Jul 042016
 

On June 17, 2016 The Lancet, one of the UK’s most prestigious medical journals, published an entire series dedicated to global transgender health.

The World Professional Association for Transgender Health biennial conference happened over the weekend of June 17-21. I wasn’t able to go this time around, so I can’t report on it directly. But! It looks like it was a fabulous conference. Topics ranged from surgical techniques to cancer prevention to health and psychological care for transgender youth. You can see the schedule yourself.

The Pentagon has announced that it will begin allowing transgender people to openly serve in the US military next month. No details on what that means for veterans or formal military who were dismissed from service because of that status have yet been revealed. Source.

President Obama has declared Stonewall a national monument.

Feb 292016
 

This week we’re continuing to explore preventive health and health promotion. Now we’re looking at more of the stuff you get at the doctors office. We’re still focusing on recommendations that apply to almost everyone. In the upcoming posts we’ll focus in on specific recommendations for gender and sexual minority groups. But for now? Just the stuff that almost everyone should get.

StethoscopeFirst — it’s best to see your physician every year or so for a “wellness” visit. During this visit the physician ask you about changes to you and your family’s health. They’ll do a physical examination. They’ll also order blood work. The blood work looks for common, invisible changes like anemia and high cholesterol (which can then be treated!). They’ll check to see if you need vaccines or screenings too, and refill any medications you may be on. This visit is also a great time to ask the physician any questions or concerns you may have. If you can’t see them every year, it won’t be the end of the world. But it’s definitely recommended.

What about these screenings? Some are a series of questions, others involve a blood test or a procedure. Let’s break them down!

All adults should be screened for:

  • HIV. All adults should receive at least one HIV test. Those who are at higher risk for HIV infection should be getting tested regularly.
  • High blood pressure
  • Obesity
  • Depression
  • Those born between 1946-1965 in should receive one test for Hepatitis C.
  • Those over the age of 45 should have their blood cholesterol checked
  • Those aged 50-75 should receive colon cancer screening. Options include colonoscopy, sigmoidoscopy, and fecal occult blood test — talk with your physician to decide which is best for you.
  • Those over the age of 55 should speak with their physician about wehther a daily aspirin would help reduce their risk for heart disease

All other screenings really depend on your risk factors and your sex/gender. We’ll dive into those more specific recommendations in later sections. These recommendations are also based on the USPSTF guidelines, and specific physician organizations have their own recommendations.

What about immunizations? All adults (who are medically able to) should receive

If you have a weak immune system, are pregnant, have kidney or heart problems, or are going to travel or become a health care professional then you likely need different vaccines.

You can also check out the CDC’s webpage which has a tool that will give you a list of topics to talk with your doctor about.

That’s it for this week! Next time we’ll start talking about specific recommendations for specific gender and sexual minority groups. In the mean time — have a lovely week.

Oct 052015
 

480px-RGB_LED_Rainbow_from_7th_symmetry_cylindrical_gratingI’ve been saying for years now that the phrase “LGBT community” is insufficient when it comes to health. It’s not one community — it is multiple communities. The social issues and health issues that a gay transgender man faces every day are different from the issues a bisexual cisgender woman faces every day. There are some similarities and grouping the communities together has been politically useful. But it should never be forgotten that L, G, B, and T all face different types of health concerns and have different civil rights battles to face.

A study came out in August that has to be one of my favorites this year. Researchers in Georgia surveyed over three thousand lesbian, gay, bisexual, pansexual, transgender, gender non-conforming, and queer people. They asked about health behaviors of all kinds. And then they did statistical analysis, comparing the various genders (cis male, cis female, trans male, trans female, genderqueer) and sexual orientations (lesbian, gay, bisexual, pansexual, queer, straight). Let’s look at what they found!

  • Diet and exercise: The researchers asked about fatty foods, eating while not hungry, quantity of vegetables and fruits eaten, and about hours and types of exercise. Transgender women had the least healthy diet of all genders. As a group, they were less likely to eat many fruits and vegetables, and more likely to drink sugared drinks and eat when they weren’t hungry. Both cisgender and transgender men were also less likely to eat many vegetables compared with other groups. Genderqueer people and gay cisgender men were most likely to exercise.
  • Substance use: The researchers asked about smoking tobacco and alcohol consumption. Cisgender men were the most likely to drink alcohol, binge drink, and to drink even when they didn’t want to. Participants who identified as queer were also more likely to drink. When it came to tobacco, transgender men and straight participants were the most likely to smoke.
  • Motor vehicle risk: The researchers asked about seatbelt use, speeding, and texting while driving. No clear differences for speeding were noted. Transgender men and straight participants were most likely to drive without a seatbelt. Texting while driving varied considerably; gay and lesbian drivers were most likely to text while driving.
  • Sexual behaviors: The researchers asked about frequency of unprotected sex and sex while intoxicated. Gay men were least likely to have unprotected sex while lesbian women were most likely to have unprotected sex. When it came to sex while intoxicated, only the bisexual participants stood out as being most likely among the groups to have sex while intoxicated.
  • Violence: The researchers asked about self harm and expressing anger at others. Overall rates of interpersonal anger were very low. Transgender men and pansexual people were most likely to self harm.
  • Medical risk taking: The researchers asked about delaying medical care and not following physician advice. Transgender women were least likely to seek care; 1/3 reported that they regularly delayed seeking medical care. Both transgender women and transgender men were more likely to not follow medical advice when it was given. Bisexual people were also more likely to delay seeking medical care compared to lesbian and gay participants.

That’s a mouthful, right? There are a lot of details I left out of this summary and it still threatens to be overwhelming with detail. So how we can break this down even more simply? By talking about the conclusions.

