When Dr. Deb Thorp began seeing transgender patients, her bosses told her to keep it quiet.
Twenty-five years later, she’s doing her best to get the word out.
Thorp, medical director of the Park Nicollet Gender Services Clinic in Minneapolis, is taking part in a rare national conference next week to address health disparities among lesbian, gay, bisexual and transgender people.
She and other researchers say the LGBT community is more vulnerable to some diseases, and has poorer access to, and a lower quality of, health care compared with the general population — in part because of fear.
Many LGBT patients shy away from seeing a doctor because they’re afraid they won’t be accepted.
“What’s at the heart of the disparities is transphobia,” Thorp said. “The history in the community at large is of people not being accepted for who they are. So patients are very concerned about going in to see a clinician, because why should the clinicians be any different than anyone else?”
Fear is also what keeps the health care system from providing the same level of care as other patients, according to Thorp, who has done many training sessions “to decrease the fear among clinicians, so they don’t have to be afraid of these patients.”
That’s where the conference comes in.
Held at the University of Minnesota, the Opportunity Conference is aimed at health care workers and policymakers. It will be hosted by Rainbow Health Initiative, a Minneapolis organization dedicated to improving the health of LGBT people.
“We work with providers,” said Joann Usher, executive director of Rainbow Health Initiative. “We know from their request to us for training that there is a significant lack of knowledge and experience in working with members of the LGBTQ community.”
The issue has garnered national attention in recent years, with the National Institutes of Health officially classifying sexual and gender minorities as a health disparity population.
“We need to address the health disparities that the LGBTQ community experiences,” Usher said.
Not everyone is a proponent of the conference.
“Regardless of lifestyle, everyone should have access to quality health care that compassionately addresses biological realities; however, medical professionals should never be required to aid lifestyle choices that do not improve individuals’ physical health,” wrote Stephani Liesmaki, a spokeswoman for the Minnesota Family Council, in an e-mail. “There is a difference between providing quality health care and abetting an unhealthy lifestyle. The Rainbow Health Initiative’s conference goals seem to blur the lines between these two distinct categories.”
On the issue of insurance coverage for transgender health services, such as hormone replacement therapy, Liesmaki wrote: “No health insurance company or medical provider should be required to cover or provide treatments that try to suppress biological realities, do not improve the health of patients, or that abet an unhealthy lifestyle.”
A hostile climate for youth
Thorp and others speaking at the conference say that stigma can be a root cause of the health risks, especially for transgender patients.
“They don’t seek care,” Thorp said. “They have a harder time getting a job, so they may not have any insurance coverage. They have higher rates of mental health issues because of the chronic stigma. They have higher rates of tobacco use and higher rates of suicide attempts.”
National and local health surveys indicate that LGBT people experience higher rates of depression, substance abuse and some cancers. In addition, lesbians are less likely to receive mammograms and Pap smears than straight women, and transgender people often struggle to find a doctor.
Marla Eisenberg, an associate professor at the University of Minnesota whose research interests include LGBT adolescent issues, is another presenter at the conference.
She’ll be discussing results from the latest Minnesota Student Survey, which for the first time included responses to questions about gender identity.
The survey, conducted every three years, asks Minnesota students about their experiences with school climate, bullying, health and nutrition, substance abuse and other issues.
Eisenberg said research shows that young people who identify as LGBT experience more bullying and violence compared with other students. They also deal with more mental health issues than their straight peers, are more likely to use substances that are harmful to their health such as tobacco and alcohol, and engage in high-risk sex behaviors.
“It kind of runs like the Heinz 57 of things you worry about with kids,” she said.
She stressed that the numbers reflect a hostile climate for LGBT youth.
“It’s not about just these kids,” she said. “It’s about living in an environment without social support. It’s about living in a community that perhaps doesn’t accept them much.”
She added, “If you’re growing up constantly getting the message there’s something wrong with you, that can be a powerful message to internalize. And that breaks out in all sorts of different risk behaviors that we’re concerned about.”
Another health care issue that Eisenberg has learned about through her work with transgender youth is the way they are referred to as patients on health documents.
The health forms don’t have boxes that reflect their chosen gender identity or preferred name or pronoun.
“People are [often] called by the name that they were given at birth and referred to in the gender that they were given at birth, and there’s no other way to do that in their system,” Eisenberg said.
Many LGBT youth have reported that they often face discrimination in health care settings that prevents them from receiving good care.
“They feel like people are freaking out when they walk in the door,” she said. “I really feel like we need to push health care providers past all of that — to recognize that these are young people, and for the most part, they’re just like any other kid who walks into their clinic.”