10 things every LGBT veteran should discuss with their doctor

Jonathan Kaupanger
June 07, 2018 - 1:18 pm

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There are several things every LGBT veteran should discuss with their medical provider especially since many people, and even some providers, aren’t really clear how sexual orientation identity and how gender identity affects health.

“Many gay, lesbian, transgender folks experience a number of mental and physical health conditions at higher rates than heterosexual and cisgender people,” says Dr. Michael Kauth who is one of the directors of VA’s LGBT Health Program.  “It doesn’t mean that every LGBT person has increased rates of some health conditions, but you don’t know until you do an assessment.”

The first part of the list are common issues across the human sexuality spectrum and while the issue may be a common one, the reason for the discussion is different, depending on where you are on the spectrum.

1.  Tobacco use.  Smoking has been associated with higher rates of cancers, heart disease and emphysema which are three major causes of death among women.  There’s research out there showing that lesbians use tobacco more often than heterosexual women.  The same can be said for gay men too, in some studies almost 50 percent of gay men use tobacco.  Health problems related to tobacco use for men include lung disease and lung cancer, heart disease and high blood pressure to name a few.  Transgender veterans taking hormones have an increased risk for heart and lung disease.

2.  Alcohol use.  Gay men and bisexuals use substances at higher rates than the general population.  The long-term effects of many of these substances is unknown, but common thought is as a person ages, there could be serious consequences.  In general, heavy and binge drinking are more common with lesbians than other women. Alcohol and hormones might be more dangerous when taken together, so transgender veterans should really have this as one of the first things they discuss with their medical provider.

3.  Fitness.  A healthy diet and good exercise routines are important for everyone.  For transgender veterans, if you’re planning to have surgery, your surgeon will want to be sure you’re in good physical condition.  Obesity is associated with higher rates of cancer, heart disease and premature death.  There is research out there that shows lesbians are more likely to be overweight or obese when compared to heterosexual women.  Gay men are more likely to have problems with body image.  Regular exercise is good for your health, but too much can be harmful.  Add in substances like anabolic steroids and other supplements and things can get very dangerous.

4.  Depression/Anxiety.  Gay and bisexual veterans are affected by this at a higher rate than the general population.  This problem is even more severe for those men who remain in the closet or don’t have adequate social support.  Adolescents and young adults are particularly at a high risk of suicide because of these concerns.  Lesbians may experience chronic stress from discrimination and this is worse for women who need to hide their orientation.  It’s very easy for transgender veterans to become sad and depressed.  If families or friends don’t want to see you, it is a very depressing time.

5.  STDs and sexual health.  It’s very important to practice safe sex.  The more partners you have sex with, the more often you should be screened for STDs. 

Here’s where the list splits off and Dr. Kauth explains why the last part of this is so vital to bring up with your health care provider.  “It’s important for health care providers to know who’s in their office, who they are treating,” he says.  “It’s important to know about sexuality and sexual orientation identity so we can do the appropriate kind of follow up questions and do the appropriate screens.”

Transgender veterans:

6.  Access to healthcare.  Finding a good healthcare provider who knows how to treat transgender people isn’t always easy.  Dr. Kauth says VA will provide evaluation for those who had surgery elsewhere and fix complications after that surgery.  It’s important to be very upfront about this right away.

7.  Health history.  Tell your VA doctors about the medicines you’ve taken and the surgeries you’ve had in the past.

8.  Hormones.  If you’re starting hormones, ask about the things you need to watch out for while taking these meds.  Transgender women: ask about estrogen and blood clots, swelling, high or low blood pressure and high blood sugar.  Transgender men:  find out about what blood tests you’ll need to be sure your testosterone dose is safe.

9.  Cardiovascular Health.  Transgender veterans could have an increased risk for heart attack or stroke.  Not because of the medicines they may be taking but due to cigarette smoking, being overweight, high blood pressure or diabetes. 

10.  Cancer.  It’s rare to develop cancer due to hormone treatment, but your provider will evaluate you for this possibility.  Your healthcare provider will also check for possible cancer of your sex organs if they haven’t been removed.

Lesbian and bisexual women veterans:

6.  Breast cancer.  Lesbians are more likely to have risk factors for breast cancer but are less likely to get screened.  This means lesbians won’t be diagnosed early when the disease is most curable.

7.  Heart Health.  Heart disease is the leading cause of death for women.  All lesbians need yearly medical exams for high blood pressure, cholesterol and diabetes.

8.  Gynecological cancer.  Lesbians have higher risks for some types of gynecological cancers when compared to straight women.  Regular exams help to find cancer early when there’s the best chance of cure.

9.  Substance use.  Maybe due to stress from homophobia, sexism and discrimination, but lesbians are more likely to use drugs than heterosexual women.  Lesbian and bisexual women need support to find good ways to cope and reduce stress.

10.  Intimate partner violence.  For some reason medical providers are less likely to ask lesbians about intimate partner violence than they would a heterosexual woman.  Discussing this with a trusted physician often leads to counseling and shelters when needed.

Gay and bisexual male veterans:

6.  Come out!  You need to let your clinician know if you’re gay or bisexual.  They will then ask the specific questions needed to provide proper care.  If your medical provider doesn’t seem comfortable with you, find another one.  All VA facilities have at least one LGBT veteran care coordinator.  Find this person and they’ll help!

7.  Hepatitis immunization and screening.  Men who have sex with men have an increased risk of infections with viruses that cause hepatitis.  This can lead to liver failure and cancer.  Immunizations are available to prevent two of the three most serious viruses and are recommended for gay men.  If you have Hep C, there are new very effective treatments for that infection as well. 

8.  Prostate, testicular and colon cancer.  Access to screening services may be harder for gay men because of not getting culturally sensitive care.  All gay men should have these screenings routinely, just like the general population.

9.  HPV.  Human papilloma virus (HPV) causes anal and genital warts and is often just thought as an inconvenience.  But these infections might cause an increase in some anal cancers for gay and bisexual man. Safe sex should be emphasized here, but there are treatments for HPV . Recurrences of the warts are common and the rate that the infection is spread between partners is very high. 

10.  HIV/AIDS. If you are HIV positive you need to be in the care of a good HIV provider.  You should discuss what to do in the event that you are exposed to HIV (contact your healthcare provider IMMEDIATELY).  If you’re in a relationship where one of you is positive, you can discuss options for prevention too.

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