The researchers go into some possible causes for all these different results. Maybe gay men are safer about sex because of HIV risk. Maybe transgender men eat few vegetables because of cultural expectations that “men eat lots of meat and not many vegetables.” Maybe gay and lesbian people text more while driving because of the lack of community-specific messages.

Maybe. And they’re all good thoughts.

I tend to look forward more to what we can do with these data. I’m pretty happy with this study — it’s one of the broadest I’ve seen for inclusion. Few health-oriented pieces of research include pansexual and genderqueer individuals.

It’s important to remember that these results are at the group level. Any individual person who is a gender/sexual minority will have their own health behaviors and risks. They should be evaluated and treated as individuals. From a public health perspective though, this research brings valuable data. Only by knowing what each group faces can prevention, screening, and treatment campaigns be created. Only by knowing, for example, that transgender and bisexual people avoid seeking medical care can we then examine “why?” and act to remove the barriers so that appropriate, respectful medical care is available.

So — can we change the conversation? Instead of talking about “the LGBT community”, let’s talk about “the LGBT communities”. Or, even better, “gender and sexual minority communities” — removing the alphabet soup and expanding the definitions at the same time. This research is only the tip of the iceberg. We have so much more to explore.

The paper is published online ahead of print. The abstract is publicly available.

Oct 252012
 

LGBT youth are at elevated risk for suicide. Researchers have been looking into the risk factors for suicide in LGBT youth. Most of the studies so far have been cross-sectional; that means they only studied how things are once, at one point in time. Longitudinal studies, in contrast, measure at multiple points in time. Longitudinal studies are expensive, and risk losing track of participants, but they provide more information.

This year, the first longitudinal study of LGBT youth suicide risk factors was published. The participants were interviewed twice, a year apart. Both times, they were psychiatrically evaluated and asked about suicide attempts. They filled out questionnaires evaluating hopelessness, impulsivity, social support, gender non-conformity, age of same-sex attraction, and LGBT-related victimization.

In this sample, roughly 31.6% of the participants had attempted suicide. This is far higher than the 8% rate reported by the CDC. Seven variables were associated with previous suicide attempts: hopelessness, impulsivity, LGBT-related victimization, low family support, being younger when first feeling same-sex attraction (for LGB youth), and symptoms of either depression or conduct disorder. That is, the more hopeless or impulsive the youth, the more likely it is that they have previously made a suicide attempt. Gender non-conforming behavior and peer support did not seem to affect suicide risk. When it came to predicting future suicide attempts, the best predictor was previous suicide attempts. Youth who had previously attempted suicide had a 10 times greater risk of another attempt compared to those who hadn’t attempted suicide.

As always, these results should be accepted with caution. For example, this study did not find that gender non-conforming behavior was associated with suicidality. This is in contrast to other studies which did find an association. This study’s participants may not be representative of the population. They also had a small (ish) sample: 237 participants; 21 were transgender, and 13 had attempted suicide. Small sample sizes can limit a study’s ability to detect statistical significance. Gender non-conforming behavior may actually be associated with suicidality, but this study may not have had a large enough sample to detect it.

For me, this study brings up the question: How do we prevent suicide attempts in our LGBT youth who have already attempted suicide? They’re the most at risk for future attempts, according to this study. I don’t have a solid answer; neither do the researchers. But they do say that “The current findings underscore the need for increased prevention efforts and specifically point to the value of targeting youth who have made a prior attempt and who acknowledge their same-sex attractions at younger ages.”

Study Abstract – Full Text – Archives of Sexual Behavior

Jul 232011
 

News has come out recently that gonorrhea is showing resistance to the antibiotics used to treat it. Gonorrhea is an infection caused by a bacterium, Neisseria gonorrhoeae. Like many bacteria, it loves dark, damp places. In both men and women, it can infect the urethra, anus, mouth and throat. In women it can also infect the ladybits.

How does a bacterium like gonorrhea become antibiotic resistant? It’s evolution. All bacteria are slightly different because of random mutations in their genes. Antibiotics don’t always kill all the bacteria in an infection. Some of them are naturally resistant to the antibiotic. Those bacteria then can reproduce. Over time and repeated applications, the resistant bacteria become the common kind. And then we have a problem.

Gonorrhea can cause some really nasty long-term damage. It can cause sterility for both sexes (through either pelvic inflammatory disease or inflammation of the epididymis). It can also spread to infect joints, causing arthritis, or into the blood, which could be fatal. Gonorrhea can also be transmitted to newborns in the process of a vaginal birth. In newborns, it can cause blindness. All gonorrhea infections should be treated.

Since all infections should be treated, the best way to deal with the rise in antibiotic resistance to gonorrhea is to prevent infections.

What are the symptoms of gonorrhea? First, it’s important to know that it’s possible to have gonorrhea without symptoms. Around 90% of women and 10% of men with gonorrhea don’t have symptoms. Symptoms of a genital infection include a) a burning feeling while peeing, b) white, yellow, or green discharge from a penis and c) bleeding between periods. An anal infection may itch or burn, cause painful bowl movements, or create a discharge. Throat infections generally only cause a sore throat. Symptoms can appear up to two weeks after the infection starts.

Gonorrhea spreads by fluid contact, so vaginal, oral, and anal sex can all spread it. A simple skin-to-skin contact won’t spread it, unlike HPV. Like all STDs, the only way to 100% prevent it is to never have sexual contact with other people. That’s usually not possible. The next best thing? a) use barriers (like condoms, latex or nitrile gloves, or dental dams) correctly and consistently with all toys and body parts that come in contact with genitals, b) get yourself and your partner(s) regularly tested, especially before having sexual contact with a new person, c) restrict the number of people you choose to have unprotected sex with.

Need to know more?: