood, and research on how to close these gaps is lacking.

In addition, SGM populations have unique health challenges. More research is needed to understand these challenges, such as transgender people taking exogenous hormones.

Progress has been made in recent years, with gains in legal rights and changing social attitudes. However, stigmatization, hate-violence, and discrimination are still major barriers to the health and well-being of SGM populations. Research shows that sexual and gender minorities who live in communities with high levels of anti-SGM prejudice die sooner—12 years on average—than those living in more accepting communities.

The Minority Health and Health Disparities Research and Education Act of 2000 authorizes the Director of the National Institute on Minority Health and Health Disparities (NIMHD), in consultation with the director of the Agency for Healthcare Research and Quality (AHRQ) at the U.S. Department of Health and Human Services, to define health disparity populations. This month, with strong support from AHRQ Director Andrew Bindman, M.D., I formally designate sexual and gender minorities as a disparity population for research purposes.

The designation builds on previous steps by NIH to advance SGM health research. In 2011, the Institute of Medicine (now The National Academies of Sciences, Engineering, and Medicine) published an NIH-commissioned report on LGBT health issues. In response to the report recommendations, NIH extended its research portfolio and created the Sexual and Gender Minority Research Office (SGMRO). The SGMRO, within the Office of the Director, coordinates NIH-supported activities on SGM health issues and provides guidance to researchers within and outside of NIH.

I offer my gratitude to inaugural SGMRO Director Karen L. Parker, Ph.D., M.S.W., and NIH Principal Deputy Director Lawrence A. Tabak, D.D.S., Ph.D., who led the proposal for designation. I also offer my gratitude to colleagues across NIH who served on the NIH-established working group for their careful consideration on this matter.

This designation marks an important and necessary step in realizing NIH’s mission to advance the health of all Americans.

Source

Feb 152016
 

Welcome back! This week we continue talking about health promotion and preventive health. We start by continuing to answer the question…

What can I do on a daily or weekly basis to promote my own health?

  • Brush your teeth: No, really. I mean it. It’s not just about having good breath! The bacteria in your mouth can cause serious health problems if they go unchecked. To find out more, talk with your dentist or dental hygienist, or visit the NIH webpage.
  • Mental health: Your emotions and thinking are just as important as your bodily health. Your own mental health is going to be different and need different kinds of care than another person’s. Cultivate stress reduction techniques, from the Mayo Clinic’s 4 A’s to activities like running, knitting, or massage. Try different things. But if the common suggestions aren’t enough or you are thinking of suicide, professional help can and does help.
  • Sexuality: Play fun and play safe. Use barriers (condoms, dental dams, gloves) to prevent the spread of sexually transmitted infections. If you do not desire pregnancy and are having sex that could lead to pregnancy, use contraception. If you prefer kinky sex, consider playing under the “Safe, Sane and Consensual” or “Risk Aware Consensual Kink” principles. For more information on (vanilla) sex, the CDC has good information.
  • Sleep: Sleep is absolutely crucial to good health. If only it was easy to consistently get good quality sleep. If you have trouble, consider trying sleep hygiene tips like keeping your bedroom dark and cool, avoiding looking at screens before bed, and avoiding tobacco/caffeine/alcohol before bed. If you’ve tried a lot of different things and you still can’t sleep well or you don’t feel rested, talk with your doctor. There could be a medical reason for your sleep difficulties. As always, the CDC has more information.
  • Vitamin/mineral supplements: Put down that multivitamin! Unless your doctor has told you otherwise, most people don’t need supplements. You might need them if you don’t eat a balanced or varied diet, are vegan (B12), are looking to get pregnant (folic acid/folate), or are concerned about your bone health (calcium). For everyone else, they don’t help and they may even do harm. Recent studies have found that antioxidants (like vitamin E) may actually raise the cancer risks.
  • Alternative medicines: There are little to no benefits from alternative medicine and there’s definitely evidence of harm. Ayurvedic supplements have been found to have heavy metals in them. Traditional Chinese medicine is a significant contributor to the loss of important species like the tiger and rhino. Acupuncture is a placebo effect that has spread blood borne illnesses. Chiropractic manipulations are associated with stroke. And homeopathy? It’s just very expensive water. If you have a medical condition or concern, please visit your physician.

That’ll be it for this week! The next post in this series will address health screenings and immunizations.

Feb 082016
 
Muscular greek statue

We don’t all have to be ready for the Olympics to enjoy the best health we can

The foundation of medicine is the prevention of disease, disability, and death so that everyone has the best quality of life they can. Treating illness once it’s happened is all well and good, but it’s far better to prevent that illness from happening wherever possible. But stigma, discrimination, and ignorance prevent many gender and sexual minority people from getting the preventive medicine they need!

So we begin a new series here on Open Minded Health: Your guide to taking care of your health. Like Trans 101 for Trans People, this is a multiparter that will slowly take the form of a living document.

This week we’ll start with the basics — definitions and health promotion that applies to everyone.

What is health promotion/preventive health? Why should I care?

At its core, health promotion gives you the tools to take care of yourself. Your actions and choices are the core of your health. Doctors, surgeons, and nurses can provide services that help, but the ultimate decision is almost always yours.

Taking care of your health every day won’t stop all bad things from happening. It can’t stop a bad car accident, for example. But it can increase the chances of you surviving the accident and thriving afterwards.

Choosing healthier options can also add years to your lifespan. For example, non-smokers live roughly 10 years longer than smokers. And smokers who quit add years onto their lifespan, no matter when they quit (though earlier is better!)

What can I do on a daily or weekly basis to promote my own health?

This is the nuts and bolts of living well. Little choices every day add to up to a lot! In general, it’s best to make small choices you think you can succeed at rather than huge life changes all at once.

  • Diet: Consider eating more vegetables, less meat, and less sugar. Too much red meat and too little vegetables is associated with heart disease. Too much sugar can lead to obesity and diabetes. So consider replacing beef with chicken, and chicken with lentils or beans. And consider drinking water, seltzer, or diet soda instead of sugared soda. You don’t have to eat kale and quinoa all day to make better choices. The mediterranean diet is another heart-healthy option. MyPlate and the American Heart Association have more details if you’re interested.
  • Exercise: Consider moving more and spending less time sitting down. Park a little further away from work and walk in. Take the stairs. Walk the long way to the bathroom. Go for a walk for part of your lunch break. It all adds up. Consider asking a friend or partner to walk/exercise with you. If your mobility is limited, do what you can. Swimming can be gentle on painful joints, and arm exercises are useful for people who need wheelchairs. Some people find a fitness tracker or pedometer helpful, others don’t. Do what works for you.
  • Tobacco: Avoid tobacco and nicotine products. If you currently use tobacco, make a plan to quit and quit as soon as you can. Many people find a support group, nicotine replacement therapy, and some medications helpful but they’re not necessary for quitting. And remember: relapsing doesn’t mean you’re a failure — you’ve quit before, you can quit again. You have the tools. Also keep in mind that e-cigarettes may not be healthier than regular cigarettes. Early reports show they’re high in formaldehyde, a carcinogen. So it’s best to avoid all tobacco and nicotine. The CDC has resources for those looking to quit.
  • Alcohol: If you drink, drink in moderation. Current recommendations are around 1-2 drinks per day. 1 “drink” is 1 shot worth of alcohol. Limit the times you drink heavily (“binge” drinking). If you do drink heavily occasionally, don’t drink to the point of passing out or vomiting. As always, don’t drink and then drive and avoid drinking when you’re on certain medications. The CDC has more information.
  • Addiction: If you feel that you may have a problem with your use of drugs or other habits, it’s probably worth taking a break from those drugs/habits for a while. If that’s intolerable, it may be time to quit outright. Help for addiction does exist. The best help comes from trained mental health professionals. But if those aren’t available for you, you can consider support groups (online or in person), seeking help from a physician, or working through workbooks on your own. Here’s more information on addiction treatment.
  • Illegal drugs: Most sources say you should always avoid using illegal drugs. And avoiding illegal drugs is best for your health. But that’s simply not reality for everyone. If you choose to use illegal drugs, it’s important to reduce your risks. First — be careful with your sources. As I’m sure you know, contamination isn’t a made up problem. Second — use those drugs as little as possible. This helps avoid addiction and tolerance. Third — use the drugs in the safest way possible. Vaporize, don’t smoke. Avoid injecting drugs, but if you do inject then don’t share needles. Here’s more information.

That’s where I’m going to leave it for this week. But don’t worry! More information is coming. 🙂 And as always — let me know if you have feedback, questions, or concerns. Have a lovely week in the meantime.

Aug 242015
 

148px-Orange_ribbon.svgRecent reports have highlighted the frequency of non-suicidal self-injury among gender and sexual minorities. 41.9% of transgender people have self-injured. I was unable to find a percentage for cis lesbian, gay and bisexual people beyond the general report that the rate was “much higher”. Gender and sexual minority (GSM) youth are at particular risk, as are cis women.

So let’s take a quick look at non-suicidal self injury this week. What is it? Why do people do it? And what should those who currently self-injure, and their loved ones, know?

Non-suicidal self injury (NSSI) is a term that refers to deliberate attempts to cause oneself injury without intending suicide. The “without intending suicide” is the important bit there. This is a separate phenomenon from suicidality, though both suicidality and NSSI can come from the same psychological source. NSSI can take many forms, but cutting and burning are the most common. People who have higher levels of stress, such as GSMs, are at higher risk for NSSI. Transgender people may have an additional risk factor because of extreme body dysphoria.

