Jun 012011
 

For “older” adults, the IOM uses retirement age (around 60) as their starting age. For this group, there are no well-studied areas of health (beyond HIV/AIDS, which I don’t cover here). I’ve decided to leave the conclusion portion for another post – the last in this series.

  • Depression: Definitely more frequent in LGB elders than heterosexual elders. A very significant mental stress for this group is surviving the start of the HIV/AIDS epidemic. One study of elder gay/bisexual men found that 93% of them had known others who were HIV+ or had died of AIDS. There is no empirical data on rates of depression in elder transgender people, but it’s thought to be high.
  • Suicide/suicidal ideation: Empirical data suggest the rates of suicide are higher in LGB elders. No data on transgender elders.
  • Sexual/reproductive health: This is a rarely studied area. PCOS and its related risks may be an issue in some transgender elders. There is some indication that gay/bisexual men may be at the same risk as heterosexual men for prostate cancer. Early research implies that “lesbian bed death” may be a real phenomenon, but it’s a controversial topic. All cis-gendered women (bisexual, heterosexual, or lesbian) appear to have the same rate of hysterectomies. Sexual violence was reported on for transgender elders and it appears to be high. One study found about half of transgender elders had experienced “unwanted touch” in the past fifteen years.
  • Cancers: There are no data on cancers and transgender elders. Elder gay/bisexual men are at a higher risk of developing anal cancer (which is linked to receiving anal sex and HPV). Non-heterosexual women also appear to be at a higher risk for reproductive cancers (due to risk factors like smoking and obesity).
  • Cardiovascular health: Data appear to be conflicted. Transwomen using estrogen may be at a higher risk for venous thromboembolism (this may be because of the specific forms of estrogen used). There’s an association between transgender people getting their hormones from someone other than a doctor and poor health outcomes (e.g., osteoporosis, cardiovascular disease). The relevant transition hormones may cause long-term health problems at high doses, but no studies have really looked at this.

Risk factors include those for the younger age groups. Ageism within the LGBT communities may be an additional challenge for LGBT elders. Elders may also feel they need to hide their orientation if they move into a retirement home. Some retirement homes may also be discriminatory.  Transgender elders especially face very high threats of violence.

Some studies have found that elders felt more prepared for the aging process by being LGBT. Why? They’d already overcome huge difficulties. They’d already done a lot of personal growth. LGBT people are also more likely to have education beyond high school, and education is a well-known protective factor for the negative effects of aging. Conversely, some LGBT elders reported fewer relationship and social opportunities, being afraid of double discrimination, and problems with health care providers.

As for elder interactions with the health care system, again there’s a lot in common with younger age groups. One out of four transgender elders report being denied health care solely because they were transgender. Elders in general face problems if they need to enter assisted living homes, as some homes are discriminatory. It’s also worth noting that LGBT elder social structure is different from heterosexual social structure. LGBT elders rely much more on close friends than relatives (and/or adult children). Their chosen families are less likely to be recognized by the medical community, especially without legal paperwork.

So that’s it for what I’ll summarize from the report. Thanks for sticking around for it… this is hefty stuff.

May 012011
 

On March 31, the Institute of Medicine released a report on LGBT (lesbian, gay, bisexual, transgender) health. It’s a fairly important document, but it is almost three hundred pages long… So I’m going to cover it in several posts. There’s a lot of material in it, and I’m not going to cover it all. The bulk of the material I am covering is broken up by age group: childhood/adolescence, early/middle adulthood, and later adulthood.

As a note: when I say LGB in these articles, I really do mean just lesbian, gay and bisexual people. Some of the studies referenced only include sexual orientation, not gender identity.

Health of LGBT Children and Adolescents

In general, studies on LGBT youth health are scarce. Most of the studies that do exist focus on mental health (because chronic disease generally doesn’t affect young people). Most LGB youth are well-adjusted and happy.

What is known? Compared with heterosexual/cisgender youth:

  • LGB youth definitely have a higher rate of suicidal ideation (thinking about committing suicide) and suicide attempts. This is true regardless of age, substance use, sex/gender, and race/ethnicity. Transgender youth may also be at a higher suicide risk.
  • LGB youth seem to have higher rates of binge eating. In addition, young gay and bisexual men seem to have a higher rate of purging.
  • What few studies have looked at LGB youth and pregnancy found that they either had similar or higher rates of teen pregnancy.
  • LGB youth may be heavier than their heterosexual peers

Health risk factors:

  • Harassment, victimization, and violence: LGBT youth report higher levels of these than heterosexual/cisgender youth. The harassment can occur at school or at home. Harassment at school is associated with lower grades, less school involvement and health problems. LGBT youth are also at a higher risk of punishment from school officials, police, or courts than heterosexual youth.
  • Substance use: LGB youth use more drugs (including alcohol and tobacco) younger than heterosexual youth.
  • Homelessness: LGBT youth are at a much higher risk for becoming homeless, and this risk appears to increase with age. 22-35% of all homeless youth are LGB. LGB youth are at a higher risk than heterosexual youth for being victimized or discriminated against while homeless. They are also at significant risk for “risky sexual behavior” (like prostitution).
  • Childhood abuse: LGBT youth are at a higher risk for being sexually or physically abused.

