- The American Heart Association released a consensus that physicians should counsel people about resuming sex after a heart-related illness (e.g., heart attack, stroke, pacemaker installation). Apparently physicians have not be doing that. Oops! More information here.
- Risk factors for developing PTSD (post-traumatic stress disorder) after exposure to a traumatic event have been further explored in adolescents. 61% of teens in this study were exposed to a potentialy traumatic event, but only 4.7% of the teens in the study actually developed PTSD. Risk factors included: previous diagnosis of a mood or anxiety disorder, being female, and the type of event. Interpersonal traumatic events (e.g., being raped or assaulted by another person) were associated with a higher risk of PTSD. Why bring this study up? Because GSM youth are at high risk for traumatic events! More info.
- Virginia Johnson passed away due to natural causes. She was one half of the Masters and Johnson team that did pioneering work on sexuality in the 1960s. Condolences to her friends, family and loved ones. More info.
- The X chromosome may have a role in sperm production. Not at all surprised by this – after all, the idea of the X chromosome as the “female” chromosome and the Y chromosome as the “male” chromosome are based in human perception, not pure biology. More info.
- Female survivors of childhood sexual abuse may benefit from writing about their experiences. A study found that female survivors who specifically wrote about how the abuse changed the way they thought about sex had improved sex lives. Abstract.
- PSA, prostate-specific antigen, may be useful as an indicator of testosterone level. While PSA’s usefulness as a screening tool for prostate cancer is still under debate, this other use is an interesting idea. It’s not currently in use for detecting low levels of testosterone, but it might be in the future. Cool! Abstract.
- The average penis size has been determined. Again. Sorta. This study was internet, self-report based. So who really knows? This study reports that the average erect penis is 14.15 cm (5.57 in) long with a 12.23 cm (4.81) circumference. The racial makeup and age of the sample was not reported in the abstract. Abstract.
- Sex addiction does not appear to be an addiction, according to a study out of UCLA. Interesting and not altogether surprising. Press release.
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.”
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.
Welcome back! This part of the IOM report covers adults aged 20 to 60. There are more data available for adults than adolescents, so this part’s broken up a bit different from the last. As a reminder: GLBT (or LGBT – same meaning, different order) stands for gay, lesbian, bisexual, and transgender. I frequently do use GLB separate from T. That is intentional, not a typo. Also, the full report is available here – you can read it online for free.
The best studied aspects of health:
- Mood/anxiety disorders: There are conflicting data here, but the consensus so far is that GLB people have higher rates of these problems. There’s almost no research on transgender people, but one preliminary study found that around half of transgender people have depression. Yikes!
- Suicide/Suicidal ideation: LGBT people as a whole appear to be at higher risk. Bisexuals and transgender people appear to be at an even higher risk. Risk also seems to vary by age, sex, race/ethnicity, and how far out of the closet a person is.
- Cancer: Gay and bisexual men are definitely at a higher risk for anal cancer than heterosexual men. This risk is linked to having anal HPV, which can be spread by anal sex.
- Eating disorders: May be more common for GLB people than heterosexuals, but we’re not sure. No data on transgender people.
- Sexual: Gay/bisexual men don’t appear to be at an elevated risk for erectile dysfunction. Transgender people who have had sexual reassignment surgery may be at a higher risk for sexual difficulties…not entirely surprising given the potential for nerve damage from any surgery.
- Cancer and obesity: Lesbian/bisexual women may be at a higher risk for breast cancer than heterosexual women.
- Hormone replacement therapy -may- affect cardiovascular health, but it’s unknown.
Essentially not studied: Reproductive health (including the effects of hormone therapy on fertility for transpeople), cancer (especially in transgender patients), and cardiovascular health
- Stigma/Discrimination/Victimization: As we all know, LGBT people face these problems all the time. Stigma is strongly associated with psychological distress. Bisexuals have reported facing discrimination from both the straight and gay communities. One study of transgender people found that 56% had faced verbal harassment, 37% had faced employment discrimination, 19% had faced physical violence.
- Violence: LGBT people are at an elevated risk for suffering violence. LGBT people do experience intimate partner violence, but the statistics and relative risk are unknown.
- Substance Use: LGBT people may be more likely to use substances, especially tobacco (read my previous post on this).
- Childhood abuse: LGB may have higher rates of childhood abuse.
Potential protective factors (LGB): supportive environments, marriage, positive LGB identity, good surgical/hormonal outcomes (T)
As for access/quality of health care? Er…it’s complicated. GLB people get less regular screening (like pap smears and basic physical exams) than heterosexuals and use the emergency room more often. Two biggest obstacles to getting good health care?: problems with the health care providers. This could be perceived discrimination (thinking that someone is acting in a discriminatory way, whether that person is or not), or simply lack of knowledge on the part of the provider. One study found only 20% of physicians had received education about LGBT health issues. That’s only one in five! I will note that this is improving – medical schools, depending on the school and its location, are starting to teach LGBT cultural competency more than they used to.
Lack of insurance is another barrier, and it especially affects transgender people. The services they need, like hormone therapy and sexual reassignment surgery aren’t covered by insurance. In addition, one study found that a third of transgender people had been treated ill by a physician.
Next time: Older Adults and conclusions…
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