To most who have never participated in NSSI, it can seem baffling. Why would a person do that to themselves? While everyone has different reasons, at core NSSI is about survival. Many use it to defuse overwhelming emotions. Emotional pain is just like physical pain in the brain, causing activation of the same areas. All pain causes the release of morphine-like chemicals in the brain which buffer the pain, causing the sensation of a “high”. By creating physical pain in reaction to emotional pain, the person doing the NSSI can regulate their own emotions and cope. Other people who do NSSI are attempting to focus. When the world seems far away or they feel numb, pain can help them to feel something and give something to concentrate on. Lastly, some people who do NSSI do so as a way to punish themselves, as a way of asserting control in a powerless situation, or to communicate their emotional pain….or for any number of other highly personal reasons.

NSSI is not an ideal way of coping with life’s stressors. It can be addictive. It’s easy to hurt oneself too much and accidentally attempt suicide or develop infection. Scars and NSSI behavior attract attention, limiting one’s ability to get or maintain a job. Over time it can permanently change a person’s responses to stress and pain.

NSSI is often misunderstood, even in psychology and medicine. Most psychologists and physicians have never experienced NSSI or been close to people who have, so they fail to understand the reasons for NSSI. Until the DSM-V, the only psychological diagnosis that applied was that of borderline personality disorder, which most people who do NSSI do not have.

It can be difficult for a person who self harms to get help. Psychologists and physicians are legally bound to report individuals who are at risk of harming themselves or others to the police. While necessary, it limits confidentiality and can harm trust. Some professionals require that a patient sign a “no self harm contract” before receiving any treatment. Not all patients are willing or able to sign such a contract. Physicians have a limited set of options for treatment: medications (which can take 4-6 weeks to begin to work), referral to a psychologist or psychiatrist, do some level of psychological intervention themselves, or admit the patient to the hospital. And then there’s the question of affordability, especially if you’re unable to hold a job because of the self injury.

Despite these barriers, psychological and medical professionals can be very helpful for people seeking to stop self-injuring. At bare minimum, having a psychologist or physician in the loop can help if a particular incident of self injury goes further than intended. NSSI is a coping strategy, and psychologists and physicians can be very helpful for the issues lying underneath self injury, whether that’s depression, post traumatic stress disorder, or just plain stress.

Lastly, it’s important to know that people can and do learn non-NSSI coping strategies and learn to be self-injury free.

If you want to learn more about non-suicidal self injury, I highly recommend this website. It’s old and the current version is broken, so that links off to the Wayback machine version. It’s still one of the best sites written by people who intimately understand self injury and work to provide information and help others. For a modern alternative, this website also has support forums.

 

 

Mar 162015
 

170px-Rod_of_Asclepius2.svgBeing a gender or sexual minority (GSM) is not only difficulty and tricky for patients — it can also be a challenge for medical providers. Medicine can be a particularly conservative field, depending on location and specialty. Lives are, after all, often at stake.

Despite recent advances it appears that some 40% of lesbian, gay and bisexual medical students are hiding their sexual minority status in medical school. Among transgender medical students, 70% were hiding their identity. All because of fear of discrimination.

That fear has been, and still is, warranted. From medical providers transitioning and losing their practices, to medical students losing their residency slots, to LGBT health student organizations fighting to exist, LGBT providers face similar discrimination as our patients.  Similar happens for other gender and sexual minority health care providers, though we lack statistics. At a meeting of kink-identified mental health care providers, one attendee noted a high level of vulnerability for the clinicians. Being “outed” could lose them their jobs or even trigger legal action.

To some extent, discretion among health care providers is warranted. Most people don’t want to know about their clinician’s (or coworker’s) personal lives. And most GSM providers don’t actually want to share those most intimate details. It’s where the line is that can be distressing — how much information is too much? Can I discuss my wife when other women clinicians are discussing their husbands? How exactly do you notify your fellow clinicians or patients about a change in gender pronouns or name? How can a clinician use information gained from intimate encounters to help patients, without revealing too much? It’s a balance we constantly seek. Sometimes mentors are there and can help. Other times we figure it out as we go along.

Yet we bring a lot to the table, as minorities. Like many racial and ethnic minorities, there are pressures and issues that affect GSM people more than the majorities. We bring that knowledge with us to the research we choose to perform, the communities we participate in, and each and every patient encounter.

We as clinicians and future clinicians need to have the support in order to be appropriately open about our gender and sexual minority status. Our patients and clients must know they can be safe and honest with us so they can receive the most complete and respectful care possible.

Some progress has been made already. There’s an association for LGBT medical professionals. There’s an association for kink psychological research. There’s an association for transgender health. All of which allow student members and provide mentoring. Many other organizations exist too. Some US medical schools are working with their students to provide a safe and welcoming environment where these issues can be explored. The American Association of Medical Colleges recently launched a program to enhance education surrounding LGBT and intersex health care. The American Medical Association also has an LGBT Advisory committee.

I’m proud to say that my medical school has been accepting and supportive of its gender and sexual minority patients, and that clinics in the area of my medical school are seeking to expand their care to be more inclusive of LGBT patients. Support exists for both those seeking medical care, and those seeking to provide that care. It’s only the beginning.