As for protective factors…there aren’t any data yet. They’re working on it, though!

Other findings? It’s pretty well known that young people (adolescents) are uncomfortable talking about sex with their doctors. However, some small preliminary studies have found that doctors generally don’t ask about sexual orientation (or gender identity)! Some doctors feared upsetting their patients. Others weren’t sure how to handle a sexual minority patient. Others had negative impressions of LGBT people. All this makes me rather sad. 🙁

…and that’s it for what’s in the literature. There is, of course, lots more to young LGBT health…but it hasn’t hit the medical and psychiatric literature yet (meaning that there aren’t any studies).

Next time!: Health of LGBT adults

Mar 072011
 

A report recently came out looking at trends in the medical literature regarding LGBT people. This is a meta-analysis (i.e., it is an article summarizing the original research of others – it is a secondary source) that looked at articles from 1950-2007.

Findings include:

  • Estimations of percentage of the population that is LGBT ranges from 2 to 10%, depending on the survey. In the United States, this should be between 6 and 30.4 million people.
  • Lesbians have a higher risk for breast and gynecological cancers. Gay men are at higher risk for anal cancer. We don’t know if these are because of genetics (homosexuality may have a genetic root), sexual practices, or culture.
  • The biggest barrier to health care for LGBT patients is stigmatization by health care providers, because of poor education and training: “Providers as a whole need to better understand the distinct difference between LGBT status and persons with ‘high risk’ sexual behaviors.” (pg 166)
  • There is an overemphasis in the literature on sexual behavior-related topics. About 1/3rd of all papers published about LGBT people are about HIV, AIDS, STIs, and other related illnesses. This is by far the biggest group of papers. About 13% of papers are about mental health issues, and another 12% are stigmatizing articles about the causes and treatment of homosexuality. All other topics are covered by less than 9% of papers. For example, only 3.28% of papers deal with patient-health care provider interactions, and 2.66% deal with transsexual issues. This overemphasis means that we don’t have enough information about other illnesses that affect LGBT people.
  • Some research specifically excludes LGBT people with no clear explanation or reasoning behind it. This is actually against NIH research policy – populations canNOT be excluded without reason.

Citation:

Snyder, J. E. (2011). Trend Analysis of Medical Publications About LGBT Persons: 1950-2007. Journal of Homosexuality, 58: 164-188.

Jan 192011
 

The Journal of Homosexuality and the American Foundation for Suicide Prevention have worked together to produce a report on suicides in LGBT (lesbian, gay, bisexual and trangender or transsexual) individuals. The report is a meta analysis, which means that it reviews and summarizes original research. It’s well known that LGBT people are at a higher risk for suicide attempts than heterosexual or cisgendered people.

LGB risk factors:

  • Suicidal ideation does not appear to be a stable predictor of suicide attempts.
  • Gay and bisexual men are at higher risk than lesbian and bisexual women.
  • Not enough is known about age or race/ethnicity to clearly state how these affect risk.
  • LGB people, as a whole, have higher rates of mental illnesses, especially mood disorders, anxiety disorders, and substance abuse, than heterosexual people. Mental disorders are a huge risk factor for suicide. Non-heterosexual men more frequently have depression and panic disorders than heterosexual men; non-heterosexual women are dependent on substances more frequently than heterosexual women. Insecurity in sexual orientation increases the chances of mental illness.
  • Stress relating to homophobia increases suicide and mental illness risk. The report identifies two kinds of discrimination: individual (e.g., rejection, harassment, bullying) and institutional (e.g., no legal rights or protections). Both increase the risk for mental illness. Institutional discrimination can also lead to lack of health care for mental illness, which increases the risk of suicide.
  • HIV/AIDS, as a significant stressor, also increases the risk of both mental illness and suicide.

Factors that reduce the suicide risk for LGB people are not yet well known. For youth, family and other adult support and safe schools appear to be important; for adults, connection to the LGB community and positive sexual identity.

Information about transgender suicide risk is likewise unclear. It’s known that transgender people are at a higher risk for depression, substance abuse, and suicide. Rejection by parents and discrimination appear to be the most well-known risk factors. Transgender people also have very high rates of job discrimination (e.g., harassment, privacy invasion, use of the wrong gender pronouns, not being hired or promoted) and unemployment, and low levels of health insurance through their employers.

There is a lot of information missing here, clearly. Research needs to shift, and the authors acknowledge and address this. Specifically, the right questions (e.g., asking for gender identity on large-scale population studies) and the right studies (e.g., looking at the differences between specific subgroups) need to be done.

There is no information about how well suicide prevention strategies work with LGBT people.

For me, these other aspects within the report stood out:

  • LGBT people need access to high quality, evidence-based psychiatric care tailored to their needs that are accessible and affordable. The report notes that there were high levels of dissatisfaction with mental health services in the 1990s. I doubt that’s changed. And while it’s known that LGBT people acces more mental health services than the general population, the quality of those services cannot be ascertained.
  • Public policy must change to support and protect sexual minorities. Institutional discrimination must be banished. Now.
  • Researchers themselves need to be educated about LGBT issues so that current research efforts can be expanded to include LGBT people.

The report is available here. It also includes some statistics and a lot of good recommendations for public health and public policy.