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Vanderbilt Cares: What Do I Need to Know As An LGBTI Patient or As Their Provider?
While we often see or hear about specific health risks that are unique to or affect certain subsets of the population, we don’t really hear as much about health risks that affect the LGBTI community. Dr. Jesse Ehrenfeld and Dr. Kristen Eckstrand talk about LGBTI health care considerations for patients and providers.
For more information:
Vanderbilt Program for LGBTI Health
The Vanderbilt University Medical Center Program for LGBTI health is an innovative effort to improve healthcare for lesbian, gay, bisexual, transgender, and intersex (LGBTI) patients
The Gay and Lesbian Medial Association GLMA’s mission is to ensure equality in healthcare for lesbian, gay, bisexual and transgender (LGBT) individuals and healthcare providers.
PFLAG (Parents and Friends of Lesbians and Gays) PFLAG is committed to advancing equality and societal acceptance of LGBT people through its threefold mission of support, education and advocacy.
GLSEN Gay, Lesbian & Straight Education Network – Mission is to ensure that every member of every school community is valued and respected regardless of sexual orientation, gender identity or gender expression.
The Trevor Project The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people ages 13-24.
The Oasis Center’s Just Us Program Just Us is an Oasis Center program dedicated to serving high school students who identify as lesbian, gay, bisexual, transgender, questioning, or intersex.
Nashville Cares Nashville CARES promotes and participates in a comprehensive and compassionate response to HIV/AIDS in Middle Tennessee. Our purpose is to educate the community for increased understanding and prevention of HIV transmission, to advocate for responsible public policy, and to provide services that improve the quality of life for people with HIV/AIDS and their families.
OutCentral Greater Nashville’s LGBT Center
Laura Osterman: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Laura Osterman with Health Plus. I am here today with Dr. Jesse Ehrenfeldand Dr. Kristen Eckstrand They are both the co‑directors for the Vanderbilt University Medical Center Program for LGBTI Health. We often hear about specific health risks that are unique to or affect certain subsets of the population, whether that be based on age, gender, or race. We do not really hear as much about the health risks that affect the LGBTI community. Can you tell us what is meant by LGBTI and explain why this is such an important topic for patients and health care providers?
Dr. Kristen Eckstrand: Absolutely, I think the first thing that we need to keep in mind is that we need to have an understanding of what the acronym LGBTI actually means, and this acronym really describes a population of people who have differences in their sexual orientation and gender identity away from what we typically think of as heterosexual individuals who are born as male or female and continue to identify their gender in that way. So when we think about sexual orientation, we have LGB and that stands for lesbian, gay, and bisexual. When we think about gender identity, we have transgender, and these are individuals who identify their gender as different than their born sex, so this can be someone who was born male but identifies as female. And then, “I” refers to not necessarily an identity but individuals who have been affected by differences in sex development, and that is a different class entirely, but if we have an understanding of sexual orientation and gender identity and how the differences in these, both the identity and the behaviors, that can go along with having that identity. If you can understand the identity and the behavior then it is very easy to understand what health condition disproportionally affect the LGBTI community.
Laura Osterman: Can you give us some examples of what specific health issues do disproportionately affect LGBTI patients?
Dr. Jesse Ehrenfeld: Sure, men who have sex with men or gay men are at increased risk for certain types of chronic diseases, cancers, and mental health problems. First, men who have sex with men continue to be at increased risk for HIV infection and so we recommend that all men who have sex with men and get regular HIV test and appropriate risk-based counseling which may include
pre-exposure prophylaxis which is now recommended by the CDC. Additionally, gay men are at high risk for having human papilloma virus which can cause anal papilloma and certain types of anal cancers and so we recommend that all men who have sex with men or gay men be screened for anal papilloma and gay men under age 27 get the HPV vaccine. Finally, for gay men, they are at increased risk for getting hepatitis, and so to avoid this, we recommend that all men who have sex with men get immunized against both hepatitis A and hepatitis B. For lesbian women or women who have sex with women, there is an increased risk for breast cancer as well as heart disease, and so we recommend that all women who have sex with women should be screened for gynecological cancers every year. Finally, for transgender people, they are in increased risk for certain chronic diseases, cancers, and mental health problems, but one of the biggest problems for transgender patients is just accessing the healthcare system. Transgender persons may often avoid medical care for the fear of being rejected because so many over the years have been turned away by health care providers or have had other negative experiences. Furthermore, none all providers know how to deal with specialized transgender issues, and so we try and work with our transgender patients to make sure they find a personal doctor who understands their specific health issues. Finally, hormone therapy is often used to make a transgender person more masculine or feminine, but the use of hormones has risks and so we recommend that transgender patients who wish to use hormones only do so under the supervision of a doctor who can prescribe an appropriate dose and monitor its effects.
Laura Osterman: What are some of the most important things that providers need to remember to address with LGBTI patients?
Dr. Kristen Eckstrand: For providers being able to ascertain a patient’s sexual orientation and gender identity is actually very important. So, being able to ask questions like do you have sex with men, women, or both; how do you identify your gender; and what pronounce would you like me to use. Another question that is important to ask for transgender patients when they have insurance is what is your billing name instead of what is your real name. These important questions help provide a space of sensitive care that allows LGBT people to keep coming back into the clinic. It is also important for providers to know that the environment that they create provides a big impact on LGBTI patients. So, making sure that providers have brochures in waiting areas, other signs whether it is a rainbow flag or the local LGBT newspaper in the waiting room, these are things that can signify to patients that they are welcome in that area, and these simple things make it a lot easier for LBGTI patient to come in and receive care.
Laura Osterman: What are some of the best resources for patients or providers with regard to LGBTI specific health issues or concerns?
Dr. Jesse Ehrenfeld: We have so many resources through the Vanderbilt Program for LGBTI Health. So, I would point anybody who is interested in learning more information directly to our website. We have a series of patient brochures that are available for download. We also have brochures in many of our clinic waiting rooms and there are links to other organizations through our website. We also are a resource to able to make referrals for patients seeking specific care. We are happy to help connect patients with providers who can provide these specialized services. Finally, through the program, we are happy to do education programs for clinics, departments, or divisions that are looking to learn more about these specific needs of the LGBTI population so we would be delighted to work with anyone interested in that.
Laura Osterman: For more information about the Vanderbilt University Medical Center program for LGBTI health and resources for patients and providers, please click the links included on this Wellcast page. Additionally, we have included a link to hear the extended version of this interview. Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at firstname.lastname@example.org or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu.
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